Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences

Shakir, Shakir I.; Udrescu, C.; Enachescu, C.; Rouvière, Olivier; Arion, S.; Caraivan, I.; Chapet, O.

doi:10.1016/j.ejmp.2016.10.009

Cited by 9 publications

(8 citation statements)

References 30 publications

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“…There is no risk of pneumothorax in the case of bronchoscopic insertion. It is necessary to check the position of all fiducial markers before irradiation because fiducial markers may migrate or fall [22][23][24][25].…”

Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy

et al. 2019

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To quantitatively evaluate and compare the image recognition performance of multiple fiducial markers available in real-time tumor-tracking radiation therapy (RTRT). Methods: Clinically available markers including sphere shape, coil shape, cylinder shape, line shape, and ball shape (folded line shape) were evaluated in liver and lung models of RTRT. Maximum thickness of the polymethyl metacrylate (PMMA) phantom that could automatically recognize the marker was determined by template-pattern matching. Image registration accuracy of the fiducial marker was determined using liver RTRT model. Lung RTRT was mimicked with an anthropomorphic chest phantom and a one-dimensional motion stage in order to simulate marker motion in heterogeneous fluoroscopic images. The success or failure of marker tracking and image registration accuracy for the lung model were evaluated in the same manner as that for the liver model. Results: All fiducial markers except for line shape and coil shape of thinner diameter were recognized by the PMMA phantom, which is assumed to have the typical thickness of an abdomen, with twodimensional image registration accuracy of <2 pixels. Three-dimensional calculation error with the use of real-time stereoscopic fluoroscopy in RTRT was thought to be within 1 mm. In the evaluation using the lung model, the fiducial markers were recognized stably with sufficient accuracy for clinical application. The same was true for the evaluation using the liver model. Conclusions: The image recognition performance of fiducial markers was quantified and compared. The results presented here may be useful for the selection of fiducial markers.

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Section: Discussionmentioning

confidence: 99%

Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy

et al. 2019

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“…Shakir et al evaluated the positional stability of fiducial markers in seven patients who underwent prostate bed salvage radiotherapy due to the presence of macroscopic recurrence. 12 The radiotherapy dose was 60 Gy to the prostate bed and 72 Gy to the recurrent nodule. The distance variation between the fiducial markers was found to be ≤1 mm in 72% and ≤2 mm in 94•3%.…”

Section: Discussionmentioning

confidence: 99%

“…The specifications of the fiducial markers have been published elsewhere. 12 In summary, fiducial markers are cylindrical in shape and made of 24-carat gold. They measure 0•5-1•5 mm in diameter and 2-5 mm in length.…”

Section: Patientsmentioning

confidence: 99%

“…11 Various image-guided radiation therapy (IGRT) methods have been used to assess prostate bed motion such as ultrasound, cone beam CT (CBCT), electronic portal imaging, kilovoltage (KV) orthogonal imaging, surgical clips and gold seed fiducial markers. [12][13][14][15][16][17][18][19][20][21][22] The use of fiducials specifically in post-prostatectomy patients has been uncommon due to the lack of an intact organ where they can be implanted. 23 The present study was undertaken to determine the feasibility of using gold seed fiducial markers for prostate bed localisation, determine the magnitude of prostate bed motion and provide recommendations regarding appropriate planning target volume (PTV) margins in post-prostatectomy radiation therapy.…”

Section: Introductionmentioning

confidence: 99%

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Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy

et al. 2019

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Aim: Accurate localisation of target position is crucial when using techniques with sharp dose fall off such as volumetric modulated arc therapy (VMAT). Gold seed fiducial markers have been used for target localisation in image-guided radiation therapy for various tumors including intact prostate cancers. However, their role for target localisation in post-prostatectomy radiotherapy is unclear. This study was undertaken to determine the feasibility and effectiveness of gold seed fiducial markers in patients undergoing prostate bed VMAT. Materials and methods: The institutional radiation oncology database was used to analyse the treatment data of 18 post-prostatectomy patients with implanted gold seed fiducial markers. The shifts of the fiducial markers were reviewed, tabulated and statistically analysed. Results: Three hundred and eighty-six orthogonal pair images for 18 patients were reviewed. Specifically, the average gold seed fiducial shifts were 0·34 cm in the superior–inferior (S/I) axis (0·31 SD), 0·31 cm (0·29 SD) in the anterior–posterior (A/P) axis and 0·28 cm (0·25 SD) in the lateral axis (R/L). As a result, the 95% probability of fiducial marker displacement was 0·96 cm in the S/I, 0·89 cm in the A/P and 0·78 cm in the R/L axes. The most frequent shifts occurred in the inferior, left and posterior directions. The percentage of shifts more than 0·5 cm were 19·74, 21·56 and 12·47% for the S/I, A/P and R/L axes, respectively. Conclusion: In the absence of fiducial markers, non-uniform planning target volume (PTV) margins of 1 cm for S/I, 9 mm for A/P and 8 mm for the lateral direction are necessary for target localisation in post-prostatectomy radiotherapy. By improving prostate bed localisation, gold seed fiducial markers can decrease PTV margins, reduce normal tissue radiation exposure and allow for dose-escalated and/or hypofractionated radiotherapy to be considered in appropriate clinical scenarios.

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“…However, the placement of only one marker is easier and looks sufficient as rotation movement might be limited (19). Shakir et al used 3 gold markers in the prostate bed for salvage therapy and showed that, despite the absence of the prostate, the implantation of gold markers was feasible; the motion of the fiducials was often limited to <2 mm (20). No biopsy was performed in the other series (12)(13)(14).…”

Section: Discussionmentioning

confidence: 99%

Stereotactic reirradiation for local recurrence in the prostatic bed after prostatectomy: Preliminary results

Olivier¹,

Basson²,

Puech³

et al. 2019

European Urology Supplements

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Objectives: To report the preliminary results of salvage re-irradiation in the prostatic bed after radical prostatectomy and salvage external beam radiation therapy (EBRT) using robotic stereotactic body radiation therapy (SBRT) with Cyberknife ® for local recurrence of prostate cancer. Materials and Methods: Retrospective monocentric analysis was performed on patients treated with SBRT for isolated macroscopic recurrence in the prostatic bed. All patients had radical prostatectomy and salvage or adjuvant EBRT. Local recurrence was documented using magnetic resonance imaging (MRI) and positron emission tomography (PET). Biochemical recurrence was defined as 2 rises in prostate-specific antigen (PSA) of ≥ 0.2 ng/mL above nadir. Internal gold fiducials were used for the tracking of tumor motion during SBRT. The prescription dose was 36 Gy in 6 fractions for all patients. Toxicity was scored according to the CTCAE v4.0. Results: Between July 2011 and November 2017, 12 patients were treated with SBRT for prostatic bed recurrence with a median follow-up of 34.2 (range, 3.5-64.4) months. Isolated non-metastatic recurrence in the prostatic bed was seen at MRI and PET imaging. Two patients were treated with 6 months androgen deprivation therapy (ADT) concomitant with re-irradiation. The median planning target volume was 4.5 cm 3 (range, 1.2-13.3). A PSA decrease after SBRT was found in 10 (83%) patients. The 1 and 2 years biochemical recurrence-free survival rates were 79 and 56%, respectively. Biochemical recurrence was observed for 6 patients (50%) after a median time of 18 (4-42) months. Toxicity showed: 3 patients (25%) with grade 1 cystitis and 1 patient (8%) with acute grade 2 proctitis at 4 months. One patient (13%) had grade 1 cystitis at 12 months. Conclusion: Re-irradiation for local recurrence in the prostatic bed using Cyberknife ® after surgery and salvage or adjuvant EBRT is well-tolerated and associated with 2 years biochemical recurrence-free survival rates of 56%. Longer follow-up and larger series are necessary.

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Transrectal implantation and stability of gold markers in prostate bed for salvage radiotherapy of macroscopic recurrences

Cited by 9 publications

References 30 publications

Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy

Quantitative evaluation of image recognition performance of fiducial markers in real-time tumor-tracking radiation therapy

Role of fiducial markers in the assessment of prostate bed motion in post-prostatectomy patients treated with volumetric modulated arc therapy

Stereotactic reirradiation for local recurrence in the prostatic bed after prostatectomy: Preliminary results

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