• James D Brierley, Laura A Dawson, Elliott Sampson, Andrew Bayley, Sandra Scott, Joanne L Moseley, Timothy Craig, Bernard Cummings, Robert Dinniwell, John J Kim, Jolie Ringash, Rebecca Wong, and Kristy K Brock.
• Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, ON, Canada. james.brierley@rmp.uhn.on.ca
• Int. J. Radiat. Oncol. Biol. Phys. 2011 May 1; 80 (1): 97-102.

PurposeTo assess the movement of rectum, mesorectum, and rectal primary during a course of preoperative chemoradiotherapy.Methods And MaterialsSeventeen patients with Stage II or III rectal cancer had a planning CT scan with rectal contrast before commencement of preoperative chemoradiation. The scan was repeated during Weeks 1, 3, and 5 of chemoradiation. The rectal primary (gross tumor volume), rectum, mesorectum, and bladder were contoured on all four scans. An in-house biomechanical model-based deformable image registration technique, Morfeus, was used to measure the three-dimensional spatial change in these structures after bony alignment. The required planning target volume margin for this spatial change, after bone alignment, was also calculated.ResultsRectal contrast was found to introduce a systematic error in the position of all organs compared with the noncontrast state. The largest change in structures during radiotherapy was in the anterior and posterior directions for the mesorectum and rectum and in the superior and inferior directions for the gross tumor volume. The planning target volume margins required for internal movement for the mesorectum based on the three scans acquired during treatment are 4 mm right, 5 mm left, 7 mm anterior, and 6 mm posterior. For the rectum, values were 8 mm right, 8 mm left, 8 mm anterior, and 9 mm posterior. The greatest movement of the rectum occurred in the upper third.ConclusionsContrast is no longer used in CT simulation. Assuming bony alignment, a nonuniform margin of 8 mm anteriorly, 9 mm posteriorly, and 8 mm left and right is recommended.Copyright © 2011 Elsevier Inc. All rights reserved.

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