Construction of a Simple Rectum Model Using Image Guidance in Prostate Patients Treated with 3D Conformal Radiotherapy — Oak Academic Publishing
Research ArticleOpen AccessGoogle Scholar indexed
Construction of a Simple Rectum Model Using Image Guidance in Prostate Patients Treated with 3D Conformal Radiotherapy
Laboratory of Medical Physics and Expert Systems, National Cancer Institute Regina Elena, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Biomedicine and Prevention, Medical Physics Section, Tor Vergata University, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
,
Department of Biomedicine and Prevention, Medical Physics Section, Tor Vergata University, Rome, Italy
,
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
1 Laboratory of Medical Physics and Expert Systems, National Cancer Institute Regina Elena, Rome, Italy
2 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
3 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
4 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
5 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
6 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
7 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
8 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
9 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
10 Department of Biomedicine and Prevention, Medical Physics Section, Tor Vergata University, Rome, Italy
11 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
12 Department of Biomedicine and Prevention, Medical Physics Section, Tor Vergata University, Rome, Italy
13 Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata University General Hospital, Rome, Italy
Purpose: To evaluate the performance of a rectum model in predicting late rectal toxicity of prostate patients undergoing 3D conformal radiation therapy while following a dietary protocol combined with image guidance. Methods: A linear accelerator equipped with a Cone Beam Computed Tomography (CBCT) system was used to treat 20 patients who were following a dietary protocol. The set-up was verified by co-registering CBCT scans with the planning CT scan (pCT). A mean dose volume histogram (< DVH > ) as the arithmetical mean of the rectum DVHs from each CBCT scan was obtained. A suitably defined 3D rectum model (Average Rectum, AR) was defined and its DVH (DVH AR ) was calculated. DVHs were also evaluated for the first five CBCT scans using both methods ( < DVH 5 > and DVH AR5 ). The Lyman-Kutcher-Burman NTCP model with QUANTEC parameters was used to compare the calculated DVHs. The QUANTEC dose values were used to describe the time behaviour of the relative volumes using the Gamma Distribution for the frequency of the relative rectum volumes at each QUANTEC dose value. Results: No statistically significant differences between NTCP AR5 and NTCP AR and between NTCP < DVH5 > and NTCP < DVH > were found. The best agreement with the observed toxicity rate (0%) was obtained form DVH AR. The Gamma Distributions of the rectum volumes at the QUANTEC dose levels were found to be highly variable among the patients. Conclusions: Both dietary protocol and image guidance were found effective in limiting late rectal toxicity. AR was a better predictor for late rectal toxicity and better described the rectum volume during the treatment course. Finally, from the Gamma distributions, and from our toxicity data, we can suggest V 75 as the best predictor of late rectal toxicity.
Jemal, A., Siegel, R., Ward, E., Hao, Y., Xu, J. and Thun, M.J. (2009) Cancer Statistics, 2009. CA: A Cancer Journal for Clinicians, 59, 225-249. http://dx.doi.org/10.3322/caac.20006
Ferlay, J., Autier, P., Boniol, M., Heanue, M., Colombet, M. and Boyle, P. (2007) Estimates of Cancer Incidence and mortality in Europe in 2006. Annals of Oncology, 18, 581-592. http://dx.doi.org/10.1093/annonc/mdl498
Peschel, R.E. and Colberg, J.W. (2003) Surgery, Brachytherapy, and External-Beam Radiotherapy for Early Prostate Cancer. Lancet Oncology, 4, 233-241. http://dx.doi.org/10.1016/S1470-2045(03)01035-0
Kuban, D.A., Tucker, S.L., Dong, L., Starkschall, G., Huang, E.H., Cheung, M.R., Lee, A.K. and Pollack, A. (2008) Long-Term Results of the M. D. Anderson Randomized Dose-Escalation Trial for Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 70, 67-74. http://dx.doi.org/10.1016/j.ijrobp.2007.06.054
Kupelian, P.A., Reddy, C.A., Carlson, T.P., Altsman, K.A. and Willoughby, T.R. (2002) Preliminary observations on biochemical relapse-free survival rates after short-course intensity-modulated radiotherapy (70 Gy at 2.5 Gy/fraction) for localized prostate cancer. International Journal of Radiation Oncology*Biology*Physics, 53, 904-912. http://dx.doi.org/10.1016/S0360-3016(02)02836-5
Herold, D.M., Hanlon, A.L. and Hanks, G.E. (1999) Diabetes Mellitus: A Predictor for Late Radiation Morbidity. International Journal of Radiation Oncology*Biology*Physics, 43, 475-479. http://dx.doi.org/10.1016/S0360-3016(98)00460-X
Peeters, S.T., Lebesque, J.V., Heemsbergen, W.D., van Putten, W.L., Slot, A., Dielwart, M.F., et al. (2006) Localized Volume Effects for Late Rectal and Anal Toxicity after Radiotherapy for Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 64, 1151-1161. http://dx.doi.org/10.1016/j.ijrobp.2005.10.002
Vavassori, V., Fiorino, C., Rancati, T., Magli, A., Fellin, G., Baccolini, M., et al. (2007) Predictors for Rectal and Intestinal Acute Toxicities during Prostate Cancer High-Dose 3D-CRT: Results of a Prospective Multicenter Study. International Journal of Radiation Oncology*Biology*Physics, 67, 1401-1410. http://dx.doi.org/10.1016/j.ijrobp.2006.10.040
Liu, M., Pickles, T., Agranovich, A., Berthelet, E., Duncan, G., Keyes, M., et al. (2004) Impact of Neoadjuvant Androgen Ablation and Other Factors on Late Toxicity after External Beam Prostate Radiotherapy. International Journal of Radiation Oncology*Biology*Physics, 58, 59-67.
Boersma, L.J., van den Brink, M., Bruce, A.M., Shouman, T., Gras, L., Annet te Velde, et al. (1998) Estimation of the Incidence of Late Bladder and Rectum Complications after High-Dose (70-78 Gy) Conformal Radiotherapy for Prostate Cancer, Using Dose-Volume Histograms. International Journal of Radiation Oncology*Biology*Physics, 41, 83-92.
Fiorino, C., Sanguineti, G., Cozzarini, C., Fellin, G., Foppiano, F., Menegotti, L., et al. (2003) Rectal Dose-Volume Constraints in High-Dose Conformal Radiotherapy for Localized Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 57, 953-962.
Rancati, T., Fiorino, C., Gagliardi, G., Cattaneo, G.M., Sanguineti, G., Borca, V.C., et al. (2004) Fitting Late Rectal Bleeding Data Using Different NTCP Models: Results from an Italian Multi-Centric Study (AIROPROS0101). Radiotherapy and Oncology, 73, 21-32. http://dx.doi.org/10.1016/j.radonc.2004.08.013
Fellin, G., Fiorino, C., Rancati, T., Valvassori, V., Barra, S., Cagna, E., et al. (2008) Late Rectal Bleeding after Conformal Radiotherapy for Prostate Cancer: NTCP Modelling. Radiotherapy and Oncology, 88, S332-S333.
Fiorino, C., Fellin, G. and Rancati, T. (2008) Clinical and Dosimetric Predictors of Late Rectal Syndrome after 3DCRT for Localized Prostate Cancer: Preliminary Results of a Multicenter Prospective Study. International Journal of Radiation Oncology*Biology*Physics, 70, 1130-1137.
Gulliford, S.L., Foo, K., Morgan, R.C., Aird, E.G., Bidmead, A.M., Critchley, H., et al. (2010) Volume Constraints to Reduce Rectal Side Effects from Prostate Radiotherapy: Evidence from mrc rt01 Trial isrctn 47772397. International Journal of Radiation Oncology*Biology*Physics, 76, 747-754.
Michalski, J.M., Gay, H., Jackson, A., Tucker, S.L. and Deasy, J.O. (2010) Radiation Dose-Volume Effects in Radiation-Induced Rectal Injury. International Journal of Radiation Oncology Biology Physics, 76, S123-S129.
Rancati, T., Fiorino, C., Fellin, G., Vavassori, V., Cagna, E., Borca, V.C., et al. (2011) Inclusion of Clinical Risk Factors into NTCP Modelling of Late Rectal Toxicity after High Dose Radiotherapy for Prostate Cancer. Radiotherapy and Oncology, 100, 124-130. http://dx.doi.org/10.1016/j.radonc.2011.06.032
Onal, C., Topkan, E., Efe, E., Yavuz, M., Sonmez, S. and Yavu, A. (2009) Comparison of Rectal Volume Definition Techniques and Their Influence on Rectal Toxicity in Patients with Prostate Cancer Treated with 3D Conformal Radiotherapy: A Dose-Volume Analysis. Radiation Oncology, 4, 14.
Boehmer, D., Kuczer, D., Badakhshi, H., Stiefel, S., Kuschke, W., Wernecke, K.D. and Budach, V. (2006) Influence of Organ at Risk Definition on Rectal Dose-Volume Histograms in Patients with Prostate Cancer Undergoing ExternalBeam Radiotherapy. Strahlentherapie und Onkologie, 82, 277-282. http://dx.doi.org/10.1007/s00066-006-1462-7
O’Donnel, H.E., Finnegan, K., Eliades, H., Oliveros, S. and Plawman, P.N. (2008) Re-Defining Rectal Volume and DVH for Analysis of Rectal Morbidity Risk after Radiotherapy for Early Prostate Cancer. The British Journal of Radiology, 81, 327-332. http://dx.doi.org/10.1259/bjr/75868623
Kupelian, A.P., Langen, K.M., Willoughby, T.R., Zeidan, O.A. and Sanford, L.M. (2008) Image-Guided Radiotherapy for Localized Prostate Cancer: Treating a Moving Target. Seminars in Radiation Oncology, 18, 58-66. http://dx.doi.org/10.1016/j.semradonc.2007.09.008
Huang, K., Palma, D.A., Scott, D., McGregor, D., Gaede, S., Yartsev, S., Bauman, G., Louie, A.V. and Rodrigues, G. (2012) Inter-and Intrafraction Uncertainty in Prostate Bed Image-Guided Radiotherapy. International Journal of Radiation Oncology*Biology*Physics, 84, 402-407. http://dx.doi.org/10.1016/j.ijrobp.2011.12.035
Thor, M., Bentzen, L., Hysing, L.B., Ekanger, C., Helle, S.I., Karlsdóttir, á., et al. (2013) Prediction of Rectum and Bladder Morbidity Following Radiotherapy of Prostate Cancer Based on Motion-Inclusive Dose Distributions. Radiotherapy and Oncology, 107, 147-152. http://dx.doi.org/10.1016/j.radonc.2013.03.029
Thor, M., V?th, M., Karlsdottir, á. and Muren, L.P. (2010) Rectum Motion and Morbidity Prediction: Improving Correlation between Late Morbidity and DVH Parameters through Use of Rectum Planning Organ at Risk Volumes. Acta Oncologica, 49, 1061-1068. http://dx.doi.org/10.3109/0284186X.2010.505200
Smitsmans, M.H.P., Floris, J.P., de Bois, R.T.T.J., Wilma, D., Heemsbergen, W.D., Sonke, J.J., Lebesque, J.V., et al. (2008) The Influence of a Dietary Protocol on Cone Beam CT-Guided Radiotherapy for Prostate Cancer Patients. International Journal of Radiation Oncology*Biology*Physics, 71, 1279-1286.
Falco, M.D., D’Andrea, M., Fedele, D., Barbarino, R., Benassi, M., Giudice, E., et al. (2011) Preliminary Experience of a Predictive Model to Define Rectal Volume and Rectal Dose during the Treatment of Prostate Cancer. The British Journal of Radiology, 84, 819-825. http://dx.doi.org/10.1259/bjr/25741415
Kutcher, G.J., Burman, C., Brewster, L., Goitein, M. and Mohan, R. (1991) Histogram Reduction Method for Calculating Complication Probabilities for Three Dimensional Treatment Planning Evaluations. International Journal of Radiation Oncology*Biology*Physics, 21, 137-146.
Falco, M.D., Fontanarosa, D., Miceli, R., Carosi, A., Santoni, R. and D’Andrea, M. (2011) Preliminary Studies for a CBCT Imaging Protocol for Off-Line Organ Motion Analysis: Registration Software Validation and CTDI Measurements. Medical Dosimetry, 36, 91-101. http://dx.doi.org/10.1016/j.meddos.2010.01.003
Peeters, S.T., Heemsbergen, W.D., van Putten, W.L.J., Scot, A., Tabak, H., Mens, J.W., et al. (2005) Acute and Late Complications after Radiotherapy for Prostate Cancer: Results of a Multicenter Randomized Trial Comparing 68 Gy to 78 Gy. International Journal of Radiation Oncology*Biology*Physics, 61, 1019-1034.
Liu, M., Berthelet, E., Patterson, K., Dick, K. and Kwan, W. (2003) Various Techniques of Contouring the Rectum and Their Impact on Rectal Dose-Volume Histograms. Medical Dosimetry, 28, 189-192. http://dx.doi.org/10.1016/S0958-3947(03)00071-2
Peeters, S.T.H., Hoogeman, M.S., Heemsbergen, W.D., Hart, A.A.M., Koper, P.C.M. and Lebesque, J.V. (2006) Rectal Bleeding, Fecal Incontinence and High Stool Frequency after Conformal Radiotherapy for Prostate Cancer: Normal Tissue Complication Probability Modelling. International Journal of Radiation Oncology Biology Physics, 66, 11-19.
Huang, E.H., Pollack, A., Levy, L., Starkschall, G., Dong, L., Rosen, I., et al. (2002) Late Rectal Toxicity: Dose-Volume Effects of Conformal Radiotherapy for Prostate Cancer. International Journal of Radiation Oncology*Biology* Physics, 54, 1009-1119.
Nuyttens, J.J., Milito, S., Rust, P.F. and Turrisi, A.T. (2002) Dose-Volume Relationship for Acute Side Effects during High Dose Conformal Radiotherapy for Prostate Cancer. Radiotherapy and Oncology, 64, 209-214. http://dx.doi.org/10.1016/S0167-8140(02)00185-8
Marzi, S., Arcangeli, G., Saracino, B., Petrongari, M.G., Bruzzaniti, V., Iaccarino, G., et al. (2007) Relationships between Rectal Wall Dose-Volume Constraints and Radiobiologic Indices of Toxicity for Patients with Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 68, 41-49.
Vargas, C., Martinez, A., Kestin, L.L., Yan, D., Grills, I., Brabbins, D.S., et al. (2005) Dose Volume Analysis of Predictors for Chronic Rectal Toxicity after Treatment of Prostate Cancer with Adaptive Image-Guided Radiotherapy. International Journal of Radiation Oncology*Biology*Physics, 62, 1297-1308.
Zelefsky, M.J., Levin, E.J., Hunt, M., Yamada, Y., Shippy, A.M., Jackson, A. and Amols, H.I. (2008) Incidence of Late Rectal and Urinary Toxicities after Three-Dimensional Conformal Radiotherapy and Intensity-Modulated Radiotherapy for Localized Prostate Cancer. International Journal of Radiation Oncology*Biology*Physics, 70, 1124-1129.