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Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy

Published online by Cambridge University Press:  30 October 2019

Maria T. Vlachaki Open the ORCID record for Maria T. Vlachaki [Opens in a new window] ,
Salahuddin Ahmad ,
Erika Kennedy ,
Amr M. Aref  and
Paul J. Chuba
Maria T. Vlachaki*
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Salahuddin Ahmad
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Erika Kennedy
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Amr M. Aref
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Paul J. Chuba
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
*
Author for correspondence: Maria T. Vlachaki, Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Webber Cancer Center, 11800 E 12 Mile Rd, Warren, MI 48093, USA. Tel: 1-586-573-5186. E-mails: [email protected]; [email protected]
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Abstract

Aim:

Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.

Materials and methods:

The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.

Results:

Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.

Conclusion:

In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.

Keywords

fiducial markersprostate bed motionprostate cancerprostatectomyVMAT
Type
Technical Note
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 3 , September 2020 , pp. 299 - 304
Copyright
© Cambridge University Press 2019

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