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Proton Therapy Delivery and Its Clinical Application in Select Solid Tumor Malignancies
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Evaluating deviations in prostatectomy patients treated with IMRT.

Ana Cravo Sá1, Ana Peres1, Mónica Pereira1

  • 1Radiotherapy Department, Lisbon School of Health Technology, Polytechnic Institute of Lisbon, Avenida D. João II, lote 4.69.01, 1990-096 Lisbon, Portugal.

Reports of Practical Oncology and Radiotherapy : Journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology
|September 8, 2016
PubMed
Summary

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This study evaluated prostatectomy patient treatment deviations to determine optimal margins for planning target volumes (PTV). Findings suggest anisotropic margins, with larger expansions in the anterior-posterior direction, are necessary for accurate Intensity-Modulated Radiation Therapy (IMRT).

Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Inaccurate margins in Intensity-Modulated Radiation Therapy (IMRT) for prostatectomy patients can lead to underdosing of target volumes and overdosing of healthy tissues, increasing morbidity.
  • Optimizing planning target volume (PTV) margins is crucial for effective radiation therapy delivery and minimizing side effects.

Purpose of the Study:

  • To evaluate treatment deviations in prostatectomy patients undergoing IMRT.
  • To calculate appropriate margins for creating the planning target volume (PTV) based on observed deviations.

Main Methods:

  • Analysis of 223 Cone-Beam Computed Tomography (CBCT) images from 12 prostatectomy patients treated with IMRT.
  • Alignment of CBCT images with planning CT scans using bony anatomy.
  • Recording of image shifts in the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions to calculate PTV margins.
Keywords:
Cone beam computed tomographyGeometric uncertaintyIntensity modulated radiotherapyPlanning target volume marginProstate tumour

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Main Results:

  • Mean deviations were -0.05 ± 1.35 mm (LR), -0.03 ± 0.65 mm (SI), and -0.02 ± 2.05 mm (AP).
  • Systematic errors were 1.35 mm (LR), 0.65 mm (SI), and 2.05 mm (AP).
  • Random errors were 2.07 mm (LR), 1.45 mm (SI), and 3.16 mm (AP), resulting in calculated PTV margins of 4.82 mm (LR), 2.64 mm (SI), and 7.33 mm (AP).

Conclusions:

  • The study supports anisotropic margin expansion for PTV, with the largest margin in the AP direction and smaller margins in the SI direction.
  • Recommended PTV margins with image-guided radiation therapy (IGRT) are 5 mm (LR), 3 mm (SI), and 8 mm (AP) for PTV1 and PTV2.