Impact of rotational errors of whole pelvis on the dose of prostate-based image-guided radiotherapy to pelvic lymph nodes and small bowel in high-risk prostate cancer

Hiroki Katayama; Shigeo Takahashi; Takuya Kobata; Akihiro Oishi; Toru Shibata

doi:10.5603/RPOR.a2021.0107

Impact of rotational errors of whole pelvis on the dose of prostate-based image-guided radiotherapy to pelvic lymph nodes and small bowel in high-risk prostate cancer

Rep Pract Oncol Radiother. 2021 Dec 30;26(6):906-914. doi: 10.5603/RPOR.a2021.0107. eCollection 2021.

Authors

Hiroki Katayama¹, Shigeo Takahashi², Takuya Kobata¹, Akihiro Oishi¹, Toru Shibata²

Affiliations

¹ Department of Clinical Radiology, Kagawa University Hospital, Kagawa, Japan.
² Department of Radiation Oncology, Kagawa University Hospital, Kagawa, Japan.

Abstract

Background: The target volume increases when the prostate and pelvic lymph nodes (PLNs) are combined, and the fiducial markers (FMs) are placed at the edge of the irradiation field. Thus, the position of FMs may be changed by the rotational errors (REs) of "whole pelvis". The aim of this study was to examine the impact of REs of "whole pelvis" on the dose of FMs-based image-guided radiotherapy to the PLNs and the small bowel in prostate cancer including the PLNs.

Materials and methods: We retrospectively evaluated 10 patients who underwent prostate cancer radiotherapy involving the PLNs. The position of FMs was calculated from the radiographs obtained before and after the 6D correction of pelvic REs. We simulated the delivery dose considering the daily pelvic REs and calculated the difference from the planned dose in the D_98% of the PLN clinical target volume and the D_2cc, and V_45Gy of the small bowel.

Result: The position of FMs strongly correlated with the pelvic REs in the pitch direction (r = 0.7788). However, the mean delivered doses to PLNs for 10 patients were not significantly different from the planned doses (p = 0.625). Although the D_2cc and V_45Gy of the small bowel strongly correlated with the pitch rotation of the pelvis, there was no significant difference between the delivered and planned doses (p = 0.922 and p = 0.232, respectively).

Conclusion: The dosimetric effect of pelvic REs on the dose to PLNs and the small bowel was negligible during the treatment course.

Keywords: fiducial marker; image-guided radiotherapy (IGRT); pelvic lymph nodes; prostate cancer; rotational errors.