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Title: Online adaptive radiotherapy of the bladder: Small bowel irradiated-volume reduction

Purpose: To assess the potential reduction of small bowel volume receiving high-dose radiation by using kilovoltage X-ray cone beam computed tomography (CBCT) and quantized margin selection for adaptive bladder cancer treatment. Methods and Materials: Twenty bladder patients were planned conformally using a four-field, 15-mm uniform margin technique. Two additional planning target volumes (PTVs) were created using margins quantized to 5 and 10 mm in the superior direction only. CBCTs ({approx}8 scans/patient) were acquired during treatment. CBCT volumes were registered with CT planning scans to determine setup errors and to select the appropriate PTV of the day. Margin reduction in other directions was considered. Outlining of small bowel in every fraction is required to properly quantify the volume of small bowel spared from high doses. In the case of CBCT this is not always possible owing to artifacts created by small bowel movement and the presence of gas. A simpler method was adopted by considering the volume difference between PTVs created using uniform and adapted margins, which corresponds to the potential volume of small bowel sparing. Results: The average small bowel volume that can be spared by this form of adaptive radiotherapy is 31 {+-} 23 cm{sup 3} ({+-}1 SD). Themore » bladder for 1 patient was systematically smaller than the planning scan and hence demonstrated the largest average reduction of 76 cm{sup 3}. The clinical target volume to PTV margins in other directions can be safely reduced to 10 mm except in the anterior direction where, like the superior direction, the bladder showed significant variation. Conclusions: Online CBCT-assisted plan selection based on quantized margins can significantly reduce the volume of small bowel receiving high doses for some bladder patients. CBCT allows the 15-mm margins used in some directions to be safely reduced to 10 mm.« less
Authors:
 [1] ;  [2] ;  [2] ;  [3] ;  [4] ;  [3] ;  [5] ;  [6] ;  [2]
  1. North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom). E-mail: nichola.burridge@physics.cr.man.ac.uk
  2. North Western Medical Physics, Christie Hospital NHS Trust, Manchester (United Kingdom)
  3. Cookridge Hospital, Leeds (United Kingdom)
  4. Wade Centre for Radiotherapy Research, Christie Hospital, Manchester (United Kingdom)
  5. Department of Clinical Oncology, Christie Hospital NHS Trust, Manchester (United Kingdom)
  6. Academic Department of Radiation Oncology, Christie Hospital, Manchester (United Kingdom)
Publication Date:
OSTI Identifier:
20850177
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 66; Journal Issue: 3; Conference: 48. annual meeting of the American Society for Therapeutic Radiology and Oncology, Pennsylvania, PA (United States), 5-9 Nov 2006; Other Information: DOI: 10.1016/j.ijrobp.2006.07.013; PII: S0360-3016(06)01168-0; Copyright (c) 2006 Elsevier Science B.V., Amsterdam, Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BEAMS; BLADDER; COMPUTERIZED TOMOGRAPHY; ERRORS; IMAGES; IRRADIATION; NEOPLASMS; PATIENTS; PLANNING; RADIATION DOSES; RADIOTHERAPY; X RADIATION