An algorithm for shifting MLC shapes to adjust for daily prostate movement during concurrent treatment with pelvic...

Concurrent treatment of the prostate and the pelvic lymph nodes encounters the problem of the prostate gland moving independently from the pelvic lymph nodes on a daily basis. The purpose of this study is to develop a leaf-tracking algorithm for adjustment of IMRT portals without requirement of online dose calculation to account for daily prostate position during concurrent treatment with pelvic lymph nodes. A leaf-shifting algorithm was developed and programmed to adjust the positions of selected MLC leaf pairs according to prostate movement in the plane perpendicular to each beam angle. IMRT plans from five patients with concurrent treatment of the prostate and pelvic lymph nodes were selected to test the feasibility of this algorithm by comparison with isocenter-shifted plans, using defined dose endpoints. When the prostate moved 0.5, 1.0, and 1.5 cm along the anterior/posterior direction, the average doses to 95% of the prostate (D95%) for the iso-shift plans were similar to the MLC-shift plans, (54.7, 54.4, and 54.1 Gy versus 54.5, 54.3, and 53.9 Gy, respectively). The corresponding D95% averages to the pelvic lymph nodes were reduced from the prescription dose of 45 Gy to 42.7, 38.3, and 34.0 Gy for iso-shift plans (p = 0.04 for each comparison), while the D95% averages for the MLC-shift plans did not significantly differ from the prescription dose, at 45.0, 44.8, and 44.5 Gy. Compensation for prostate movement along the superior/inferior direction was more complicated due to a limiting MLC leaf width of 1.0 cm. In order to concurrently treat the prostate and pelvic lymph nodes with the prostate moving independently, shifting selected MLC leaf pairs may be a more practical adaptive solution than shifting the patient.