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Original article
peer-reviewed

Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer



Abstract

Purpose

Prostate motion occurs during radiotherapy for localized prostate cancer. We evaluated the input of intraprostatic fiducials for image-guided radiation therapy and compared it with bony anatomy and skin marks.

Methods

Eleven patients were implanted with three fiducial markers in the prostate. Daily sets of orthogonal kV-kV images were compared with digitally reconstructed radiography. Data were recorded for skin marks, bony anatomy, and fiducial markers. The variations were analyzed along three principal axes (left-right: LR, superoinferior: SI, and anteroposterior: AP).

Results

A total of 2,417 measures were recorded over 38 fractions of radiotherapy (76 Gy). Fiducial marker movements from bony anatomy were ≤ 5 mm for 84.2% (confidence interval: CI 95%±1.5), 91.3% (CI 95%±1.1), and 99.5% (CI 95%±0.4) of the measures along the AP, SI, and LR axes, respectively. Ninety-five percent of the shifts between a fiducial marker and the bony anatomy were < 8 mm in the AP and SI axes, and < 3 mm in the LR axis. Fiducial marker movements from skin marks were ≤ 5 mm for 64.8% (CI 95%±1.9), 79.2% (CI 95%±1.6), and 87.2% (CI 95%±1.3) of the measures along the AP, SI, and LR axes, respectively. Bony anatomy movements from skin marks were ≤ 5 mm for 84% (CI 95%±1.4), 92% (CI 95%±1.1), and 87% (CI 95%±1.3) of the measurements along the AP, SI, and LR axes, respectively.

Conclusion

Using fiducial markers provides better accuracy of repositioning of the prostate than using bony anatomy and skin marks for image-guided radiotherapy of prostate cancer.



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Original article
peer-reviewed

Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer


Author Information

Juliette Moreau

Radiotherapy, Centre Jean

Julian Biau Corresponding Author

Radiotherapy Department, Centre Jean Perrin

Jean-Louis Achard

Radiotherapy, Centre Jean Perrin

Ivan Toledano

Radiotherapy, Centre Jean Perrin

Charles Benhaim

Radiotherapy, Centre Jean Perrin

Fabrice Kwiatkowski

Radiotherapy, Centre Jean Perrin

Geneviève Loos

Radiotherapy, Centre Jean Perrin

Michel Lapeyre

Radiotherapy, Centre Jean Perrin


Ethics Statement and Conflict of Interest Disclosures

Human subjects: Consent was obtained by all participants in this study. Auvergne Rhones Alpes ethics committee (Grenoble CECIC , Comité d'Ethique des Centres d'Investigation Clinique en région Rhône-Alpes-Auvergne). issued approval CECIC Rhône-Alpes-Auvergne, Grenoble, IRB 5921. Our study was approved by Auvergne Rhones Alpes ethics committee (Grenoble CECIC , Comité d'Ethique des Centres d'Investigation Clinique en région Rhône-Alpes-Auvergne). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.


Original article
peer-reviewed

Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer


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Original article
peer-reviewed

Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer

Juliette Moreau">Juliette Moreau, Julian Biau">Julian Biau , Jean-Louis Achard">Jean-Louis Achard, Ivan Toledano">Ivan Toledano, Charles Benhaim">Charles Benhaim, Fabrice Kwiatkowski">Fabrice Kwiatkowski, Geneviève Loos">Geneviève Loos, Michel Lapeyre">Michel Lapeyre

  • Author Information
    Juliette Moreau

    Radiotherapy, Centre Jean

    Julian Biau Corresponding Author

    Radiotherapy Department, Centre Jean Perrin

    Jean-Louis Achard

    Radiotherapy, Centre Jean Perrin

    Ivan Toledano

    Radiotherapy, Centre Jean Perrin

    Charles Benhaim

    Radiotherapy, Centre Jean Perrin

    Fabrice Kwiatkowski

    Radiotherapy, Centre Jean Perrin

    Geneviève Loos

    Radiotherapy, Centre Jean Perrin

    Michel Lapeyre

    Radiotherapy, Centre Jean Perrin


    Ethics Statement and Conflict of Interest Disclosures

    Human subjects: Consent was obtained by all participants in this study. Auvergne Rhones Alpes ethics committee (Grenoble CECIC , Comité d'Ethique des Centres d'Investigation Clinique en région Rhône-Alpes-Auvergne). issued approval CECIC Rhône-Alpes-Auvergne, Grenoble, IRB 5921. Our study was approved by Auvergne Rhones Alpes ethics committee (Grenoble CECIC , Comité d'Ethique des Centres d'Investigation Clinique en région Rhône-Alpes-Auvergne). Animal subjects: All authors have confirmed that this study did not involve animal subjects or tissue. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

    Acknowledgements


    Article Information

    Published: October 12, 2017

    DOI

    10.7759/cureus.1769

    Cite this article as:

    Moreau J, Biau J, Achard J, et al. (October 12, 2017) Intraprostatic Fiducials Compared with Bony Anatomy and Skin Marks for Image-Guided Radiation Therapy of Prostate Cancer. Cureus 9(10): e1769. doi:10.7759/cureus.1769

    Publication history

    Received by Cureus: August 03, 2017
    Peer review began: August 27, 2017
    Peer review concluded: September 06, 2017
    Published: October 12, 2017

    Copyright

    © Copyright 2017
    Moreau et al. This is an open access article distributed under the terms of the Creative Commons Attribution License CC-BY 3.0., which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

    License

    This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Abstract

Purpose

Prostate motion occurs during radiotherapy for localized prostate cancer. We evaluated the input of intraprostatic fiducials for image-guided radiation therapy and compared it with bony anatomy and skin marks.

Methods

Eleven patients were implanted with three fiducial markers in the prostate. Daily sets of orthogonal kV-kV images were compared with digitally reconstructed radiography. Data were recorded for skin marks, bony anatomy, and fiducial markers. The variations were analyzed along three principal axes (left-right: LR, superoinferior: SI, and anteroposterior: AP).

Results

A total of 2,417 measures were recorded over 38 fractions of radiotherapy (76 Gy). Fiducial marker movements from bony anatomy were ≤ 5 mm for 84.2% (confidence interval: CI 95%±1.5), 91.3% (CI 95%±1.1), and 99.5% (CI 95%±0.4) of the measures along the AP, SI, and LR axes, respectively. Ninety-five percent of the shifts between a fiducial marker and the bony anatomy were < 8 mm in the AP and SI axes, and < 3 mm in the LR axis. Fiducial marker movements from skin marks were ≤ 5 mm for 64.8% (CI 95%±1.9), 79.2% (CI 95%±1.6), and 87.2% (CI 95%±1.3) of the measures along the AP, SI, and LR axes, respectively. Bony anatomy movements from skin marks were ≤ 5 mm for 84% (CI 95%±1.4), 92% (CI 95%±1.1), and 87% (CI 95%±1.3) of the measurements along the AP, SI, and LR axes, respectively.

Conclusion

Using fiducial markers provides better accuracy of repositioning of the prostate than using bony anatomy and skin marks for image-guided radiotherapy of prostate cancer.



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Juliette Moreau

Radiotherapy, Centre Jean

Julian Biau, M.D., Ph.D.

Radiotherapy Department, Centre Jean Perrin

For correspondence:
julian.biau@clermont.unicancer.fr

Jean-Louis Achard

Radiotherapy, Centre Jean Perrin

Ivan Toledano

Radiotherapy, Centre Jean Perrin

Charles Benhaim

Radiotherapy, Centre Jean Perrin

Fabrice Kwiatkowski

Radiotherapy, Centre Jean Perrin

Geneviève Loos

Radiotherapy, Centre Jean Perrin

Michel Lapeyre

Radiotherapy, Centre Jean Perrin

Juliette Moreau

Radiotherapy, Centre Jean

Julian Biau, M.D., Ph.D.

Radiotherapy Department, Centre Jean Perrin

For correspondence:
julian.biau@clermont.unicancer.fr

Jean-Louis Achard

Radiotherapy, Centre Jean Perrin

Ivan Toledano

Radiotherapy, Centre Jean Perrin

Charles Benhaim

Radiotherapy, Centre Jean Perrin

Fabrice Kwiatkowski

Radiotherapy, Centre Jean Perrin

Geneviève Loos

Radiotherapy, Centre Jean Perrin

Michel Lapeyre

Radiotherapy, Centre Jean Perrin