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Evaluation and development of an image-guided radiotherapy protocol for prostate and nodes

Published online by Cambridge University Press:  17 February 2017

Nicky Hutton ,
Angela Baker ,
Olivia Naismith ,
Antony Carver  and
Anne Jessop
Nicky Hutton*
Affiliation:
Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
Angela Baker
Affiliation:
Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
Olivia Naismith
Affiliation:
Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
Antony Carver
Affiliation:
Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
Anne Jessop
Affiliation:
Clatterbridge Cancer Centre NHS Foundation Trust, Wirral, UK
*
Correspondence to: Nicky Hutton, Clatterbridge Cancer Centre NHS Foundation Trust, Clatterbridge Road, Bebington Wirral, CH63 4JY UK. E-mail: [email protected]
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Abstract

Purpose

To evaluate and develop an image-guided radiotherapy (IGRT) protocol for the effective treatment of prostate and pelvic lymph nodes.

Methods and materials

This study comprised of nine patients receiving radiotherapy for node negative prostate cancer, who had a pair of planar kV images taken for 37 treatment fractions. The positioning accuracy for both implanted fiducial markers and pelvic bony anatomy (surrogate for pelvic node position) was calculated using random and systematic errors. Appropriate margins were also determined. All patients followed a strict bladder and bowel protocol before computed tomography planning and treatment.

Results

In total, 292 sets of images were used for fiducial marker and pelvic bone registration. A discrepancy of >5 mm between the fiducial markers and the anatomical pelvic bone was seen in 4% of treatment sessions. The maximum displacement observed between the fiducial match and the bone match was 7, 10 and 4 mm in the A/P (anterior/posterior), S/I (superior/inferior) and R/L (right/left) directions, respectively.

Conclusion

The margins used in combination with an online IGRT strategy ensure both the fiducial match and the bone match correlate within 5 mm thus allows good coverage of both prostate and nodal target volumes. It is essential that this is combined with a strict bladder and rectal preparation protocol to ensure accuracy and reproducibility.

Keywords

image-guided radiotherapypelvic nodesProstate cancerradiotherapy
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 16 , Issue 1 , March 2017 , pp. 5 - 12
Copyright
© Cambridge University Press 2017 

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