Adaptive off-line protocol for prostate external radiotherapy with cone beam computer tomography.
OBJECTIVE
The goal of this work was to prepare and to evaluate an off-line adaptive protocol for prostate teleradiotherapy with kilovoltage cone beam computer tomography (CBCT).


METHODS
Ten patients with localized prostate carcinoma treated with external beams underwent image-guided radiotherapy. In total, 162 CBCT images were collected. Position of prostate and pubis symphysis (PS) with respect to the isocenter were measured off-line. Using the CBCT scans obtained in the first three fractions the average position of prostate in relation (AvPosPr) to PB was calculated. On each CBCT scan, the position of prostate with respect to AvPosPr was calculated and cumulative histogram of prostate displacement with respect to AvPosPr was prepared. Using this data, the adaptive protocol was prepared in which (1) based on the CBCT made in the first three fractions the AvPosPr to PS is obtained, (2) in all other fractions two orthogonal images are acquired and if for any direction set-up error exceeds 0.2 cm the patient's position is corrected, and (3) additionally, the patient's position is corrected if the AvPosPr exceeds 0.2 cm in any direction. To evaluate the adaptive protocol for 30 consecutive patients, the CBCT was also made in 10th and 21st fraction.


RESULTS
For the first 10 patients, the results revealed that the prostate was displaced in relation to AvPosPr >0.7 cm in the vertical and longitudinal directions only on 4 and 5 images of 162 CBCT images, respectively. For the lateral direction, this displacement was >0.3 cm in one case. For the group of 30 patients, displacement was never >0.7, and 0.3 cm for the vertical and lateral directions. In two cases, displacements were >0.7 cm for the longitudinal direction.


CONCLUSIONS
Implementation of the proposed adaptive procedure based on the on-line set-up error elimination followed by a reduction of systematic internal error enables reducing the CTV-PTV margin to 0.7, 0.7, and 0.4 cm for the vertical, longitudinal, and lateral directions, respectively.
Medical Physics Department, Center of Oncology, Warsaw, Poland.
M
M
Piziorska
P
P
Kukołowicz
A
A
Zawadzka
M
M
Pilichowska
P
P
Pęczkowski
D000368:Aged; D054893:Cone-Beam Computed Tomography / Q000379:methods*; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D056888:Patient Positioning / Q000009:adverse effects* / Q000379:methods; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011867:Radioisotope Teletherapy / Q000379:methods*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D061106:Radiotherapy Setup Errors / Q000009:adverse effects* / Q000517:prevention & control; D061089:Radiotherapy, Image-Guided / Q000379:methods*