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• W2000735474 abstract "(1) To investigate the value of fiducials in daily image-guided prostate targeting for proton therapy (PT) in discounting interfraction prostate displacement; and (2) to determine intrafraction displacement with two stabilization strategies, rectal saline and rectal balloon, and their respective impacts on planning target volume (PTV) expansions. Fiducial markers were implanted in the prostate prior to simulation. Forty patients with low-risk prostate cancer treated with PT between 2006 and 2012 according to an institutional review board-approved prospective outcome tracking protocol were randomly selected from groups using either rectal saline or rectal balloon for prostate stabilization. Daily pre- and posttreatment orthovoltage (kV) films and digitally reconstructed radiographs (DRRs) were analyzed, and prostate interfraction displacement, intrafraction motion, and setup residual error data extracted. Population PTV expansions were calculated using van Herk's formula (2.5Σ + 0.7σ). Comparison of the location of the fiducials relative to bony landmarks on serial pretreatment kV films versus the simulation DRRs showed that interfraction displacement population means did not differ significantly between saline- and balloon-stabilized patients in the anterior-posterior (AP), superior-inferior (SI), or left-right (LR) axes. The ranges of absolute displacement were 0 to 10.1 mm, 0 to 9.2 mm, and 0 to 12.8 mm in the AP, SI, and LR axes for saline, compared with 0 to 11.3 mm, 0 to 11.8 mm, and 0 to 3.5 mm for balloons. The use of fiducials allows us to ignore these displacements in determining PTV margins. Pre- and posttreatment kV films demonstrated that intrafraction displacement population means with balloons were smaller than with saline in the AP direction (0.4 vs −0.2 mm; p = 0.02). No significant changes were found between saline and balloons along the SI (0.6 vs 0.1 mm, respectively; p = 0.08) and LR axes (0.07 vs −0.03 mm, respectively; p = 0.17). Balloons reduced setup residuals from 0.4 to 0.02 mm (p = 0.003) in the SI direction with no significant effect along the AP or LR axes. The van Herk formula indicates that rectal balloons decreased necessary PTV margins, compared with saline, from 3.6 to 2.3 mm in the AP direction, 3.4 to 2.7 mm in the SI direction, and 2.0 to 1.1 mm in the LR direction. This study supports prior findings that fiducial markers reduce the PTV expansion necessary for interfraction prostate displacement. It also demonstrates that rectal balloons decrease intrafraction displacement in the AP and SI directions, permitting a reduction in PTV margins relative to rectal saline." @default.
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• W2000735474 date "2013-10-01" @default.
• W2000735474 modified "2023-10-16" @default.
• W2000735474 title "Fiducial Markers, Rectal Saline, and Rectal Balloons as Prostate Localization and Stabilization Strategies in Patients Receiving Proton Therapy" @default.
• W2000735474 doi "https://doi.org/10.1016/j.ijrobp.2013.06.1008" @default.
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