Variation of organ at risk dose due to daily rectal filling during prostate intensitymodulated
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- Camron Conley
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1 Variation of organ at risk dose due to daily rectal filling during prostate intensitymodulated radiotherapy Leonel A. Kahn B.S., Arthur Y. Hung, M.D., Barbara Agrimson, B.S., C.M.D., Sanja Ognjenovic, Tulsee S. Doshi, Halkene M. Gemechu, Catherine M. Kato, Lu Z. Meng, Ph.D., Anna O. Simeonova, M.D., James A. Tanyi, Ph.D Department of Radiation Medicine Oregon Health & Science University The authors have no disclosures
2 Study Aims Characterize the values of and evaluate for daily trends in the rectal volume, rectal anterior-posterior translation, and volume of the rectum receiving 45 Gy, 65 Gy and 70 Gy (V 40 /V 65 /V 70 ) during IMRT of the prostate Assess for correlation between the interfraction motion parameters and the dosimetric data
3 Methods Retrospective review of 16 patients undergoing IMRT of the prostate Enemas prior to simulation & no bowel preparation prior to daily treatment Outer walls of the rectum were contoured on all on-treatment CBCT series for each patient Determined daily rectal volume changes, displacement of the anterior rectal wall at three levels, and rectal V 45, V 60, V 70 Pearson s coefficients were used to determine trends in dosevolume histogram (DVH) values vs. fraction number, translation change, and volume change
4 Anterior-posterior positional change of anterior wall of the rectum Patient Number Displacement [cm] Superior level Isocenter level Inferior level (0.34, 1.64) 0.45 (0.19, 0.88) 0.21 (0.29, 1.65) (0.82, 4.17) 0.46 (0.44, 2.04) (0.44, 1.59) (0.45, 2.17) 0.19 (0.18, 0.81) (0.31, 1.56) (0.44, 1.97) 0.31 (0.18, 0.72) 0.27 (0.3, 1.31) (0.6, 2.94) 0.04 (0.25, 1.26) (0.41, 1.65) (0.68, 2.59) 0.34 (0.24, 1.01) 0.49 (0.4, 1.45) (0.45, 2.01) 0.63 (0.29, 1.42) (0.55, 4.11) (0.62, 2.64) 0.29 (0.35, 1.73) (0.31, 1.52) (0.84, 2.96) 0.32 (0.27, 1.12) 0.05 (0.35, 1.35) (0.41, 1.82) 0.71 (0.35, 2.12) (0.43, 2.29) (0.97, 3.97) (0.56, 2.2) (0.37, 1.85) (0.3, 1.31) 0.58 (0.41, 2.09) 0.23 (0.33, 1.34) (0.56, 2.61) 0.42 (0.27, 1.46) (0.96, 2.98) (0.89, 3.56) 0.25 (0.26, 1.33) 0.37 (0.33, 1.39) (1.03, 3.64) 0.29 (0.24, 1.06) (0.2, 0.74) (0.76, 2.78) 0.27 (0.26, 0.92) (0.29, 1.35)
5 Anterior-posterior positional change of anterior wall of the rectum Largest translation means and ranges at the superior level Patient Number Displacement [cm] Superior level Isocenter level Inferior level (0.34, 1.64) 0.45 (0.19, 0.88) 0.21 (0.29, 1.65) (0.82, 4.17) 0.46 (0.44, 2.04) (0.44, 1.59) (0.45, 2.17) 0.19 (0.18, 0.81) (0.31, 1.56) (0.44, 1.97) 0.31 (0.18, 0.72) 0.27 (0.3, 1.31) (0.6, 2.94) 0.04 (0.25, 1.26) (0.41, 1.65) (0.68, 2.59) 0.34 (0.24, 1.01) 0.49 (0.4, 1.45) (0.45, 2.01) 0.63 (0.29, 1.42) (0.55, 4.11) (0.62, 2.64) 0.29 (0.35, 1.73) (0.31, 1.52) (0.84, 2.96) 0.32 (0.27, 1.12) 0.05 (0.35, 1.35) (0.41, 1.82) 0.71 (0.35, 2.12) (0.43, 2.29) (0.97, 3.97) (0.56, 2.2) (0.37, 1.85) (0.3, 1.31) 0.58 (0.41, 2.09) 0.23 (0.33, 1.34) (0.56, 2.61) 0.42 (0.27, 1.46) (0.96, 2.98) (0.89, 3.56) 0.25 (0.26, 1.33) 0.37 (0.33, 1.39) (1.03, 3.64) 0.29 (0.24, 1.06) (0.2, 0.74) (0.76, 2.78) 0.27 (0.26, 0.92) (0.29, 1.35)
6 Anterior-posterior positional change of anterior wall of the rectum No significant correlation between translational motion and fraction number for any patient at any rectal level Patient Number Displacement [cm] Superior level Isocenter level Inferior level (0.34, 1.64) 0.45 (0.19, 0.88) 0.21 (0.29, 1.65) (0.82, 4.17) 0.46 (0.44, 2.04) (0.44, 1.59) (0.45, 2.17) 0.19 (0.18, 0.81) (0.31, 1.56) (0.44, 1.97) 0.31 (0.18, 0.72) 0.27 (0.3, 1.31) (0.6, 2.94) 0.04 (0.25, 1.26) (0.41, 1.65) (0.68, 2.59) 0.34 (0.24, 1.01) 0.49 (0.4, 1.45) (0.45, 2.01) 0.63 (0.29, 1.42) (0.55, 4.11) (0.62, 2.64) 0.29 (0.35, 1.73) (0.31, 1.52) (0.84, 2.96) 0.32 (0.27, 1.12) 0.05 (0.35, 1.35) (0.41, 1.82) 0.71 (0.35, 2.12) (0.43, 2.29) (0.97, 3.97) (0.56, 2.2) (0.37, 1.85) (0.3, 1.31) 0.58 (0.41, 2.09) 0.23 (0.33, 1.34) (0.56, 2.61) 0.42 (0.27, 1.46) (0.96, 2.98) (0.89, 3.56) 0.25 (0.26, 1.33) 0.37 (0.33, 1.39) (1.03, 3.64) 0.29 (0.24, 1.06) (0.2, 0.74) (0.76, 2.78) 0.27 (0.26, 0.92) (0.29, 1.35)
7 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
8 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients All patients had a mean volume change of at least 30 cc (except patient 16) Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
9 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients No significant correlation between volume change and the fraction number was noted for any patient Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
10 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients All patients had mean V 70 <17%, a mean V 65 <25%, and a mean V 40 <35% (ie: less than than the rectal tolerance limits) Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
11 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients In 14/16 patients, 97.8% of the fractions delivered met the rectal tolerance criteria at each dose level Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
12 Rectal volume change and rectal V 40, V 65 and V 70 for individual patients No significant correlation between the fraction number and the rectal V 40, V 65, and V 70 values, respectively, were noted for any patient Patient Number Volume changes [cm 3 ] Rectal V 40 [cm 3 ] Rectal V 65 [cm 3 ] Rectal V 70 [cm 3 ] (5.89, 30.1) (3.44, 19.55) 4.19 (2.06, 11.52) 3.2 (1.77, 9.93) (16.71, (10.71, (25.29, 99.3) 9.96 (9.41, 39.52) 71.74) 45.28) (5.98, 27.1) 8.92 (3.1, 11.32) 4.49 (2.15, 8.71) 3.63 (1.9, 7.91) (6.9, 28.9) 8.62 (4.05, 15.26) 2.55 (1.8, 7.54) 1.76 (1.41, 6.08) (12.37, 74.2) (5.71, 32.11) 4.28 (3.05, 16.08) 3.09 (2.55, 13.39) (12.42, 53.4) 6.68 (4.21, 14.93) 2.77 (2.15, 8.28) 2.15 (1.78, 6.99) (9.2, 40.3) 9.98 (5.78, 22.7) 4.53 (3.63, 15.41) 3.51 (3.12, 13.71) (8.99, 44.5) 12.6 (4.56, 20.53) 5.7 (2.55, 11.99) 4.57 (2.12, 10.02) (13.41, 55.6) (8.91, 37.94) 7.87 (6.83, 29.09) 6.73 (6.3, 26.82) (4.47, 17.7) (3.84, 23.22) 8.21 (3.11, 19.51) 7.14 (2.92, 18.41) (10.42, (19.85, 68.6) 5.4 (6.32, 23.82) 4.25 (5.38, 20.75) 36.82) (4.87, 18.3) (3.12, 13.44) 8.56 (2.51, 11.69) 7.31 (2.37, 10.94) (20.96, 86.6) (8.15, 29.37) 9.37 (4.85, 18.55) 7.98 (4.06, 15.54) (12.65, 51) (7.29, 32.09) 8.36 (5.15, 23.69) 6.38 (3.62, 17.26) (11.29, 47) (7.2, 28.95) 4.34 (4.71, 20.34) 2.92 (3.87, 16.99) (2.99, 12.26) 4.13 (2.99, 12.26) 1.19 (1.17, 5.03) 0.49 (0.42, 1.73)
13 Correlation of rectal translation (superior and isocenter levels) with rectal V 40, V 65 and V 70 for individual patients Patient Number Translation/V 40 Translation/V 65 Translation/V 70 1 ** ** 2 * * * 3 ** ** 4 5 * 6 ** ** 7 *,** *,** ** 8 9 * * * 10 ** ** ** 11 * * * ** ** ** (*) positive superior displacement correlation; (**) positive isocenter displacement correlation
14 Correlation of rectal translation (superior and isocenter levels) with rectal V 40, V 65 and V 70 for individual patients Patient Number Translation/V 40 Translation/V 65 Translation/V 70 1 ** ** 2 * * * Significant correlations between the superior rectal translations and the V 40, V 65, and/or V 70 present in a minority of patients 3 ** ** 4 5 * 6 ** ** 7 *,** *,** ** 8 9 * * * 10 ** ** ** 11 * * * ** ** ** (*) positive superior displacement correlation; (**) positive isocenter displacement correlation
15 Correlation of rectal translation (superior and isocenter levels) with rectal V 40, V 65 and V 70 for individual patients Patient Number Translation/V 40 Translation/V 65 Translation/V 70 1 ** ** Compared to superior translations, positive correlations between the isocenter-level rectal translations and the V 40, V 65, and/or V 70 were seen in a slightly greater number, yet still a minority, of patients 2 * * * 3 ** ** 4 5 * 6 ** ** 7 *,** *,** ** 8 9 * * * 10 ** ** ** 11 * * * ** ** ** (*) positive superior displacement correlation; (**) positive isocenter displacement correlation
16 Correlation of rectal translation (superior and isocenter levels) with rectal V 40, V 65 and V 70 for individual patients Patient Number Translation/V 40 Translation/V 65 Translation/V 70 1 ** ** 2 * * * 3 ** ** 4 No significant correlations were seen between the inferior rectal translations and the V 40, V 65, or V 70 in any patient 5 * 6 ** ** 7 *,** *,** ** 8 9 * * * 10 ** ** ** 11 * * * ** ** ** (*) positive superior displacement correlation; (**) positive isocenter displacement correlation
17 Correlations of rectal volume changes and rectal V 40, V 65 and V 70 values for individual patients Patient Number Volume change/v 40 Volume change/v 65 Volume change/v 70 1 * * * 2 * * * 3 * * * 4 * * * 5 * * * 6 * * * 7 * * * 8 * * 9 * * * * * * * * * 14 * * 15 * * * 16 * (*) Indicates positive correlation
18 Correlations of rectal volume changes and rectal V 40, V 65 and V 70 values for individual patients Patient Number Volume change/v 40 Volume change/v 65 Volume change/v 70 1 * * * 2 * * * Significant positive correlations between rectal volume changes and V 40, V 65, and/or V 70 in the majority (87.5%) of patients 3 * * * 4 * * * 5 * * * 6 * * * 7 * * * 8 * * 9 * * * * * * * * * 14 * * 15 * * * 16 * (*) Indicates positive correlation
19 Correlations of rectal volume changes and rectal V 40, V 65 and V 70 values for individual patients Patient Number Volume change/v 40 Volume change/v 65 Volume change/v 70 1 * * * 2 * * * 3 * * * 4 * * * 11/16 patients had a positive correlation between volume changes and all three dose-volume levels 5 * * * 6 * * * 7 * * * 8 * * 9 * * * * * * * * * 14 * * 15 * * * 16 * (*) Indicates positive correlation
20 How to Ensure Adequate Rectal DVH Throughout Treatment Course? No correlation between treatment fraction number and rectal V 40, V 65, or V 70 values Underscores random nature of variation in the rectal DVH values Not practical to create population-based algorithm, applicable to all patients, to ensure reproducible daily rectal DVH parameters
21 Method to Ensure Adequate Rectal DVH Over Treatment Course? IGRT for the purpose of online dosimetric evaluation of rectal doses with subsequent implementation of multi-adaptive planning (MAP) may be the solution Dynamically adjusting apertures on a daily basis MAP Method 1 Creation of a series of plans that represent possible relationships between the prostate and rectum prior to treatment, with selection of an appropriate plan on a daily basis MAP Method 2 Accommodate independent prostate and rectal motion
22 Is Further Intervention Required to Ensure Appropriate Rectal DVHs? Interfraction variation in rectal DVHs likely to be reduced with MAP However: potential benefit must be interpreted in a clinically relevant manner Goal of MAP: ensure maintenance of rectal DVH under specified tolerance values Frequency with which the tolerance limits are met could argue for or against the need for MAP
23 Is Further Intervention Required to Ensure Appropriate Rectal DVHs? 97.8% remained within the specified dose-volume limits on a daily basis Argue against need for MAP for the purpose of improving rectal DVH
24 Is Further Intervention Required to Ensure Appropriate Rectal DVHs? Volumetric Changes MAP not needed for all patients Significant correlation between rectal volume changes and V 40, V 65, and/or V 70 in the majority of patients Volume not predictable over the course of treatment, necessitating individualized approach to managing volumeinduced DVH change May benefit from MAP
25 Is Further Intervention Required to Ensure Appropriate Rectal DVHs? Volumetric Changes However: subset of patients may benefit Significant correlation between rectal volume changes and V 40, V 65, and/or V 70 in the majority of patients Volume not predictable over the course of treatment, necessitating individualized approach to managing volumeinduced DVH change May benefit from MAP
26 Is Further Intervention Required to Ensure Appropriate Rectal DVHs? Vast majority of patients continued to meet the rectal dosevolume tolerance criteria despite the presence of interfraction volume changes Volumetric Changes Significant correlation between rectal volume changes and V 40, V 65, and/or V 70 in the majority of patients Volume not predictable over the course of treatment, necessitating individualized approach to managing volumeinduced DVH change May benefit from MAP
27 Conclusion Documented that nearly all patients met rectal tolerance criteria at all dose-volume levels at least 97.8% of the time MAP post-interfraction prostate motion correction not needed in the majority of cases for the purpose of improving daily rectal DVH compliance
28 Limitations Retrospective Use of CBCTs Number of patients Present study and the current literature fail to evaluate the correlation of acute and late rectal toxicity compared to the interfraction DVH variation
29 Variation of organ at risk dose due to daily rectal filling during prostate intensity-modulated radiotherapy Project funding Rubinstein Research Scholarship 2012 Tartar Trust Fund OHSU School of Medicine Dean s Fund Ted R. Lilley Cancer Continuing Umbrella of Research Experience Program
30 Variation of organ at risk dose due to daily rectal filling during prostate intensity-modulated radiotherapy Collaboration investigators James Tanyi, PhD Arthur Hung, MD Charles Thomas, MD Barbara Agrimson, CMD Departmental Affiliation OHSU Department of Radiation Medicine Knight Cancer Institute
31 Questions?
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