Paper detail

Dosimetric uncertainties related to the elasticity of bladder and rectal walls: Adenocarcinoma of the prostate

Purpose. - Radiotherapy is an important treatment for prostate cancer.During treatment sessions, bladder and rectal repletion is difficult to quantify and cannot be measured with a single and initial CT scan acquisition. Some methods, such as image-guided radiation therapy and dose-guided radiation therapy, aimto compensate thismissing information through periodic CT acquisitions. The aimis to adapt patient's position, beam configuration or prescribed dose for a dosimetric compliance. Methods. -We evaluated organmotion (and repletion) for 54 patients after having computed the original ballistic on a new CT scan acquisition. A new delineation was done on the prostate, bladder and rectum to determine the newdisplacements and define organ dosesmistakes (equivalent uniformdose, average dose and dose-volume histograms). Results. - The new CT acquisitions confirmed that bladder and rectal volumes were not constant during sessions. Some cases showed that previously validated treatment plan became unsuitable. A proposed solution is to correct dosimetries when bladder volume modifications are significant. The result is an improvement for the stability of bladder doses, D50 error is reduced by 25.3%, mean dose error by 5.1% and equivalent uniform dose error by 2.6%. For the rectum this method decreases errors by only 1%. This process can reduce the risk of mismatch between the initial scan and following treatment sessions. Conclusion. - For the proposedmethod, the cone-beamCT is necessary to properly position the isocenter and to quantify bladder and rectal volume variation and deposited doses. The dosimetries are performed in the event that bladder (or rectum) volume modification limits are exceeded. To identify these limits, we have calculated that a tolerance of 10% for the equivalent uniformdose (compared to the initial value of the first dosimetry), this represents 11% of obsolete dosimetries for the bladder, and 4% for the rectum.