Evaluation de la precision du traitement du cancer de la prostate par radiotherapie avec l'aide de l'imagerie portale numerique en temps reel

Abstract

Le but cette etude est d'evaluer la precision et la reproductibilite des traitements du cancer de la prostate par radiotherapie. Dans un premier temps, nous avons cherche a evaluer et a quantifier le positionnement des patients avec l'aide d'un systeme d'imagerie portale electronique. Des erreurs systematiques moyennes de positionnement de l'ordre de 2 a 3 mm ont ete mesurees. Cependent, dans certains cas des valeurs plus extremes ont ete detectees, et ce sont ces deviations extremes qu'il faut s'employer a corriger.

Dans un deuxieme temps, a l'aide d'un marqueur radio-opaque implante pres de l'apex prostatique, nous avons evalue les mouvements de la prostate par rapport au bassin. Dans environ 18% des cas, les deplacements de la prostate dans les directions cephalo-caudales et antero-posterieures furent superieures a 5 mm. De plus, les deplacements observes dans ces memes directions sont en moyenne plus grands ou egaux aux erreurs de positonnement. La prostate est un organe mobile a l'interieur de bassin et il faut tenir compte de ces mouvements lors de la planification et de l'execution des traitements.

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The aim of this study is to evaluate the precision and reproducibility of prostate cancer treatments using radiotherapy. First, we sought to evaluate and quantify patient positioning with the help of an electronic portal imaging system. Average systematic positioning errors of the order of 2 to 3 mm were measured. However, in certain cases more extreme values have been detected, and it is these extreme deviations that we must endeavor to correct.

Secondly, using a radiopaque marker implanted near the prostatic apex, we evaluated the movements of the prostate in relation to the pelvis. In approximately 18% of cases, the displacements of the prostate in the cephalo-caudal and antero-posterior directions were greater than 5 mm. Furthermore, the displacements observed in these same directions are on average greater than or equal to the positioning errors. The prostate is a mobile organ within the pelvis and these movements must be taken into account when planning and carrying out treatments.