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Duration-dependent margins for prostate radiotherapy-a practical motion mitigation strategy.

Eric Pei Ping Pang1,2, Kellie Knight3, Sung Yong Park4

  • 1Division of Radiation Oncology, National Cancer Centre Singapore, 11 Hospital Crescent, 169610, Singapore, Singapore. eric.pang.p.p@nccs.com.sg.

Strahlentherapie Und Onkologie : Organ Der Deutschen Rontgengesellschaft ... [Et Al]
|January 15, 2020
PubMed
Summary

Prostate displacement during radiotherapy increases with treatment time. This study quantifies this intra-fractional prostate movement, showing required margins expand linearly with duration, impacting planning target volume calculations.

Keywords:
Intra-fractional prostate displacementMarginsProstate cancerReal-time trackingTransperineal ultrasound

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Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Imaging Technology

Background:

  • Intra-fractional prostate displacement correlates with patient positioning time during radiotherapy.
  • Real-time monitoring is crucial for understanding and mitigating this movement.

Purpose of the Study:

  • To quantify minute-by-minute prostate displacement during radiotherapy.
  • To calculate the impact of this displacement on duration-dependent margins.
  • To assess the influence of treatment duration on planning target volume (PTV) margins.

Main Methods:

  • Prospective study of 55 patients undergoing prostate radiotherapy.
  • Real-time intra-fractional prostate position monitoring using four-dimensional transperineal ultrasound (4D TPUS).
  • Analysis of 1745 monitoring sessions using Van Herk's margin recipe to estimate duration-dependent margins up to 15 minutes.
  • Linear regression analysis of margins against time and direction.

Main Results:

  • Mean intra-fractional prostate displacement at 15 minutes: 0.76 mm Inferior, 0 mm Lateral, 0.94 mm Posterior.
  • Required margin expansion increased linearly with treatment duration (R² = 0.99, p < 0.01).
  • Significantly larger margins were needed for longer treatment durations (e.g., 15 min vs. 8 min) and in the Left/Right direction compared to Superior/Inferior and Anterior/Posterior.

Conclusions:

  • The study successfully derived minimum duration-dependent margins for prostate radiotherapy planning.
  • Required margins increase linearly with treatment duration within 15 minutes.
  • The choice of radiotherapy technique (IMRT, VMAT, 3DCRT, proton therapy) influences the required margin based on treatment duration.