Strategies for online organ motion correction for intensity-modulated radiotherapy of prostate cancer: prostate, rectum, and bladder dose effects

Erik-Jan Rijkhorst, Annemarie Lakeman, Jasper Nijkamp, Josien de Bois, Marcel van Herk, Joos V Lebesque, Jan-Jakob Sonke
International Journal of Radiation Oncology, Biology, Physics 2009 November 15, 75 (4): 1254-60

PURPOSE: To quantify and evaluate the accumulated prostate, rectum, and bladder dose for several strategies including rotational organ motion correction for intensity-modulated radiotherapy (IMRT) of prostate cancer using realistic organ motion data.

METHODS AND MATERIALS: Repeat computed tomography (CT) scans of 19 prostate patients were used. Per patient, two IMRT plans with different uniform margins were created. To quantify prostate and seminal vesicle motion, repeat CT clinical target volumes (CTVs) were matched onto the planning CTV using deformable registration. Four different strategies, from online setup to full motion correction, were simulated. Rotations were corrected for using gantry and collimator angle adjustments. Prostate, rectum, and bladder doses were accumulated for each patient, plan, and strategy. Minimum CTV dose (D(min)), rectum equivalent uniform dose (EUD, n = 0.13), and bladder surface receiving >or=78 Gy (S78), were calculated.

RESULTS: With online CTV translation correction, a 7-mm margin was sufficient (i.e., D(min) >or= 95% of the prescribed dose for all patients). A 4-mm margin required additional rotational correction. Margin reduction lowered the rectum EUD(n = 0.13) by approximately 2.6 Gy, and the bladder S78 by approximately 1.9%.

CONCLUSIONS: With online correction of both translations and rotations, a 4-mm margin was sufficient for 15 of 19 patients, whereas the remaining four patients had an underdosed CTV volume <1%. Margin reduction combined with online corrections resulted in a similar or lower dose to the rectum and bladder. The more advanced the correction strategy, the better the planned and accumulated dose agreed.

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