Clinical experience and feasibility of using 2D-kVimage online intervention in the ultrafractionated stereotactic radiation treatment of prostate cancer Journal Article


Authors: Kuo, H. C.; Della-Biancia, C.; Damato, A. L.; Happersett, L.; Lim, S. B.; Cerviño, L. I.; Shasha, D.; Berry, S.
Article Title: Clinical experience and feasibility of using 2D-kVimage online intervention in the ultrafractionated stereotactic radiation treatment of prostate cancer
Abstract: Purpose: This study reports clinical experience and feasibility of using a 2-dimensional (2D)-kV image system with online intervention in the ultrafractionated stereotactic body radiation treatment (UF-SBRT) of prostate cancer. Methods and Materials: Fifteen patients with prostate cancer who had a low- to intermediate-risk marker implanted received UF-SBRT with online 2D-kV image tracking and a manual beam interruption strategy with a 2-mm motion threshold. A total of 180 kV paired setup images and 1272 intrabeam 2D-kV images were analyzed to evaluate the setup deviation and intratreatment target deviation. Correlation of expected treatment interruptions with a set of parameters (eg, image and treatment time; direction of deviation) was performed (Spearman test). A subset of the data from 22 fractions was re-evaluated to check the differences in analysis results between using the planning position and using the pretreatment setup position as a reference. Margins based on the derived system and random errors were calculated to evaluate the feasibility of the workflow in ensuring prostate coverage during treatment. Results: Mean target motion in 3D propagated from 1.0 mm (setup at 0 minutes) to 2.0 mm (beam on at 7 minutes) to 2.4 mm (end at 13.5 minutes). Out of 75 fractions, 50 were found to require beam interruption. Interruption had a strong correlation with prostate motion along the longitudinal direction and had moderate correlation with prostate motion along the vertical direction and the prostate's treatment starting position along vertical and longitudinal directions. Using the pretreatment position as a reference for intrabeam monitoring, the magnitude of motion deviation from the reference position was reduced by 0.3 mm at a vertical direction and 0.4 mm at lateral and longitudinal directions. The calculated 3D margin to ensure target coverage was 3.7 mm, 4.6 mm, and 5.0 mm in lateral, vertical, and longitudinal directions, respectively. Conclusions: Prostate motion propagated over time. It is feasible to use a 2D-kV online intrabeam monitoring system with a proper intervention scheme to perform UF-SBRT for prostate cancer. © 2022 American Society for Radiation Oncology
Keywords: prostatic neoplasms; feasibility study; feasibility studies; prostate tumor; radiosurgery; radiotherapy planning, computer-assisted; procedures; humans; human; male; web-based intervention; internet-based intervention
Journal Title: Practical Radiation Oncology
Volume: 13
Issue: 3
ISSN: 1879-8519
Publisher: Elsevier Inc.  
Date Published: 2023-05-01
Start Page: e308
End Page: e318
Language: English
DOI: 10.1016/j.prro.2022.10.014
PUBMED: 36476984
PROVIDER: scopus
PMCID: PMC11253237
DOI/URL:
Notes: The MSK Cancer Center Support Grant (P30 CA008748) is acknowledged in the PDF. Corresponding author is MSK author Hsiang-Chi Kuo -- Source: Scopus
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MSK Authors
  1. Seng Boh Lim
    91 Lim
  2. Sean L Berry
    70 Berry
  3. Antonio Leonardo Damato
    77 Damato
  4. Hsiang-Chi Kuo
    22 Kuo
  5. Daniel Shasha
    13 Shasha