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

Omar Jmour,Chaimaa Lahmamssi,Layal Obeid,Majed Ben Mrad,Alexis Vallard,Amel Rehailia-Blanchard,Sandrine Sotton,Amal Bousarsar,Anis Hamrouni,Meiling Lan,Nicolas Magné,Pierre Champagnol,Julien Langrand-Escure,Nicolas Vial,Marouan Benna

doi:10.1186/s13014-020-01534-2

Omar Jmour, Chaimaa Lahmamssi + Show 13 more

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https://doi.org/10.1186/s13014-020-01534-2

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Abstract

BackgroundIn 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).MethodsData 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.ResultsEight 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.ConclusionMajor 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 registrationNCT02361515, February 11th, 2015.

Highlights

In most clinical trials, gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam
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 [3,4,5], especially when performed with hyaluronic acid spacer
The present study reports on the intra- and interfraction movements of the target and the OARs during a prostate stereotactic body radiotherapy (SBRT) with hyaluronic acid spacer

Summary

Introduction

Gold fiducial markers are implanted in the prostate to tune the table position before each radiation beam 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 rectoprostatic spacer implantation. Gold fiducial markers were implanted in the prostate to tune the table position before each radiation beam 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 [3,4,5], especially when performed with hyaluronic acid spacer. The present technical note was designed to assess this question

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Discussion

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