Based on 0.35 T magnetic resonance-guided radiotherapy, what are the nonisotropic PTV margins required for conventional prostate radiotherapy?

ABSTRACT

This study aims to calculate planning target volume (PTV) margins for the prostate and seminal vesicles (SVs) from the use of magnetic resonance-guided radiation therapy (MRgRT). And whether nonisotropic PTV margins are beneficial for these structures. Organ motion is linked to the displacement of the prostate and SVs. From the use of MRgRT, the nearby organs at risk (OAR) can be visualized both inter- and intrafraction. This study looked to determine if there is a correlation between interfractional OAR changes and displacements to the prostate and SVs. Inter- and intrafractional data from 20 consecutive prostate cancer patients treated using extreme hypofractionated 0.35 T MRgRT indicated prostate and SV motion during treatment. Tracking points (TPs) on 2D sagittal cine-MRI enabled assessment of this intrafractional motion. To determine a correlation between rectal changes and target displacements, the rectal diameter (RD) changes were compared against the displacement differences (DDs) at the prostate and SVs. Eighty percent of patients required intrafractional imaging corrections during radiotherapy, including 16/100 fractions due to rectal volume increases and 24/100 fractions due to bladder volume increases. The frequency of ≥3 mm intrafraction displacement was considerably greater in TPs in the SV than in the prostate. A moderate positive correlation (R2 = 0.417) was shown between RD changes and DDs at the level of the prostate and SVs. The PTV margins required for 90% of the patient cohort for prostate and SVs are nonuniform in different directions, and the margin is larger for SVs. Organ motion contributed toward prostate and SV displacements and showed the importance of a robust bladder and rectal-filling protocol.