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• W2056179110 abstract "Purpose/Objective(s)In obtaining CT scans for external beam radiotherapy planning for prostate cancer, various degrees of rectal distension are observed. We investigated if the degree of daily isocenter shifts guided by intraprostatic fiducial gold seeds correlated with the amount of rectal distension present at the time of CT simulation prior to treatment.Materials/Methods41 consecutive patients with prostatic adenocarcinoma had intraprostatic gold seed-guided IGRT treatments in a community-hospital setting. Patients were instructed to empty bladder and rectum prior to simulation and daily treatments. Based on gold seed markers, daily shifts from the isocenter were performed with an onboard kV imager and recorded in X, Y, and Z dimensions. Standard deviations of shifts in all 3 dimensions were calculated. Patients with the five highest and five lowest standard deviations of shifts in each of the 3 dimensions were further analyzed by calculating individual rectal and bladder volumes at the time of CT simulation. In an effort to characterize rectal distension, rectal volumes were further divided into 3 parts: a) superior rectum, defined as located superior to the prostate up to the level of the recto-sigmoid junction, b) middle rectum, defined as located at the level of the prostate, and c) inferior rectum, defined as located inferior to the prostate up to 2 cm and may include anal canal. A single physician contoured all bladder, rectal, and prostate volumes for reproducibility. The correlation between degree of daily shifts throughout the treatment and contoured volumes were analyzed.ResultsRange of standard deviations of isocenter shifts in the X, Y, and Z directions were 0.4–1.28 cm, 0.24–0.82 cm, and 0.16–0.62 cm, respectively. Overall rectal volume did not correlate with standard deviation of shifts among all 3 dimensions (r = −0.148, p = 0.435, df = 28). Superior, middle, and inferior rectal volumes each did not correlate with standard deviation of shifts in all 3 dimensions, nor did the ratio of combined superior and middle rectal volumes to inferior rectal volumes (r = −0.081, p = 0.672). Similarly, there was no correlation between standard deviation of shifts and greatest rectal width on axial images (r = −0.245, p = 0.192). Finally, other parameters such as overall bladder (r = 0.176, p = 0.352) and prostate (r = −0.259, p = 0.167) volumes did not correlate with standard deviation of shifts among all 3 dimensions.ConclusionsThere was no correlation between parameters such as rectal or bladder distension at the time of simulation and IGRT shifts guided by gold seed fiducial markers. This lack of correlation may suggest that other factors are also influencing the degree of isocenter shifts. Rectal or bladder distension at the time of CT simulation may reflect patient-specific properties that can be consistent throughout an external radiation treatment course. With the spectrum of isocenter shifts observed in this study, our data underscores the importance of daily localization of the prostate for accurate delivery of radiotherapy. Purpose/Objective(s)In obtaining CT scans for external beam radiotherapy planning for prostate cancer, various degrees of rectal distension are observed. We investigated if the degree of daily isocenter shifts guided by intraprostatic fiducial gold seeds correlated with the amount of rectal distension present at the time of CT simulation prior to treatment. In obtaining CT scans for external beam radiotherapy planning for prostate cancer, various degrees of rectal distension are observed. We investigated if the degree of daily isocenter shifts guided by intraprostatic fiducial gold seeds correlated with the amount of rectal distension present at the time of CT simulation prior to treatment. Materials/Methods41 consecutive patients with prostatic adenocarcinoma had intraprostatic gold seed-guided IGRT treatments in a community-hospital setting. Patients were instructed to empty bladder and rectum prior to simulation and daily treatments. Based on gold seed markers, daily shifts from the isocenter were performed with an onboard kV imager and recorded in X, Y, and Z dimensions. Standard deviations of shifts in all 3 dimensions were calculated. Patients with the five highest and five lowest standard deviations of shifts in each of the 3 dimensions were further analyzed by calculating individual rectal and bladder volumes at the time of CT simulation. In an effort to characterize rectal distension, rectal volumes were further divided into 3 parts: a) superior rectum, defined as located superior to the prostate up to the level of the recto-sigmoid junction, b) middle rectum, defined as located at the level of the prostate, and c) inferior rectum, defined as located inferior to the prostate up to 2 cm and may include anal canal. A single physician contoured all bladder, rectal, and prostate volumes for reproducibility. The correlation between degree of daily shifts throughout the treatment and contoured volumes were analyzed. 41 consecutive patients with prostatic adenocarcinoma had intraprostatic gold seed-guided IGRT treatments in a community-hospital setting. Patients were instructed to empty bladder and rectum prior to simulation and daily treatments. Based on gold seed markers, daily shifts from the isocenter were performed with an onboard kV imager and recorded in X, Y, and Z dimensions. Standard deviations of shifts in all 3 dimensions were calculated. Patients with the five highest and five lowest standard deviations of shifts in each of the 3 dimensions were further analyzed by calculating individual rectal and bladder volumes at the time of CT simulation. In an effort to characterize rectal distension, rectal volumes were further divided into 3 parts: a) superior rectum, defined as located superior to the prostate up to the level of the recto-sigmoid junction, b) middle rectum, defined as located at the level of the prostate, and c) inferior rectum, defined as located inferior to the prostate up to 2 cm and may include anal canal. A single physician contoured all bladder, rectal, and prostate volumes for reproducibility. The correlation between degree of daily shifts throughout the treatment and contoured volumes were analyzed. ResultsRange of standard deviations of isocenter shifts in the X, Y, and Z directions were 0.4–1.28 cm, 0.24–0.82 cm, and 0.16–0.62 cm, respectively. Overall rectal volume did not correlate with standard deviation of shifts among all 3 dimensions (r = −0.148, p = 0.435, df = 28). Superior, middle, and inferior rectal volumes each did not correlate with standard deviation of shifts in all 3 dimensions, nor did the ratio of combined superior and middle rectal volumes to inferior rectal volumes (r = −0.081, p = 0.672). Similarly, there was no correlation between standard deviation of shifts and greatest rectal width on axial images (r = −0.245, p = 0.192). Finally, other parameters such as overall bladder (r = 0.176, p = 0.352) and prostate (r = −0.259, p = 0.167) volumes did not correlate with standard deviation of shifts among all 3 dimensions. Range of standard deviations of isocenter shifts in the X, Y, and Z directions were 0.4–1.28 cm, 0.24–0.82 cm, and 0.16–0.62 cm, respectively. Overall rectal volume did not correlate with standard deviation of shifts among all 3 dimensions (r = −0.148, p = 0.435, df = 28). Superior, middle, and inferior rectal volumes each did not correlate with standard deviation of shifts in all 3 dimensions, nor did the ratio of combined superior and middle rectal volumes to inferior rectal volumes (r = −0.081, p = 0.672). Similarly, there was no correlation between standard deviation of shifts and greatest rectal width on axial images (r = −0.245, p = 0.192). Finally, other parameters such as overall bladder (r = 0.176, p = 0.352) and prostate (r = −0.259, p = 0.167) volumes did not correlate with standard deviation of shifts among all 3 dimensions. ConclusionsThere was no correlation between parameters such as rectal or bladder distension at the time of simulation and IGRT shifts guided by gold seed fiducial markers. This lack of correlation may suggest that other factors are also influencing the degree of isocenter shifts. Rectal or bladder distension at the time of CT simulation may reflect patient-specific properties that can be consistent throughout an external radiation treatment course. With the spectrum of isocenter shifts observed in this study, our data underscores the importance of daily localization of the prostate for accurate delivery of radiotherapy. There was no correlation between parameters such as rectal or bladder distension at the time of simulation and IGRT shifts guided by gold seed fiducial markers. This lack of correlation may suggest that other factors are also influencing the degree of isocenter shifts. Rectal or bladder distension at the time of CT simulation may reflect patient-specific properties that can be consistent throughout an external radiation treatment course. With the spectrum of isocenter shifts observed in this study, our data underscores the importance of daily localization of the prostate for accurate delivery of radiotherapy." @default.
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• W2056179110 title "Impact of Rectal Distension in IGRT for Prostate Cancer" @default.
• W2056179110 doi "https://doi.org/10.1016/j.ijrobp.2007.07.2102" @default.
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