Highlights
- •Prostate motion during SABR can result in inaccurate radiation dose delivery.
- •Both MLC tracking and gating were effective methods for real-time motion adaptation.
- •MLC tracking and gating were comparable dosimetrically.
- •Gating resulted in more interruptions to the clinical workflow.
Abstract
Purpose
Stereotactic Ablative Radiotherapy (SABR) has recently emerged as a favourable treatment
option for prostate cancer patients. With higher doses delivered over fewer fractions,
motion adaptation is a requirement for accurate delivery of SABR. This study compared
the efficacy of multileaf collimator (MLC) tracking vs. gating as a real-time motion
adaptation strategy for prostate SABR patients enrolled in a clinical trial.
Methods
Forty-four prostate cancer patients treated over five fractions in the TROG 15.01
SPARK trial were analysed in this study. Forty-nine fractions were treated using MLC
tracking and 166 fractions were treated using beam gating and couch shifts. A time-resolved
motion-encoded dose reconstruction method was used to evaluate the dose delivered
using each motion adaptation strategy and compared to an estimation of what would
have been delivered with no motion adaptation strategy implemented.
Results
MLC tracking and gating both delivered doses closer to the plan compared to when no
motion adaptation strategy was used. Differences between MLC tracking and gating were
small with differences in the mean discrepancy from the plan of −0.3% (CTV D98%), 1.4% (CTV D2%), 0.4% (PTV D95%), 0.2% (rectum V30Gy) and 0.0% (bladder V30Gy). On average, 0.5 couch shifts were required per gated fractions with a mean interruption
duration of 1.8 ± 2.6 min per fraction treated using gating.
Conclusion
Both MLC tracking and gating were effective strategies at improving the accuracy of
the dose delivered to the target and organs at risk. While dosimetric performance
was comparable, gating resulted in interruptions to treatment.
Clinical trial registration number: NCT02397317.
Keywords
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Article info
Publication history
Published online: August 20, 2020
Accepted:
August 16,
2020
Received in revised form:
July 17,
2020
Received:
March 20,
2020
Identification
Copyright
© 2020 Elsevier B.V. All rights reserved.
