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Title: SU-F-T-394: Impact of PTV Margins With Taking Into Account Shape Variation On IMRT Plans For Prostate Cancer

Abstract

Purpose: The purpose of this study was to investigate the impact of planning target volume (PTV) margins with taking into consideration clinical target volume (CTV) shape variations on treatment plans of intensity modulated radiation therapy (IMRT) for prostate cancer. Methods: The systematic errors and the random errors for patient setup errors in right-left (RL), anterior-posterior (AP), and superior-inferior (SI) directions were obtained from data of 20 patients, and those for CTV shape variations were calculated from 10 patients, who were weekly scanned using cone beam computed tomography (CBCT). The setup error was defined as the difference in prostate centers between planning CT and CBCT images after bone-based registrations. CTV shape variations of high, intermediate and low risk CTVs were calculated for each patient from variances of interfractional shape variations on each vertex of three-dimensional CTV point distributions, which were manually obtained from CTV contours on the CBCT images. PTV margins were calculated using the setup errors with and without CTV shape variations for each risk CTV. Six treatment plans were retrospectively made by using the PTV margins with and without CTV shape variations for the three risk CTVs of 5 test patients. Furthermore, the treatment plans were applied to CBCTmore » images for investigating the impact of shape variations on PTV margins. Results: The percentages of population to cover with the PTV, which satisfies the CTV D98 of 95%, with and without the shape variations were 89.7% and 74.4% for high risk, 89.7% and 76.9% for intermediate risk, 84.6% and 76.9% for low risk, respectively. Conclusion: PTV margins taking into account CTV shape variation provide significant improvement of applicable percentage of population (P < 0.05). This study suggested that CTV shape variation should be taken consideration into determination of the PTV margins.« less

Authors:
; ; ;  [1]; ; ;  [2]
  1. Kyushu University, Fukuoka (Japan)
  2. Kyushu University Hospital, Fukuoka (Japan)
Publication Date:
OSTI Identifier:
22648991
Resource Type:
Journal Article
Resource Relation:
Journal Name: Medical Physics; Journal Volume: 43; Journal Issue: 6; Other Information: (c) 2016 American Association of Physicists in Medicine; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
60 APPLIED LIFE SCIENCES; 61 RADIATION PROTECTION AND DOSIMETRY; COMPUTERIZED TOMOGRAPHY; ERRORS; HAZARDS; NEOPLASMS; PATIENTS; PLANNING; PROSTATE; RADIOTHERAPY

Citation Formats

Hirose, T, Arimura, H, Oga, S, Sasaki, T, Shibayama, Y, Fukunaga, J, and Umezu, Y. SU-F-T-394: Impact of PTV Margins With Taking Into Account Shape Variation On IMRT Plans For Prostate Cancer. United States: N. p., 2016. Web. doi:10.1118/1.4956579.
Hirose, T, Arimura, H, Oga, S, Sasaki, T, Shibayama, Y, Fukunaga, J, & Umezu, Y. SU-F-T-394: Impact of PTV Margins With Taking Into Account Shape Variation On IMRT Plans For Prostate Cancer. United States. doi:10.1118/1.4956579.
Hirose, T, Arimura, H, Oga, S, Sasaki, T, Shibayama, Y, Fukunaga, J, and Umezu, Y. Wed . "SU-F-T-394: Impact of PTV Margins With Taking Into Account Shape Variation On IMRT Plans For Prostate Cancer". United States. doi:10.1118/1.4956579.
@article{osti_22648991,
title = {SU-F-T-394: Impact of PTV Margins With Taking Into Account Shape Variation On IMRT Plans For Prostate Cancer},
author = {Hirose, T and Arimura, H and Oga, S and Sasaki, T and Shibayama, Y and Fukunaga, J and Umezu, Y},
abstractNote = {Purpose: The purpose of this study was to investigate the impact of planning target volume (PTV) margins with taking into consideration clinical target volume (CTV) shape variations on treatment plans of intensity modulated radiation therapy (IMRT) for prostate cancer. Methods: The systematic errors and the random errors for patient setup errors in right-left (RL), anterior-posterior (AP), and superior-inferior (SI) directions were obtained from data of 20 patients, and those for CTV shape variations were calculated from 10 patients, who were weekly scanned using cone beam computed tomography (CBCT). The setup error was defined as the difference in prostate centers between planning CT and CBCT images after bone-based registrations. CTV shape variations of high, intermediate and low risk CTVs were calculated for each patient from variances of interfractional shape variations on each vertex of three-dimensional CTV point distributions, which were manually obtained from CTV contours on the CBCT images. PTV margins were calculated using the setup errors with and without CTV shape variations for each risk CTV. Six treatment plans were retrospectively made by using the PTV margins with and without CTV shape variations for the three risk CTVs of 5 test patients. Furthermore, the treatment plans were applied to CBCT images for investigating the impact of shape variations on PTV margins. Results: The percentages of population to cover with the PTV, which satisfies the CTV D98 of 95%, with and without the shape variations were 89.7% and 74.4% for high risk, 89.7% and 76.9% for intermediate risk, 84.6% and 76.9% for low risk, respectively. Conclusion: PTV margins taking into account CTV shape variation provide significant improvement of applicable percentage of population (P < 0.05). This study suggested that CTV shape variation should be taken consideration into determination of the PTV margins.},
doi = {10.1118/1.4956579},
journal = {Medical Physics},
number = 6,
volume = 43,
place = {United States},
year = {Wed Jun 15 00:00:00 EDT 2016},
month = {Wed Jun 15 00:00:00 EDT 2016}
}
  • Purpose: Our aim of this study was to propose a computational approach for determination of anisotropic planning target volume (PTV) margins based on statistical shape analysis with taking into account time variations of clinical target volume (CTV) shapes for the prostate cancer radiation treatment planning (RTP). Methods: Systematic and random setup errors were measured using orthogonal projection and cone beam computed tomography (CBCT) images for data of 20 patients, who underwent the intensity modulated radiation therapy for prostate cancer. The low-risk, intermediate-risk, and high-risk CTVs were defined as only a prostate, a prostate plus proximal 1-cm seminal vesicles, and amore » prostate plus proximal 2-cm seminal vesicles, respectively. All CTV regions were registered with a reference CTV region with a median volume to remove the effect of the setup errors, and converted to a point distribution models. The systematic and random errors for translations of CTV regions were automatically evaluated by analyzing the movements of centroids of CTV regions. The random and systematic errors for shape variations of CTV regions were obtained from covariance matrices based on point distributions for the CTV contours on CBCT images of 72 fractions of 10 patients. Anisotropic PTV margins for 6 directions (right, left, anterior, posterior, superior and inferior) were derived by using Yoda’s PTV margin model. Results: PTV margins with and without shape variations were 5.75 to 8.03 mm and 5.23 to 7.67 mm for low-risk group, 5.87 to 8.33 mm and 5.23 to 7.67 mm for intermediate-risk group, and 5.88 to 8.25 mm and 5.29 to 7.82 mm for highrisk group, respectively. Conclusion: The proposed computational approach could be feasible for determination of the anisotropic PTV margins with taking into account CTV shape variations for the RTP.« less
  • Purpose: The aim of this work is to study the dosimetric impact of leaf interdigitation in prostate cancer dynamic IMRT treatment planning. Methods: Fifteen previously treated prostate cancer patients were replanned for dynamic IMRT (dMLC) with and without leaf interdigitation using Monaco 3.3 TPS on the Elekta Synergy linear accelerator. The prescription dose of PTV was 70Gy/35 fractions. Various dosimetric variables, such as PTV coverage, OAR sparing, delivery efficiency and optimization time, were evaluated for each plan. Results: Interdigitation did not improve the coverage, HI and CI for PTV. Regarding OARs, sparing was equivalent with and without interdigitation. Interdigitation shownmore » an increase in MUs and segments. It was worth noting that leaf interdigitation saved the optimization time. Conclusion: This study shows that leaf interdigitation does not improve plan quality when performing dMLC treatment plan for prostate cancer. However, it influences delivery efficiency and optimization time. Interdigitation may gain efficiency for dosimetrist when designing the prostate cancer dMLC plans.« less
  • Purpose: Due to the high dose per fraction in SBRT, dose conformity and dose fall-off are critical. In patients with cervical cancer, rapid dose fall-off is particularly important to limit dose to the nearby rectum, small bowel, and bladder. This study compares the target volume dose fall-off for two radiation delivery techniques, fixed-field IMRT & VMAT, using non-coplanar beam geometries. Further comparisons are made between 6 and 10MV photon beam energies. Methods: Eleven (n=11) patients were planned in Pinnacle3 v9.10 with a NovalisTx (HD120 MLC) machine model using 6 and 10 MV photons. The following three techniques were used: (1)more » IMRT (10 non-coplanar beams) (2) Dual, coplanar 360° VMAT arcs (4° spacing), and (3) Triple, non-coplanar VMAT arcs (1 full arc and dual partial arcs). All plans were normalized such that 98% of the PTV received at least 28Gy/4Fx. Dose was calculated using a 2.0mm isotropic dose grid. To assess dose fall-off, twenty concentric 2mm thick rings were created around the PTV. The maximum dose in each ring was recorded and the data was fitted to model dose fall-off. A separate analysis was performed by separating target volumes into small (0–50cc), medium (51–80cc), and large (81–110cc). Results: Triple, non-coplanar VMAT arcs showed the best dose fall-off for all patients evaluated. All fitted regressions had an R{sup 2}≥0.99. At 10mm from the PTV edge, 10 MV VMAT3-arc had an absolute improvement in dose fall-off of 3.8% and 6.9% over IMRT and VMAT2-arc, respectively. At 30mm, 10 MV VMAT3-arc had an absolute improvement of 12.0% and 7.0% over IMRT and VMAT2-arc, respectively. Faster dose fall-off was observed for small volumes as opposed to medium and large ones—9.6% at 20mm. Conclusion: Triple, non-coplanar VMAT arcs offer the sharpest dose fall-off for cervical SBRT plans. This improvement is most pronounced when treating smaller target volumes.« less
  • Purpose: Stereotactic body radiation therapy (SBRT) may be used to increase surgery candidacy in borderline resectable (BRPC) and locally advanced (LAPC) pancreatic cancer. However, the planning target volume (PTV) may need to be limited to avoid toxicity when the gross tumor volume (GTV) is anatomically involved with surrounding critical structures. Our study aims to characterize the coverage of GTV and investigate the association between modified PTV and pathologic (pCR) or near pathologic (npCR) complete response rates determined from the surgical specimen. Methods: Patients treated with neoadjuvant pancreas SBRT followed by surgery from 2010–2015 were selected from Oncospace. Overlap volume histogrammore » (OVH) analysis was performed to determine the extent of compromise of the PTV from both the GTV and a standard target (GTV+3mm). Subsequently, normalized overlap volume (%) was calculated for: (1) GTV-PTV, and (2) GTV+3mm expansion-PTV. A logistic regression model was used to identify the association between the overlap ratios and ≥ npCR(pCR/npCR) stratified by active breathing control (ABC) versus free-breathing status. Results: Eighty-one (BRPC: n=42, LAPC: n=39) patients were available for analysis. Nearly 40% (31/81) had ≥npCR and 75% (61/81) were able to complete ABC. Mean coverage of the GTV-PTV was 92.6% (range, 59.9%–100%, SD = 8.68) and coverage of the GTV+3mm expansion-PTV was 85. 2% (range, 59.9% −100.0%, SD= 8.67). Among the patients with ABC, every 10% increase in GTV coverage doubled the odds to have ≥npCR (OR = 1.82, p=0.06). Coverage of GTV+3mm expansion was not associated with ≥npCR regardless of ABC status. Conclusion: Preferential sparing of critical anatomy over GTV-PTV coverage with ABC management suggests worse ≥npCR rates for neoadjuvant SBRT in BRPC and LAPC. Limiting the GTV and GTV+3mm expansion in free-breathing patients was not associated with pathologic response perhaps due to larger GTV definitions as a result of motion artifacts in free-breathing CT scans. Collaboration with Toshiba, Elekta, and Phillips.« less
  • Purpose: Our assumption was that interfractional shape variations of target volumes could not be negligible for determination of clinical target volume (CTV)-to-planning target volume (PTV) margins. The aim of this study was to investigate this assumption as a simulation study by developing a computational framework of CTV-to-PTV margins with taking the interfractional shape variations into account based on point distribution model (PDM) Methods: The systematic and random errors for interfractional shape variations and translations of target volumes were evaluated for four types of CTV regions (only a prostate, a prostate plus proximal 1-cm seminal vesicles, a prostate plus proximal 2-cmmore » seminal vesicles, and a prostate plus whole seminal vesicles). The CTV regions were delineated depending on prostate cancer risk groups on planning computed tomography (CT) and cone beam CT (CBCT) images of 73 fractions of 10 patients. The random and systematic errors for shape variations of CTV regions were derived from PDMs of CTV surfaces for all fractions of each patient. Systematic errors of shape variations of CTV regions were derived by comparing PDMs between planning CTV surfaces and average CTV surfaces. Finally, anisotropic CTV-to-PTV margins with shape variations in 6 directions (anterior, posterior, superior, inferior, right, and left) were computed by using a van Herk margin formula. Results: Differences between CTV-to-PTV margins with and without shape variations ranged from 0.7 to 1.7 mm in anterior direction, 1.0 to 2.8 mm in posterior direction, 0.8 to 2.8 mm in superior direction, 0.6 to 1.6 mm in inferior direction, 1.4 to 4.4 mm in right direction, and 1.3 to 5.2 mm in left direction. Conclusion: More than 1.0 mm additional margins were needed at least in 3 directions to guarantee CTV coverage due to shape variations. Therefore, shape variations should be taken into account for the determination of CTV-to-PTV margins.« less