Practical Issues in the Implementation of Image-guided Radiotherapy for the Treatment of Prostate Cancer within a UK Department

Rimmer, Y.; Burnet, N.G.; Routsis, D.; Twyman, N.; Hoole, A.; Treeby, Jo; Welford, D.; Fairfoul, J.; Aho, Tevita; Vowler, SL; Benson, Richard

doi:10.1016/j.clon.2007.10.001

Cited by 13 publications

(20 citation statements)

References 40 publications

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“…6 Currently, most literature reports the insertion of seeds by a urologist under transrectal ultrasound guided implantation. 7 In current practice described by Rimmer et al, 8 three seeds are inserted using the following seed positions/locations: one seed at the base of the prostate, one at the apex and one in the left lateral position of the prostate. 7 In current practice described by Rimmer et al, 8 three seeds are inserted using the following seed positions/locations: one seed at the base of the prostate, one at the apex and one in the left lateral position of the prostate.…”

Section: Introductionmentioning

confidence: 99%

“…Van den Heuvel et al 7 proved that implanting a larger number of seeds did not provide increased accuracy in prostate localisation. 8 The use of seeds in prostate cases is based on the assumption that the markers are fixed within the prostate, however, this is not always the case. 8 The use of seeds in prostate cases is based on the assumption that the markers are fixed within the prostate, however, this is not always the case.…”

Section: Introductionmentioning

confidence: 99%

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The stability of seeds in external beam prostate radiotherapy and implications of migration in current practice: a systematic review

Soprun¹,

Sale

Knight³

2014

J Radiother Pract

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Purpose: To determine and summarise the literature on prostatic seed stability by investigating seed marker migration and loss in prostate cancer patients. In addition, documenting the implications of significant seed migration and loss in clinical practise.Methods: PubMed and Sciencedirect databases were used to locate papers on the stability of gold seed markers in prostate patients treated with external beam radiation therapy. The search found 3,238 articles and ten articles were selected and reviewed based on inclusion and exclusion criteria for the scope of this literature review.Results: Minimal migration and loss of seeds was observed in the literature reviewed, with the majority of authors reporting <2·0 mm migration within the prostate; however, there were individual cases reported outside of the 2·0 mm threshold. It was also found that significant migration had an impact on image matching, as well as, planning treatment volume margins.Conclusion: Seed stability within the prostate has been proven, with most authors reporting minimal migration within a 2·0 mm threshold and minimal loss of seeds. Although individual cases can have significant migration and loss, if marker migration exceeds the 2·0 mm threshold, a protocol is required to deal with both non-significant and significant migration.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The stability of seeds in external beam prostate radiotherapy and implications of migration in current practice: a systematic review

Soprun¹,

Sale

Knight³

2014

J Radiother Pract

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“…For tumours in the head and neck, the close proximity of the target to other structures makes IMRT an attractive option, and the evidence for reduction in long-term side effects with IMRT is most notable in this site. Image guidance is attractive for mobile internal targets such as the prostate [10,18]. Many other sites may also benefit from the combined techniques.…”

mentioning

confidence: 99%

“…For a mobile structure, such as the prostate, this also includes an important contribution from random day-to-day variation in the position of the prostate within the patient [10]. Image guidance has been revolutionised by the integration of online imaging capability on linear accelerators, with full software integration for image matching and positional correction.…”

mentioning

confidence: 99%

The value of image-guided intensity-modulated radiotherapy in challenging clinical settings

Treece

Mukesh²,

Rimmer³

et al. 2013

BJR

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“…Intrafraction motion changes during the delivery over the time period of seconds and minutes and includes anatomical changes such as bowel movements, respiration and heartbeats. Studies have been carried out to determine the magnitude of inter-and intrafraction motion at different tumour sites [30][31][32].…”

Section: Motionmentioning

confidence: 99%

Treatment planning optimisation in proton therapy

McGowan¹,

Burnet²,

Lomax³

2013

BJR

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ABSTRACT. The goal of radiotherapy is to achieve uniform target coverage while sparing normal tissue. In proton therapy, the same sources of geometric uncertainty are present as in conventional radiotherapy. However, an important and fundamental difference in proton therapy is that protons have a finite range, highly dependent on the electron density of the material they are traversing, resulting in a steep dose gradient at the distal edge of the Bragg peak. Therefore, an accurate knowledge of the sources and magnitudes of the uncertainties affecting the proton range is essential for producing plans which are robust to these uncertainties. This review describes the current knowledge of the geometric uncertainties and discusses their impact on proton dose plans. The need for patient-specific validation is essential and in cases of complex intensity-modulated proton therapy plans the use of a planning target volume (PTV) may fail to ensure coverage of the target. In cases where a PTV cannot be used, other methods of quantifying plan quality have been investigated. A promising option is to incorporate uncertainties directly into the optimisation algorithm. A further development is the inclusion of robustness into a multicriteria optimisation framework, allowing a multi-objective Pareto optimisation function to balance robustness and conformity. The question remains as to whether adaptive therapy can become an integral part of a proton therapy, to allow re-optimisation during the course of a patient's treatment. The challenge of ensuring that plans are robust to range uncertainties in proton therapy remains, although these methods can provide practical solutions. The ability to create and deliver the ideal treatment plan, where the target volume receives 100% of the prescribed dose and normal tissue receives 0%, is the holy grail of radiation therapy [1]. It is, however, impossible to achieve this perfect balance. Instead, multiple trade-offs are required to achieve a clinically acceptable plan, so the problem becomes one of optimisation. There are many factors that can affect how ''optimised'' a patient's treatment can be. This review focuses on the challenges of proton therapy plan optimisation, particularly in regard to range uncertainties, and how to incorporate them into the plan evaluation and verification process.The nature of proton therapy makes the aim of cure without complications potentially more achievable, owing to the highly localised deposition of dose in the characteristic Bragg peak [2]. This relates predominantly to the ability to deliver high doses of radiation close to normal tissue structures, which would be dose limiting in conventional X-ray treatments, and to the finite range of protons, which results in a reduced integral dose to surrounding normal tissues.From a clinical perspective, the exact role of proton therapy has yet to be defined. However, for childhood cancers, proton therapy delivers a lower dose to tissues around the tumour than X-rays, resulting in less growth disturbance and l...

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Practical Issues in the Implementation of Image-guided Radiotherapy for the Treatment of Prostate Cancer within a UK Department

Cited by 13 publications

References 40 publications

The stability of seeds in external beam prostate radiotherapy and implications of migration in current practice: a systematic review

The stability of seeds in external beam prostate radiotherapy and implications of migration in current practice: a systematic review

The value of image-guided intensity-modulated radiotherapy in challenging clinical settings

Treatment planning optimisation in proton therapy

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