Intrafraction motion during CyberKnife® prostate SBRT: impact of imaging frequency and patient factors

Purpose: To determine the relationship between imaging frequencies and prostate motion during CyberKnife stereotactic body radiotherapy (SBRT) for prostate cancer. Methods: Intrafraction displacement data for 331 patients who received treatment with CyberKnife for prostate cancer were retrospectively analysed. Prostate positions were tracked with a large variation in imaging frequencies. The percent of treatment time that patients remained inside various motion thresholds for both real and simulated imaging frequencies was calculated. Results: 84,920 image acquisitions over 1635 fractions were analysed. Fiducial distance travelled between consecutive images were less than 2, 3, 5, and 10 mm for 92.4%, 94.4%, 96.2%, and 97.7% of all consecutive imaging pairs respectively. The percent of treatment time that patients received adequate geometric coverage increased with more frequent imaging intervals. No significant correlations between age, weight, height, BMI, rectal, bladder or prostate volumes and intrafraction prostate motion were observed. Conclusions: There are several combinations of imaging intervals and movement thresholds that may be suitable for consideration during treatment planning with respect to imaging and calculation of the margin between the clinical target volume and planning target volume (CTV-to-PTV), resulting in adequate geometric coverage for approximately 95% of treatment time. Rectal toxicities and treatment duration need to be considered when implementing combinations clinically.