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Title: Assessing the Dosimetric Impact of Real-Time Prostate Motion During Volumetric Modulated Arc Therapy

Purpose: To develop a method for dose reconstruction by incorporating the interplay effect between aperture modulation and target motion, and to assess the dosimetric impact of real-time prostate motion during volumetric modulated arc therapy (VMAT). Methods and Materials: Clinical VMAT plans were delivered with the TrueBeam linac for 8 patients with prostate cancer. The real-time target motion during dose delivery was determined based on the 2-dimensional fiducial localization using an onboard electronic portal imaging device. The target shift in each image was correlated with the control point with the same gantry angle in the VMAT plan. An in-house-developed Monte Carlo simulation tool was used to calculate the 3-dimensional dose distribution for each control point individually, taking into account the corresponding real-time target motion (assuming a nondeformable target with no rotation). The delivered target dose was then estimated by accumulating the dose from all control points in the plan. On the basis of this information, dose–volume histograms and 3-dimensional dose distributions were calculated to assess their degradation from the planned dose caused by target motion. Thirty-two prostate motion trajectories were analyzed. Results: The minimum dose to 0.03 cm{sup 3} of the gross tumor volume (D{sub 0.03cc}) was only slightly degraded after takingmore » motion into account, with a minimum value of 94.1% of the planned dose among all patients and fractions. However, the gross tumor volume receiving prescription dose (V{sub 100%}) could be largely affected by motion, dropping below 60% in 1 trajectory. We did not observe a correlation between motion magnitude and dose degradation. Conclusions: Prostate motion degrades the delivered dose to the target in an unpredictable way, although its effect is reduced over multiple fractions, and for most patients the degradation is small. Patients with greater prostate motion or those treated with stereotactic body radiation therapy would benefit from real-time prostate tracking to reduce the margin.« less
Authors:
 [1] ;  [2] ; ; ; ;  [1]
  1. Department of Radiation Oncology, Stanford University, Stanford, California (United States)
  2. (Spain)
Publication Date:
OSTI Identifier:
22416534
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 88; Journal Issue: 5; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The 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; BIOMEDICAL RADIOGRAPHY; COMPUTERIZED SIMULATION; LINEAR ACCELERATORS; MONTE CARLO METHOD; NEOPLASMS; PATIENTS; PROSTATE; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; THREE-DIMENSIONAL CALCULATIONS