Impact of the Treatment Margin On Tumor Control and Normal Tissue Complication for Prostate Treatment
JS Li*, M-H Lin, C-M Ma, Fox Chase Cancer Center, PHILADELPHIA, PASU-E-T-464 Sunday 3:00:00 PM - 6:00:00 PM Room: Exhibit Hall
Purpose: To investigate the consequence of treatment margin reduction on normal tissue complication probability (NTCP) and tumor control probability (TCP) of prostate external beam treatment.
Methods: Intensity modulated rotational radiotherapy plans were generated for 10 prostate patients with 6 different posterior margin sizes from 5mm to 0. The prescription dose is 80Gy for 40 treatment fractions. The dose distributions were recalculated with consideration of the intrafractional motion and the localization error. The statistical uncertainties of the intrafractional motion and the localization error were derived based on the motion tracking data recorded by the Calypso 4D localization system for a large patient population. The TCP and NTCP were calculated based on the dose volume histograms (DVH) of prostate and rectum for plans with different margins using an equivalent uniform dose (EUD) based biological model. The 50% tumor control dose (TCD50) of 60Gy for prostate and the median toxic dose (TD50) of 55Gy for rectum were used in the calculation.
Results: The minimum dose of the prostate and the mean dose of the rectum dropped with the decrease of the treatment margin. When the posterior treatment margin was reduced from 5mm to zero, the EUD of prostate decreased from 83Gy (±0.5Gy) to 81Gy (±0.5Gy) and the TCP dropped from 93.2% (±0.1%) to 91.7% (±0.1%), the EUD of the rectum decreased more significantly from 48.9Gy (±0.4Gy) to 32.5Gy (±0.5Gy) and the NTCP dropped from 13.3% (±1.5%) to 0.03% (± 0.01%).
Conclusions: The treatment margin size affects the dose to the target and the nearby critical structure. More significant impact on NTCP has been observed than on TCP. This gives us some room to consider the quality of the patient's after-treatment life. A wise choice of treatment margin can be made based on physician's opinion and patient's preference on the tumor control and the quality of life.