Abstract
PURPOSE: To retrospectively analyze and estimate the dosimetric benefit of online and offline motion mitigation strategies for prostate IMRT. METHODS: Intrafractional motion data of 21 prostate patients receiving intensity-modulated radiotherapy was acquired with an electromagnetic tracking system. Target trajectories of 734 fractions were analyzed per delivered multileaf-collimator segment in five motion metrics: three-dimensional displacement, distance from beam axis (DistToBeam), and three orthogonal components. Time-resolved dose calculations have been performed by shifting the target according to the sampled motion for the following scenarios: without adaptation, online-repositioning with a minimum threshold of 3 mm, and an offline approach using a modified field order applying horizontal before vertical beams. Change of D95 (targets) or V65 (organs at risk) relative to the static case, that is, ΔD95 or ΔV65, was extracted per fraction in percent. Correlation coefficients (CC) between the motion metrics and the dose metrics were extracted. Mean of patient-wise CC was used to evaluate the correlation of motion metric and dosimetric changes. Mean and standard deviation of the patient-wise correlation slopes (in %/mm) were extracted. RESULTS: For ΔD95 of the prostate, mean DistToBeam per fraction showed the highest correlation for all scenarios with a relative change of -0.6 ± 0.7%/mm without adaptation and -0.4 ± 0.5%/mm for the repositioning and field order strategies. For ΔV65 of the bladder and the rectum, superior-inferior and posterior-anterior motion components per fraction showed the highest correlation, respectively. The slope of bladder (rectum) was 14.6 ± 5.8 (15.1 ± 6.9) %/mm without adaptation, 14.0 ± 4.9 (14.5 ± 7.4) %/mm for repositioning with 3 mm, and 10.6 ± 2.5 (8.1 ± 4.6) %/mm for the field order approach. CONCLUSIONS: The correlation slope is a valuable concept to estimate dosimetric deviations from static plan quality directly based on the observed motion. For the prostate, both mitigation strategies showed comparable benefit. For organs at risk, the field order approach showed less sensitive response regarding motion and reduced interpatient variation.