title: Rectal motion can reduce CTV coverage and increase rectal dose during prostate radiotherapy: A daily cone-beam CT study.
abstract: OBJECTIVE
  Daily on-treatment verification cone-beam CT (CBCT) was used to study the effect of rectal motion on clinical target volume (CTV) coverage during prostate radiotherapy.
  
  
  METHODS
  CBCT scans were acquired from 15 patients immediately after daily treatment. From these images, the rectum was contoured allowing the analysis of rectal volume cross-sectional area (CSA) and the determination of rectal dose. Rectal wall motion was quantified as a surrogate measure of prostate displacement and CTV coverage was subjectively assessed.
  
  
  RESULTS
  Rectal volume decreased over the treatment course in 13 patients (P<0.001). Rectal wall regions corresponding to the prostate base displayed the greatest motion; larger displacements were seen in patients with larger rectal planning volumes. CTV coverage was inadequate, at the prostate base only, in 38% of the fractions delivered to 4/7 patients with a large rectum at planning (>100 cm(3)). In patients with small rectum at planning (<50 cm(3)) up to 25% more rectal volume than predicted was included in the high-dose region.
  
  
  CONCLUSIONS
  Rectal motion during treatment in prostate cancer patients has implications for CTV coverage and rectal dose. Measures to ensure consistency in daily rectal volume or image-guided strategies should be considered.
authors.affiliation: Clatterbridge Centre for Oncology, Bebington, Wirral, UK.
authors.forename: Raj
authors.initials: R
authors.lastname: Sripadam
authors.forename: Julie
authors.initials: J
authors.lastname: Stratford
authors.forename: Ann M
authors.initials: AM
authors.lastname: Henry
authors.forename: Andrew
authors.initials: A
authors.lastname: Jackson
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Moore
authors.forename: Pat
authors.initials: P
authors.lastname: Price
mesh_terms: D000368:Aged; D054893:Cone-Beam Computed Tomography; D006801:Humans; D008297:Male; D008875:Middle Aged; D009038:Motion; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D012007:Rectum / Q000000981:diagnostic imaging / Q000502:physiology* / Q000528:radiation effects*