Analysis of Prostate Deformation during a Course of Radiation Therapy for Prostate Cancer.

Takuya Nakazawa,Kensei Nakata,Akihiro Nakata,Masakazu Hori,Tadanori Abe,Masaki Yano,Kunihiko Tateoka,Hirokazu Narimatsu,Koichi Sakata,Yuji Yaegashi,Kazunori Fujimoto,Masanori Someya,Yuichi Saito,Masato Hareyama

doi:10.1371/journal.pone.0131822

Takuya Nakazawa, Kensei Nakata + Show 12 more

Open Access

https://doi.org/10.1371/journal.pone.0131822

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Abstract

PurposeAccurate analysis of the correlation between deformation of the prostate and displacement of its center of gravity (CoG) is important for efficient radiation therapy for prostate cancer. In this study, we addressed this problem by introducing a new analysis approach.MethodA planning computed tomography (CT) scan and 7 repeat cone-beam CT scans during the course of treatment were obtained for 19 prostate cancer patients who underwent three-dimensional conformal radiation therapy. A single observer contoured the prostate gland only. To evaluate the local deformation of the prostate, it was divided into 12 manually defined segments. Prostate deformation was calculated using in-house developed software. The correlation between the displacement of the CoG and the local deformation of the prostate was evaluated using multiple regression analysis.ResultsThe mean value and standard deviation (SD) of the prostate deformation were 0.6 mm and 1.7 mm, respectively. For the majority of the patients, the local SD of the deformation was slightly lager in the superior and inferior segments. Multiple regression analysis revealed that the anterior-posterior displacement of the CoG of the prostate had a highly significant correlation with the deformations in the middle-anterior (p < 0.01) and middle-posterior (p < 0.01) segments of the prostate surface (R2 = 0.84). However, there was no significant correlation between the displacement of the CoG and the deformation of the prostate surface in other segments.ConclusionAnterior-posterior displacement of the CoG of the prostate is highly correlated with deformation in its middle-anterior and posterior segments. In the radiation therapy for prostate cancer, it is necessary to optimize the internal margin for every position of the prostate measured using image-guided radiation therapy.

Highlights

The goal of radiation therapy is to concentrate radiation doses on the tumor while minimizing exposure of surrounding healthy tissue [1]
Anterior-posterior displacement of the center of gravity (CoG) of the prostate is highly correlated with deformation in its middle-anterior and posterior segments
In the radiation therapy for prostate cancer, it is necessary to optimize the internal margin for every position of the prostate measured using image-guided radiation therapy

Summary

Introduction

The goal of radiation therapy is to concentrate radiation doses on the tumor while minimizing exposure of surrounding healthy tissue [1]. This goal can be achieved by using two radiation therapy techniques: three-dimensional conformal radiation therapy (3DCRT) and intensitymodulated radiation therapy (IMRT) [2]. Planning target volume (PTV) margin, which takes into account both the internal margin (IM) and the set up margin (SM), is utilized during the radiation therapy planning to deliver a prescribed absorbed dose to the clinical target volume (CTV). PTV margin reduction that does not account for physiological uncertainties (e.g. rectum filling) can lead to biochemical failure of radiation therapy for prostate cancer [6]. Significant prostate deformations have been demonstrated that can cause differences between the delivered dose and the planned dose [9]

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