Internal target and organ motion during treatment is a challenge in radiotherapy (RT) of the prostate and the involved elective targets, with residual motion being present also following image-guidance strategies. The aim of this study was to investigate organ motion-induced dose degradations for the prostate, seminal vesicle and the pelvic lymph node when treating these targets with proton therapy, using different image-guidance and delivery strategies. Material and methods. Four patients were selected from a larger series as they displayed large inter-fractional variation in bladder and rectum volume. Intensity-modulated proton therapy plans were generated using both simultaneous integrated and sequential boost delivery. For each technique, three isotropic margin expansions (in the range of 4-10 mm) were evaluated for the clinical target volume of prostate (CTV-p), seminal vesicles (CTV-sv) and lymph nodes (CTV-ln). Simulation of the dose degradations for all treatment plans were based on dose re-calculations for the 8-9 repeat CTs available for each patient, after applying rigid registrations to reproduce set-up based on either intra-prostatic fiducials or bony anatomy. Results. The simulated dose received by 99% of the target volume (D99) and generalized equivalent dose (gEUD) showed substantial inter-patient variations. For 40% of the investigated scenarios, the patient average simulated D99 for all targets were within 2 GyE from the planned dose. The largest difference between simulated and planned dose was seen for the CTV-sv when using SIB delivery, with an average relative reduction in D99 of 13% and 15% for the largest margin expansion, when positioned using fiducials and bony anatomy, respectively. Conclusions. The most severe dose degradations were found for CTV-sv, but they were also evident for CTV-ln. The degradations could not be completely resolved, neither by using the largest margin expansion nor with the choice of set-up. With fiducial set-up CTV-p was robust against the inter-fraction changes. © 2013 Informa Healthcare.
CITATION STYLE
Thörnqvist, S., Muren, L. P., Bentzen, L., Hysing, L. B., Hoyer, M., Grau, C., & Petersen, J. B. B. (2013). Degradation of target coverage due to inter-fraction motion during intensity-modulated proton therapy of prostate and elective targets. Acta Oncologica, 52(3), 521–527. https://doi.org/10.3109/0284186X.2012.752860
Mendeley helps you to discover research relevant for your work.