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Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy

Published online by Cambridge University Press:  30 October 2019

Maria T. Vlachaki Open the ORCID record for Maria T. Vlachaki [Opens in a new window] ,
Salahuddin Ahmad ,
Erika Kennedy ,
Amr M. Aref  and
Paul J. Chuba
Maria T. Vlachaki*
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Salahuddin Ahmad
Affiliation:
Department of Radiation Oncology, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
Erika Kennedy
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Amr M. Aref
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
Paul J. Chuba
Affiliation:
Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Warren, MI, USA
*
Author for correspondence: Maria T. Vlachaki, Department of Radiation Oncology, Ascension Macomb-Oakland Hospital, Webber Cancer Center, 11800 E 12 Mile Rd, Warren, MI 48093, USA. Tel: 1-586-573-5186. E-mails: maria.vlachaki@ascension.org; drmvlachaki@gmail.com
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Abstract

Aim:

Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT.

Materials and methods:

The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed.

Results:

Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively.

Conclusion:

In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.

Keywords

fiducial markersprostate bed motionprostate cancerprostatectomyVMAT
Type
Technical Note
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 3 , September 2020 , pp. 299 - 304
Copyright
© Cambridge University Press 2019

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References

Siegel, R, Miller, KD, Jemal, A.Cancer statistics, 2017. CA Cancer J Clin 2017; 67: 7–30.CrossRefGoogle ScholarPubMed
Thompson, IM, Tangen, CM, Taradelo, Jet al.Adjuvant radiotherapy for pathological T3N0Mo prostate cancer significantly reduces risk of metastases and improves survival: long-term follow-up of a randomized clinical trial. J Urol 2009; 181: 956–962.CrossRefGoogle ScholarPubMed
Swanson, GP, Goldman, B, Tangen, CMet al.The prognostic impact of seminal vesicle involvement found at prostatectomy and the effects of adjuvant radiation: data from the Southwest Oncology Group 8794. J Urol 2008; 180: 2453–2457.CrossRefGoogle ScholarPubMed
Van der Kwast, TH, Bolla, M, Van Poppel, Het al.Identification of patients with prostate cancer who benefit from immediate postoperative radiotherapy: EORTC 22911. J Clin Oncol 2007; 25: 4178–4186.CrossRefGoogle ScholarPubMed
Wiegel, T, Bottke, D, Steiner, Uet al.Phase III postoperative adjuvant radiotherapy after radical prostatectomy compared with radical prostatectomy alone in p T3 prostate cancer with postoperative undetectable prostate-specific antigen: ARO 96-02/AUO AP 09/95. J Clin Oncol 2009; 27: 2924–2930.CrossRefGoogle Scholar
Thompson, IM, Valicenti, RK, Albertsen, Pet al.Adjuvant and salvage radiotherapy after prostatectomy: AUA/ASTRO Guideline. J Urol 2013; 190: 441–449.CrossRefGoogle Scholar
Goldin, GH, Sheets, NC, Meyer, AMet al.Comparative effectiveness of intensity-modulated radiotherapy and conventional conformal radiotherapy in the treatment of prostate cancer after radical prostatectomy. J Am Med Assoc Intern Med 2013; 173: 1136–43.Google ScholarPubMed
Zelefsky, MJ, Levin, EJ, Hunt, Met al.Incidence of late rectal and urinary toxicities after three-dimensional conformal therapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70: 1124–1129.CrossRefGoogle ScholarPubMed
Palma, D, Vollans, E, James, Ket al.Volumetric modulated arc therapy for delivery of prostate radiotherapy: comparison with intensity-modulated radiotherapy and three-dimensional conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008; 72: 996–1001.CrossRefGoogle ScholarPubMed
Zhang, P, Happersett, L, Hunt, Met al.Volumetric modulated arc therapy: planning and evaluation for prostate cancer cases. Int J Radiat Oncol Biol Phys 2010; 76: 1456–1462.CrossRefGoogle ScholarPubMed
Schiffner, DC, Gottschalk, AR, Lometti, Met al.Daily electronic portal imaging of implanted gold seed fiducials in patients undergoing radiotherapy after radical prostatectomy. Int J Radiat Oncol Biol Phys 2007; 67: 610–619.CrossRefGoogle ScholarPubMed
Shakir, SI, Udrescu, D, Enachescu, Cet al.Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences. Physica Medica 2016; 32: 1422–1427.CrossRefGoogle ScholarPubMed
Ålander, E, Visapää, H, Kouri, M, Keyriläinen, J, Saarilahti, K, Tenhunen, M.Gold seed fiducials in analysis of linear and rotational displacement of the prostate bed. Radiat Oncol 2013; 110: 256–260.CrossRefGoogle ScholarPubMed
Fortin, I, Carrier, JF, Beauchemin, MC, Béliveau-Nadeau, D, Delouya, G, Taussky, D.Using fiducial markers in the prostate bed for postprostatectomy external beam radiation therapy improves accuracy over surgical clips. Strahlenther Onkol 2014; 190: 467–471.CrossRefGoogle ScholarPubMed
Cavalieri, R, Gay, HA, Liu, Jet al.Total error shift patterns for daily CT on rails image-guided radiotherapy to the prostate bed. Radiat Oncol 2011; 6: 142.CrossRefGoogle ScholarPubMed
Huang, K, Palma, DA, Scott, Det al.Inter and intrafraction uncertainty in prostate bed image-guided radiotherapy. Int J Radiat Oncol Biol Phys 2012; 84: 402–407.CrossRefGoogle ScholarPubMed
Klayton, T, Price, R, Buyyounouski, Met al.Prostate bed motion during intensity modulated radiotherapy treatment. Int J Radiat Oncol Biol Phys 2012; 84: 130–136.CrossRefGoogle ScholarPubMed
Ng, M, Brown, E, Williams, A, Chao, M, Lawrentschuk, N, Chee, R.Fiducial markers and spacers in prostate radiotherapy: current applications. BJU International 2014; 113: 13–20.CrossRefGoogle ScholarPubMed
Song, S, Yenice, KM, Kopec, M, Liauw, SL.Image-guided radiotherapy using surgical clips as fiducial markers after prostatectomy: a report of total setup error, required PTV expansion, and dosimetric implications. Radiat Oncol 2012; 103: 270–274.CrossRefGoogle ScholarPubMed
Haworth, A, Paneghel, A, Herschtal, Aet al.Verification of target position in the post-prostatectomy cancer patient using cone beam CT. J Med Imaging Radiat Oncol 2009; 53: 212–220.CrossRefGoogle ScholarPubMed
Brown, S, Lehman, M, Ferrari-Anderson, J, Glyde, A, Burmeister, E, Nicol, D.Assessment of prostatic fiducial marker introduction: patient morbidity, staff satisfaction and improved treatment field placement. J Med Imaging Radiat Oncol 2011; 55: 417–424.CrossRefGoogle ScholarPubMed
Bell, LJ, Cox, J, Eade, T, Rinks, M, Kneebone, A.Prostate bed motion may cause geographic miss in post-prostatectomy image-guided intensity-modulated radiotherapy. J Med Imaging Radiat Oncol. 2013; 57 (6): 725–732.CrossRefGoogle ScholarPubMed
Langenhuijsen, J, Donker, R, Mccoll, G, Kiemeney, L, Witjes, J, Lin, EV.Postprostatectomy ultrasound-guided transrectal implantation of gold markers for external beam radiotherapy. Strahlentherapie und Onkologie 2013; 189: 476–481.CrossRefGoogle ScholarPubMed
Gill, S, Isiah, R, Adams, Ret al.Conventional margins not sufficient for post-prostatectomy prostate bed coverage: an analysis of 477 cone-beam computed tomography scans. Radiat Oncol 2014; 110: 235–239.CrossRefGoogle Scholar