Hostname: page-component-848d4c4894-ndmmz Total loading time: 0 Render date: 2024-05-31T16:59:07.110Z Has data issue: false hasContentIssue false
  • English
  • Français

Does body mass index or subcutaneous adipose tissue thickness affect interfraction prostate motion in patients receiving radical prostate radiotherapy?

Published online by Cambridge University Press:  09 September 2016

Jonathan Rogers ,
Camarie Welgemoed  and
Dorothy Gujral
Jonathan Rogers*
Affiliation:
Department of Radiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
Camarie Welgemoed
Affiliation:
Department of Radiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
Dorothy Gujral
Affiliation:
Department of Radiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, London, UK
*
Correspondence to: Jonathan Rogers, Department of Radiotherapy, Imperial College Healthcare NHS Trust, Charing Cross Hospital, Fulham Palace Road, London, W6 8RF, UK. Tel: 44 20 8846 7648. E-mail: jonathan.rogers@imperial.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Aim

It is unclear whether body mass index (BMI) is a useful measurement for examining prostate motion. Patient’s subcutaneous adipose tissue thickness (SAT) and weight has been shown to correlate with prostate shifts in the left/right direction. We sought to analyse the relationship between BMI and interfraction prostate movement in order to determine planning target volume (PTV) margins based on patient BMI.

Materials and methods

In all, 38 prostate cancer patients with three implanted gold fiducial markers in their prostate were recruited. Height, mass and SAT were measured, and the extent of interfraction prostate movement in the left/right, superior/inferior and anterior/posterior directions was recorded during each daily fiducial marker-based image-guided radiotherapy treatment. Mean corrective shift in each direction for each patient, along with BMI values, were calculated.

Results

The median BMI value was 28·4 kg/m2 (range 21·4–44·7). Pearson’s product-moment correlation analysis showed no significant relationship between BMI, mass or SAT and the extent of prostate movement in any direction. Linear regression analysis also showed no relationship between any of the patient variables and the extent of prostate movement in any direction (BMI: R2=0·006 (ρ=0·65), 0·002 (ρ=0·80) and 0·001 (ρ=0·86); mass: R2=0·001 (ρ=0·87), 0·010 (ρ=0·54) and 0·000 (ρ=0·99); SAT: R2=0·012 (ρ=0·51), 0·013 (ρ=0·50) and 0·047 (ρ=0·19) for shifts in the X, Y and Z axis, respectively). Patients were grouped according to BMI, as BMI<30 (n=25, 65·8%) and BMI≥30 (n=13, 34·2%). A two-tailed t-test showed no significant difference between the mean prostate shifts for the two groups in any direction (ρ=0·320, 0·839 and 0·325 for shifts in the X, Y and Z axis, respectively).

Findings

BMI is not a useful parameter for determining individualised PTV margins. Gold fiducial marker insertion should be used as standard to improve treatment accuracy.

Keywords

body mass indeximage-guided radiotherapyprostate motionsubcutaneous adipose tissue
Type
Original Articles
Information
Journal of Radiotherapy in Practice , Volume 15 , Issue 4 , December 2016 , pp. 334 - 340
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Center, M M, Jemal, A, Lortet-Tieulent, J et al. International variation in prostate cancer incidence and mortality rates. Eur Urol 2012; 61 (6): 1079–1092.CrossRefGoogle ScholarPubMed
2. Jackson, A, Murthy, V, Dearnlaley, D. External beam radiotherapy for prostate cancer. In: Hoskin, P (ed.). Radiotherapy in Practice: External Beam Therapy. New York: Oxford University Press, 2006: 181–211.Google Scholar
3. Formiguera, X, Cantón, A. Obesity: epidemiology and clinical aspects. Best Pract Res Clin Gastroenterol 2004; 18 (6): 1125–1146.CrossRefGoogle ScholarPubMed
4. Wong, J R, Gao, Z, Merrick, S, Uematsu, M, Wilson, P, Cheng, C. Subcutaneous adipose-tissue thickness is a more accurate indicator of the variation of the interfraction prostate position throughout radiation treatment than patient’s weight or body mass index. Int J Radiat Oncol Biol Phys 2008; 72 (1, suppl): S344.CrossRefGoogle Scholar
5. Wong, J R, Gao, Z, Merrick, S et al. Potential for higher treatment failure in obese patients: correlation of elevated body mass index and increased daily prostate deviations from the radiation beam isocenters in an analysis of 1,465 computed tomographic images. Int J Radiat Oncol Biol Phys 2009; 75 (1): 49–55.CrossRefGoogle Scholar
6. Millender, L E, Aubin, M, Pouliot, J, Shinohara, K, Roach, M III. Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2004; 59 (1): 6–10.CrossRefGoogle ScholarPubMed
7. Maruoka, S, Yoshioka, Y, Isohashi, F et al. Correlation between patients’ anatomical characteristics and interfractional internal prostate motion during intensity modulated radiation therapy for prostate cancer. Springerplus 2015; 4: 579.CrossRefGoogle ScholarPubMed
8. Piotrowski, T, Kaczmarek, K, Jodda, A et al. Image guidance procedures in radiotherapy for prostate cancer and the influence of body mass index. J Radiother Pract 2014; 13: 410–417.CrossRefGoogle Scholar
9. Butler, W M, Morris, M N, Merrick, G S, Kurko, B S, Murray, B C. Effect of body mass index on intrafraction prostate displacement monitored by real-time electromagnetic tracking. Int J Radiat Oncol Biol Phys 2012; 84 (2): e173–e179.CrossRefGoogle ScholarPubMed
10. Chen, Y J, Lee, R J, Handrahan, D, Sause, W T. Intensity-modulated radiotherapy using implanted fiducial markers with daily portal imaging: assessment of prostate organ motion. Int J Radiat Oncol Biol Phys 2007; 68 (3): 912–919.CrossRefGoogle ScholarPubMed
11. Osei, K E, Jiang, R, Barnett, R, Fleming, K, Panjwani, D. Evaluation of daily online set-up errors and organ displacement uncertainty during conformal radiation treatment of the prostate. Br J Radiol 2009; 82: 49–61.CrossRefGoogle ScholarPubMed
12. Thompson, A L, Gill, S, Thomas, J et al. In pursuit of individualised margins for prostate cancer patients undergoing image-guided radiotherapy: the effect of body mass index on intrafraction prostate motion. Clin Oncol 2011; 23: 449–453.CrossRefGoogle ScholarPubMed
13. Ma, J, Li, H, Giovannucci, E et al. Prediagnostic body-mass index, plasma C-peptide concentration, and prostate cancer-specific mortality in men with prostate cancer: a long-term survival analysis. Lancet Oncol 2008; 9: 1039–1047.CrossRefGoogle ScholarPubMed
14. Smyth, G, McCallum, H M, Pearson, M J M, Lawrence, G P. Comparison of a simple dose-guided intervention technique for prostate radiotherapy with existing anatomical image guidance methods. Br J Radiol 2012; 85: 127–134.CrossRefGoogle ScholarPubMed
15. Bujold, A, Craig, T, Jaffray, D, Dawson, L A. Image-guided radiotherapy: has it influenced patient outcomes? Semin Radiat Oncol 2012; 22: 50–61.CrossRefGoogle ScholarPubMed
16. Lometti, M W, Thurston, D, Aubin, M et al. Are lateral electronic portal images adequate for accurate on-line daily targeting of the prostate? Results of a prospective study. Med Dosimetry 2008; 33 (1): 22–29.CrossRefGoogle ScholarPubMed
17. Zelefsky, M J, Kollmeier, M, Cox, B et al. Improved clinical outcomes with high dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 84 (1): 125–129.CrossRefGoogle ScholarPubMed
18. Barney, B M, Lee, R J, Handrahan, D, Welsh, K T, Cook, J T, Sause, W T. Image-guided radiotherapy (IGRT) for prostate cancer comparing kV imaging of fiducial markers with cone beam computed tomography (CBCT). Int J Radiat Oncol Biol Phys 2011; 80 (1): 301–305.CrossRefGoogle ScholarPubMed
19. Poulsen, P R, Muren, L P, Hoyer, M. Residual set-up errors and margins in on-line image-guided prostate localization in radiotherapy. Radiother Oncol 2007; 85: 201–206.CrossRefGoogle ScholarPubMed
20. Langenhuijsen, J F, Smeenk, R J, Louwe, R J et al. Reduction of treatment volume and radiation doses to surrounding tissues with intraprostatic gold markers in prostate cancer radiotherapy. Clin Genitourin Cancer 2011; 9 (2): 109–114.CrossRefGoogle ScholarPubMed
21. van Haaren, P, Bel, A, Hofman, P, van Vulpen, M, Kotte, A N T J, van der Heide, U A. Influence of daily setup measurements and corrections on the estimated delivered dose during IMRT treatment of prostate cancer patients. Radiother Oncol 2009; 90: 291–298.CrossRefGoogle ScholarPubMed
22. King, C R, Spiotto, M T, Kapp, D S. Obesity and risk of biochemical failure for patients receiving salvage radiotherapy after prostatectomy. Int J Radiat Oncol Biol Phys 2009; 73 (4): 1017–1022.CrossRefGoogle ScholarPubMed
23. Geinitz, H, Thamm, R, Mueller, T et al. Impact of body mass index on outcomes after conformal radiotherapy in patients with prostate cancer. Int J Radiat Oncol Biol Phys 2011; 81 (1): 16–22.CrossRefGoogle ScholarPubMed
24. Ly, D, Reddy, C A, Klein, E A, Ciezki, J P. Association of body mass index with prostate cancer biochemical failure. J Urol 2010; 183 (6): 2193–2199.CrossRefGoogle ScholarPubMed
25. Stasi, M, Munoz, F, Fiorino, C et al. Emptying the rectum before treatment delivery limits the variations of rectal dose-volume parameters during 3DCRT of prostate cancer. Radiother Oncol 2006; 80: 363–370.CrossRefGoogle ScholarPubMed
26. Faithfull, S. Gastrointestinal effects of radiotherapy. In: Faithfull, S, Wells, M (eds). Supportive Care in Radiotherapy. China: Elsevier Churchill Livingstone, 2003: 247–267.Google Scholar
27. McNair, H A, Wedlake, L, Lips, I M, Andreyev, J, Van Vulpen, M, Dearnaley, D. A systematic review: effectiveness of rectal emptying preparation in prostate cancer patients. Pract Radiat Oncol 2014; 4: 437–447.CrossRefGoogle ScholarPubMed
28. Jotwani, A, Surendran, J, Chilukuri, S, Ramamohan, R, Ibrahim, S, Shivakumar, R. Rectum and bladder dose variations during prostate IGRT: an evaluation of bowel and bladder preparation protocol. Int J Radiat Oncol Biol Phys 2012; 84 (3, suppl): S395.CrossRefGoogle Scholar
29. Delouya, G, Carrier, J, Beliveau-Nadeau, D, Donath, D, Taussky, D. Migration of intraprostatic fiducial markers and its influence on the matching quality in external beam radiation therapy for prostate cancer. Radiother Oncol 2010; 96: 43–47.CrossRefGoogle ScholarPubMed
30.Department of Health Radiotherapy: developing a world class service for England report to Ministers from National Radiotherapy Advisory Group DH, London (2007).Google Scholar
31. Lazos, D, Mourad, W F, Hauerstock, D et al. Assessment of fiducial-based 2D kV orthogonal imaging, fiducial-based CBCT, and soft-tissue-based CBCT for prostate cancer patients with implanted fiducial markers. Int J Radiat Oncol Biol Phys 2012; 84 (3): S736.CrossRefGoogle Scholar
32. Wachter, S, Gerstner, N, Dorner, D et al. The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2002; 52 (1): 91–100.CrossRefGoogle ScholarPubMed
33. Smeenk, R J, Teh, B S, Butler, E B, van Lin, E N J T, Kaanders, J H A M. Is there a role for endorectal balloons in prostate radiotherapy? A systematic review. Radiother Oncol 2010; 95: 277–282.CrossRefGoogle Scholar
34. Teh, B S, Woo, S Y, Mai, W et al. Clinical experience with intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of rectal balloon for prostate immobilization. Med Dosimetry 2002; 27 (2): 105–113.CrossRefGoogle ScholarPubMed
35. Huang, S H, Catton, C, Jezioranski, J, Bayley, A, Rose, S, Rosewall, T. The effect of changing technique, dose, and PTV margin on therapeutic ratio during prostate radiotherapy. Int J Radiat Oncol Biol Phys 2008; 71 (4): 1057–1064.CrossRefGoogle ScholarPubMed
36. van der Laan, H P, van den Bergh, A, Schilstra, C, Vlasman, R, Meertens, H, Langendijk, J A. Grading-system-dependent volume effects for late radiation-induced rectal toxicity after curative radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70 (4): 1138–1145.CrossRefGoogle ScholarPubMed