Table of Contents
Journal of Radiotherapy
Volume 2014, Article ID 298904, 7 pages
Research Article

Variations in Rectal Volumes and Dosimetry Values Including NTCP due to Interfractional Variability When Administering 2D-Based IG-IMRT for Prostate Cancer

1Department of Radiology, School of Medicine, Keio University, Shinanomachi 35, Shinjuku-ku, Tokyo 160-8582, Japan
2Department of Radiology, Tokyo Medical Center, National Hospital Organization, Higashigaoka 2-5-1, Meguro-ku, Tokyo 152-8902, Japan

Received 11 January 2014; Revised 2 July 2014; Accepted 2 July 2014; Published 15 July 2014

Academic Editor: Carlos A. Perez

Copyright © 2014 Takashi Hanada et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


We estimated variations in rectal volumes and dosimetry values including NTCP with interfractional motion during prostate IG-IMRT. Rectal volumes, DVH parameters, and NTCPs of 20 patients were analyzed. For this patient population, the median (range) volume on the initial plan for the rectum was 45.6 cc (31.3–82.0), showing on-treatment spread around the initial prediction based on the initial plan. DVH parameters of on-treatment CBCT analyses showed systematic regularity shift from the prediction based on the initial plan. Using the Lyman-Kutcher-Burman model, NTCPs of predicted late rectal bleeding toxicity of rectal grade ≥ 2 (RTOG) and the QUANTEC update rectal toxicity for the prediction based on the initial plan were 0.09% (0.02–0.24) and 0.02% (0.00–0.07), respectively, with NTCPs from on-treatment CBCT analyses being 0.35% (0.01–6.16) and 0.12% (0.00–4.11), respectively. Using the relative seriality model, for grade ≥ 2 bleeding rectal toxicity, NTCP of the prediction based on the initial plan was 0.64% (0.15–1.22) versus 1.48% (0.18–7.66) for on-treatment CBCT analysis. Interfraction variations in rectal volumes occur in all patients due to physiological changes. Thus, rectal assessment during 2D-based IG-IMRT using NTCP models has the potential to provide useful and practical dosimetric verification.