NDLI: CBCT evaluation of inter- and intra-fraction motions during prostate stereotactic body radiotherapy: a technical note

Content Provider	Springer Nature : BioMed Central
Author	Jmour, Omar Benna, Marouan Champagnol, Pierre Ben Mrad, Majed Hamrouni, Anis Obeid, Layal Lahmamssi, Chaimaa Bousarsar, Amal Vial, Nicolas Rehailia-Blanchard, Amel Sotton, Sandrine Lan, Meiling Langrand-Escure, Julien Vallard, Alexis Magné, Nicolas
Abstract	Background In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam. Yet, it is unclear if a cone-beam computed tomography (CBCT) should be performed before each beam to monitor a possible variation of the organs at risk (OARs) fullness, especially in case of recto-prostatic spacer implantation. The present study aimed at assessing the inter- and intra-fraction movements of prostate, bladder and rectum in patients implanted with a hyaluronic acid spacer and undergoing prostate stereotactic body radiotherapy (SBRT). Methods Data about consecutive patients undergoing prostate SBRT were prospectively collected between 2015 and 2019. Inter-and intra-fraction prostate displacements and volume variation of organs at risk (OARs) were assessed with CBCTs. Results Eight patients were included. They underwent prostate SBRT (37.5Gy, 5 fractions of 7.5Gy) guided by prostate gold fiducial markers. Inter-fraction variation of the bladder volume was insignificant. Intra-fraction mean increase of the bladder volume was modest (29 cc) but significant (p < 0.001). Both inter- and intra-fraction variations of the rectum volume were insignificant but for one patient. He had no rectal toxicity. The magnitude of table displacement necessary to match the prostate gold fiducial marker frequently exceeded the CTV/PTV margins (0.4 cm) before the first (35%) and the second arc (15%). Inter- and intra-fraction bladder and rectum volume variations did not correlate with prostate displacement. Conclusion Major prostate position variations were reported. In-room kV fiducial imaging before each arc seems mandatory. Intra-fraction imaging of the OARs appears unnecessary. We suggest that only one CBCT is needed before the first arc. Trial registration NCT02361515, February 11th, 2015.
Related Links	https://ro-journal.biomedcentral.com/counter/pdf/10.1186/s13014-020-01534-2.pdf
Ending Page	6
Page Count	6
Starting Page	1
File Format	HTM / HTML
DOI	10.1186/s13014-020-01534-2
Journal	Radiation Oncology
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2020-04-19
Access Restriction	Open
Subject Keyword	Cancer Research Oncology Radiotherapy Imaging Radiology Prostate cancer Stereotactic body radiotherapy Cone beam CT motion Bladder Rectum Organs at risk
Content Type	Text
Resource Type	Article
Subject	Radiology, Nuclear Medicine and Imaging Oncology
Journal Impact Factor	3.3/2023
5-Year Journal Impact Factor	3.6/2023

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