Real-time Image-guided Adaptive-predictive Prostate Radiotherapy using Rectal Diameter as a Predictor of Motion

Oates, Richard; Brown, Amy; Tan, Alex; Foroudi, Farshad; Joon, Michael Lim; Schneider-Kolsky, Michal Elisabeth; Herschtal, Alan; Kron, Tomas

doi:10.1016/j.clon.2016.09.019

Cited by 12 publications

(10 citation statements)

References 30 publications

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“…Nakamura et al [11] and O'Doherty et al [12] both observed inconsistent bladder volume during the course of radiotherapy when using a full bladder protocol, whilst irregular prostate motion has been attributed to both bladder filling and patient movement [13]. Previous studies have also investigated the impact of rectal diameter on prostate motion [14][15][16]. However, in these studies either real-time imaging or bladder volumes was missing in the study design.…”

Section: Introductionmentioning

confidence: 99%

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Pang

Knight

Hussain

et al. 2018

Technical Innovations & Patient Support in Radiation Oncolo

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Background and purpose: Inconsistent bladder and rectal volumes have been associated with motion uncertainties during prostate radiotherapy. This study investigates the impact of these volumes to determine the optimal bladder volume. Materials and methods: 60 patients from two Asian hospitals were recruited prospectively. 1887 daily cone-beam computed tomography (CBCT) images were analysed. Intra-fraction motion of the prostate was monitored real-time using a four-dimension transperineal ultrasound (4D TPUS) Clarity Ò system. The impact of planned bladder volume, adequacy of daily bladder filling, and rectum volume on mean intra-fraction motion of the prostate was analysed. Patients' ability to comply with the full bladder hydration protocol and level of frustration was assessed using a questionaire. Acute side effects were assessed using the Common Terminology Criteria for Adverse Events (CTCAE) version 3.0 and quality of life (QoL) assessed using the International Prostate Symptom Score (IPSS). Results: The mean (SD) bladder and rectum volumes achieved during daily treatment were 139.7 cm 3 (82.4 cm 3) and 53.3 cm 3 (18 cm 3) respectively. Mean (SD) percentage change from planned CT volumes in bladder volume was reduced by 8.2% (48.7%) and rectum volume was increased by 12.4% (42.2%). Linear Mixed effect model analysis revealed a reduction in intra-fraction motion in both the Sup/Inf (p = 0.008) and Ant/Post (p = 0.0001) directions when the daily bladder was filled between 82 and 113% (3rd Quartiles) of the planned CT volumes. A reduction in intra-fraction motion of the prostate in the Ant/Post direction (z-plane) (p = 0.03) was observed when the planned bladder volume was greater than 200 ml. Patients complied well with the hydration protocol with minimal frustration (mean (SD) scores of 2.1 (1.4) and 1.8 (1.2) respectively). There was a moderate positive correlation (0.496) between mean bladder volume and IPSS reported post-treatment urinary straining (p = 0.001). Conclusions: A planned bladder volume >200 cm 3 and daily filling between 82 and 113%, reduced intrafraction motion of the prostate. The hydration protocol was well tolerated.

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Section: Introductionmentioning

confidence: 99%

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Pang

Knight

Hussain

et al. 2018

Technical Innovations & Patient Support in Radiation Oncolo

View full text Add to dashboard Cite

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“…This was further investigated by Oates et al, concluding that a mean rectal diameter measured on daily CBCT of less than or equal to 3.5 cm would result in a prostate displacement of less than or equal to 5.5 mm. 16 Rotation was evident in our results, particularly when considering the magnitude and frequency of pitch (Table 5 and Fig. 3).…”

Section: Rotationmentioning

confidence: 50%

“…Bowel protocols minimise these rectal differences, however, even if the patient has an acceptable rectal diameter on planning scan, a small difference in rectal diameter at treatment can produce a large difference in prostate displacement and rotation. This was further investigated by Oates et al, concluding that a mean rectal diameter measured on daily CBCT of less than or equal to 3.5 cm would result in a prostate displacement of less than or equal to 5.5 mm …”

Section: Discussionmentioning

confidence: 99%

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Obesity does not influence prostate intrafractional motion

Brown

Tan

Cooper

et al. 2018

J of Medical Radiation Sci

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IntroductionMotion of the prostate is problematic in the accurate delivery of external beam radiation therapy (EBRT) for prostate cancer. This study investigated the relationship between body mass index (BMI), an easily measured indicator of obesity, and prostate motion.MethodsProstate motion during EBRT was assessed by measuring the displacement of fiducial markers implanted within the prostate in 130 prostate cancer patients. Interfractional motion was corrected on daily imaging through pre‐treatment cone‐beam‐computed tomography (CBCT) and intrafractional motion measured using movie sequences captured using an electronic portal imaging device (EPID) during treatment delivery.ResultsThere was no statistically significant relationship between the mean intrafractional motion and BMI, except in the left‐right (LR) translation (P = 0.049) over the study population. For each BMI category, there was no statistical significance (P > 0.05) between any of the translations/rotations except LR (P = 0.003).ConclusionWhile intrafractional motion is an important consideration, prostate motion cannot be reliably predicted through measurement of patient's BMI.

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“…While the variability in location of external skin markers relative to internal anatomy in obese patients caused a signi cant difference in terms of interfractional prostate shift (15), there was no relationship between body mass index (BMI) and intrafractional prostate motion (16). It was reported that the shorter the maximum rectal diameter is, the less the intrafractional prostate motion is (17).…”

Section: Introductionmentioning

confidence: 99%

Injection of hydrogel spacer increased intrafractional prostate motion during volumetric modulated arc therapy-stereotactic body radiation therapy for prostate cancer

Sawayanagi¹,

Yamashita²,

Ogita³

et al. 2021

Preprint

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BackgroundThe aim of this study was to clarify the association between intrafractional prostate shift and hydrogel spacer.MethodsThirty-eight patients who received definitive volumetric modulated arc therapy (VMAT)-stereotactic body radiation therapy (SBRT) for prostate cancer with prostate motion monitoring in our institution in 2018–2019 were retrospectively evaluated. In order to move the rectum away from the prostate, hydrogel spacer (SpaceOAR system, Boston Scientific, Marlborough, the United States) injection was proposed to the patients as an option in case of meeting the indication of use. We monitored intrafractional prostate motion by using a 4-dimensional (4D) transperineal ultrasound (US) device: the Clarity 4D ultrasound system (Elekta AB). The deviation of the prostate was monitored in each direction: superior-inferior (SI), left-right (LR), and anterior-posterior (AP). We also calculated the vector length (VL). The maximum intrafractional displacement (MID) per fraction for each direction was detected and mean of MIDs was calculated per patient. The MIDs in the non-spacer group and the spacer group were compared using the unpaired t-test.ResultsWe reviewed 33 fractions in eight patients as the spacer group and 148 fractions in 30 patients as the non-spacer group. The superior MID was 0.47 ± 0.07 (mean ± SE) mm vs. 0.97 ± 0.24 mm (P = 0.014), the inferior MID was 1.07 ± 0.11 mm vs. 1.03 ± 0.25 mm (P = 0.88), the left MID was 0.74 ± 0.08 mm vs. 0.87 ± 0.27 mm (P = 0.55), the right MID was 0.67 ± 0.08 mm vs. 0.92 ± 0.21 mm (P = 0.17), the anterior MID was 0.45 ± 0.06 mm vs. 1.16 ± 0.35 mm (P = 0.0023), and the posterior MID was 1.57 ± 0.17 mm vs. 1.37 ± 0.22 mm (P = 0.56) in the non-spacer group and the spacer group, respectively. The max of VL was 2.24 ± 0.19 mm vs. 2.89 ± 0.62 mm (P = 0.19), respectively.ConclusionsOur findings suggest that intrafractional prostate motion during VMAT-SBRT was larger in patients with hydrogel spacer injection in the superior and anterior directions.

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Real-time Image-guided Adaptive-predictive Prostate Radiotherapy using Rectal Diameter as a Predictor of Motion

Cited by 12 publications

References 30 publications

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Reduction of intra-fraction prostate motion – Determining optimal bladder volume and filling for prostate radiotherapy using daily 4D TPUS and CBCT

Obesity does not influence prostate intrafractional motion

Injection of hydrogel spacer increased intrafractional prostate motion during volumetric modulated arc therapy-stereotactic body radiation therapy for prostate cancer

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