Progress in Medical Physics (한국의학물리학회지:의학물리)

Korean Society of Medical Physics (한국의학물리학회)
권호 표지
DOI QR코드

DOI QR Code

Minimization of Treatment Time Using Partial-Arc Volumetric Modulated Arc Therapy with Bladder Filling Protocol for Prostate Cancer

  • Hojeong Lee (Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Dong Woon Kim (Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Ji Hyeon Joo (Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Yongkan Ki (Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital) ;
  • Wontaek Kim (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Dahl Park (Department of Radiation Oncology, Pusan National University Hospital) ;
  • Jiho Nam (Department of Radiation Oncology, Pusan National University Hospital) ;
  • Dong Hyeon Kim (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Hosang Jeon (Department of Radiation Oncology and Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital)
  • Received : 2022.11.11
  • Accepted : 2022.12.12
  • Published : 2022.12.31
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: Radiotherapy after bladder filling protocol (BFP) is known to enhance treatment quality and reduce side effects in prostate cancer, a common male solid cancer globally. However, due to the need to hold back urine during treatment, patients frequently complain of discomfort, and treatment is frequently suspended when patients urinate during treatment and urine penetrates the treatment device, causing malfunction. Therefore, the effect of minimizing treatment time when partial-arc volumetric modulated arc therapy (VMAT) was used instead of full-arc was assessed in this study. Methods: A total of 70 plans were created in 10 patients using 7 different arc sizes, and the treatment time for each plan was calculated. Results: Reduced arc size by half resulted in a 54.4% decrease in mean treatment duration, with a proportional tendency observed. Furthermore, the effect of VMAT arc size reduction on target dose homogeneity was significantly limited, and the effect on surrounding organs at risk (OAR) was negligible. It should be noted, however, that when the arc size decreases by >40%, the dose increases in the area without OAR around the target. Conclusions: The results of this study demonstrated that partial-arc VMAT for enhancing treatment convenience and efficacy of prostate cancer patients undergoing BFP can achieve a considerable reduction in treatment time while preserving treatment quality, and it is expected to be useful for partial-arc VMAT plan design and implementation in practice.

Keywords

Acknowledgement

This research was supported by the Basic Science Research Program through the National Research Foundation of Korea (NRF) funded by the Korean government (2020R1C1C1013300) and a 2022 research grant from Pusan National University Yangsan Hospital.

References

  1. Zaorsky NG, Palmer JD, Hurwitz MD, Keith SW, Dicker AP, Den RB. What is the ideal radiotherapy dose to treat prostate cancer? A meta-analysis of biologically equivalent dose escalation. Radiother Oncol. 2015;115:295-300. https://doi.org/10.1016/j.radonc.2015.05.011
  2. Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016;17:1047-1060. Erratum in: Lancet Oncol. 2016;17:e321. https://doi.org/10.1016/S1470-2045(16)30102-4
  3. Fischer-Valuck BW, Rao YJ, Michalski JM. Intensity-modulated radiotherapy for prostate cancer. Transl Androl Urol. 2018;7:297-307. https://doi.org/10.21037/tau.2017.12.16
  4. Hoffmann M, Pacey J, Goodworth J, Laszcyzk A, Ford R, Chick B, et al. Analysis of a volumetric-modulated arc therapy (VMAT) single phase prostate template as a class solution. Rep Pract Oncol Radiother. 2019;24:92-96. https://doi.org/10.1016/j.rpor.2018.10.009
  5. Stam MR, van Lin EN, van der Vight LP, Kaanders JH, Visser AG. Bladder filling variation during radiation treatment of prostate cancer: can the use of a bladder ultrasound scanner and biofeedback optimize bladder filling? Int J Radiat Oncol Biol Phys. 2006;65:371-377. https://doi.org/10.1016/j.ijrobp.2005.12.039
  6. Yoon HI, Chung Y, Chang JS, Lee JY, Park SJ, Koom WS. Evaluating variations of bladder volume using an ultrasound scanner in rectal cancer patients during chemoradiation: is protocol-based full bladder maintenance using a bladder scanner useful to maintain the bladder volume? PLoS One. 2015;10:e0128791.
  7. Smith GA, Dunlop A, Barnes H, Herbert T, Lawes R, Mohajer J, et al. Bladder filling in patients undergoing prostate radiotherapy on a MR-linac: the dosimetric impact. Tech Innov Patient Support Radiat Oncol. 2022;21:41-45. https://doi.org/10.1016/j.tipsro.2022.02.002
  8. O'Doherty UM, McNair HA, Norman AR, Miles E, Hooper S, Davies M, et al. Variability of bladder filling in patients receiving radical radiotherapy to the prostate. Radiother Oncol. 2006;79:335-340.
  9. Braide K, Kindblom J, Lindencrona U, Mansson M, Hugosson J. The value of a bladder-filling protocol for patients with prostate cancer who receive post-operative radiation: results from a prospective clinical trial. Acta Oncol. 2019;58:463-468. https://doi.org/10.1080/0284186X.2018.1554261
  10. Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys. 2010;76(3 Suppl):S123-S129. Erratum in: Int J Radiat Oncol Biol Phys. 2019;104:1185. https://doi.org/10.1016/j.ijrobp.2009.03.078