Comunicazione orale o poster

D. terapia radiante
5. prostata

100-600 parole

Intraprostatic fiducials markers stability during radiation treatment

G. Mantello, F.Fenu, B.Vagnoni, L.Vicenzi, F.Cucciarelli, L.Balardi, M.Valenti, G.Muzzonigro,
A.B.Galosi, S.Maggi, M.Cardinali
MNTGNN62E63742A
SOD Radioterapia Azienda Ospedaliero-Universitaria Ospedali Riuniti Ancona
SOD Fisica Sanitaria
Clinica Urologica
UOC Urologia Ospedale Augusto Murri- Fermo
Introduction/Background/Aim
The use of fiducials markers (FM) as surrogate of prostate position in IGRT
modality requires a stable markers position within the gland. Several factors
can affect their stability as the spontaneous marker migration soon after
implantation or prostate volume
reduction or deformation during the
radiotherapy course.
Aim of this study was to assess the true marker migration, if it occurs, during
the full course of prostate radiotherapy.
Materials and Methods
The analysis was performed on 55 low risk cT1-2 prostate cancer patients, treated with
Image Guided Radiotherapy between June 2009 and May 2014. Three markers were
implanted at the base (A), middle (B) and apex (C) of the gland (gold markers in 40 patients and
carbon steel 15patients). All patients underwent computed tomography (CT sim) 1-mm thickness
within 10 days after implantation; a daily CBCT was used to correct prostate organ motion
checking markers position before each treatment session . Retrospectively CT sim and CBCTs
acquired at 1st , 10th , 20th , 30th and 39th fraction were used to record FM coordinates
(x,y,z). The distances between markers (FMD) as AB, BC, CA were measured in mm as:
.
FMDs variations before and during the full course of radiotherapy were then calculated as the
differences between CBCTs and CTs data.
Results
990 FDMs (mm) were recorded . The average absolute variation of all FMDs
was 1,200,67 mm. The largest observed variation in FMD was 8,96
mm.
94% of recorded variations were 3 mm or less , while 80% were 2 mm or less.
A simultaneous progressive reduction of FMDs (negative values in mm) was
seen in 77% of patients and it was related to the shrinking of the prostate
volume during the treatment (Fig 1).
Three main trends of the FMDs variation were observed: a) constant reduction
of FMDs due to the prostate volume reduction during the all treatment (fig 2a);
b) initial increase of the FMDs due to the large edema post implantation (fig
2b); c) multiple peaks of the FMDs due to the prostate organ motion.
No correlation was found between FMD variations and initial prostate volume.
Smaller variations were recorded in patients with gap between markers
1

implantation and CT sim acquisition 10 days and in patients with

between CT sim and the start of the Radiotherapy 22 days.

gap

Discussion and Conclusion

The results obtained in our patient population indicate small variations in the
relative position of the markers (1,20 0,67 mm), in accordance with the
literature data [1-3]. The obtained values could be related to the uncertainties
of our IGRT System (also marker length = 3 mm) rather than to the markers
migration.
References
[1] Kupelian A.K., Willoughby T.R., Meeks S.L., Forbes A., Wagner T., Maach M., Langen K., Intraprostatic fiducials for
localization of the prostate gland: monitoring intermarker distances during radiation therapy to test for marker stability, Int. J.
Radiation Oncology Biol. Phys., Vol. 62, No. 5, pp. 12911296, 2005
[2] Udrescu C., De Bari B., Rouvire O., Ruffion A., Michel-Amadry G., Jalade P., Devonec M., Colombel M., Chapet O., Does
hormone therapy modify the position of the gold markers in the prostate during irradiation? A daily evaluation with kV-images,
Cancer/Radiothrapie 17 (2013) 21522
[3] Poggi M.M., Gant D.A., Sewchand W., Warlick W.B., Marker seed migration in prostate localization, Int. J. Radiation Oncology
Biol. Phys., Vol. 56, No. 5, pp. 12481251, 2003