The effect of an endorectal balloon and off-line correction on the interfraction systematic and random prostate position variations: a comparative study.
OBJECTIVE
To investigate the effect of an endorectal balloon (ERB) and an off-line correction protocol on the day-to-day, interfraction prostate gland motion, in patients receiving external beam radiotherapy for prostate cancer.


METHODS
In 22 patients, irradiated with an ERB in situ (ERB group) and in 30 patients without an ERB (No-ERB group), prostate displacements were measured daily in three orthogonal directions with portal images. Implanted gold markers and an off-line electronic portal imaging correction protocol were used for prostate position verification and correction. Movie loops were analyzed to evaluate prostate motion and rectal filling variations.


RESULTS
The off-line correction protocol reduced the systematic prostate displacements, equally for the ERB and No-ERB group, to 1.3-1.8 mm (1 SD). The mean 3D displacement was reduced to 2.8 mm and 2.4 mm for the ERB and No-ERB group, respectively. The random interfraction displacements, relative to the treatment isocenter, were not reduced by the ERB and remained nearly unchanged in all three directions: 3.1 mm (1 SD) left-right, 2.6 mm (1 SD) superior-inferior, and 4.7 mm (1 SD) for the anterior-posterior direction. These day-to-day prostate position variations can be explained by the presence of gas and stool beside the ERB.


CONCLUSIONS
The off-line corrections on the fiducial markers are effective in reducing the systematic prostate displacements. The investigated ERB does not reduce the interfraction prostate motion. Although the overall mean displacement is low, the day-to-day interfraction motion, especially in anterior-posterior direction, remains high compared with the systematic displacements.
van Lin
Emile N J Th
EN
Department of Radiation Oncology, University Medical Centre Nijmegen, Nijmegen, The Netherlands. E.vanLin@rther.umcn.nl
van der Vight
Lisette P
LP
Witjes
J Alfred
JA
Huisman
Henkjan J
HJ
Leer
Jan Willem
JW
Visser
Andries G
AG
D002408:Catheters, Indwelling; D006801:Humans; D008297:Male; D009068:Movement; D010384:Pelvic Bones / Q000000981:diagnostic imaging; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D012007:Rectum; D014057:Tomography, X-Ray Computed