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Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers

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Title: Analysis of inter- and intra fractional partial bladder wall movement using implanted fiducial markers
Authors: Nishioka, Kentaro Browse this author →KAKEN DB
Shimizu, Shinichi Browse this author →KAKEN DB
Shinohara, Nobuo Browse this author →KAKEN DB
Ito, Yoichi M. Browse this author →KAKEN DB
Abe, Takashige Browse this author →KAKEN DB
Maruyama, Satoru Browse this author →KAKEN DB
Katoh, Norio Browse this author →KAKEN DB
Kinoshita, Rumiko Browse this author →KAKEN DB
Hashimoto, Takayuki Browse this author →KAKEN DB
Miyamoto, Naoki Browse this author →KAKEN DB
Onimaru, Rikiya Browse this author →KAKEN DB
Shirato, Hiroki Browse this author →KAKEN DB
Keywords: Bladder cancer
Interfractional uncertainty of position
Intrafractional uncertainty of position
Real-time tumor tracking system
Issue Date: 1-Mar-2017
Publisher: BioMed Central
Journal Title: Radiation Oncology
Volume: 12
Start Page: 44
Publisher DOI: 10.1186/s13014-017-0778-z
Abstract: Background: Current adaptive and dose escalating radiotherapy for muscle invasive bladder cancer requires knowledge of both inter-fractional and intra-fractional motion of the bladder wall involved. The purpose of this study is to characterize inter- and intra-fractional movement of the partial bladder wall using implanted fiducial markers and a real-time tumor-tracking radiotherapy system. Methods: Two hundred fifty one sessions with 29 patients were analysed. After maximal transurethral bladder tumor resection and 40 Gy of whole bladder irradiation, up to six gold markers were implanted transurethrally into the bladder wall around the tumor bed and used for positional registration. We compared the systematic and random uncertainty of positions between cranial vs. caudal, left vs. right, and anterior vs. posterior tumor groups. The variance in intrafractional movement and the percentage of sessions where 3 mm and 5 mm or more of intrafractional wall movement occurring at 2, 4, 6, 8, 10, and at more than 10 min until the end of a session were determined. Results: The cranial and anterior tumor group showed larger interfractional uncertainties in the position than the opposite side tumor group in the CC and AP directions respectively, but these differences did not reach significance. Among the intrafractional uncertainty of position, the cranial and anterior tumor group showed significantly larger systematic uncertainty of position than the groups on the opposite side in the CC direction. The variance of intrafractional movement increased over time; the percentage of sessions where intrafractional wall movement was larger than 3 mm within 2 min of the start of a radiation session or larger than 5 mm within 10 min was less than 5%, but this percentage was increasing further during the session, especially in the cranial and anterior tumor group. Conclusions: More attention for intrafractional uncertainty of position is required in the treatment of cranial and anterior bladder tumors especially in the CC direction. The optimal internal margins in each direction should be chosen or a precise intrafractional target localization system is required depending on the tumor location and treatment delivery time in the setting of partial bladder radiotherapy.
Type: article
Appears in Collections:医学院・医学研究院 (Graduate School of Medicine / Faculty of Medicine) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)
国際連携研究教育局 : GI-CoRE (Global Institution for Collaborative Research and Education : GI-CoRE) > 雑誌発表論文等 (Peer-reviewed Journal Articles, etc)

Submitter: 西岡 健太郎

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