ABSTRACT
OBJECTIVE: Literature regarding image-guidance and interfractional motion of the anal canal (AC) during anal cancer radiotherapy is sparse. This study investigates interfractional AC motion during anal cancer radiotherapy. METHODS: Bone matched cone beam CT (CBCT) images were acquired for 20 patients receiving anal cancer radiotherapy allowing population systematic and random error calculations. 12 were selected to investigate interfractional AC motion. Primary anal gross tumour volume and clinical target volume (CTVa) were contoured on each CBCT. CBCT CTVa volumes were compared to planning CTVa. CBCT CTVa volumes were combined into a CBCT-CTVa envelope for each patient. Maximum distortion between each orthogonal border of the planning CTVa and CBCT-CTVa envelope was measured. Frequency, volume and location of CBCT-CTVa envelope beyond the planning target volume (PTVa) was analysed. RESULTS: Population systematic and random errors were 1 and 3 mm respectively. 112 CBCTs were analysed in the interfractional motion study. CTVa varied between each imaging session particularly T location patients of anorectal origin. CTVa border expansions ≥ 1 cm were seen inferiorly, anteriorly, posteriorly and left direction. The CBCT-CTVa envelope fell beyond the PTVa ≥ 50% imaging sessions (n = 5). Of these CBCT CTVa distortions beyond PTVa, 44% and 32% were in the upper and lower thirds of PTVa respectively. CONCLUSION: The AC is susceptible to volume changes and shape deformations. Care must be taken when calculating or considering reducing the PTV margin to the anus. Advances in knowledge: Within a limited field of research, this study provides further knowledge of how the AC deforms during anal cancer radiotherapy.
Subject(s)
Anus Neoplasms/pathology , Anus Neoplasms/radiotherapy , Cone-Beam Computed Tomography/methods , Radiotherapy Planning, Computer-Assisted/methods , Radiotherapy, Image-Guided/methods , Adult , Aged , Aged, 80 and over , Anal Canal/pathology , Anal Canal/radiation effects , Female , Humans , Male , Middle Aged , Motion , Radiotherapy Dosage , Tumor BurdenABSTRACT
PURPOSE: To develop and compare a volumetric modulated arc therapy (VMAT) technique with conventional radiotherapy for craniospinal irradiation with respect to improved dose conformity and homogeneity in the planning target volume (PTV) and to reduced dose to organs at risk (OAR). METHODS AND MATERIALS: Conventional craniospinal axis radiotherapy plans of 5 patients were acquired. The median (range) length of the PTV was 58.9 (48.1-83.7) cm. The 6-MV VMAT plans were inversely planned with one isocenter near the base of the brain and the minimum number of isocenters required for the specified lengths of spine. The plans were optimized with high weighting for PTV coverage and low weighting for OAR sparing. Conformity and heterogeneity indices, dose-volume histograms, mean doses, and non-PTV integral doses from the two plans (prescription dose 23.4 Gy in 13 fractions) were compared. RESULTS: The median (range) conformity index of VMAT was 1.22 (1.09-1.45), compared with 1.69 (1.44-2.67) for conventional plans (p = 0.04). The median (range) heterogeneity index was also lower for VMAT compared with conventional plans: 1.04 (1.03-1.07) vs. 1.12 (1.09-1.19), respectively (p = 0.04). A significant reduction of mean and maximum doses was observed in the heart, thyroid, esophagus, optic nerves, and eyes with VMAT when compared with conventional plans. A decrease in body V(10Gy) was observed, but for 4 of 5 patients non-PTV integral dose was increased with VMAT when compared with the conventional plans. CONCLUSIONS: A VMAT technique to treat the craniospinal axis significantly reduces OAR dose, potentially leading to lower late organ toxicity. However, this is achieved at the expense of increased low-dose volumes, which is inherent to the technique, carrying a potentially increased risk of secondary malignancies.
