Prostatic displacement during extreme hypofractionated radiotherapy using volumetric modulated arc therapy (VMAT)

Adam Gladwish, Geordi Pang, Patrick Cheung, Laura D'Alimonte, Andrea Deabreu, Andrew Loblaw, Adam Gladwish, Geordi Pang, Patrick Cheung, Laura D'Alimonte, Andrea Deabreu, Andrew Loblaw

Abstract

Background: To determine prostate displacement during extreme hypofractionated volume modulated arc radiotherapy (VMAT) using pre- and post-treatment orthogonal images with three implanted gold seed fiducial markers.

Methods: A total of 150 image pairs were obtained from 30 patients who underwent extreme hypofractionated radiotherapy to a dose of 40 Gy in five fractions on standard linear accelerators. Position verification was obtained with orthogonal x-rays before and after treatment and were used to determine intra-fraction prostate displacement.

Results: The mean prostate displacements were 0.03 ± 1.23 mm (1SD), 0.18 ± 1.55 mm, and 0.37 ± 1.95 mm in the left-right, superior-inferior, and anterior-posterior directions, respectively. The mean 3D displacement was 2.32 ± 1.55 mm. Only 6 (4%) fractions had a 3D displacement of >5 mm. The average time of treatment delivery for a given fraction was 195 ± 59 seconds.

Conclusions: The mean intra-fraction prostate displacement during a course of extreme hypofractionated radiotherapy delivered via VMAT, continues to be small. Clinical margins typically used in a similar fixed-angle IMRT treatment are adequate. The use of VMAT in further extreme hypofractionation may limit prostatic motion uncertainties that would be otherwise be associated with longer treatment times.

Figures

Figure 1
Figure 1
Frequency and standard deviation of displacements in the Left-right (LR), Superior-Inferior (SI) and Anterior-Posterior (AP) directions.
Figure 2
Figure 2
Frequency of overall displacement in 3-dimensions.

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Source: PubMed

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