The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy.

2019-03

Chao, Michael

Ho, Huong

Lim Joon, Daryl

Chan, Yee

Spencer, Sandra

Ng, Michael

Wasiak, Jason

Lawrentschuk, Nathan

McMillan, Kevin

Sengupta, Shomik

Tan, Alwin

Koufogiannis, George

Cokelek, Margaret

Foroudi, Farshad

Khong, Tristan-Scott

Bolton, Damien M

Fiducial marker

Image-guided radiotherapy

Intensity-modulated radiotherapy

Prostate cancer

Prostatectomy

Journal Article

0000-0002-5145-6783

0000-0001-8553-5618

0000-0001-8387-0965

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10.3857/roj.2018.00556

The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV70) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

link

Radiation Oncology Journal 2019; 37(1): 43-50

Radiation Oncology Journal

2234-1900