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Evaluating the need for adaptive therapy when delivering conformal bladder radiotherapy

Published online by Cambridge University Press:  12 January 2016

Ann M. Henry ,
Helen Summers ,
Louise Murray ,
Ankit Jain ,
Wasif Tahir ,
Saadat Ali ,
Joji Joseph ,
Sarah Bastow ,
Rebecca Artschan  and
Jonathan Sykes
Ann M. Henry*
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK University of Leeds, UK
Helen Summers
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Louise Murray
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Ankit Jain
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Wasif Tahir
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Saadat Ali
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Joji Joseph
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Sarah Bastow
Affiliation:
Department of Radiotherapy, St James’s University Hospital, UK
Rebecca Artschan
Affiliation:
Department of Medical Physics, St James’s University Hospital, UK
Jonathan Sykes
Affiliation:
Department of Medical Physics, St James’s University Hospital, UK
*
Correspondence to: Dr Ann M Henry, St. James’s University Hospital, Beckett St, Leeds, West Yorkshire LS9 7TF, UK. Tel: 44 113 206 7630. Fax: 44 113 206 7582. E-mail: [email protected]
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Abstract

Background and purpose

The purpose of this study was to audit positioning errors during bladder image-guided radiotherapy (IGRT) and quantify survival outcomes.

Materials and methods

We carried out a retrospective review of 141 patients treated between March 2007 and July 2010 with three-dimensional conformal radiotherapy. An offline imaging protocol using kV cone beam computed tomography (CBCT) was used. Positioning errors, clinical interventions and re-planning rates were quantified. Cancer outcomes and survival were collected by review of patient notes and a registry search.

Results

Among all, 43% of the patients required no intervention. Isocentre corrections were used for systematic bony set-up error in 13% and to improve bladder coverage in 28%. Clinical interventions to improve bladder coverage were required in 16% of the patients and repeat computed tomography planning in a further 16%. Overall, 44% of the patients demonstrated some form of organ deformation that would have resulted in inadequate dose to the bladder or significant overdose to an organ at risk if not corrected for. Post-treatment check cystoscopy was undertaken in 107 patients (76%) with 72 noted to have a complete response. Overall survival was 47·8% at 3 years.

Conclusions

Organ deformation during radiotherapy for bladder cancer is a significant problem for over 40% of patients. Strategies to compensate are essential to ensure optimal plan delivery.

Keywords

adaptive radiotherapybladder cancerexternal beam radiotherapyimage-guided radiotherapyorgan motion
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 1 , March 2016 , pp. 15 - 22
Copyright
© Cambridge University Press 2016 

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