The use of tissue fiducial markers in improving the accuracy of post-prostatectomy radiotherapy

Michael Chao, Huong Ho, Daryl Lim Joon, Yee Chan, Sandra Spencer, Michael Ng, Jason Wasiak, Nathan Lawrentschuk, Kevin McMillan, Shomik Sengupta, Alwin Tan, George Koufogiannis, Margaret Cokelek, Farshad Foroudi, Tristan Scott Khong, Damien Bolton

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5 Citations (Scopus)


Purpose: The aim of this retrospective study was to investigate the use of a radiopaque tissue fiducial marker (TFM) in the treatment of prostate cancer patients who undergo post-prostatectomy radiotherapy (PPRT). TFM safety, its role and benefit in quantifying the set-up uncertainties in patients undergoing PPRT image-guided radiotherapy were assessed. Materials and Methods: A total of 45 consecutive PPRT patients underwent transperineal implantation of TFM at the level of vesicourethral anastomosis in the retrovesical tissue prior to intensity-modulated radiotherapy. Prostate bed motion was calculated by measuring the position of the TFM relative to the pelvic bony anatomy on daily cone-beam computed tomography. The stability and visibility of the TFM were assessed in the initial 10 patients. Results: No postoperative complications were recorded. A total of 3,500 images were analysed. The calculated prostate bed motion for bony landmark matching relative to TFM were 2.25 mm in the left-right, 5.89 mm in the superior-inferior, and 6.59 mm in the anterior-posterior directions. A significant 36% reduction in the mean volume of rectum receiving 70 Gy (rV 70 ) was achieved for a uniform planning target volume (PTV) margin of 7 mm compared with the Australian and New Zealand Faculty of Radiation Oncology Genito-Urinary Group recommended PTV margin of 10 mm. Conclusion: The use of TFM was safe and can potentially eliminate set-up errors associated with bony landmark matching, thereby allowing for tighter PTV margins and a consequent favourable reduction in dose delivered to the bladder and rectum, with potential improvements in toxicities.

Original languageEnglish
Pages (from-to)43-50
Number of pages8
JournalRadiation Oncology Journal
Issue number1
Publication statusPublished - Mar 2019
Externally publishedYes


  • Fiducial marker
  • Image-guided radiotherapy
  • Intensity-modulated radiotherapy
  • Prostate cancer
  • Prostatectomy

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