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Case Reports
. 2023 Jun 22;15(6):e40778.
doi: 10.7759/cureus.40778. eCollection 2023 Jun.

Stereotactic Body Radiation Therapy for Prostate Cancer Using Tomotherapy With Synchrony Fiducial Tracking

Takashi Shintani  1 , Shimpei Anami  1 , Keisuke Sano  1 , Wataru Okada  1 , Masao Tanooka  1
Affiliations
Case Reports

Stereotactic Body Radiation Therapy for Prostate Cancer Using Tomotherapy With Synchrony Fiducial Tracking

Takashi Shintani et al. Cureus. .

Abstract

Numerous prospective and retrospective studies have demonstrated the efficacy and safety of stereotactic body radiation therapy (SBRT) for prostate cancer. Since SBRT utilizes a very tight margin, management of intrafraction prostate motion is necessary. As a real-time motion tracking and correction system (Synchrony; Accuray, Sunnyvale, CA) has been introduced in the newer platform of tomotherapy (Radixact; Accuray), Radixact can deliver tracking SBRT. In the case report, we present the first clinical experience with prostate SBRT using tomotherapy with Synchrony fiducial tracking.

Keywords: intrafraction motion; prostate cancer; sbrt; stereotactic body radiation therapy; tomotherapy.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Dose distribution of prostate SBRT
The prostate SBRT treatment plan is displayed on fused T2-weighted MRI on the representative (A) axial and (B) sagittal views. Abbreviations: SBRT, stereotactic body radiation therapy; MRI, magnetic resonance imaging
Figure 2
Figure 2. Workflow of treatment delivery
On-board kV CT is used for the initial setup to match the three fiducial markers to the positions on the planning CT. The translational correction and the roll rotational correction can be made by the couch shift and by the adjustment of the gantry start angle while the pitch and yaw rotational error cannot be corrected. Intratreatment 2D kV radiographs are obtained six times (25, 75, 155, 205, 255, and 335 degrees) per one gantry rotation. Several parameters to control tracking SBRT delivery are shown, and if these parameters continuously exceed the threshold, we acquire another onboard kV CT to correct the motion shift. Abbreviations: SBRT, stereotactic body radiation therapy; CT, computed tomography; kV, x-ray tube voltage
Figure 3
Figure 3. Example of the delivery report of tracking SBRT
International electrotechnical commission X (lateral), Y (longitudinal), and Z (vertical) displacement of fiducial markers from the position in the planning CT at fraction four is displayed. The target offset exceeded the threshold level (2.5 mm) due to a gradual shift (red arrow), and we acquired onboard another kV CT to correct the position and resumed the treatment. Abbreviations: SBRT, stereotactic body radiation therapy; CT, computed tomography; kV, x-ray tube voltage
See this image and copyright information in PMC

References

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