Planned versus ‘delivered’ bladder dose reconstructed using solid and hollow organ models during prostate cancer IMRT

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• 作者：Tara Rosewall^a ; ^b ; ^c ; ^{Tara.Rosewall@rmp.uhn.on.ca" class="auth_mail" title="E-mail the corresponding author} ; Janelle Wheat^c ; ^d ; Geoffrey Currie^c ; ^d ; Vickie Kong^a ; Andrew J. Bayley^a ; ^b ; Joanne Moseley^a ; Peter Chung^a ; ^b ; Charles Catton^a ; ^b ; Tim Craig^a ; ^b ; Michael Milosevic^a ; ^b
• 关键词：Intensity Modulated Radiation Therapy ; Dose accumulation ; Deformable registration ; Bladder wall
• 刊名：Radiotherapy and Oncology
• 出版年：2016
• 出版时间：June 2016
• 年：2016
• 卷：119
• 期：3
• 页码：417-422
• 全文大小：654 K

文摘

All studies to date have evaluated the dosimetric effect of bladder deformation using an organ model that includes the dose to the urine. This research reconstructed bladder dose using both hollow and solid organ models, to determine if dose/volume differences exist.

Materials and methods

35 prostate IMRT patients were selected, who had received 78 Gy in 39 fractions and full bladder instructions. Biomechanical modelling and finite element analysis were used to reconstruct bladder dose (solid and hollow organ model) using every third CBCT throughout the treatment course.

Results

Reconstructed dose (ReconDose) was 11.3 Gy greater than planned dose (planDose) with a hollow bladder model (p < 0.001) and 12.3 Gy greater with a solid bladder model (p < 0.0001). Median reconstructed volumes within the 30 Gy, 65 Gy and 78 Gy isodoses were 3–4 times larger with the solid organ model (p < 0.0001). The difference between planning bladder volume and median treatment volume was associated with the difference between the planDose and reconDose below 78 Gy (R² > 0.61).

Conclusions

Substantial differences exist between planned and reconstructed bladder dose, associated with the differences in bladder filling between planning and treatment. Dose reconstructed using a solid bladder model over-reports the volume of bladder within key isodose levels and overestimates the differences between planned and reconstructed dose. Dose reconstruction with a hollow organ model is recommended if the goal is to associate that dose with toxicity.