Purpose: To quantify intrafraction prostate motion between patient groups treated with and without daily endorectal balloon (ERB) employed during prostate radiotherapy and establish the effectiveness of the ERB. Methods: Real time intrafraction prostate motion from 29 non‐ERB (1061 sessions) and 30 ERB (1008 sessions) patients was evaluated based on three‐dimensional (3D), left, right, cranial, caudal, anterior and posterior displacements. The average percentage of time with 3D and unidirectional prostate displacements > 2, 3, 4, 5, 6, 7, 8, 9, and 10mm in 1 minute intervals was calculated for up to 6 minutes of treatment time. The Kolmogorov‐Smirnov method was used to evaluate the intrafraction prostate motion pattern between both groups. Results: 3D motion >=1 cm was observed for the non‐ERB group only. The motion increased as a function of elapsed time for displacements > 2 to 8mm for the non‐ERB group and > 2 to 4 mm for the ERB group (p < 0.05). The percentage time distributions between the two groups were significantly different for motion > 5 mm (p < 0.05). The 3D internal margin (IM) covering 95% treatment time can be reduced from 5 to 3 mm (40% reduction) while the asymmetrical IM can be reduced from 3 to 2 mm (33% reduction) in cranial, caudal, anterior, and posterior for 6 minutes treatment, when ERB is employed. Beyond 6 minutes, the 3D and cranial, caudal, anterior, and posterior IMs can be reduced from 9, 4, 7, 7, and 8 to 5, 2, 5, 3, and 4 mm, respectively (up to 57% reduction). The calculated IMs apply to the worst case scenario patient as well. Conclusions: The ERB effectively reduces prostate motion and allows for smaller IMs. Therefore, daily ERB has the potential to further improve toxicity profiles in prostate radiotherapy.
ASJC Scopus subject areas
- Radiology Nuclear Medicine and imaging