Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region

Research output: Contribution to journalArticle

Abstract

Purpose: To evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. Methods: Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. Results: The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9–9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5–10.5 mm in AP, 9 mm in LL and 8–10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. Conclusions: without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.

Original languageEnglish
Pages (from-to)59-66
Number of pages8
JournalPhysica Medica
Volume46
DOIs
Publication statusPublished - Feb 1 2018

Fingerprint

Cone-Beam Computed Tomography
Pelvis
Prostate
margins
cones
tumors
rectum
canals
International System of Units
Anal Canal
Rectum
Neoplasms
beds
cancer
Pelvic Neoplasms
Anus Neoplasms
toxicity
organs
Therapeutics
Direction compound

Keywords

  • Cone-beam computed tomography
  • Gynecological cancer
  • Image-guided radiotherapy
  • Prostate cancer
  • Rectum cancer
  • Tumor localization errors

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging
  • Physics and Astronomy(all)

Cite this

@article{e0ba4739015d46948aae437a87636b4d,
title = "Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region",
abstract = "Purpose: To evaluate inter-fraction tumor localization errors (TE) in the RapidArc{\circledR} treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. Methods: Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. Results: The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9–9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5–10.5 mm in AP, 9 mm in LL and 8–10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. Conclusions: without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.",
keywords = "Cone-beam computed tomography, Gynecological cancer, Image-guided radiotherapy, Prostate cancer, Rectum cancer, Tumor localization errors",
author = "Cristina Garibaldi and Cristiana Fodor and Giulia Riva and Rojas, {Damaris Patricia} and Samantha Dicuonzo and Elisa Pace and Giuseppe Fanetti and {De Marco}, Paolo and Veronica Dell'acqua and Giulia Marvaso and Leonardi, {Maria Cristina} and Roberta Lazzari and Federica Cattani and Marta Cremonesi and Roberto Orecchia and Jereczek-Fossa, {Barbara Alicja}",
year = "2018",
month = "2",
day = "1",
doi = "10.1016/j.ejmp.2018.01.011",
language = "English",
volume = "46",
pages = "59--66",
journal = "Physica Medica",
issn = "1120-1797",
publisher = "Associazione Italiana di Fisica Medica",

}

TY - JOUR

T1 - Cone-beam CT-based inter-fraction localization errors for tumors in the pelvic region

AU - Garibaldi, Cristina

AU - Fodor, Cristiana

AU - Riva, Giulia

AU - Rojas, Damaris Patricia

AU - Dicuonzo, Samantha

AU - Pace, Elisa

AU - Fanetti, Giuseppe

AU - De Marco, Paolo

AU - Dell'acqua, Veronica

AU - Marvaso, Giulia

AU - Leonardi, Maria Cristina

AU - Lazzari, Roberta

AU - Cattani, Federica

AU - Cremonesi, Marta

AU - Orecchia, Roberto

AU - Jereczek-Fossa, Barbara Alicja

PY - 2018/2/1

Y1 - 2018/2/1

N2 - Purpose: To evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. Methods: Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. Results: The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9–9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5–10.5 mm in AP, 9 mm in LL and 8–10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. Conclusions: without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.

AB - Purpose: To evaluate inter-fraction tumor localization errors (TE) in the RapidArc® treatment of pelvic cancers based on CBCT. Appropriate CTV-to PTV margins in a non-IGRT scenario have been proposed. Methods: Data of 928 patients with prostate, gynecological, and rectum/anal canal cancers were retrospectively analyzed to determine systematic and random localization errors. Two protocols were used: daily online IGRT (d-IGRT) and weekly IGRT. The latter consisted in acquiring a CBCT for the first 3 fractions and subsequently once a week. TE for patients who underwent d-IGRT protocol were calculated using either all CBCTs or the first 3. Results: The systematic (and random) TE in the AP, LL, and SI direction were: for prostate bed 2.7(3.2), 2.3(2.8) and 1.9(2.2) mm; for prostate 4.2(3.1), 2.9(2.8) and 2.3(2.2) mm; for gynecological 3.0(3.6), 2.4(2.7) and 2.3(2.5) mm; for rectum 2.8(2.8), 2.4(2.8) and 2.3(2.5) mm; for anal canal 3.1(3.3), 2.1(2.5) and 2.2(2.7) mm. CTV-to-PTV margins determined from all CBCTs were 14 mm in the AP, 10 mm in the LL and 9–9.5 mm in the SI directions for the prostate and the gynecological groups and 9.5–10.5 mm in AP, 9 mm in LL and 8–10 mm in the SI direction for the prostate bed and the rectum/anal canal groups. If assessed on the basis of the first 3 CBCTs, the calculated CTV-to-PTV margins were slightly larger. Conclusions: without IGRT, large CTV-to-PTV margins up to 15 mm are required to account for inter-fraction tumor localization errors. Daily IGRT should be used for all hypo-fractionated treatments to reduce margins and avoid increased toxicity to critical organs.

KW - Cone-beam computed tomography

KW - Gynecological cancer

KW - Image-guided radiotherapy

KW - Prostate cancer

KW - Rectum cancer

KW - Tumor localization errors

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U2 - 10.1016/j.ejmp.2018.01.011

DO - 10.1016/j.ejmp.2018.01.011

M3 - Article

C2 - 29519410

AN - SCOPUS:85043234354

VL - 46

SP - 59

EP - 66

JO - Physica Medica

JF - Physica Medica

SN - 1120-1797

ER -