Geometric and dosimetric evaluations of an online image-guidance strategy for 3D-CRT of prostate cancer.
OBJECTIVE
To evaluate an online image-guidance strategy for conformal treatment of prostate cancer and to estimate margin-reduction benefits.


METHODS
Twenty-eight patients with at least 16 helical computed tomography scans were each used in this study. Two prostate soft-tissue registration methods, including sagittal rotation, were evaluated. Setup errors and rigid organ motion were corrected online; non-rigid and intrafraction motion were included in offline analysis. Various clinical target volume-planning target volume (CTV-PTV) margins were applied. Geometrical evaluations included analyses of isocenter shifts and rotations and overlap index. Dosimetric evaluations included minimum dose and equivalent uniform dose (EUD) for prostate and gEUD for rectum.


RESULTS
Average isocenter shift and rotation were (dX,dY,dZ,theta) = (0.0 +/- 0.7,-1.1 +/- 4.0,-0.1 +/- 2.5,0.7 degrees +/- 2.0 degrees ) mm. Prostate motion in anterior-posterior (AP) direction was significantly higher than superior-inferior and left-right (LR) directions. This observation was confirmed by isocenter shift in perspectives AP (1.8 +/- 1.8 mm) and RL (3.7 +/- 3.0 mm). Organ motion degrades target coverage and reduces doses to rectum. If 2% dose reduction on prostate D(99) is allowed for 90% patients, then minimum 3 mm margins are necessary with ideal image registration.


CONCLUSIONS
Significant margin reduction can be achieved through online image guidance. Certain margins are still required for nonrigid and intrafraction motion. To further reduce margin, a strategy that combines online geometric intervention and offline dose replanning is necessary.
Wu
Qiuwen
Q
Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA. qwu@beaumont.edu
Ivaldi
Giovanni
G
Liang
Jian
J
Lockman
David
D
Yan
Di
D
Martinez
Alvaro
A
D000465:Algorithms; D006801:Humans; D008297:Male; D009068:Movement; D011467:Prostate / Q000000981:diagnostic imaging*; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D012007:Rectum / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed / Q000379:methods; D001743:Urinary Bladder / Q000000981:diagnostic imaging