Dosimetric implications of residual seminal vesicle motion in fiducial-guided intensity-modulated radiotherapy for prostate cancer - Abstract

PURPOSE: To determine whether residual interfraction seminal vesicle (SV) displacement necessitates specific planning target volume (PTV) margins during fiducial-guided intensity modulated radiation therapy (IMRT) of the prostate.

METHODS: A planning computed tomography (CT) scan and 2 subsequent CT scans were prospectively obtained for 20 prostate cancer patients with intraprostatic fiducial markers. After CT registration, SV displacement relative to the prostate was quantified as a function of margin size for both the proximal (1 cm) SV (PSV) and the full SV (FSV). Two IMRT plans were simulated for each patient (prostate + PSV and prostate + FSV) both with a uniform 5-mm PTV margin. Minimum clinical target volume (CTV) dose (Dmin) and the volume of SV receiving 95% of the prescription dose (V95%) were assessed during treatment and compared with the initial plan.

RESULTS: In all cases, SV displacement with respect to the prostate was greater for the FSV compared with the PSV. To ensure at least 95% geometrical coverage of the CTV for 90% of patients, margins of 5 and 8 mm were required for the PSV and FSV, respectively. Dosimetrically, residual SV displacement had minimal impact on PSV coverage compared with FSV coverage. For the PSV Dmin was ≥95% of the prescribed dose in 90% of patients with an overall mean V95% of 99.6 ± 0.8%; for the FSV Dmin was ≥95% of the prescribed dose in only 45% of patients with a mean V95% of 97.9 ± 2.4%.

CONCLUSIONS: The SVs move differentially from the prostate and exhibit greater variation with increasing distance from the prostate. For plans targeting just the prostate and PSVs, 5-mm PTV expansions are adequate. However, despite daily localization of the prostate, larger PTV margins are required for cases where the intent is to completely cover the FSV.

Stenmark MH, Vineberg K, Ten Haken RK, Hamstra DA, Feng M.   Are you the author?
Department of Radiation Oncology, University of Michigan, Ann Arbor, MI.

Reference: Med Dosim. 2011 Dec 19. Epub ahead of print.
doi: 10.1016/j.meddos.2011.09.002

PubMed Abstract
PMID: 22189029 Prostate Cancer Section