Daily electronic portal imaging for morbidly obese men undergoing radiotherapy for localized prostate cancer

PURPOSE: We summarize our experience with a series of morbidly obese men treated using daily online portal imaging and implanted gold markers to guide external beam radiation therapy (EBRT). METHODS AND MATERIALS: Three consecutive morbidly obese men were treated with EBRT for localized prostate cancer. Daily electronic portal imaging was used to verify patient position. The magnitude and direction of patient positioning error were documented for each fraction. RESULTS: The absolute magnitude of positioning error was greatest in the left-right direction with a mean of 11.4 mm/fraction (median, 8 mm; range, 0-42 mm). Mean error in the superior-inferior direction was also substantial at 7.2 mm/fraction (median, 5 mm; range, 0-47 mm). Anteroposterior error was the least problematic with a mean value of 2.6 mm/fraction (median, 2.5 mm; range, 0-8 mm). CONCLUSIONS: Daily electronic portal imaging combined with gold fiducial markers dramatically improves the precision of EBRT in the treatment of morbidly obese men with prostate cancer. Setup error rather than organ motion appears to be the dominant force in positioning error in obese men.