title: Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer.
abstract: OBJECTIVE
  The aim of this work was to study the variations in delivered doses to the prostate, rectum, and bladder during a full course of image-guided external beam radiotherapy.
  
  
  METHODS
  Ten patients with localized prostate cancer were treated with helical tomotherapy to 78 Gy at 2 Gy per fraction in 39 fractions. Daily target localization was performed using intraprostatic fiducials and daily megavoltage pelvic computed tomography (CT) scans, resulting in a total of 390 CT scans. The prostate, rectum, and bladder were manually contoured on each CT by a single physician. Daily dosimetric analysis was performed with dose recalculation. The study endpoints were D95 (dose to 95% of the prostate), rV2 (absolute rectal volume receiving 2 Gy), and bV2 (absolute bladder volume receiving 2 Gy).
  
  
  RESULTS
  For the entire cohort, the average D95 (+/-SD) was 2.02 +/- 0.04 Gy (range, 1.79-2.20 Gy). The average rV2 (+/-SD) was 7.0 +/- 8.1 cc (range, 0.1-67.3 cc). The average bV2 (+/-SD) was 8.7 +/- 6.8 cc (range, 0.3-36.8 cc). Unlike doses for the prostate, there was significant daily variation in rectal and bladder doses, mostly because of variations in volume and shape of these organs.
  
  
  CONCLUSIONS
  Large variations in delivered doses to the rectum and bladder can be documented with daily megavoltage CT scans. Image guidance for the targeting of the prostate, even with intraprostatic fiducials, does not take into account the variation in actual rectal and bladder doses. The clinical impact of techniques that take into account such dosimetric parameters in daily patient set-ups should be investigated.
authors.affiliation: Department of Radiation Oncology, The M. D. Anderson Cancer Center Orlando, Orlando, FL 32806, USA. patrick.kupelian@orhs.org
authors.forename: Patrick A
authors.initials: PA
authors.lastname: Kupelian
authors.forename: Katja M
authors.initials: KM
authors.lastname: Langen
authors.forename: Omar A
authors.initials: OA
authors.lastname: Zeidan
authors.forename: Sanford L
authors.initials: SL
authors.lastname: Meeks
authors.forename: Twyla R
authors.initials: TR
authors.lastname: Willoughby
authors.forename: Thomas H
authors.initials: TH
authors.lastname: Wagner
authors.forename: Sam
authors.initials: S
authors.lastname: Jeswani
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Ruchala
authors.forename: Jason
authors.initials: J
authors.lastname: Haimerl
authors.forename: Gustavo H
authors.initials: GH
authors.lastname: Olivera
mesh_terms: D006801:Humans; D008297:Male; D011467:Prostate / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed; D001743:Urinary Bladder / Q000000981:diagnostic imaging