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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Position verification for the prostate: effect on rectal wall dose.

Marie A D Haverkort1, Jeroen B van de Kamer, Bradley R Pieters

  • 1Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands. m.a.haverkort@amc.uva.nl

International Journal of Radiation Oncology, Biology, Physics
|July 22, 2010
PubMed
Summary
This summary is machine-generated.

Gold marker (GM)-based position correction in prostate cancer radiotherapy significantly reduces the cumulative dose to the anorectal wall compared to bony anatomy (BA)-based correction. This method ensures adequate prostate treatment while sparing the rectum.

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Oncology

Background:

  • Accurate patient positioning is crucial in external beam radiotherapy (EBRT) for prostate cancer to ensure effective tumor coverage and minimize dose to organs at risk.
  • Traditional bony anatomy (BA)-based image guidance relies on skeletal landmarks, which may not accurately reflect the position of the prostate, especially with changes in anorectal shape and position.
  • Gold markers (GMs) offer a potential alternative for image guidance by directly tracking the prostate's position.

Purpose of the Study:

  • To compare the effect of gold marker (GM)-based position correction versus traditional bony anatomy (BA)-based correction on the cumulative dose delivered to the anorectal wall.
  • To evaluate the impact of these different image guidance strategies on prostate dose coverage.
  • To account for internal organ motion and changes in anorectal shape and position in the dose assessment.

Main Methods:

  • Twenty prostate cancer patients undergoing curative EBRT were included.
  • Four fiducial GMs were implanted in the prostate for direct tracking.
  • Position verification and correction were performed daily using electronic portal images, comparing GM-based (GM-on, GM-off) and BA-based (BA-off) protocols with reduced planning target volume margins for GM protocols (8mm) vs. BA (10mm).
  • Dose distribution was recomputed on 11 repeat CT scans to estimate cumulative dose to the prostate and anorectal wall, considering organ motion.

Main Results:

  • All protocols achieved acceptable dose coverage to the prostate (at least 99% of the dose received by 99% of the prostate).
  • GM-based protocols demonstrated superior prostate dose coverage (>95% of prescribed dose for all patients).
  • The cumulative dose to the anorectal wall was significantly lower with GM-based protocols compared to BA-based correction.
  • Specifically, the dose received by 30% of the rectal wall was significantly lower for GM-on (54.6 Gy) and GM-off (54.1 Gy) compared to BA-off (58.9 Gy) (p <.001).

Conclusions:

  • Position verification using gold markers, combined with reduced planning target volume margins, provides adequate treatment for prostate cancer.
  • GM-based image guidance significantly lowers the cumulative dose to the rectal wall.
  • These benefits are achieved even when accounting for independent movement of the prostate and anorectal wall, highlighting the clinical advantage of GM-based radiotherapy.