Gold marker displacement due to needle insertion during HDR-brachytherapy for treatment of prostate cancer: A prospective cone beam computed tomography and kilovoltage on-board imaging (kV-OBI) study

Radiation Oncology

Andrea Hille¹  Clemens F Hess¹  Hendrik A Wolff¹  Hans Christiansen¹  Mareike Herrmann²  Arne Strauss²  Mohamed Bouabdallaoui¹  Gerhard Pollul¹  Eugen Bloch¹  Tammo Gsänger¹  Tereza Kertesz¹  Markus KA Herrmann¹ 

[1] Department of Radiotherapy, University of Goettingen, Goettingen, Germany;Department of Urology, University of Goettingen, Goettingen, Germany

关键词: Intensity modulated radiotherapy;    Conformal radiotherapy;    Gold markers;    HDR-brachytherapy;    Prostate cancer;   

Others  :  1160892
DOI  :  10.1186/1748-717X-7-24

 received in 2011-11-07, accepted in 2012-02-20,  发布年份 2012

【 摘 要 】

Purpose

To evaluate gold marker displacement due to needle insertion during HDR-brachytherapy for therapy of prostate cancer.

Patients and methods

18 patients entered into this prospective evaluation. Three gold markers were implanted into the prostate during the first HDR-brachytherapy procedure after the irradiation was administered. Three days after marker implantation all patients had a CT-scan for planning purpose of the percutaneous irradiation. Marker localization was defined on the digitally-reconstructed-radiographs (DRR) for daily (VMAT technique) or weekly (IMRT) set-up error correction. Percutaneous therapy started one week after first HDR-brachytherapy. After the second HDR-brachytherapy, two weeks after first HDR-brachtherapy, a cone-beam CT-scan was done to evaluate marker displacement due to needle insertion. In case of marker displacement, the actual positions of the gold markers were adjusted on the DRR.

Results

The value of the gold marker displacement due to the second HDR-brachytherapy was analyzed in all patients and for each gold marker by comparison of the marker positions in the prostate after soft tissue registration of the prostate of the CT-scans prior the first and second HDR-brachytherapy. The maximum deviation was 5 mm, 7 mm and 12 mm for the anterior-posterior, lateral and superior-inferior direction. At least one marker in each patient showed a significant displacement and therefore new marker positions were adjusted on the DRRs for the ongoing percutaneous therapy.

Conclusions

Needle insertion in the prostate due to HDR-brachytherapy can lead to gold marker displacements. Therefore, it is necessary to verify the actual position of markers after the second HDR-brachytherapy. In case of significant deviations, a new DRR with the adjusted marker positions should be generated for precise positioning during the ongoing percutaneous irradiation.

【 授权许可】

   
2012 Herrmann et al; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Harris EJ, McNair HA, Evans PM: Feasibility of fully automated detection of fiducial markers implanted into the prostate using electronic portal imaging: a comparison of methods. Int J Radiat Oncol Biol Phys 2006, 66:1263-1270.
• [2]Osei EK, Jiang R, Barnett R, Fleming K, Panjwani D: Evaluation of daily online set-up errors and organ displacement uncertainty during conformal radiation treatment of the prostate. Br J Radiol 2009, 82:49-61.
• [3]Owen R, Kron T, Foroudi F, Cox J, Zhu L, Cramb J, et al.: The detectability and localization accuracy of implanted fiducial markers determined on in-room computerized tomography (CT) and electronic portal images (EPI). Med Dosim 2008, 33:226-233.
• [4]Schiffner DC, Gottschalk AR, Lometti M, Aubin M, Pouliot J, Speight J, et al.: Daily electronic portal imaging of implanted gold seed fiducials in patients undergoing radiotherapy after radical prostatectomy. Int J Radiat Oncol Biol Phys 2007, 67:610-619.
• [5]Van den Heuvel F, Fugazzi J, Seppi E, Forman JD: Clinical application of a repositioning scheme, using gold markers and electronic portal imaging. Radiother Oncol 2006, 79:94-100.
• [6]Edgren M, Ekelund AM, Albertsson P, Lundberg LM, Ullen A, Levitt S, et al.: High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: technical and methodological aspects. Int J Oncol 2006, 29:1517-1524.
• [7]Galalae RM, Martinez A, Nuernberg N, Edmundson G, Gustafson G, Gonzalez J, et al.: Hypofractionated conformal HDR brachytherapy in hormone naïve men with localized prostate cancer. Is escalation to very high biologically equivalent dose beneficial in all prognostic risk groups? Strahlenther Onkol 2006, 182:135-141.
• [8]Ishikawa H, Sato M, Shirai S, Kishi K, Naya Y, Tokunaga H: Interfractional fluctuation of rectal dose in high dose rate brachytherapy for prostate cancer. Radiat Med 2006, 24:610-616.
• [9]Lee B, Shinohara K, Weinberg V, Gottschalk AR, Pouliot J, Roach M, et al.: Feasibility of high-dose-rate brachytherapy salvage for local prostate cancer recurrence after radiotherapy: The University of California-San Francisco experience. Int J Radiat Oncol Biol Phys 2007, 67:1106-1112.
• [10]Martin T, Roddiger S, Kurek R, Dannenberg T, Eckart O, Kolotas C, et al.: 3D conformal HDR brachytherapy and external beam irradiation combined with temporary androgen deprivation in the treatment of localized prostate cancer. Radiother Oncol 2004, 71:35-41.
• [11]Martin T, Baltas D, Kurek R, Roddiger S, Kontova M, Anagnostopoulos G, et al.: 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study. Strahlenther Onkol 2004, 180:225-232.
• [12]Rades D, Schwarz R, Todorovic M, Thurmann H, Graefen M, Walz J, et al.: Experiences with a new high-dose-rate brachytherapy (HDR-BT) boost technique for T3b prostate cancer. Strahlenther Onkol 2007, 183:398-402.
• [13]Soumarova R, Homola L, Stursa M, Perkova H: Acute toxicity of conformal high dose interstitial brachytherapy boost in prostate cancer. Neoplasma 2006, 53:410-417.
• [14]Van Gellekom MP, Moerland MA, Kal HB, Battermann JJ: Biologically effective dose for permanent prostate brachytherapy taking into account postimplant edema. Int J Radiat Oncol Biol Phys 2002, 53:422-433.
• [15]Vordermark D, Wulf J, Markert K, Baier K, Kolbl O, Beckmann G, et al.: 3-D conformal treatment of prostate cancer to 74 Gy vs. high-dose-rate brachytherapy boost: a cross-sectional quality-of-life survey. Acta Oncol 2006, 45:708-716.
• [16]Yoshioka Y, Konishi K, Oh RJ, Sumida I, Yamazaki H, Nakamura S, et al.: High-dose-rate brachytherapy without external beam irradiation for locally advanced prostate cancer. Radiother Oncol 2006, 80:62-68.
• [17]Demanes DJ, Rodriguez RR, Altieri GA: High dose rate prostate brachytherapy: the California Endocurietherapy (CET) method. Radiother Oncol 2000, 57:289-296.
• [18]Galalae RM, Kovacs G, Schultze J, Loch T, Rzehak P, Wilhelm R, et al.: Long-term outcome after elective irradiation of the pelvic lymphatics and local dose escalation using high-dose-rate brachytherapy for locally advanced prostate cancer. Int J Radiat Oncol Biol Phys 2002, 52:81-90.
• [19]Mate TP, Gottesman JE, Hatton J, Gribble M, Van Hollebeke L: High dose-rate afterloading 192Iridium prostate brachytherapy: feasibility report. Int J Radiat Oncol Biol Phys 1998, 41:525-533.
• [20]Pellizzon AC, Nadalin W, Salvajoli JV, Fogaroli RC, Novaes PE, Maia MA, et al.: Results of high dose rate afterloading brachytherapy boost to conventional external beam radiation therapy for initial and locally advanced prostate cancer. Radiother Oncol 2003, 66:167-172.
• [21]Pinkawa M, Gagel B, Piroth MD, Borchers H, Jakse G, Eble MJ: Changes of dose delivery distribution within the first month after permanent interstitial brachytherapy for prostate cancer. Strahlenther Onkol 2006, 182:525-530.
• [22]Aubin M, Pouliot J, Milender L, Shinohara K, Pickett B, Anezinos C, et al.: Daily prostate targeting with implanted gold markers and an a-Si flat panel EPID at UCSF: a five year clinical experience. Int J Radiat Oncol Biol Phys 2004, 60(Suppl):S266-S267.
• [23]UICC: Prostata. In TNM Klassifikation maligner Tumore. 6th edition. Edited by Wittekind Ch, Meyer HJ, Bootz F. Berlin: Springer-Verlag; 2003:172-175.
• [24]International Commission on Radiation Units and Measurements: ICRU Report 50: Prescribing, Recording, and Reporting Photon Beam Therapy. In International Commission on Radiation Units and Measurements. Washington, DC; 1993.
• [25]Fraass BA, McShan DL, Kessler ML, Matrone GM, Lewis JD, Weaver TA: A computer-controlled conformal radiotherapy system I: Overview. Int J Radiat Oncol Biol Phys 1995, 33:1139-1157.
• [26]Sandler HM, Bree RL, McLaughlin PW, Grossman HB, Lichter AS: Localization of the prostatic apex for radiation therapy using implanted markers. Int J Radiat Oncol Biol Phys 1993, 27:915-919.
• [27]Herrmann MK, Gsänger T, Strauss A, Kertesz T, Wolff HA, Christiansen H, et al.: The impact of prostate volume changes during external-beam irradiation in consequence of HDR brachytherapy in prostate cancer treatment. Strahlenther Onkol 2009, 185:397-403.