Hodgins T, Forde E
Applied Radiation Therapy Trinity (ARTT), Discipline of Radiation Therapy, School of Medicine, Trinity St. James's Cancer Institute, Trinity College Dublin, University of Dublin, Dublin, Ireland.
Tech Innov Patient Support Radiat Oncol. 2024 Oct 29;32:100287. doi: 10.1016/j.tipsro.2024.100287. eCollection 2024 Dec.
Prostate bed (PB) motion may lead to geographical miss of the target volume in post-prostatectomy radiotherapy (RT). Optimal clinical target volume (CTV) to planning target volume (PTV) margins prevent geographical miss and unnecessary irradiation of normal tissue. There is little data available informing appropriate CTV to PTV margins in the post-prostatectomy setting. The purpose of this review was to quantify the inter-fraction and intra-fraction motion of the PB and draw a conclusion regarding the use of anisotropic CTV to PTV margins for post-prostatectomy RT treatment.
A search of PubMed and EMBASE databases was carried out using keywords (prostate bed [Title/Abstract]) AND (motion [Title/Abstract]). All study types assessing inter-fraction and/or intra-fraction motion of the PB based on imaging of soft tissue anatomy were included. Data on patient preparation, immobilisation, and image guidance was abstracted from the included studies. Magnitude of PB motion along with the estimated CTV to PTV margins calculated was also tabulated. Quality of studies was assessed using the MINORS tool.
Seventeen studies were included in the analysis. The largest magnitude of inter-fraction PB motion occurs in the anterior-posterior direction. This motion is attributed to the influence of the bladder and rectal volume on the PB. The PB moves independently of bone and the magnitude of motion varies between the superior and inferior portions of the prostate bed.
Anisotropic CTV to PTV margins are appropriate for use in the post-prostatectomy setting and their implementation for treatment planning purposes are warranted based on the evidence reviewed.
前列腺床（PB）运动可能导致前列腺切除术后放疗（RT）中靶区体积的几何遗漏。从最佳临床靶区体积（CTV）到计划靶区体积（PTV）的边界可防止几何遗漏和对正常组织的不必要照射。在前列腺切除术后的情况下，几乎没有数据可用于确定合适的CTV到PTV边界。本综述的目的是量化PB的分次间和分次内运动，并就前列腺切除术后RT治疗中使用各向异性的CTV到PTV边界得出结论。
使用关键词（前列腺床[标题/摘要]）和（运动[标题/摘要]）在PubMed和EMBASE数据库中进行检索。纳入所有基于软组织解剖成像评估PB分次间和/或分次内运动的研究类型。从纳入的研究中提取有关患者准备、固定和图像引导的数据。还列出了PB运动的幅度以及计算出的估计CTV到PTV边界。使用MINORS工具评估研究质量。
17项研究纳入分析。分次间PB运动的最大幅度出现在前后方向。这种运动归因于膀胱和直肠体积对PB的影响。PB独立于骨骼移动，且运动幅度在前列腺床的上部和下部之间有所不同。
基于所审查的证据，各向异性的CTV到PTV边界适用于前列腺切除术后的情况，并且有必要将其用于治疗计划目的。
