3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting

Prakash Chinnaiyan, Wolfgang A. Tome, Rakesh Patel, Rick Chappell, Mark Ritter

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Daily transabdominal ultrasound-directed localization has proven valuable in correcting for setup error and organ motion in the treatment of prostate cancer with three-dimensional conformal radiation therapy (3DCRT). The present study sought to determine whether this transabdominal ultrasound technology could also be reliably applied in the post-operative adjuvant or salvage setting to improve the reproducibility of coverage of the intended volumes and to enhance conformal avoidance of adjacent normal structures. Sixteen consecutive patients who received external beam radiotherapy underwent daily localization using an optically guided 3D-ultrasound target localization system (SonArray™, Zmed, Inc., Ashland, MA). Six of the above patients were treated in a post-prostatectomy setting, either adjuvantly or for salvage, while the remaining 10 with intact prostates were treated definitively. Because the bladder neck generally approximates the postoperative prostatic fossa, it was used during ultrasound localization as the primary reference structure for the post-prostatectomy patients. For patients treated definitively, the prostate was the primary reference structure. Daily shifts were recorded and port films were taken weekly immediately after ultrasound-based repositioning. By comparing port films taken after ultrasound localization, which evaluates for both set-up error and internal shift, with the original digitally reconstructed radiographs (DRRs), which represents a zero clinical set-up error situation, the degree of variability in organ position was determined. The average absolute, ultrasound-based shifts from the clinical set-up position in the anterior/posterior, lateral, and cranial/caudal directions for the post-prostatectomy patients were 5 ± 4 mm SD, 3 ± 3 mm SD, and 3 ± 4 mm SD over the entire course of treatment, respectively. The average vector length shift was 8 ± 4 mm SD. For patients treated with an intact prostate, the analogous average absolute shifts in the anterior/posterior, lateral, and cranial/caudal directions were 4 ± 3 mm SD, 4 ± 3 mm SD, and 4 ± 3 mm SD over the entire course of treatment. The average vector length shift was 7 ± 4 mm SD. Vector length shifts representing interfraction internal motion were estimated by comparing post-ultrasound port films with DRRs. These were 5 ± 3 mm SD and 4 ± 4mm SD for post-prostatectomy and intact prostate patients, respectively. These ultrasound-based displacements were not statistically different in patients with an intact prostate versus patients post-prostatectomy (p > 0.1). In conclusion, daily transabdominal 3D-ultrasound localization proved to be a clinically feasible method of correcting for set-up and internal motion displacements. The bladder neck, which serves as an adequate localization reference structure for the prostatic fossa, could be readily ultrasound imaged and repositioned as necessary. Daily internal motion errors that would have occurred if only pre-treatment port films were used were similar in magnitude to those observed for the patients with intact prostates and were of sufficient magnitude to support the use of daily pre-treatment ultrasound localization in the post-prostatectomy setting.

Original languageEnglish (US)
Pages (from-to)455-458
Number of pages4
JournalTechnology in Cancer Research and Treatment
Volume2
Issue number5
StatePublished - Oct 2003
Externally publishedYes

Fingerprint

Prostatectomy
Radiotherapy
Prostate
Urinary Bladder
Ultrasonic Waves
Therapeutics
Prostatic Neoplasms
Technology

Keywords

  • Organ motion
  • Post-prostatectomy
  • Prostate cancer
  • Radiation therapy
  • Ultrasound localization

ASJC Scopus subject areas

  • Cancer Research
  • Radiology Nuclear Medicine and imaging

Cite this

3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting. / Chinnaiyan, Prakash; Tome, Wolfgang A.; Patel, Rakesh; Chappell, Rick; Ritter, Mark.

In: Technology in Cancer Research and Treatment, Vol. 2, No. 5, 10.2003, p. 455-458.

Research output: Contribution to journalArticle

Chinnaiyan, P, Tome, WA, Patel, R, Chappell, R & Ritter, M 2003, '3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting', Technology in Cancer Research and Treatment, vol. 2, no. 5, pp. 455-458.
Chinnaiyan, Prakash ; Tome, Wolfgang A. ; Patel, Rakesh ; Chappell, Rick ; Ritter, Mark. / 3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting. In: Technology in Cancer Research and Treatment. 2003 ; Vol. 2, No. 5. pp. 455-458.
@article{537dedde550946b78b22fc52a9f568d5,
title = "3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting",
abstract = "Daily transabdominal ultrasound-directed localization has proven valuable in correcting for setup error and organ motion in the treatment of prostate cancer with three-dimensional conformal radiation therapy (3DCRT). The present study sought to determine whether this transabdominal ultrasound technology could also be reliably applied in the post-operative adjuvant or salvage setting to improve the reproducibility of coverage of the intended volumes and to enhance conformal avoidance of adjacent normal structures. Sixteen consecutive patients who received external beam radiotherapy underwent daily localization using an optically guided 3D-ultrasound target localization system (SonArray™, Zmed, Inc., Ashland, MA). Six of the above patients were treated in a post-prostatectomy setting, either adjuvantly or for salvage, while the remaining 10 with intact prostates were treated definitively. Because the bladder neck generally approximates the postoperative prostatic fossa, it was used during ultrasound localization as the primary reference structure for the post-prostatectomy patients. For patients treated definitively, the prostate was the primary reference structure. Daily shifts were recorded and port films were taken weekly immediately after ultrasound-based repositioning. By comparing port films taken after ultrasound localization, which evaluates for both set-up error and internal shift, with the original digitally reconstructed radiographs (DRRs), which represents a zero clinical set-up error situation, the degree of variability in organ position was determined. The average absolute, ultrasound-based shifts from the clinical set-up position in the anterior/posterior, lateral, and cranial/caudal directions for the post-prostatectomy patients were 5 ± 4 mm SD, 3 ± 3 mm SD, and 3 ± 4 mm SD over the entire course of treatment, respectively. The average vector length shift was 8 ± 4 mm SD. For patients treated with an intact prostate, the analogous average absolute shifts in the anterior/posterior, lateral, and cranial/caudal directions were 4 ± 3 mm SD, 4 ± 3 mm SD, and 4 ± 3 mm SD over the entire course of treatment. The average vector length shift was 7 ± 4 mm SD. Vector length shifts representing interfraction internal motion were estimated by comparing post-ultrasound port films with DRRs. These were 5 ± 3 mm SD and 4 ± 4mm SD for post-prostatectomy and intact prostate patients, respectively. These ultrasound-based displacements were not statistically different in patients with an intact prostate versus patients post-prostatectomy (p > 0.1). In conclusion, daily transabdominal 3D-ultrasound localization proved to be a clinically feasible method of correcting for set-up and internal motion displacements. The bladder neck, which serves as an adequate localization reference structure for the prostatic fossa, could be readily ultrasound imaged and repositioned as necessary. Daily internal motion errors that would have occurred if only pre-treatment port films were used were similar in magnitude to those observed for the patients with intact prostates and were of sufficient magnitude to support the use of daily pre-treatment ultrasound localization in the post-prostatectomy setting.",
keywords = "Organ motion, Post-prostatectomy, Prostate cancer, Radiation therapy, Ultrasound localization",
author = "Prakash Chinnaiyan and Tome, {Wolfgang A.} and Rakesh Patel and Rick Chappell and Mark Ritter",
year = "2003",
month = "10",
language = "English (US)",
volume = "2",
pages = "455--458",
journal = "Technology in Cancer Research and Treatment",
issn = "1533-0346",
publisher = "Adenine Press",
number = "5",

}

TY - JOUR

T1 - 3D-Ultrasound Guided Radiation Therapy in the Post-Prostatectomy Setting

AU - Chinnaiyan, Prakash

AU - Tome, Wolfgang A.

AU - Patel, Rakesh

AU - Chappell, Rick

AU - Ritter, Mark

PY - 2003/10

Y1 - 2003/10

N2 - Daily transabdominal ultrasound-directed localization has proven valuable in correcting for setup error and organ motion in the treatment of prostate cancer with three-dimensional conformal radiation therapy (3DCRT). The present study sought to determine whether this transabdominal ultrasound technology could also be reliably applied in the post-operative adjuvant or salvage setting to improve the reproducibility of coverage of the intended volumes and to enhance conformal avoidance of adjacent normal structures. Sixteen consecutive patients who received external beam radiotherapy underwent daily localization using an optically guided 3D-ultrasound target localization system (SonArray™, Zmed, Inc., Ashland, MA). Six of the above patients were treated in a post-prostatectomy setting, either adjuvantly or for salvage, while the remaining 10 with intact prostates were treated definitively. Because the bladder neck generally approximates the postoperative prostatic fossa, it was used during ultrasound localization as the primary reference structure for the post-prostatectomy patients. For patients treated definitively, the prostate was the primary reference structure. Daily shifts were recorded and port films were taken weekly immediately after ultrasound-based repositioning. By comparing port films taken after ultrasound localization, which evaluates for both set-up error and internal shift, with the original digitally reconstructed radiographs (DRRs), which represents a zero clinical set-up error situation, the degree of variability in organ position was determined. The average absolute, ultrasound-based shifts from the clinical set-up position in the anterior/posterior, lateral, and cranial/caudal directions for the post-prostatectomy patients were 5 ± 4 mm SD, 3 ± 3 mm SD, and 3 ± 4 mm SD over the entire course of treatment, respectively. The average vector length shift was 8 ± 4 mm SD. For patients treated with an intact prostate, the analogous average absolute shifts in the anterior/posterior, lateral, and cranial/caudal directions were 4 ± 3 mm SD, 4 ± 3 mm SD, and 4 ± 3 mm SD over the entire course of treatment. The average vector length shift was 7 ± 4 mm SD. Vector length shifts representing interfraction internal motion were estimated by comparing post-ultrasound port films with DRRs. These were 5 ± 3 mm SD and 4 ± 4mm SD for post-prostatectomy and intact prostate patients, respectively. These ultrasound-based displacements were not statistically different in patients with an intact prostate versus patients post-prostatectomy (p > 0.1). In conclusion, daily transabdominal 3D-ultrasound localization proved to be a clinically feasible method of correcting for set-up and internal motion displacements. The bladder neck, which serves as an adequate localization reference structure for the prostatic fossa, could be readily ultrasound imaged and repositioned as necessary. Daily internal motion errors that would have occurred if only pre-treatment port films were used were similar in magnitude to those observed for the patients with intact prostates and were of sufficient magnitude to support the use of daily pre-treatment ultrasound localization in the post-prostatectomy setting.

AB - Daily transabdominal ultrasound-directed localization has proven valuable in correcting for setup error and organ motion in the treatment of prostate cancer with three-dimensional conformal radiation therapy (3DCRT). The present study sought to determine whether this transabdominal ultrasound technology could also be reliably applied in the post-operative adjuvant or salvage setting to improve the reproducibility of coverage of the intended volumes and to enhance conformal avoidance of adjacent normal structures. Sixteen consecutive patients who received external beam radiotherapy underwent daily localization using an optically guided 3D-ultrasound target localization system (SonArray™, Zmed, Inc., Ashland, MA). Six of the above patients were treated in a post-prostatectomy setting, either adjuvantly or for salvage, while the remaining 10 with intact prostates were treated definitively. Because the bladder neck generally approximates the postoperative prostatic fossa, it was used during ultrasound localization as the primary reference structure for the post-prostatectomy patients. For patients treated definitively, the prostate was the primary reference structure. Daily shifts were recorded and port films were taken weekly immediately after ultrasound-based repositioning. By comparing port films taken after ultrasound localization, which evaluates for both set-up error and internal shift, with the original digitally reconstructed radiographs (DRRs), which represents a zero clinical set-up error situation, the degree of variability in organ position was determined. The average absolute, ultrasound-based shifts from the clinical set-up position in the anterior/posterior, lateral, and cranial/caudal directions for the post-prostatectomy patients were 5 ± 4 mm SD, 3 ± 3 mm SD, and 3 ± 4 mm SD over the entire course of treatment, respectively. The average vector length shift was 8 ± 4 mm SD. For patients treated with an intact prostate, the analogous average absolute shifts in the anterior/posterior, lateral, and cranial/caudal directions were 4 ± 3 mm SD, 4 ± 3 mm SD, and 4 ± 3 mm SD over the entire course of treatment. The average vector length shift was 7 ± 4 mm SD. Vector length shifts representing interfraction internal motion were estimated by comparing post-ultrasound port films with DRRs. These were 5 ± 3 mm SD and 4 ± 4mm SD for post-prostatectomy and intact prostate patients, respectively. These ultrasound-based displacements were not statistically different in patients with an intact prostate versus patients post-prostatectomy (p > 0.1). In conclusion, daily transabdominal 3D-ultrasound localization proved to be a clinically feasible method of correcting for set-up and internal motion displacements. The bladder neck, which serves as an adequate localization reference structure for the prostatic fossa, could be readily ultrasound imaged and repositioned as necessary. Daily internal motion errors that would have occurred if only pre-treatment port films were used were similar in magnitude to those observed for the patients with intact prostates and were of sufficient magnitude to support the use of daily pre-treatment ultrasound localization in the post-prostatectomy setting.

KW - Organ motion

KW - Post-prostatectomy

KW - Prostate cancer

KW - Radiation therapy

KW - Ultrasound localization

UR - http://www.scopus.com/inward/record.url?scp=0242298671&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0242298671&partnerID=8YFLogxK

M3 - Article

VL - 2

SP - 455

EP - 458

JO - Technology in Cancer Research and Treatment

JF - Technology in Cancer Research and Treatment

SN - 1533-0346

IS - 5

ER -