Abstract
Background and purpose: The aim of this study was to assess the feasibility of using gold seed implants
in the prostate for position verification, using an a-Si flat panel imager as a detector
during megavoltage irradiation of prostate carcinoma. This is a study to guarantee
positioning accuracy in intensity-modulated radiotherapy.
Methods and materials: Ten patients with localized prostate carcinoma (T2–3) received between one and three
fiducial gold markers in the prostate. All patients were treated with 3-D conformal
radiotherapy with an anterior–posterior (AP) and two lateral wedge fields. The acute
gastrointestinal (GI) and genitourinary (GU) toxicities were scored using common toxicity
criteria scales (CTC). Using three consecutive CT scans and portal images obtained
during the treatment we have studied the occurrence of any change in prostate shape
(deformation), seed migration and the magnitude of translations and rotations of the
prostate.
Results: We observed no acute major complications for prostate irradiation regarding the
seed implantation. The maximum acute GU toxicity grade 2 (dysuria and frequency) was
observed in seven patients during the treatment. The maximum grade 2 (diarrhoea) was
scored in two patients regarding the acute GI toxicities. No significant prostate
deformation could be detected in the consecutive CT scans. It appeared that the distances
between the markers only slightly changed during treatment (S.D. 0.5 mm). Random prostate
translations were (1 S.D.) 2.1, 3.2 and 2.2 mm in the lateral (LR), AP and cranial–caudal
(CC) directions, respectively, whereas systematic translations were 3.3, 4.8 and 3.5
mm in the LR, AP and CC directions, respectively. Random prostate rotations were (1
S.D.) 3.6, 1.7 and 1.9° around the LR, AP and CC axis, respectively, whereas systematic
rotations were 4.7, 2.0 and 2.7° around the LR, AP and CC axis, respectively.
Conclusions: We found that the fiducial gold seeds are a safe and appropriate device to verify
and correct the position of prostate during megavoltage irradiation. The amount of
seed migration and prostate deformation is far below our present tumour delineation
accuracy.
Keywords
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Article info
Publication history
Accepted:
February 26,
2003
Received in revised form:
January 15,
2003
Received:
May 2,
2002
Identification
Copyright
© 2003 Published by Elsevier Inc.
