|Table of Contents|

Analysis of target location shift in intensity modulated radiotherapy for prostate cancer based on iCBCT

Journal Of Modern Oncology[ISSN:1672-4992/CN:61-1415/R]

Issue:
2024 17
Page:
3285-3290
Research Field:
Publishing date:

Info

Title:
Analysis of target location shift in intensity modulated radiotherapy for prostate cancer based on iCBCT
Author(s):
LI Zhanwei1; 2; LUO Yu2; WANG Shaojin2; CHEN Xuanguang2; LIU Yang2; XU Senkui2; DING Zhenhua1
1.Department of Radiology,School of Public Health,Southern Medical University,Guangdong Guangzhou 510000,China;2.Department of Radiation Oncology,Sun Yat-sen University Cancer Center,Guangdong Guangzhou 510000,China.
Keywords:
prostate cancer; intensity modulated radiotherapy; iCBCT; advanced image guidance; registration method
PACS:
R735.25
DOI:
10.3969/j.issn.1672-4992.2024.17.020
Abstract:
Objective:To investigate the disparity in target localization between the pelvic lymphatic drainage area and the prostate seminal vesicle gland in iCBCT-guided intensity modulated radiotherapy for prostate cancer,with the intention of providing valuable insights for selecting an optimal image guidance strategy in clinical practice.Methods:Twenty-one patients with prostate cancer who underwent intensity modulated radiotherapy in the Sun Yat-Sen University Cancer Center from January 2023 to September 2023 were retrospectively selected.Prior to positioning and treatment,the patients were instructed to ensure bladder filling and rectal emptying.Offline registration(manual adjustment after automatic registration) was performed on the pre-treatment iCBCT images based on pelvic bone structure as well as prostate seminal vesicle gland.The displacement errors in the pelvic lymphatic drainage area and prostate seminal vesicle gland target locations were evaluated separately,obtaining displacement values in left-right(LR),superior-inferior(SI),and anterior-posterior(AP) directions.The differences and correlations of displacement between these two regions were analyzed,along with calculating relative displacement.The expansion boundary of PTV was determined using the formula MPTV=2.5Σ+0.7σ.Results:The positioning errors of pelvic lymphatic drainage area and prostate seminal vesicle gland target were as follows：LR:(0.27±0.58)mm vs (0.31±0.61)mm,SI:(0.53±0.91)mm vs (0.68±0.98)mm,AP:(2.03±1.86)mm vs (2.79±2.52)mm.Significant differences were observed in SI and AP(H=4.577,5.035,P<0.05).Displacement in LR showed a high correlation coefficient(r=0.736),while moderate correlation coefficient in SI(r=0.542).However,the displacement in AP displayed a very weak correlation coefficient(r=0.190).The relative displacements in LR,SI,AP exceeded the threshold value of 5 mm by percentages of 4 .9 %,5 .3 %,and 29.2 %respectively.The PTV expansion ranges of pelvic lymphatic drainage area in LR,SI and AP directions were 1.08 mm,1.96 mm and 6.38 mm,respectively.The PTV expansion ranges of prostate seminal vesicle gland in LR,SI and AP directions of prostate seminal vesicle were 1.20 mm,2.39 mm and 8.74 mm,respectively.Conclusion:In intensity modulated radiotherapy for prostate cancer,the pelvic lymphatic drainage area and the prostate seminal vesicle have a large displacement in the anterior-posterior direction between sessions of treatment,and the target area of the two areas is prone to a large relative displacement in the anterior-posterior direction,which cannot be corrected by image guidance.The status of the bladder and rectum should be kept as consistent as possible with that in CT simulated positioning.

References:

[1] MORGAN SC,HOFFMAN K,LOBLAW DA,et al.Hypofractionated radiation therapy for localized prostate cancer：Executive summary of an ASTRO,ASCO and AUA evidence-based guideline［J］.The Journal of Urology,2019,201(3)：528-534.
[2] HEND SP,LOW SH,SIVAMANY K.The influence of the bowel and bladder preparation protocol for radiotherapy of prostate cancer using kilo-voltage cone beam CT：Our experience［J］.Indian J Cancer,2015,52(4)：639-644.
[3] BYRNE TE.A review of prostate motion with considerations for the treatment of prostate cancer［J］.Med Dosim,2005,30(3)：155-161.
[4] VAN HERK M,BRUCE A,KROES AP,et al.Quantification of organ motion during conformal radiotherapy of the prostate by three dimensional image registration［J］.Int J Radiat Oncol Biol Phys,1995,33(5)：1311-1320.
[5] RIHITO A,HARUO I,ITARU I,et al.Impact of prostate position-based image-guidance in intensity-modulated radiation therapy for localized prostate cancer［J］.International Journal of Clinical Oncology,2024,29(3):325-332.
[6] ELISABETH W,JIAN W,WILLIAM S,et al.Clinical evaluation of soft tissue organ boundary visualization on cone-beam computed tomographic imaging［J］.International Journal of Radiation Oncology,Biology,Physics,2010,78(3):929-936.
[7] 李明,高鸿,修霞,等.CBCT引导前列腺癌 Imrt 图像配准及靶区外放边界分析［J］.中华放射肿瘤学杂志,2016，25(3):249-254. LI M,GAO H,XIU X,et al.Image registration and target volume margins in cone-beam computed tomography-guided intensity-modulated radiotherapy for prostate cancer［J］.Chinese Journal of Radiation Oncology,2016，25(3):249-254.
[8] WEBSTER A,APPELT AL,EMINOWICZ G.Image-guided radiotherapy for pelvic cancers：A review of current evidence and clinical utilisation［J］.Clinical Oncology,2020,32(12):805-816.
[9] 田龙,席强,赵鑫,等.膀胱癌图像引导放疗中基于软组织灰度值与基于内植标记物的锥形束CT校准比较［J］.中国医学物理学杂志,2018,35(01)：31-35. TIAN L,XI Q,ZHAO X,et al.Comparison of cone beam computed tomography calibrations based on soft tissue grey value and implanted markers in image-guided radiotherapy for bladder cancer［J］.Chinese Jurnal of Medical Physics,2018,35(01)：31-35.
[10] 田龙,席强,赵鑫,等.膀胱癌图像引导放疗中基于骨骼与基于内植标记物锥形束CT校准比较［J］.中国医学物理学杂志,2019，36(06)：647-652. TIAN L,XI Q,ZHAO X,et al.Comparison between CBCT calibrations based on skeleton vs implanted markers in image-guided radiotherapy for bladder cancer［J］.Chinese Jurnal of Medical Physics,2019，36(06)：647-652.
[11] BRADY SL.Clinical practice evolvement for post-operative prostate cancer radiotherapy-part 2：Feasibility of margin reduction for fractionated radiation treatment with advanced image guidance［J］.Cancers,2022,15(1):40.
[12] 黄虹,陈炫光,林志悦,等.前列腺癌调强放疗中四种固定方式的摆位精度对比［J］.中华肿瘤防治杂志,2022,29(19)：1422-1426. HUANG H,CHEN XG,LIN ZY,et al.Comparision of the positioning accuracy of four immobilizations intensity-modulated radiotherapy for prostate cancer［J］.Chinese Journal of Cancer Prevention and Treatment,2022,29(19)：1422-1426.
[13] REDDY NM,NORI D,SARTIN W,et al.Influence of volumes of prostate,rectum,and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image-guided IMRT［J］.Med Phys,2009,36(12)：5604-5611.
[14] BELTRAN C,HERMAN MG,DAVIS BJ,Planning target margin calculations for prostate radiotherapy based on intrafraction and interfraction motion using four localization methods［J］.Int J Radiat Oncol Biol Phys,2008,70(1)：289-295.
[15] MAYYAS E,KIM J,KUMAR S,et al.A novel approach for evaluation of prostate deformation and associated dosimetric implications in IGRT of the prostate［J］.Medical physics,2014,41(9)：091709.
[16] 田龙,闫洁诚,胡逸民.前列腺癌靶区位移影响因素分析［J］.北京生物医学工程,2021,40(4)：406-412. TIAN L,YAN JC,HU YM.Analysis of influence factors of cone beam CT calibration in prostate cancer［J］.Beijing Biomed Eng,2021,40(4)：406-412.
[17] MARNOUCHE EA,HADADI K,ABDELHAK M,et al.Evaluation of margins in pelvic lymph nodes and prostate radiotherapy and the impact of bladder and rectum on prostate position［J］.Cancer Radiother,2021,25(2)：161-168.
[18] ZELEFSKY MJ,CREAN D,MAGERAS GS,et al.Quantification and predictors of prostate position variability in 50 patients evaluated with multiple CT scans during conformal radiotherapy［J］.Radiother Oncol,1999,50(2)：225-234.
[19] SCHALLENKAMP JM,HERMAN MG,KRUSE JJ,et al.Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging［J］.International Journal of Radiation Oncology,Biology,Physics,2005,63(3)：800-811.
[20] 中国医师协会放射肿瘤治疗医师分会,中华医学会放射肿瘤治疗学分会,中国抗癌协会肿瘤放射治疗专业委员会.中国前列腺癌放射治疗指南(2020年版)［J］.中华肿瘤防治杂志,2021,28(5)：323-337. Radiation Oncologist Branch of Chinese Mediacl Doctor Association,Radiation Oncologist Branch of Chinese Medical Association,Tumor Radiation Therapy Professional Committee of Chinese Anti-cancer Association.Chinese Guidelines for Radiation Therapy of Prostate Cancer(2020 edition)［J］.Chinese Journal of Cancer Prevention And Treatment,2021,28(5)：323-337.
[21] 中国医促会泌尿健康促进分会,中国研究型医院学会泌尿外科学专业委员会.前列腺癌放射治疗安全共识［J］.现代泌尿外科杂志,2019,24(5)：336-346. Urological Health Promotion Branch of China Medical Promotion Association,Urological Surgery Professional Committee of Chinese Research Hospital Society.Safety consensus of radiotherapy for prostate cancer［J］.J Modern Urol,2019,24(5)：336-346.

Memo

Memo:
广东省医学科学技术研究基金（编号：A2017613）；广东省食管癌研究所科技计划（编号：Q202107）
Last Update: 2024-07-31