Analysis of motion of the rectum during preoperative intensity modulated radiation therapy for rectal cancer using cone-beam computed tomography

Purpose: The purpose of the present study was to quantify the inter-fractional motion of the rectum and the rectal and bladder volumes using CBCT scans taken during chemoradiation therapy (CRT) for rectal cancer. Also, assessment was made for a better margin for simultaneous integrated boost - intensity modulated radiation therapy (SIB-IMRT) for rectal cancer. Methods and materials: There were 32 patients in this study undergoing preoperative CRT for rectal cancer. Each rectum and bladder was contoured on all planning CTs and CBCTs (day 1, 7, 13, 19, 25). The target volume was configured by adding margins (0, 3, 5, 7, 10, and 15 mm) to the rectum on planning CT. The respective percentage of rectal volume that exceeds the target volume was calculated for each of these margins. The percentage of bladder volume that exceeds the bladder volume in the planning CT and motion of the center of gravity of rectum were also analyzed. Results: Planning CTs and series of each 5 CBCTs for 32 patients were analyzed in this study. The rectal volume tended to shrink week after week. The mean values (+/- SD) in the 32 series per patient of the percentage of rectum on the CBCTs exceeding target volume in which the margins of 0, 3, 5, 7, 10, and 15 mm were added to the rectum on planning CT were 20.7 +/- 12.5%, 7.2 +/- 8.3%, 3.9 +/- 5.9%, 2.1 +/- 3.9%, 0.7 +/- 1.8%, and 0.1 +/- 0.3%, respectively. No association was seen between the percentage of changes of bladder volume and motion of rectal centroid. Conclusions: In this study, we estimated the motion of the rectum using planning CT and CBCT. Ten to fifteen mm is a sufficient margin for the rectum during SIB-IMRT for rectal cancer in the supine position.