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Margin verification for hypofractionated prostate radiotherapy using a novel dose accumulation workflow and iterative

Matthew T Studenski1, Rodrigo Delgadillo1, Yihang Xu1

  • 1Department of Radiation Oncology, Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, 1475 NW 12th Ave., Miami, FL 33136, United States.

Physica Medica : PM : an International Journal Devoted to the Applications of Physics to Medicine and Biology : Official Journal of the Italian Association of Biomedical Physics (AIFB)
|August 31, 2020
PubMed
Summary

Hypofractionated radiotherapy for prostate cancer uses a novel workflow to validate treatment margins. This method ensures adequate prostate dose coverage while sparing organs at risk, even with daily image guidance.

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Area of Science:

  • Radiation Oncology
  • Medical Physics

Background:

  • Hypofractionated radiotherapy offers patient convenience for prostate cancer treatment.
  • Standardization of treatment margins is crucial for balancing tumor control and toxicity.

Purpose of the Study:

  • To validate treatment margins in hypofractionated prostate cancer radiotherapy using a novel dose accumulation workflow.
  • To assess the impact of iterative CBCT (iCBCT) on dose distribution and target coverage.

Main Methods:

  • Sixteen patients undergoing hypofractionated prostate radiotherapy were analyzed.
  • A novel adaptive dose accumulation workflow with daily iCBCT images was employed.
  • Synthetic CTs were generated to recalculate and accumulate daily delivered doses.

Main Results:

  • Prostate coverage remained adequate despite a drop in planning target volume (PTV) coverage in the accumulated dose.
  • Dose to the bladder and anorectum showed no significant differences.
  • A significant decrease in coverage was observed for the intra-prostatic gross tumor volume (GTV) boost in the accumulated dose.

Conclusions:

  • The novel dose accumulation workflow using daily iCBCT is feasible for assessing treatment margins.
  • Current clinical margins provide adequate prostate dose while sparing organs at risk.
  • A margin may be necessary for delivering the full dose to an intra-prostatic GTV boost.