ArticlePhysics and imaging in radiation oncology2026
Periodic intrafraction image-guided focal dose-escalated stereotactic body radiotherapy for prostate carcinoma on a standard linear accelerator.
Article in Physics and imaging in radiation oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Background and purpose: Intrafraction motion degrades the efficacy of radiation therapy. We reported on the implementation of focal dose-escalated stereotactic body radiation therapy (HypoFocal-SBRT) for prostate carcinoma on standard linear accelerator, and assessed whether periodic intrafraction image guidance (PIF-IG) improved the accuracy of treatment. Materials and methods: Twenty prostate cancer patients underwent HypoFocal-SBRT. Treatment planning prioritized plan robustness and efficiency accommodating image guidance as-needed for treatment on standard accelerator. A three-dose level planning target volume (PTV) SBRT regime with focal boost was prescribed: PTV30 (seminal vesicles), PTV35 (prostate), and PTV40-42 (intraprostatic tumor lesion) in 5 fractions. Fiducial marker-based PIF-IG, triggered at pre-defined imaging control point(s) (ICPs), was performed using 1 mm (translations)/1° (rotations) action thresholds for online couch corrections. Applied marker registration values were compared to estimated ground-truth, as well as simulated treatment with no PIF-IG and effect on delivered dose estimated. Results: Interventions occurred at least once in 95% of patients and 83% of fractions. PIF-IG reduced the geometric uncertainty (root-mean-square error) from 1.6 mm, 2.3 mm, and 2.2 mm for the left-right (LR), superior-inferior (SI), and anterior-posterior (AP) directions to 0.6 mm, 0.9 mm, and 0.8 mm, respectively. With PIF-IG, target volumes D Conclusions: Focal dose-escalated SBRT for prostate cancer can be efficiently and accurately performed on standard accelerator. PIF-IG improved the geometric and delivered dose accuracy.
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