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Research Article
Hideomi Yamashita
University of Tokyo Hospital: Tokyo Daigaku Igakubu Fuzoku Byoin
Corresponding Author
License:
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Background
The aim of this study was to clarify the association between intrafractional prostate shift and hydrogel spacer.
Methods
Thirty-eight patients who received definitive volumetric modulated arc therapy (VMAT)-stereotactic body radiation therapy (SBRT) for prostate cancer with prostate motion monitoring in our institution in 2018–2019 were retrospectively evaluated. In order to move the rectum away from the prostate, hydrogel spacer (SpaceOAR system, Boston Scientific, Marlborough, the United States) injection was proposed to the patients as an option in case of meeting the indication of use. We monitored intrafractional prostate motion by using a 4-dimensional (4D) transperineal ultrasound (US) device: the Clarity 4D ultrasound system (Elekta AB). The deviation of the prostate was monitored in each direction: superior-inferior (SI), left-right (LR), and anterior-posterior (AP). We also calculated the vector length (VL). The maximum intrafractional displacement (MID) per fraction for each direction was detected and mean of MIDs was calculated per patient. The MIDs in the non-spacer group and the spacer group were compared using the unpaired t-test.
Results
We reviewed 33 fractions in eight patients as the spacer group and 148 fractions in 30 patients as the non-spacer group. The superior MID was 0.47 ± 0.07 (mean ± SE) mm vs. 0.97 ± 0.24 mm (P = 0.014), the inferior MID was 1.07 ± 0.11 mm vs. 1.03 ± 0.25 mm (P = 0.88), the left MID was 0.74 ± 0.08 mm vs. 0.87 ± 0.27 mm (P = 0.55), the right MID was 0.67 ± 0.08 mm vs. 0.92 ± 0.21 mm (P = 0.17), the anterior MID was 0.45 ± 0.06 mm vs. 1.16 ± 0.35 mm (P = 0.0023), and the posterior MID was 1.57 ± 0.17 mm vs. 1.37 ± 0.22 mm (P = 0.56) in the non-spacer group and the spacer group, respectively. The max of VL was 2.24 ± 0.19 mm vs. 2.89 ± 0.62 mm (P = 0.19), respectively.
Conclusions
Our findings suggest that intrafractional prostate motion during VMAT-SBRT was larger in patients with hydrogel spacer injection in the superior and anterior directions.
Keywords
prostate cancer, stereotactic body radiation therapy, intrafractional prostate motion, transperineal ultrasound, hydrogel spacer
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CURRENT STATUS: Under Review
Version 1
Posted 05 Apr, 2021
No community comments so far
Editorial decision: Major revision
On 16 May, 2021
Review #1 received
Received 15 May, 2021
Review #2 received
Received 26 Apr, 2021
Reviewer #2 agreed
On 05 Apr, 2021
Reviewer #1 agreed
On 03 Apr, 2021
Reviews received
Received 03 Apr, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
First submitted
On 31 Mar, 2021
Editor assigned
On 30 Mar, 2021
Submission checks complete
On 30 Mar, 2021
Editor invited
On 30 Mar, 2021
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Subject Areas
Oncology
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A new preprint design is coming!
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This preprint is under consideration at Radiation Oncology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Research Article
Hideomi Yamashita
University of Tokyo Hospital: Tokyo Daigaku Igakubu Fuzoku Byoin
Corresponding Author
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Under Review
Version 1
Posted 05 Apr, 2021
No community comments so far
Editorial decision: Major revision
On 16 May, 2021
Review #1 received
Received 15 May, 2021
Review #2 received
Received 26 Apr, 2021
Reviewer #2 agreed
On 05 Apr, 2021
Reviewer #1 agreed
On 03 Apr, 2021
Reviews received
Received 03 Apr, 2021
Reviewers invited
Invitations sent on 31 Mar, 2021
First submitted
On 31 Mar, 2021
Editor assigned
On 30 Mar, 2021
Submission checks complete
On 30 Mar, 2021
Editor invited
On 30 Mar, 2021
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Oncology
License:
This work is licensed under a CC BY 4.0 License. Read Full License
Background
The aim of this study was to clarify the association between intrafractional prostate shift and hydrogel spacer.
Methods
Thirty-eight patients who received definitive volumetric modulated arc therapy (VMAT)-stereotactic body radiation therapy (SBRT) for prostate cancer with prostate motion monitoring in our institution in 2018–2019 were retrospectively evaluated. In order to move the rectum away from the prostate, hydrogel spacer (SpaceOAR system, Boston Scientific, Marlborough, the United States) injection was proposed to the patients as an option in case of meeting the indication of use. We monitored intrafractional prostate motion by using a 4-dimensional (4D) transperineal ultrasound (US) device: the Clarity 4D ultrasound system (Elekta AB). The deviation of the prostate was monitored in each direction: superior-inferior (SI), left-right (LR), and anterior-posterior (AP). We also calculated the vector length (VL). The maximum intrafractional displacement (MID) per fraction for each direction was detected and mean of MIDs was calculated per patient. The MIDs in the non-spacer group and the spacer group were compared using the unpaired t-test.
Results
We reviewed 33 fractions in eight patients as the spacer group and 148 fractions in 30 patients as the non-spacer group. The superior MID was 0.47 ± 0.07 (mean ± SE) mm vs. 0.97 ± 0.24 mm (P = 0.014), the inferior MID was 1.07 ± 0.11 mm vs. 1.03 ± 0.25 mm (P = 0.88), the left MID was 0.74 ± 0.08 mm vs. 0.87 ± 0.27 mm (P = 0.55), the right MID was 0.67 ± 0.08 mm vs. 0.92 ± 0.21 mm (P = 0.17), the anterior MID was 0.45 ± 0.06 mm vs. 1.16 ± 0.35 mm (P = 0.0023), and the posterior MID was 1.57 ± 0.17 mm vs. 1.37 ± 0.22 mm (P = 0.56) in the non-spacer group and the spacer group, respectively. The max of VL was 2.24 ± 0.19 mm vs. 2.89 ± 0.62 mm (P = 0.19), respectively.
Conclusions
Our findings suggest that intrafractional prostate motion during VMAT-SBRT was larger in patients with hydrogel spacer injection in the superior and anterior directions.
Figure 1
Figure 2
Figure 3
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