Analysis of PTV margin for IMRT and VMAT techniques in prostate cancer using IGRT

Clinical radiotherapy procedures aim at high precision. However, there are many errors sources that act during treatment preparation and execution that limit its accuracy. The use of imaged-guided radiotherapy (IGRT) increases the agreement between the planned dose and the actual dose deposited in the target, at the same time allows to evaluate the uncertainties related to the setup and a possible reduction in the planning target volume (PTV) margin. Thus the aim of this study was to determine the best PTV margin to be used in radiotherapy treatment of prostate cancer using intensity modulated radiotherapy (IMRT) and volumetric modulated arc radiotherapy (VMAT) techniques associated with IGRT. A total of four patients with prostate daily cone beam computed tomography (CBCT) were analyzed. Systematic and random errors were calculated statistically based on the displacements couch for 128 CBCTs. It was found that a symmetric margin of 0.75 cm from clinical treatment volume (CTV) to PTV is sufficient to encompass the uncertainties inherent to the treatment applying IGRT. Besides without that and maintaining the same tumor control probability, a symmetric margin of 1,24 cm would be necessary. This study showed that using daily image verification the setup errors are reduced, which generates a lower PTV margin. (author)