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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Assessing prostate, bladder and rectal doses during image guided radiation therapy--need for plan adaptation?

Raj Varadhan1,2, Susanta K Hui2, Sarah Way1

  • 1Minneapolis Radiation Oncology, North Radiation Therapy Center, Robbinsdale, MN, U.S.A.

Journal of Applied Clinical Medical Physics
|August 21, 2009
PubMed
Summary

Image Guided Radiotherapy (IGRT) for prostate cancer uses daily imaging to track organ movement. Adapting treatment plans with daily imaging, like on the Tomotherapy system, ensures accurate radiation doses are delivered to the tumor while sparing healthy organs.

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Area of Science:

  • Medical Physics
  • Radiation Oncology
  • Radiotherapy Technology

Background:

  • Image Guided Radiotherapy (IGRT) is crucial for precise dose delivery in localized prostate cancer treatment.
  • In-room imaging (CT) allows for daily tracking of prostate, bladder, and rectum anatomy to adjust radiation therapy.
  • Inter-fraction organ motion introduces dosimetric uncertainties that need evaluation.

Purpose of the Study:

  • To evaluate dosimetric uncertainties caused by inter-fraction organ variation during IGRT for prostate cancer.
  • To assess the accuracy of dose recomputation using daily CT scans from different imaging modalities.
  • To investigate the feasibility of adaptive radiotherapy planning based on daily image feedback.

Main Methods:

  • Compared kilovoltage cone beam CT (kvCBCT) on Elekta Synergy and Megavoltage CT (MVCT) on Tomotherapy Hi-ART for 10 patients.
  • Performed dose recomputation using daily CT anatomy and evaluated image quality using phantoms (ComTom, Catphan 600).
  • Utilized Planned Adaptive software on Tomotherapy to construct cumulative Dose Volume Histograms (DVHs) and adapt plans.

Main Results:

  • Direct dose recomputation on kvCBCT was inaccurate due to CT number deviations.
  • Maximum deviation to the prostate was 2.7% with kvCBCT.
  • Significant daily variations observed in rectum (up to 12%) and bladder (up to 40%) doses without adaptation.
  • Tomotherapy's adaptive planning with MVCT enabled delivered doses to closely match planned doses.

Conclusions:

  • IGRT requires careful consideration of imaging modality accuracy for dose recomputation.
  • Adaptive planning, particularly with systems like Tomotherapy using daily MVCT, is effective in managing organ variations.
  • Adaptive strategies ensure accurate dose delivery and improve treatment outcomes in prostate cancer radiotherapy.