Comparison of Image-guided Radiotherapy Technologies for Prostate Cancer

Abstract

Radiation oncology has seen a rapid increase in the use of image-guided radiotherapy technology (IGRT) for prostate cancer patients over the past decade. The increase in the use of IGRT is largely driven by the fact that these technologies have been approved by the Food and Drug Administration and are now readily reimbursed by many insurance companies. Prostate cancer patients undergoing intensity modulated radiotherapy (IMRT) now have access to a wide variety of IGRTs that can cost anywhere from $500,000 or more in upfront costs, and can add anywhere from 10 to 15 thousand dollars to a course of IMRT. Some of the IGRT options include daily cone beam computed tomography, ultrasound, orthogonal x-ray units using implanted fiducial markers, implanted radiofrequency markers with the ability to localize and track prostate motion during radiotherapy (Calypso 4D), and cine magnetic resonance imaging. Although these technologies add to the cost of IMRT, there is little direct comparative effectiveness data to help patients, physicians, and policy makers decide if one technology is better than another. In our critical review, the first of its kind, we summarize the advantages, disadvantages, and the limitations of each technology. We also provide an overview of existing literature as it pertains to the comparison of existing IGRTs. Lastly, we provide insights about the need for future outcomes research that may have a significant impact on health policies as it comes to reimbursement in the modern era.

Continuous Monitoring and Intrafraction Target Position Correction During Treatment Improves Target Coverage for Patients Undergoing SBRT Prostate Therapy

“…The need for CMI, given the tight 3-mm posterior margin, is consistent with the findings of Mayyas et al (14), who reported that a posterior margin of 3.9 mm was needed to account for residual setup error and intrafractional motion. A study by Wu et al (3) and a review Das et al (15) also pointed out that the Calypso-based intervention would make possible the detection and correction of patients exhibiting occasional large shifts. This will be of much greater importance in hypofractionated treatment.…”

Feasibility of MRI-only treatment planning for proton therapy in brain and prostate cancers: Dose calculation accuracy in substitute CT images

“…[51][52][53][54][55] Our robustness settings assume that any systematic and random shift in the target position will be accounted for using daily online imaging and position correction; this would be reasonable for proton therapy given recent developments in IGRT. [56][57][58] Robustness settings would have no impact on the average dose agreement between heterogeneous sCT and CT. Different perturbation distances might shift the observed gamma pass rates for homogeneous sCT and dual bulk sCT relative to the (dotted) line of equivalence on Fig.…”

Comparison between electromagnetic transponders and radiographic imaging for prostate localization: A pelvic phantom study with rotations and translations

“…In current radiotherapy practice, various methods of target localization are used to correct for prostate motion 6. Standard practice in Australia is to use radiographic imaging to visualize radiopaque fiducial markers implanted into the prostate 2, 7.…”