The Influence of Intrafraction Movement on Margins for Prostate Radiotherapy
Reviewer: Charles Wood, MD
Abramson Cancer Center of the University of Pennsylvania
Last Modified: October 18, 2005
Presenter: D. W. Litzenberg Presenter's Affiliation: University of Michigan Type of Session: Plenary
As set-up and interfraction errors are being reduced by in-room imaging guidance, the importance of intrafraction errors increases. Unfortunately, little data exists documenting the significance of intrafraction target movement. The Calypso® 4D Localization System utilizes electromagnetic tracking of implanted markers to provide continuous organ monitoring. Data was collected using this investigational system to assess the relative importance of intrafraction organ movement during radiation treatment.
Materials and Methods
11 patients underwent ultrasound-guided placement of 3 transponders within the apex, right base, and left base of the prostate
An isocenter was chosen that corresponded to the geometric center of the transponders, and patients were thereafter positioned via the electromagnetic system
Following initial positioning and radiographic verification, the position of the implanted transponders was monitored for 8 minutes at a rate of 10 measurements per second
Transponder positions were compared with previously measured data on organ position relative to skin marks, and the combined data were considered using van Herk's formula to establish margins in the following situations
Skin marker-based positioning
Pretreatment transponder positioning
Intratreatment continuous tracking consisting of a 3 mm threshold-based beam cutoff with repositioning and resumption of treatment
Without consideration of intrafractional organ motion, necessary average prostate margin for skin marker-based positioning was 8.0 mm, 7.3 mm, and 10 mm in the left-right (LR), anterior-posterior (AP), and cranial-caudal (CC) directions, respectively
With consideration of intrafractional organ motion, necessary average prostate margin for skin marker-based positioning increased to 8.2 mm, 10.2 mm, and 12.5 mm in the LR, AP, and CC directions, respectively
With transponder positioning prior to each radiation fraction, necessary average prostate margin decreased to 1.8 mm, 5.8 mm, and 7.1 mm in the LR, AP, and CC directions, respectively
With transponder repositioning prior to treatment of each field, necessary average prostate margin again decreased to 0.4 mm, 2.3 mm, and 1.8 mm in the LR, AP, and CC directions, respectively
With intrafractional adjustment, necessary average prostate margin further decreased to 0.3 mm, 1.5 mm, and 1.5 mm in the LR, AP, and CC directions, respectively
Interfractional, interbeam, and intrafractional adjustment allowed increasingly small margins to be employed for prostate radiation treatment
Significant margin reduction was accomplished by interbeam adjustment, though 2 of the 11 patients in the study with wide variation in organ motion benefited from continuous monitoring and intrafraction adjustment
This investigational device allowed continuous non-ionizing tracking of organ motion via transponders that were amenable to placement in the path of the radiation beam without a compromise in dose distribution. Although this technology is still early in its development, it could potentially be utilized in other treatment sites for documentation of organ motion. Further study is needed to more fully characterize its utility and potential for clinical implementation.
Jan 21, 2013 - For patients receiving radiotherapy for glioblastoma, use of clinical target volume margins as small as 5 mm does not lead to an increase in marginal failures, according to a study published online Dec. 1 in the American Journal of Clinical Oncology.