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Positioning error and expanding margins of planning target volume with kilovoltage cone beam computed tomography for prostate cancer radiotherapy

Authors Wang G, Wang WL, Liu YQ, Dong HM, Hu YX

Received 29 September 2017

Accepted for publication 18 December 2017

Published 6 April 2018 Volume 2018:11 Pages 1981—1988


Checked for plagiarism Yes

Review by Single-blind

Peer reviewer comments 3

Editor who approved publication: Dr Ingrid Espinoza

Gang Wang, Wen-Ling Wang, Yi-Qun Liu, Hong-Min Dong, Yin-Xiang Hu

Department of Abdominal Oncology, Affiliated Hospital of Guizhou Medical University, Guizhou Cancer Hospital, Guiyang, People’s Republic of China

Objective: In this study, prostate cancer patients were treated with image-guided radiotherapy (IGRT). The translational positioning errors were discussed to provide the basis for determining margins of the planning target volume (PTV).
Methods: Thirty prostate cancer patients were treated with radical radiotherapy using the IGRT system. Patients were placed in the supine position and underwent kilovoltage cone beam computed tomography (KVCBCT) scans before radiotherapy. A total of 447 images were acquired. The translational positioning errors were obtained in three linear directions which were X (left-to-right), Y (superior-to-inferior) and Z (anterior-to-posterior) axes (denoted as Lx, Ly and Lz) through the contrast between images adjusted with gray and manual registrations and the planning CT images. Rotational errors were denoted as Rx, Ry and Rz.
Results: Uncorrected translational errors Lx, Ly and Lz in the 251 positioning images were all higher than those after correction, and the differences were all statistically significant (P=0.000, 0.037 and 0.004, respectively). For rotational errors Rx, Ry and Rz, only Rx had a significant difference before and after correction (P=0.044). Before correction, PTV margins in the X, Y and Z directions were 0.61, 0.78 and 0.41 cm, respectively; after correction, these were 0.17, 0.12 and 0.17 cm, respectively.
Conclusion: KVCBCT can be applied to measure positioning errors in prostate cancer radiotherapy and correct these errors in real time through the 6° robotic patient positioning system, in order to improve patient positioning accuracy. The application of IGRT with KVCBCT may reduce PTV margins.

prostate cancer, image-guided radiotherapy, kilovoltage cone beam CT, positioning error, planning target volume

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