Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland

Role of daily inter- and intrafraction motion

James Tanyi, Tongming He, Paige A. Summers, Ruth G. Mburu, Catherine M. Kato, Stephen M. Rhodes, Arthur Hung, Martin Fuss

Research output: Contribution to journalArticle

56 Citations (Scopus)

Abstract

Purpose: To determine planning target volume margins for prostate intensity-modulated radiotherapy based on inter- and intrafraction motion using four daily localization techniques: three-point skin mark alignment, volumetric imaging with bony landmark registration, volumetric imaging with implanted fiducial marker registration, and implanted electromagnetic transponders (beacons) detection. Methods and Materials: Fourteen patients who underwent definitive intensity-modulated radiotherapy for prostate cancer formed the basis of this study. Each patient was implanted with three electromagnetic transponders and underwent a course of 39 treatment fractions. Daily localization was based on three-point skin mark alignment followed by transponder detection and patient repositioning. Transponder positioning was verified by volumetric imaging with cone-beam computed tomography of the pelvis. Relative motion between the prostate gland and bony anatomy was quantified by offline analyses of daily cone-beam computed tomography. Intratreatment organ motion was monitored continuously by the Calypso® System for quantification of intrafraction setup error. Results: As expected, setup error (that is, inter- plus intrafraction motion, unless otherwise stated) was largest with skin mark alignment, requiring margins of 7.5 mm, 11.4 mm, and 16.3 mm, in the lateral (LR), longitudinal (SI), and vertical (AP) directions, respectively. Margin requirements accounting for intrafraction motion were smallest for transponder detection localization techniques, requiring margins of 1.4 mm (LR), 2.6 mm (SI), and 2.3 mm (AP). Bony anatomy alignment required 2.1 mm (LR), 9.4 mm (SI), and 10.5 mm (AP), whereas image-guided marker alignment required 2.8 mm (LR), 3.7 mm (SI), and 3.2 mm (AP). No marker migration was observed in the cohort. Conclusion: Clinically feasible, rapid, and reliable tools such as the electromagnetic transponder detection system for pretreatment target localization and, subsequently, intratreatment target location monitoring allow clinicians to reduce irradiated volumes and facilitate safe dose escalation, where appropriate.

Original languageEnglish (US)
Pages (from-to)1579-1585
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume78
Issue number5
DOIs
StatePublished - Dec 1 2010

Fingerprint

prostate gland
Intensity-Modulated Radiotherapy
transponders
planning
Prostate
radiation therapy
margins
International System of Units
Electromagnetic Phenomena
alignment
Cone-Beam Computed Tomography
markers
anatomy
Skin
glands (anatomy)
electromagnetism
Anatomy
Fiducial Markers
Calypso
cones

Keywords

  • Fiducial markers
  • Image guidance
  • Organ motion
  • Prostate cancer
  • Target setup

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland : Role of daily inter- and intrafraction motion. / Tanyi, James; He, Tongming; Summers, Paige A.; Mburu, Ruth G.; Kato, Catherine M.; Rhodes, Stephen M.; Hung, Arthur; Fuss, Martin.

In: International Journal of Radiation Oncology Biology Physics, Vol. 78, No. 5, 01.12.2010, p. 1579-1585.

Research output: Contribution to journalArticle

Tanyi, James ; He, Tongming ; Summers, Paige A. ; Mburu, Ruth G. ; Kato, Catherine M. ; Rhodes, Stephen M. ; Hung, Arthur ; Fuss, Martin. / Assessment of planning target volume margins for intensity-modulated radiotherapy of the prostate gland : Role of daily inter- and intrafraction motion. In: International Journal of Radiation Oncology Biology Physics. 2010 ; Vol. 78, No. 5. pp. 1579-1585.
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AU - He, Tongming

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AU - Mburu, Ruth G.

AU - Kato, Catherine M.

AU - Rhodes, Stephen M.

AU - Hung, Arthur

AU - Fuss, Martin

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