Intensity-modulated radiotherapy (IMRT) to prostate and pelvic nodes—is pelvic lymph node coverage adequate with fiducial-based image-guided radiotherapy?

Eminowicz, Gemma; Dean, Christopher; Shoffren, O.; MacDougall, N D; Wells, Paula; Muirhead, R.

doi:10.1259/bjr.20130696

Cited by 19 publications

(14 citation statements)

References 24 publications

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“…Several studies investigated the effect of different correction strategies on target coverage [1,3,10,11,14]. These studies focussed on evaluating the target dose for a given PTV margin, reporting only the target dose without evaluating the OAR doses.…”

Section: Discussionmentioning

confidence: 99%

“…They concluded that neither a prostate or bone registration is optimal, and that further research is required to determine which strategy results in the lowest OAR doses. A number of studies have investigated the coverage of the target volumes for a given PTV margin, but did not report on OAR dose [1,10,11]. Hsu et al, Rossi et al and Eminowicz et al investigated different correction strategies, but also focused on target coverage.…”

mentioning

confidence: 99%

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Optimal image guided radiation therapy strategy for organs at risk sparing in radiotherapy of the prostate including pelvic lymph nodes

Nunen

Toorn

Budiharto

et al. 2018

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Optimal image guided radiation therapy strategy for organs at risk sparing in radiotherapy of the prostate including pelvic lymph nodes

Nunen

Toorn

Budiharto

et al. 2018

Radiotherapy and Oncology

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“…This raises the question of adequacy of PLN coverage when the image‐guided setup based on a prostate fiducial match is utilized for patients undergoing intensity modulated radiation therapy. This has been extensively studied for conventional fractionation, and it has been concluded that over a conventionally fractionated course of treatment, random shifts will provide adequate coverage that is unlikely to result in impactful underdosing . However, limited studies with small number of patients exist regarding pelvic node coverage using SBRT .…”

Section: Introductionmentioning

confidence: 99%

Impact of daily soft‐tissue image guidance to prostate on pelvic lymph node (PLN) irradiation for prostate patients receiving SBRT

Tyagi

Hipp

Cloutier

et al. 2019

J Applied Clin Med Phys

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Purpose To determine the impact of using fiducial match for daily image‐guidance on pelvic lymph node (PLN) coverage for prostate cancer patients receiving stereotactic body radiation therapy (SBRT). Methods Thirty patients underwent SBRT treatment to the prostate and PLN from 2014 to 2016. Each patient received either 800cGy × 5 or 500cGy × 5 to the prostate and 500cGy × 5 to the PLN. A 5 mm clinical target volume (CTV)‐to‐planning target volume (PTV) margin around the PLN was used for planning. Two registrations with planning computed tomography (PCT) for each of the daily cone beam CTs (CBCTs) were performed: a rigid registration to fiducials and to the bony anatomy. The average translational difference between fiducial and bony match as well as percentage of fractions with differences > 5mm were calculated. Changes in bladder and rectal volume as well as center‐of‐mass (COM) position from simulation parameters, and their correlation with translational difference were also evaluated. The dosimetric impact of the translational differences was calculated by shifting the plan isocenter. Results The average translational difference between fiducial and bony match was 0.06 ± 0.82, 2.1 ± 4.1, −2.8 ± 4.3, and 5.5 ± 4.2 mm for lateral, vertical, longitudinal, and vector directions. The average change in bladder and rectal volume from simulation was −67.2 ± 163.04 cc (−12 ± 52%) and −1.6 ± 18.75 (−2 ± 30%) cc. The average change in COM of bladder from the simulation position was 0.34 ± 2.49, 4.4 ± 8.1, and −3.9 ± 7.5 mm along the LR, AP, and SI directions. The corresponding COM change for the rectum was 0.17 ± 1.9, 1.34 ± 3.5, and −0.6 ± 5.2 mm. Conclusions The 5 mm margin covered ~75% of fractions receiving PLN irradiation with SBRT, daily CBCT and fiducial‐guided setup. The dosimetric impact on PLN coverage was significant in 19% of fractions or 25% of patients. A larger translational shift was due to variation in rectal volume and changes in COM position of the bladder and rectum. A consistent bladder positioning and/or rectum filling compared with presimulation volume were essential for adequate coverage of PLN in a hypofractionated treatment regime.

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“…Intensity modulated radiotherapy (IMRT) is used with great success in the treatment of head and neck as well as prostate cancers [1][2][3] . This success was in both dose escalation as well as reduction of toxicity.…”

Section: Introductionmentioning

confidence: 99%

Intensity Modulated Versus 3D-Conformal Radiotherapy in the Treatment of Locally Advanced Cervical Cancer: a Dosimetric study

Salama

Zawam

Haggag

et al. 2015

Kasr-Al-Aini J.of Clin. Onc. and Nuc. Med.

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Background and Aim: Three dimensional conformal radiotherapy (3D-CRT) is considered the standard technique used in cervical cancer. However, toxicity is still a concern. The aim of this study was to compare 3D-CRT with intensity modulated radiotherapy (IMRT) as a way to reduce toxicity. Material and Methods: Thirty patients with confirmed diagnosis of cervical cancer stage IIB-IVA treated with concurrent chemo-radiation using 3D-CRT were re-planned using IMRT. Analysis was done for target coverage, organ at risk, as well as dose homogeneity. Planning was done on Xio-Elekta planning system. Results: D 95 % was 42.7Gy for 3D-CRT plans versus 41Gy for IMRT plans and V40 for the rectum, bladder and small bowel was significantly less for IMRT. For the femoral heads: V30 was 59.4 % with IMRT versus 96 % with 3D-CRT. V10 of the pelvic bone marrow was significantly less with 3D-CRT than IMRT; however V20 was better for IMRT plans. In terms of overall treatment time, IMRT calculated treatment time is longer, with mean integral monitor unit (IMU) of 1177.01 compared to 144.30 with 3D-CRT. Conclusion: IMRT for locally advanced cervical cancer can reduce the dose to risk structures without compromising tumour coverage.

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Intensity-modulated radiotherapy (IMRT) to prostate and pelvic nodes—is pelvic lymph node coverage adequate with fiducial-based image-guided radiotherapy?

Abstract: This study strengthens the evidence supporting the safe implementation of fiducial-based IG-IMRT treating the prostate and pelvic nodes in high-risk prostate cancer.

Cited by 19 publications

References 24 publications

Optimal image guided radiation therapy strategy for organs at risk sparing in radiotherapy of the prostate including pelvic lymph nodes

Optimal image guided radiation therapy strategy for organs at risk sparing in radiotherapy of the prostate including pelvic lymph nodes

Impact of daily soft‐tissue image guidance to prostate on pelvic lymph node (PLN) irradiation for prostate patients receiving SBRT

Intensity Modulated Versus 3D-Conformal Radiotherapy in the Treatment of Locally Advanced Cervical Cancer: a Dosimetric study

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