Purpose: Proton therapy is a sophisticated treatment modality for prostate cancer. We investigated how physiologic factors affected the distribution of autoactivation as detected by positron emission tomography (PET) after proton beam therapy.
Methods and materials: Autoactivation was evaluated in 59 patients treated with a 210-MeV proton beam. Data acquisition for autoactivation by PET started 5 minutes after proton irradiation to assess activation. In the first 29 patients, five regions of interest were evaluated: planning target volume (PTV) center, urinary bladder inside the PTV, urinary bladder outside the PTV, rectum (outside the PTV), and contralateral femoral bone head (outside the PTV). In the remaining 30 patients, urine activity was measured directly. In a phantom study autoactivation and its diffusion after proton beam irradiation were evaluated with water or an ice block.
Results: Mean activities calculated by use of PET were 629.3 Bq in the PTV center, 555.6 Bq in the urinary bladder inside the PTV, 332.5 Bq in the urinary bladder outside the PTV, 88.4 Bq in the rectum, and 23.7 Bq in the femoral bone head (p < 0.001). Mean urine activity was 679.4 Bq, recorded 10 minutes after therapy completion, and the half-life for urine autoactivation was 4.5 minutes.
Conclusions: Urine is a major diffusion mediator of autoactivation after proton beam therapy. Our results indicate that physiologic factors can influence PET images of autoactivation in the context of proton beam therapy verification.