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Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy

Comparison of gold marker-based registrations with native MVCT

Dosimetrische Veränderungen durch inter- und intrafraktionelle Prostataverschiebungen bei der Tomotherapie

Vergleich der goldmarkerbasierten Registrierung mit nativer MVCT

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Abstract

Introduction

For high-dose radiation therapy (RT) of prostate cancer, image-guided (IGRT) and intensity-modulated RT (IMRT) approaches are standard. Less is known regarding comparisons of different IGRT techniques and the resulting residual errors, as well as regarding their influences on dose distributions.

Patients and methods

A total of 58 patients who received tomotherapy-based RT up to 84 Gy for high-risk prostate cancer underwent IGRT based either on daily megavoltage CT (MVCT) alone (n = 43) or the additional use of gold markers (n = 15) under routine conditions. Planned Adaptive (Accuray Inc., Madison, WI, USA) software was used for elaborated offline analysis to quantify residual interfractional prostate positioning errors, along with systematic and random errors and the resulting safety margins after both IGRT approaches. Dosimetric parameters for clinical target volume (CTV) coverage and exposition of organs at risk (OAR) were also analyzed and compared. Interfractional as well as intrafractional displacements were determined.

Results

Particularly in the vertical direction, residual interfractional positioning errors were reduced using the gold marker-based approach, but dosimetric differences were moderate and the clinical relevance relatively small. Intrafractional prostate motion proved to be quite high, with displacements of 1–3 mm; however, these did not result in additional dosimetric impairments.

Conclusion

Residual interfractional positioning errors were reduced using gold marker-based IGRT; however, this resulted in only slightly different final dose distributions. Therefore, daily MVCT-based IGRT without markers might be a valid alternative.

Zusammenfassung

Einführung

Bei der hochdosierten Bestrahlung des Prostatakarzinoms sind die bildgesteuerte (IGRT) und die intensitätsmodulierte Bestrahlung (IMRT) Standard. Offene Fragen gibt es beim Vergleich von IGRT-Techniken im Hinblick auf residuelle Fehler und Beeinflussungen der Dosisverteilung.

Methoden und Patienten

Bei 58 Patienten, deren Hochrisiko-Prostatakarzinom am Tomotherapie-System bis 84 Gy bestrahlt wurde, durchliefen die IGRT entweder routinemäßig basierend auf einem alleinigen Megavolt-CT (MVCT; n = 43) oder zusätzlich unter Ausnutzung implantierter Goldmarker (n = 15). Die Software Planned Adaptive (Accuray Inc., Madison, WI, USA) wurde für eine Offline-Analyse eingesetzt, um residuelle Verschiebungen, daraus resultierende systematische und zufällige Fehler sowie Sicherheitssäume für die beiden IGRT-Verfahren zu vergleichen. Außerdem wurden dosimetrische Parameter für die Abdeckung des klinischen Zielvolumens (CTV) und Expositionen von Risikoorganen (OAR) analysiert und verglichen. Inter- und intrafraktionelle Verschiebungen wurden bestimmt.

Ergebnisse

Residuelle interfraktionelle Verschiebungen werden unter Ausnutzung von Goldmarkern insbesondere in dorsaler Richtung reduziert. Die dosimetrischen Verbesserungen sind allerdings moderat und in ihrer klinischen Relevanz überschaubar. Intrafraktionelle Prostataverschiebungen sind mit 1–3 mm hoch, führen aber zu keinen wesentlichen dosimetrischen Verschlechterungen.

Schlussfolgerung

Interfraktionelle residuelle Positionsfehler können mit Hilfe einer goldmarkerbasierten IGRT reduziert werden. Aufgrund der geringen Differenz in den Dosisverteilungen ist jedoch eine IGRT mit täglicher MVCT ohne Marker eine valide Alternative.

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Authors and Affiliations

  1. Department of Radiation Oncology and Radiotherapy, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Peter Wust MD, Marc Joswig MD, Reinhold Graf MD, Dirk Böhmer MD, Marcus Beck, Thomasz Barelkowski, Volker Budach MD & Pirus Ghadjar MD

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  1. Peter Wust MD
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  2. Marc Joswig MD
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  3. Reinhold Graf MD
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Correspondence to Peter Wust MD.

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Conflict of interest

P. Wust, M. Joswig, R. Graf, D. Böhmer, M. Beck, T. Barelkowski, V. Budach, and P. Ghadjar declare that they have no competing interests.

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Wust, P., Joswig, M., Graf, R. et al. Dosimetric implications of inter- and intrafractional prostate positioning errors during tomotherapy. Strahlenther Onkol 193, 700–706 (2017). https://doi.org/10.1007/s00066-017-1141-x

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