March 3, 2026Open Access

Three-Step Image Guidance Strategy for Rectal Anterior Wall Margin Reduction in Hypofractionated Prostate Radiation Therapy

Key Points

Enhanced rectal protection resulted from a three-step image guidance strategy in hypofractionated radiation therapy.
Rectal protection improved while maintaining target coverage, with variations in DIL coverage depending on its location.
This observational analysis utilized a three-step image guidance protocol to optimize PTV margin and CTV coverage.
Adaptive radiation therapy may be necessary to personalize margins and prevent underdosage, especially with specific DIL conditions.

Abstract

A 3-step image guidance protocol enhanced rectal protection while maintaining target coverage compared to prostate-only alignment. Reducing the posterior PTV margin preserved CTV coverage, but DIL coverage varied by location. If the DIL is less than 0.7 mm from the rectum or overlaps more than 1.5 cm³ within 2 mm of the rectum, the reduced margin may not be suitable, potentially compromising DIL coverage, suggesting the need for personalized margins and adaptive radiation therapy to prevent underdosage.

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Cite This Study

Yan et al. (Sun,) studied this question.

synapsesocial.com/papers/69a76659badf0bb9e87dca4f https://doi.org/https://doi.org/10.1016/j.prro.2025.10.020

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