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Implanted UroLift Device Works as Fiducial Markers in IGRT Planning of Patients with Benign Prostatic Hyperplasia: A Case Study

N Biswal1*, B Swann2 , M McKenna3 , R Singh4 , (1) Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, (2) Robert Wood Johnson University Hospital, Hamilton, New Jersey, (3) Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey, (4) Rutgers Cancer Institute of New Jersey, New Brunswick, New Jersey


(Sunday, 7/29/2018) 3:00 PM - 6:00 PM

Room: Exhibit Hall

Purpose: To investigate if using a novel treatment device for obstructive benign prostatic hyperplasia ‘UroLift’ as a surrogate for fiducial markers for image-guided radiation therapy of prostate cancer patients. This eliminates the need for a second transrectal procedure to implant fiducial markers into the prostate for radiation therapy image guidance.

Methods: The patient in our study was a 70 year old male with benign prostatic hyperplasia. A total of 4 UroLift implants were placed by the patient’s urologist, a few days prior to radiation consultation. The implanted clips in the UroLift system were radiopaque. The pre-simulation coronal view x-ray image, generated in linear accelerator On-Board Imager (OBI), was used as a guideline to delineate UroLift clips on the planning CT image. All the 4 clips of UroLift implant were clearly identified in coronal view (AP) and orthogonal oblique views (at angles of 45° and 315°) kV x-ray images and CBCT images. After the images were registered before each treatment, a treatment table shift was generated with Varian image matching software and the patient was treated with new treatment position.

Results: All the UroLift clips were clearly visible every day in all orthogonal x-ray images and also in CBCT images. Couch shifts were minimal in daily setup for treatment in 39 fractions and were very similar to that with fiducial markers for other prostate cancer patients. Our technique of using oblique orthogonal kV images (45° and 315°) provided excellent contrast for therapists to perform the daily pre-treatment registration.

Conclusion: The implanted UroLift system serves as fiducial markers for IGRT. The full course of radiation therapy was completed without an extra surgical procedure to place fiducial markers for image guidance. The UroLift clips were sufficiently radiopaque in orthogonal planes to localize daily and track prostate throughout the course of treatment.


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