title: Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy.
abstract: OBJECTIVE
  The aim of this work was to analyze interfraction and intrafraction deviations and residual set-up errors (RSE) after online repositioning to determine PTV margins for 3 different alignment techniques in prostate cancer radiotherapy.
  
  
  METHODS
  The present prospective study included 44 prostate cancer patients with implanted fiducials treated with three-dimensional (3D) conformal radiotherapy. Daily localization was based on skin marks followed by marker detection using kilovoltage (kV) imaging and subsequent patient repositioning. Additionally, in-treatment megavoltage (MV) images were obtained for each treatment field. In an off-line analysis of 7,273 images, interfraction prostate motion, RSE after marker-based prostate localization, prostate position during each treatment session, and the effect of treatment time on intrafraction deviations were analyzed to evaluate PTV margins.
  
  
  RESULTS
  Margins accounting for interfraction deviation, RSE and intrafraction motion were 14.1, 12.9, and 15.1 mm in anterior-posterior (AP), superior-inferior (SI), and left-right (LR) direction for skin mark alignment and 9.6, 8.7, and 2.6 mm for bony structure alignment, respectively. Alignment to implanted markers required margins of 4.6, 2.8, and 2.5 mm. As margins to account for intrafraction motion increased with treatment prolongation PTV margins could be reduced to 3.9, 2.6, and 2.4 mm if treatment time was ≤ 4 min.
  
  
  CONCLUSIONS
  With daily online correction and repositioning based on implanted fiducials, a significant reduction of PTV margins can be achieved. The use of an optimized workflow with faster treatment techniques such as volumetric modulated arc techniques (VMAT) could allow for a further decrease.
authors: Department of Therapeutic Radiology and Oncology, Medical University of Graz, Auenbruggerplatz 32, Graz, Austria. tanja.langsenlehner@klinikum-graz.at
authors: T
authors: T
authors: Langsenlehner
authors: C
authors: C
authors: Döller
authors: P
authors: P
authors: Winkler
authors: G
authors: G
authors: Gallé
authors: K S
authors: KS
authors: Kapp
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D057918:Fiducial Markers; D006801:Humans; D008297:Male; D056888:Patient Positioning / Q000379:methods*; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000379:methods*; D011882:Radiotherapy, High-Energy / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D014057:Tomography, X-Ray Computed / Q000379:methods; D001743:Urinary Bladder / Q000528:radiation effects