Dosimetric impact of intra-fraction prostate motion under a tumour-tracking system in hypofractionated robotic radiosurgery.

For CyberKnife-mediated prostate cancer treatment, a tumour-tracking approach is applied to correct the target location by acquiring X-ray images of implanted fiducial markers intermittently. This study investigated the dosimetric impact of intra-fraction prostate motion during CyberKnife treatment. We retrospectively analyzed 16 patients treated using the CyberKnife (35 Gy delivered in five fractions). Using log files of recorded prostate motion, the intra-fraction prostate motion was simulated. We defined the worst-case intra-fraction prostate motion as the difference between pre- and post-deviation on log files and shifted structure sets according to the corresponding offsets for each beam. The dose-volume indices were calculated and compared with the original plan in terms of clinical target volume (CTV), planning target volume (CTV plus a 2-mm margin), rectum, bladder, and urethra. Prostate motions of >3, >5, and >10 mm were observed for 31.3, 9.1, and 0.5% of the 1929 timestamps, respectively. Relative differences between the simulated and original plans were mostly less than 1%. Although significant decreases were observed in D50% and D98% of the target, absolute dose differences were <0.1 Gy compared with the planned dose. The dosimetric impact of intra-fraction prostate motion may be small even with longer treatment durations, indicating that the tumour tracking using the CyberKnife could be a robust system for examining prostate motion.