Proximal seminal vesicle displacement and margins for prostate cancer radiotherapy

• Main Authors: Daryl Lim Joon, Michael Chao, Angelina Piccolo, Michal Schneider, Nigel Anderson, Monica Handley, Margaret Benci, Wee Loon Ong, Karen Daly, Rebecca Morrell, Kenneth Wan, Nathan Lawrentschuk, Farshad Foroudi, Trish Jenkins, David Angus, Morikatsu Wada, Shomik Sengupta, Vincent Khoo
• Format: Article
• Language: English
• Published: Wiley 2021-09-01
• Series: Journal of Medical Radiation Sciences
• Subjects: Clinical target volume; displacement; fiducial markers; margins; planning target volume; prostate cancer
• Online Access: https://doi.org/10.1002/jmrs.457
• ISSN: 2051-3895; 2051-3909

Abstract Introduction Guidelines recommend that the proximal seminal vesicles (PrSV) should be included in the clinical target volume for locally advanced prostate cancer patients undergoing radiotherapy. Verification and margins for the prostate may not necessarily account for PrSV displacement. The purpose was to determine the inter‐fraction displacement of the PrSV relative to the prostate during radiotherapy. Methods Fiducials were inserted into the prostate, and right and left PrSV (RSV and LSV) in 30 prostate cancer patients. Correctional shifts for the prostate, right and left PrSV and pelvic bones were determined from each patient's 39 daily orthogonal portal images relative to reference digitally reconstructed radiographs. Results There was a significant displacement of the RSV relative to the prostate in all directions: on average 0.38 mm (95% confidence interval (CI) 0.26 to 0.50) to the left, 0.80–0.81 mm (CI 0.68 to 0.93) superiorly and 1.51 mm (CI 1.36 to 1.65) posteriorly. The LSV was significantly displaced superiorly to the prostate 1.09–1.13 mm (CI 0.97 to 1.25) and posteriorly 1.81 mm (CI 1.67 to 1.96), but not laterally (mean 0.06, CI −0.06 to 0.18). The calculated PTV margins (left–right, superior–inferior, posterior–anterior) were 4.9, 5.3–5.6 and 4.8 mm for the prostate, 5.2, 7.1–8.0 and 9.7 mm for the RSV, and 7.2, 7.5–7.6 and 8.6 mm for the LSV. Conclusion There is a significant displacement of the PrSV relative to the prostate during radiotherapy. Greater margins are recommended for the PrSV compared to the prostate.