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Dosimetric impact of rectum and bladder anatomy and intrafractional prostate motion on hypofractionated prostate radiation therapy

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Abstract

Objective

The objective of this study was to evaluate the dosimetric impact on hypofractionated prostate radiation therapy of two geometric uncertainty sources: rectum and bladder filling and intrafractional prostate motion.

Materials and methods

This prospective study included 544 images (375 pre-treatment cone-beam CT [CBCT] and 169 post-treatment CBCT) from 15 prostate adenocarcinoma patients. We recalculated the dose on each pre-treatment CBCT once the positioning errors were corrected. We also recalculated two dose distributions on each post-treatment CBCT, either using or not intrafractional motion correction. A correlation analysis was performed between CBCT-based dose and rectum and bladder filling as well as intrafraction prostate displacements.

Results

No significant differences were found between administered and planned rectal doses. However, we observed an increase in bladder dose due to a lower bladder filling in 66% of treatment fractions. These differences were reduced at the end of the fraction since the lower bladder volume was compensated by the filling during the treatment session. A statistically significant reduction in target volume coverage was observed in 27% of treatment sessions and was correlated with intrafractional prostate motion in sagittal plane > 4 mm.

Conclusions

A better control of bladder filling is recommended to minimize the number of fractions in which the bladder volume is lower than planned. Fiducial mark tracking with a displacement threshold of 5 mm in any direction is recommended to ensure that the prescribed dose criteria are met.

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References

  1. Spratt DE, Pei X, Yamada J, Kollmeier MA, Cox B, Zelefsky MJ. Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2013;85(3):686–92.

    Article  Google Scholar 

  2. Palma D, Vollans E, James K, Nakano S, Moiseenko V, Shaffer R, et al. Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys. 2008;72:996–1001. https://doi.org/10.1016/j.ijrobp.2008.02.047.

    Article  PubMed  Google Scholar 

  3. Zelefsky MJ, Kollmeier M, Cox B, Fidaleo A, Sperling D, Pei X, et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84:125–9. https://doi.org/10.1016/j.ijrobp.2011.11.047.

    Article  PubMed  Google Scholar 

  4. Zapatero A, Roch M, Büchser D, Castro P, Fernández-Banda L, Pozo G, et al. Reduced late urinary toxicity with high-dose intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer. Clin Transl Oncol. 2017;19:1161–7. https://doi.org/10.1007/s12094-017-1655-9.

    Article  CAS  PubMed  Google Scholar 

  5. Ghilezan M, Yan D, Liang J, Jaffray D, Wong J, Martinez A. Online image-guided intensity-modulated radiotherapy for prostate cancer: How much improvement can we expect? A theoretical assessment of clinical benefits and potential dose escalation by improving precision and accuracy of radiation delivery. Int J Radiat Oncol Biol Phys. 2004;60:1602–10. https://doi.org/10.1016/j.ijrobp.2004.07.709.

    Article  PubMed  Google Scholar 

  6. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43:1095–101.

    Article  CAS  Google Scholar 

  7. Fowler J, Chappell R, Ritter M. Is alpha/beta for prostate tumors really low? Int J Radiat Oncol Biol Phys. 2001;50:1021–31.

    Article  CAS  Google Scholar 

  8. Williams SG, Taylor JMG, Liu NG, et al. Use of individual fraction size data from 3756 patients to directly determine the alpha/beta ratio of prostate cancer. Int J Radiat Oncol Biol Phys. 2007;64:24–33.

    Article  Google Scholar 

  9. Proust-Lima C, Taylor JM, Sécher S, et al. Confirmation of a low alpha/beta ratio for prostate cancer treated by external beam radiation therapy alone using a post-treatment repeated-measures model for PSA dynamics. Int J Radiat Oncol Biol Phys. 2010;79:195–201.

    Article  Google Scholar 

  10. Miralbell R, Roberts SA, Zubizarreta E, et al. Dose–fractionation radiosensitivity of prostate cancer deduced from radiotherapy outcome of 5969 patients in seven international institutional datasets. Int J Radiat Oncol Biol Phys. 2009;75:S81.

    Article  Google Scholar 

  11. Vogelius IR, Bentzen SM. Meta-analysis of the alpha/beta ratio for prostate cancer in the presence of an overall time factor: bad news, good news, or no news? Int J Radiat Oncol Biol Phys. 2013;1:89–94.

    Article  Google Scholar 

  12. Arcangeli S, Strigari L, Gomellini S, Saracino B, Petrongari MG, Pinnarò P, et al. Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys. 2012;84:1172–8.

    Article  Google Scholar 

  13. Wilkins A, Mossop H, Syndikus I, Khoo V, Bloomfield D, Parker C et al. Hypofractionated radiotherapy versus conventionally fractionated radiotherapy for patients with intermediate-risk localised prostate cancer: 2-year patient-reported outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. https://doi.org/10.1016/S1470-2045(15)00280-6

  14. Thor M, Deasy JO, Paulus R, Robert Lee W, Amin MB, Bruner DW, et al. Tolerance doses for late adverse events after hypofractionated radiotherapy for prostate cancer on trial NRG Oncology/RTOG 0415. Radiother Oncol. 2019;135:19–24. https://doi.org/10.1016/j.radonc.2019.02.014.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Pollack A, Walker G, Horwitz EM, Price R, Feigenberg S, Konski AA, et al. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol. 2013;31:3860–8.

    Article  Google Scholar 

  16. Jereczek-Fossa BA, Surgo A, Maisonneuve P, Maucieri A, Gerardi MA, Zerini D, et al. Late toxicity of image-guided hypofractionated radiotherapy for prostate: non-randomized comparison with conventional fractionation. Radiol Med. 2019;124:65–78. https://doi.org/10.1007/s11547-018-0937-9.

    Article  PubMed  Google Scholar 

  17. Roch M, Zapatero A, Castro P, Büchser D, Pérez L, Hernández D, et al. Impact of rectum and bladder anatomy in intrafractional prostate motion during hypofractionated radiation therapy. Clin Transl Oncol. 2019;21:607–14.

    Article  CAS  Google Scholar 

  18. Castro P, Roch M, Zapatero A, Büchser D, Garayoa J, Ansón C, et al. Multicomponent assessment of the geometrical uncertainty and consequent margins in prostate cancer radiotherapy treatment using fiducial markers. Int J Med Phys Clin Eng Radiat Oncol. 2018;07:503–21.

    Article  Google Scholar 

  19. Chen Z, Yang Z, Wang J, Hu W. Dosimetric impact of different bladder and rectum filling during prostate cancer radiotherapy. Radiat Oncol. 2016;11:1–8. https://doi.org/10.1186/s13014-016-0681-z.

    Article  CAS  Google Scholar 

  20. Pearson D, Gill SK, Campbell N, Reddy K. Dosimetric and volumetric changes in the rectum and bladder in patients receiving CBCT-guided prostate IMRT: analysis based on daily CBCT dose calculation. J Appl Clin Med Phys. 2016;17:107–17.

    Article  Google Scholar 

  21. McParland N, Pearson M, Wong J, Sigur I, Stenger C, Tyldesley S. Quantifying daily variation in volume and dose to the prostate, rectum and bladder using cone-beam computerised tomography. J Radiother Pract. 2014;13:79–86.

    Article  Google Scholar 

  22. Murthy V, Shukla P, Adurkar P, Master Z, Mahantshetty U, Shrivastava SK. Dose variation during hypofractionated image-guided radiotherapy for prostate cancer: planned versus delivered. J Cancer Res Ther. 2011;7:162–7.

    Article  Google Scholar 

  23. Kupelian PA, Langen KM, Zeidan OA, Meeks SL, Willoughby TR, Wagner TH, et al. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66:876–82.

    Article  Google Scholar 

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Funding

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Authors and Affiliations

  1. Department of Medical Physics, Hospital La Princesa, Health Research Institute IIS-IP, Diego de León 62, 28006, Madrid, Spain

    M. Roch, P. Castro & D. Hernández

  2. Department of Radiation Oncology, Hospital La Princesa, IIS-IP, Madrid, Spain

    A. Zapatero

  3. Medical Physics Group, Radiology Department, Complutense University of Madrid, Madrid, Spain

    M. Chevalier

  4. Department of Medical Physics, Hospital Ramón Y Cajal, Madrid, Spain

    F. García-Vicente

Authors
  1. M. Roch
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  2. A. Zapatero
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  3. P. Castro
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  4. D. Hernández
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  6. F. García-Vicente
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Correspondence to M. Roch.

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All the authors have contributed sufficiently to the scientific work and therefore share collective responsibility and accountability for the results. All the authors have read, approved, and consented to submit the manuscript. All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Roch, M., Zapatero, A., Castro, P. et al. Dosimetric impact of rectum and bladder anatomy and intrafractional prostate motion on hypofractionated prostate radiation therapy. Clin Transl Oncol 23, 2293–2301 (2021). https://doi.org/10.1007/s12094-021-02628-3

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  • DOI: https://doi.org/10.1007/s12094-021-02628-3

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