Target Intrafraction Motion Dosimetric Impact On 5-Fraction Proton Prostate SBRT
Z Su1*, R Slopsema1, S Flampouri1, Z Li1, (1) University of Florida, Jacksonville, FLSU-E-J-214 Sunday 3:00:00 PM - 6:00:00 PM Room: Exhibit Hall
Purpose: To investigate dosimetric impact of prostate intra-fraction motion to five fraction hypofractionated proton treatment with uniform scanning (US) and double scattering (DS) techniques using real-time prostate tracking data from electromagnetic transponder system.
Methods: Prostate intra-fraction motion can have spatiotemporal interplay with proton treatment delivery. Five fraction (7.25Gy/fraction) prostate proton stereotactic body radiotherapy (SBRT) treatments were simulated for total 14 patients using in-house proton treatment simulation program. The US treatment was simulated by rigidly moving CTV through a series of temporal-spatial dose matrices indexed by energy layers, according to prostate motion traces. The CTV temporal doses of the whole treatment fraction were obtained and summed as final prostate CTV dose. The DS treatment was simulated by moving CTV through the energy layer summed dose matrix. For all patients, the fraction doses and the total dose to the CTV were presented for both DS and US treatments.
Results: The CTV dose of different fractions indicated that its dose degradation depends on magnitude and direction of prostate intra-fraction motion and is patient specific. For one of the prostate motion traces investigated, only 70% of CTV received 100% prescribed dose for a simulated US treatment and 79% CTV had 100% dose for a DS treatment. Furthermore, DVH and isodose graphs of both treatments revealed that intra-fraction motion caused significant CTV cold and hot spots in US treatment whereas only cause CTV underdose in DS treatment.
Conclusions: Intra-fraction prostate motion causes dose uncertainty to CTV. In the 5 fraction prostate SBRT, prostate intra-fraction motion causes significant target dose degradation. In US treatment, spatiotemporal interplay between energy layers delivery and prostate motion leads to hot and cold spots in CTV for some patients with severe prostate intra-fraction motion. Further investigation of intra-fraction motion management and its impact on CTV dose is necessary.