Endorectal balloons in the post prostatectomy setting: do gains in stability lead to more predictable dosimetry?

Abstract

Purpose: To perform a comparative study assessing potential benefits of endorectal-balloons (ERB) in post-prostatectomy patients.

Method and materials: Ten retrospective post-prostatectomy patients treated without ERB and ten prospective patients treated with the ERB in situ were recruited. All patients received IMRT and IGRT using kilovoltage cone-beam computed tomography (kVCBCT). kVCBCT datasets were registered to the planning dataset, recontoured and the original plan recalculated on the kVCBCTs to recreate anatomical conditions during treatment. The imaging, structure and dose data were imported into in-house software for the assessment of geometric variation and cumulative equivalent uniform dose (EUD) in the two groups.

Results: The difference in location (ΔCOV) for the bladder between planning and each CBCT was similar for each group. The range of mean ΔCOV for the rectum was 0.15-0.58 cm and 0.15-0.59 cm for the non-ERB and ERB groups. For superior-CTV and inferior-CTV the difference between planned and delivered D95% (mean ± SD) for the non-ERB group was 2.1 ± 6.0 Gy and -0.04 ± 0.20 Gy. While for the ERB group the difference in D95% was 8.7 ± 12.6 Gy and 0.003 ± 0.104 Gy.

Conclusions: The use of ERBs in the post-prostatectomy setting did improve geometric reproducibility of the target and surrounding normal tissues, however no improvement in dosimetric stability was observed for the margins employed.

Keywords: EUD; Endorectal balloon; IMRT; Inter-fraction motion; Post prostatectomy.