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Quantification of the margin required for treating intraprostatic lesions.

Matthew T Studenski1, Yanisley Valenciaga, Matthew C Abramowitz

  • 1University of Miami Miller School of Medicine. m.studenski@med.miami.edu.

Journal of Applied Clinical Medical Physics
|May 12, 2016
PubMed
Summary

A 3.0 mm margin around the intraprostatic lesion (IPL) on MRI is sufficient for prostate radiation therapy, accounting for prostate motion and deformation. This ensures adequate dose delivery for improved tumor control.

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Prostate Cancer Treatment

Background:

  • Magnetic resonance imaging (MRI) advances enable precise definition of intraprostatic lesions (IPLs) for prostate radiation therapy.
  • Dose escalation to the IPL can potentially improve tumor control.

Purpose of the Study:

  • To quantify the necessary margin around MRI-defined IPLs to account for prostate motion and deformation.
  • To evaluate dosimetric differences with incremental margins.
  • To determine the optimal margin for ensuring adequate IPL coverage.

Main Methods:

  • Retrospective analysis of 10 patients treated with simultaneous integrated intraprostatic boost (SIIB).
  • Re-planning with 0-5 mm incremental margins around the IPL.
  • Sensitivity analysis incorporating prostate motion and deformation uncertainties (assessed via CBCT and fiducial markers).

Main Results:

  • IPL volume increased from 2.3% to 11.8% of PTV with a 5 mm margin.
  • The only significant dosimetric change was an increase in PTV maximum dose with larger margins.
  • Sensitivity analysis indicated a 3.0 mm margin ensures >95% IPL coverage, considering motion and deformation.

Conclusions:

  • A 3.0 mm margin around the MRI-defined IPL is sufficient for most cases.
  • This margin adequately addresses random and systematic errors in IPL positioning during radiation therapy.