Retrospective Evaluation Of Interfraction Ureteral Movement In Dogs Undergoing Radiation Therapy To Elucidate Appropriate Setup Margins

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Yoshikawa H, Nolan MW, Lewis DW, et al.

Veterinary Radiology & Ultrasound 2016;57:170-179.

Radiation-induced ureteral damage can result in serious complications (i.e., hydronephrosis). Also, ureters can be included in planning target volume (PTV) such as ureteral invasion of urinary bladder carcinoma. Therefore, knowing the interfractional movement of the ureters is critical for creation of appropriate planning organs at risk (pOAR) and PTV. This retrospective and descriptive study of 17 dogs with genitourinary carcinomas that underwent intensity-modulated, image-guided radiation therapy (IM-IGRT) was conducted to describe the movement and calculate suggested pOAR/PTV expansions at three locations (at the levels of third lumbar vertebra, immediately cranial to vesicoureteral junction [VUJ], and midway between those two) and from two perspectives: during a course of (1) IM-IGRT, where position verification is performed using soft tissue registration when the dogs underwent clinical IM-IGRT; (2) radiation therapy whereby position verification is performed using planar radiography with a corresponding bony registration. This registration was performed by fusing the radiation planning computed tomography (CT) and cone-beam CTs using bony landmarks. With soft tissue registration, findings supported the use of larger pOAR expansion (0.7–1.8 cm) for the mid region of the ureters compared to the areas near VUJ (0.7–1.1 cm). With bony registration, findings supported the use of larger pOAR/PTV expansions (1.6–1.7 cm) for dorsal direction bilaterally at areas near VUJ compared to those with soft tissue registration (0.9–1.0 cm). The results of this study should help radiation oncologists use appropriate ureter expansions for specific patient orientations and positioning verification methods.