Angela Kempen 11/22/2011 Paraphrasing

INTRODUCTION Interfraction and intrafraction target motion during external beam radiotherapy (RT) for prostate cancer has been reported (19). Multiple image-guidance systems have been developed to manage prostate motion both with and without daily endorectal balloon (ERB) xation (13,7,911) with particular attention to interfraction motion. For example, ultrasound guidance, implanted ducial markers, and inroom tomographic imaging have been used for initial patient setup and pretreatment prostate localization (2,7,1216). Data on intrafraction motion of the prostate is less abundant (46,17,18), and there is, to our knowledge, no published report on real-time positional changes of the prostate during RT when daily ERB is used. Besides physiologic changes in bladder lling, rectal peristalsis causing variation of the rectal volume or diameter is a leading factor in motion of the prostate gland (19). The assessment of intrafraction prostate movement with or without ERB has been attempted without real-time technique by use of pretreatment and post-treatment localizations (3,7,9,10). DAmico et al. (20) studied prostate motion with the ERB using serial computed tomography (CT) scans. More recently, prostate motion in prostate cancer patients placed in either the supine or prone position with or without daily ERB was assessed by cinemagnetic resonance imaging (MRI) under simulated treatment conditions (9). To achieve a full understanding of potential changes in prostate motion with an ERB in place, prostate displacement would ideally be continuously monitored during the entire treatment fraction. This prospective study reports on real-time prostate movements during 787 tracking sessions in 24 prostate cancer patients treated with a daily ERB and Calypsobased localization and tracking (Calypso Medical Technologies, Inc, Seattle, WA). The specic aim was to assess the percentage of time during which intrafraction threedimensional (3D), lateral (L), cranial-caudal (CC), and anteriorposterior (AP) prostate displacements of various magnitudes occurred and to analyze this as a function of treatment time. We also sought to address the heterogeneity of intrafraction motion, classify the patient-specic prostate motion within our study group, and analyze changes in prostate motion as a function of treatment week. Ultimately, we evaluated the optimal internal margin size (21,22) when daily ERB is used.

PARAPHRASE Endorectal balloons (ERB) have been investigated in previous studies to understand the effectiveness in reducing interfraction and intrafraction prostate motion. Bladder filling variations and variations in rectum volumes are prominent causes of prostate displacement during radiation therapy treatment. In order to evaluate prostate motion, multiple-imaging systems including ultrasound, fiducial markers, and in room imaging have been used for patient setups and prior to treatments delivered to patients with and without ERB. However, this particular study used real-time imaging in order to

determine prostate displacement continually while the entire treatment was delivered. Real-time imaging techniques that are capable of monitoring prostate motion during treatment will ideally achieve a better understanding of the changes that occur. During the real-time imaging, three dimensions were evaluated to assess prostate displacement when a daily ERB is used, including anterior-posterior, medial-lateral, and cranial-caudal, in addition to evaluation of the margin size required for internal prostate movement. REFERENCE 1. Both S, Kang-Hsin Wang K, Plastaras J, Deville C, Bar Ad V, Tochner Z, Vapiwala N. Real-time study of prostate intrafraction motion during external beam radiotherapy with daily endorectal balloon. [published online ahead of print November 1, 2010]. Int J of Radiat Oncol. Biol. Phys. doi:10.1016/j.ijrobp.2010.08.05.

Angela Kempen 11/22/2011 Abstract

ABSTRACT Purpose: To prospectively investigate intrafraction prostate motion during radiofrequency-guided prostate radiotherapy with implanted electromagnetic transponders when daily endorectal balloon (ERB) is used. Methods and Materials: Intrafraction prostate motion from 24 patients in 787 treatment sessions was evaluated based on three-dimensional (3D), lateral, cranial-caudal (CC), and anterior-posterior (AP) displacements. The mean percentage of time with 3D, lateral, CC, and AP prostate displacements >2, 3, 4, 5, 6, 7, 8, 9, and 10 mm in 1 minute intervals was calculated for up to 6 minutes of treatment time. Correlation between the mean percentage time with 3D prostate displacement >3 mm vs. treatment week was investigated. Results: The percentage of time with 3D prostate movement >2, 3, and 4 mm increased with elapsed treatment time (p < 0.05). Prostate movement >5 mm was independent of elapsed treatment time (p = 0.11). The overall mean time with prostate excursions >3 mm was 5%. Directional analysis showed negligible lateral prostate motion; AP and CC motion were comparable. The fraction of time with 3D prostate movement >3 mm did not depend on treatment week of (p > 0.05) over a 4-minute mean treatment time. Conclusions: Daily endorectal balloon consistently stabilizes the prostate, preventing clinically signicant displacement (>5 mm). A 3-mm internal margin may sufciently account for 95% of intrafraction prostate movement for up to 6 minutes of treatment time. Directional analysis suggests that the lateral internal margin could be further reduced to 2 mm.

This study provided an abstract with many key components. It summarizes the purpose of the study and how it was conducted, states the results of the research and the proposed conclusions, using the same language in which the entire article was written. It clearly states the information in a simplistic, easy to understand format. Pertinent information was provided, and after reviewing the abstract I had a general idea of what the paper included, and was able to make the decision of reviewing the entire study. The abstract followed the chronology of the article and demonstrated the complexity of the research performed. After reviewing the abstract, I found the information presented at a complexity level useful for my research, yet simple enough to comprehend.