Abstract： Objective To analyze the data from intensity-modulated radiotherapy (IMRT) for prostate cancer guided by kilovoltage cone-beam computed tomography (CBCT), and to provide a clinical basis for selecting the optimal image registration method and reasonable target volume margins. Methods A total of 16 patients with prostate cancer who received radical IMRT were enrolled, and CBCT for online position verification was performed 214 times. The images were obtained after conventional skin marking and laser alignment, and automatic registration, bone registration, soft tissue registration, and manual registration were performed for CBCT images and planned CT images. The differences between these four registration methods were evaluated, and the margins for extending clinical target volume into planning target volume (PTV) were calculated. Results The setup errors in left-right, anterior-posterior, and cranial-caudal directions for automatic registration, bone registration, soft tissue registration, and manual registration were-0.6±2.8 mm/-0.6±4.5 mm/-0.6±3.8 mm,-0.7±2.7 mm/-0.9±4.5 mm/-0.8±4.1 mm,-0.8±2.6 mm/-0.3±4.4 mm/-1.1±4.0 mm, and-0.6±2.9 mm/-0.7±5.1 mm/-0.9±3.9 mm, respectively. There were no significant differences between the four registration methods. The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions were calculated as 4.7 mm, 5.2 mm, and 6.5 mm, respectively. Conclusions With a comprehensive consideration of various factors, a default setting of automatic registration and manual fine adjustment is appropriate for CBCT-guided radiotherapy for prostate cancer. The margins for extension in the left-right, anterior-posterior, and cranial-caudal directions are 4.7 mm, 5.2 mm, and 6.5 mm, respectively.
Li Ming,Gao Hong,Xiu Xia et al. Image registration and target volume margins in cone-beam computed tomography-guided intensity-modulated radiotherapy for prostate cancer[J]. Chinese Journal of Radiation Oncology, 2016, 25(3): 249-254.
[1] Remeijer P,Geerlof E,Ploeger L,et al.3-D portal image analysis in clinical practice:an evaluation of 2-D and 3-D analysis techniques as applied to 30 prostate cancer patients[J].Int J Radiat Biol Phys,2000,46(5):1281-1290.DOI:10.1016/S0360-3016(99)00468-X. [2] van Herk M.Errors and margins in radiotherapy[J].Semin Radiat Oncol Biol,2004,14(1):52-64.DOI:10.1053/j.semradonc.2003.10.003. [3] van Herk M,Remeijer P,Rasch C,et al. The probability of correct target dosage:dose-population histograms for deriving treatment margins in radiotherapy[J].Int J Radiat Oncol Biol Phys,2000,47(4):1121-1135.DOI:10.1016/S0360-3016(00)00518-6. [4] Kupelian PA,Langen KM,Willoughby TR,et al. Image-guided radiotherapy for localized prostate cancer:treating a moving target[J].Semin Radiat Oncol,2008,18(1):58-66.DOI:10.1016/j.semradonc.2007.09.008. [5] Schallenkamp JM,Herman MG,Kruse JJ,et al. Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging[J].Int J Radiat Oncol Biol Phys,2005,63(3):800-811.DOI:10.1016/j.ijrobp.2005.02.022. [6] Ashildur L,Stine K,Peter M.Comparison of the accuracy and precision of prostate localization with 2D-and 3D-images[J].Radiother Oncol,2011,98(2):175-180.DOI:10.1016/j.radonc.2010.11.012. [7] Derek S,Jian L,Di Y,et al. Comparison of various online IGRT strategies:The benefits of online treatment plan re-optimization[J].Radiother Oncol,2009,90(3):367-376.DOI:10.1016/j.radonc.2008.08.012. [8] Yoshinori H,Mitsuhiro N,Tsuneyuki T,et al. Evaluation of different set-up error corrections on dose-volume metrics in prostate IMRT using CBCT images[J].J Radiat Res,2014,55(5):966-975.DOI:10.1093/jrr/rru033. [9] Remeijer P,Geerlof E,Ploeger L,et al.3-D portal image analysis in clinical practice:an evaluation of 2-D and 3-D analysiS techniques as applied to 30 prostate cancer patients[J].Int J Oncol Biol Phys,2000,46(5):1281-1290.DOI:10.1016/S0360-3016(99)00468-X. [10] Kupelian PA,Langen KM,Zerdan OA,et al. Daily variations in delivered doses in patients treated with radiotherapy for localized prostate cancer[J].Int J Radiat Oncol Biol Phys,2006,66(3):876-882.DOI:10.1016/j.ijrobp.2006.06.011. [11] Devleena P,Pinaki D,Niladri S,et al. Image guidance in prostate cancer can offline corrections be an effective substitute for daily online imaging?[J].J Cancer Res Therapeut,2014,10(1):21-25.DOI:10.4103/0973-1482.131342. [12] Piziorska P,Kuko owicz A,Zawadzka,et al. Adaptive off-line protocol for prostate external radiotherapy with cone beam computer tomography[J].Strahlenther Onkol,2012,188(11):1003-1009.DOI:10.1007/s00066-012-0226-9. [13] Essa M,Jinkoo K,Sanath K,et al. A novel approach for evaluation of prostate deformation and associated dosimetric implications in IGRT of the prostate[J].Med Phys,2014,41(9):091709.DOI:10.1118/1.4893196. [14] Suki G,Rajesh I,Rohan A,et al. Conventional margins not sufficient for post-prostatectomy prostate bed coverage:an analysis of 477 cone-beam computed tomography scans[J].Radiother Oncol,2014,110(2):235-239.DOI:10.1016/j.radonc.2013.12.004. [15] Tom B,Pieter S,Karin H,et al. Intrafractional prostate motion during online image guided intensity-modulated radiotherapy for prostate cancer[J].Radiother Oncol,2011,98(2):181-186.DOI:10.1016/j.radonc.2010.12.019. [16] Langsenlehner T,Dller C,Winkler P,et al. Impact of inter-and intrafraction deviations and residual set-up errors on PTV margins[J].Strahlenther Onkol,2013,189(4):321-328.DOI:10.1007/s00066-012-0303-0. [17] Simon JT,Mark A,George-Samuel JT,et al. Intra-fraction motion of the prostate during treatment with helical Tomotherapy[J].Radiother Oncol,2013,109(3):482-486.DOOI:10.1016/j.radonc.2013.09.011 [18] 齐昕,高献书.前列腺癌根治性放疗靶区勾画共识与争议[J].中华放射肿瘤学杂志,2014,23(4):279-281.DOI:10.3760/cma.j.issn.1004-4221.2014.04.001. Qi X,Gao XSH. Consensus and controversy of gross target volume delineation in prostate cancer radical radiotherapy[J].Chin J Radiat Oncol,2014,23(4):279-281.DOI:10.3760/cma.j.issn.1004-4221.2014.04.001. [19] 李炯雁,郭小毛,姚伟强,等.在线千伏级锥形束CT引导前列腺癌调强放疗摆位误差研究[J].中华放射肿瘤学杂志,2010,19(6):541-543.DOI:10.3760/cma.j.issn.1004-4221.2010.06.018. Li JY,Guo XM,Yao WQ,et al. Positioning errors assessed with kV cone beam CT for image guided prostate radiotherapy[J].Chin J Radiat Oncol,2010,19(6):541-543.DOI:10.3760/cma.j.issn.1004-4221.2010.06.018. [20] Hurkmans CW,Remeijer P,Lebesque JV,et al. Set-up verification using portal imaging:review of current clinical practice[J].Radiother Oncol,2001,58(2):105-120.DOI:10.1016/S0167-8140(00)00260-7.
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