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Updated: Jul 28, 2026
Stereotactic Radiosurgery for Gynecologic Cancer
Published on: April 17, 2012
Reconstructed dose and geometric coverage for tight margins using intrafraction re-planning on an integrated magnetic
Ingeborg van den Berg1,2, Cornel Zachiu1, Eline N de Groot-van Breugel1
1Department of Radiation Oncology, Division of Imaging & Oncology, University Medical Center Utrecht, Utrecht, The Netherlands.
Background And Purpose:
A sub-fractionation workflow enables a substantial reduction in planning target volume (PTV) margin in prostate cancer (PCa) patients by reducing systematic motion during magnetic resonance (MR)-guided radiotherapy. This study assessed geometric and reconstructed dose outcomes in patients treated with a tight-margin sub-fractionation workflow on a combined linear accelerator with a 1.5 T MRI scanner (MR-Linac).
Materials And Methods:
We evaluated the sub-fractionation workflow with tight margins (2-3 mm) on 128 PCa patients who completed treatment with 5 × 7.25 Gy (36.25 Gy total dose). A traffic light protocol was applied based on residual motions to detect patients with unexpectedly large motions. When 'red' traffic light criteria were met, plans with larger margins (5 mm isotropic) were adopted for subsequent fractions. Intra- and inter-fraction dose accumulation was performed via an in-house developed deformable image registration algorithm.
Results:
A total of 89 % (114/128) of patients completed treatment with the initial tight margins. The mean 3D intrafraction shifts were 1.0 mm (SD: 0.6 mm) in the group with the tight margins and 1.9 mm (SD: 1.5 mm) in the patient group who switched to large margins. The median accumulated D99% was 34.9 Gy (interquartile range: 34.0-35.3 Gy) for patients with prostate shifts who switched to larger margins. In 57 % (8/14) of these patients, the accumulated D99% was above the threshold of 34.4 Gy.
Conclusions:
Tight margins of 2-3 mm can be safely applied for at least 95 % (122/128) of the PCa patients undergoing a sub-fractionation workflow on a 1.5 T MR-linac.
