Aims: As the trend towards more conformal treatment continues, the accuracy of treatment delivery becomes more important. Conventionally, treatment set-up for prostate cancer patients is verified in relation to the bony anatomy. However, there can be prostate movement independent of bony anatomy. This study tested the feasibility of using Beam cath to enable online correction of treatment set-up in relation to the prostate position, and to assess inter-fraction and intra-fraction prostate movement.
Materials and methods: Beam cath is a urethral catheter containing radio-opaque markers, which can be seen on electronic portal imaging, enabling verification of prostate rather than bony anatomy position. The Beam cath was used for planning and treatment of a boost phase of 10 Gy in 5 fractions, delivered before the conventional conformal plan of 60 Gy in 30 fractions. Patients were scanned by computed tomgography (CT), with and without the catheter, and a radio-opaque marker in the catheter was used as the isocentre of the boost phase to enable accurate and rapid pre-treatment isocentre adjustment. The set-up errors between the Beam Cath and bony images were compared to identify the magnitude of prostate movement, independent of bony anatomy. Post-treatment portal images were taken to assess intra-fraction prostate movement.
Results: Of 29 patients approached to take part in the study, 18 patients gave informed consent, but only five completed the intended 5 fractions of the boost phase using Beam cath. Pre- and post-treatment portal images were obtained for a total of 29 fractions in six patients. Inter-fraction prostate movement, independent of bony anatomy, was identified. The mean movements were 0.2 mm (standard deviation [SD] 1.2 mm), 2.9 mm (SD 3.1 mm) and 0.7 mm (SD 2.3 mm) in the right left (RL), cranio-caudal (CC) and anterior posterior (AP) direction, respectively. The mean intra-fraction movement was 0.2 mm (SD 1.2 mm), 2.9 mm (SD 3.1 mm) and 0.7 mm (SD 2.3 mm) in the RL, CC and AP direction, respectively.
Conclusion: Although independent prostate movement was identified, the use of Beam cath was poorly tolerated. Alternative methods of identifying and correcting for prostate movement should be investigated.