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Does Interfraction Cone Beam Computed Tomography Improve Target Localization in Prostate Bed Radiotherapy?

Sara Elakshar1, James Man Git Tsui2, Michael Jonathan Kucharczyk3

  • 11 McGill University, Jewish General Hospital, Montreal, Quebec, Canada.

Technology in Cancer Research & Treatment
|February 21, 2019
PubMed
Summary

Cone beam computed tomography (CBCT) improved prostate bed localization in post-radical prostatectomy patients compared to kilovoltage imaging. Daily CBCT revealed a greater need for patient position shifts, potentially preventing geographic misses.

Keywords:
cone beam CTimage-guided radiotherapykV imagingprostate cancerprostatectomy

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Area of Science:

  • Radiation Oncology
  • Medical Imaging
  • Urologic Oncology

Background:

  • Image-guided radiotherapy (IGRT) is crucial for precise radiation delivery.
  • Accurate patient positioning is essential in post-prostatectomy radiotherapy to target the prostate bed.
  • Traditional kilovoltage imaging may have limitations in accurately localizing targets without fiducials.

Purpose of the Study:

  • To compare the efficacy of cone beam computed tomography (CBCT) versus 2D orthogonal kilovoltage (kV) images for image-guided radiotherapy in the post-radical prostatectomy setting.
  • To assess the impact of CBCT on patient positioning adjustments.
  • To evaluate the interfractional changes in organ volumes and their correlation with imaging-guided shifts.

Main Methods:

  • Prospective phase II study involving 419 treatment fractions.
  • 3D matching using CBCT versus 2D matching using kV images for patient alignment.
  • Analysis of shifts required for each treatment fraction.
  • Measurement of interfractional bladder and rectal volume changes.
  • Calculation of the proportion of fractions with shift differences exceeding the planning target volume (PTV) margin of 7 mm.

Main Results:

  • A significant difference in shifts was observed in the anterior-posterior direction between kV and CBCT (P = .01).
  • The proportion of fractions exceeding the 7 mm PTV margin was 6% (anterior-posterior), 2% (lateral), and 3% (superior-inferior) for the differences between kV and CBCT shifts.
  • Mean shifts were comparable across directions, with slight variations between the two imaging modalities.

Conclusions:

  • Daily volumetric CBCT for treatment localization in post-prostatectomy patients necessitates more frequent patient position adjustments.
  • CBCT appears to improve the localization of the prostate bed, potentially reducing geographic misses compared to kV imaging without fiducials.
  • The findings support the use of CBCT for enhanced IGRT in this patient population.