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Berger D, Van Dyk S, Beaulieu L, Major T, Kron T. Modern Tools for Modern Brachytherapy. Clin Oncol (R Coll Radiol) 2023:S0936-6555(23)00182-6. [PMID: 37217434 DOI: 10.1016/j.clon.2023.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 03/28/2023] [Accepted: 05/04/2023] [Indexed: 05/24/2023]
Abstract
This review aims to showcase the brachytherapy tools and technologies that have emerged during the last 10 years. Soft-tissue contrast using magnetic resonance and ultrasound imaging has seen enormous growth in use to plan all forms of brachytherapy. The era of image-guided brachytherapy has encouraged the development of advanced applicators and given rise to the growth of individualised 3D printing to achieve reproducible and predictable implants. These advances increase the quality of implants to better direct radiation to target volumes while sparing normal tissue. Applicator reconstruction has moved beyond manual digitising, to drag and drop of three-dimensional applicator models with embedded pre-defined source pathways, ready for auto-recognition and automation. The simplified TG-43 dose calculation formalism directly linked to reference air kerma rate of high-energy sources in the medium water remains clinically robust. Model-based dose calculation algorithms accounting for tissue heterogeneity and applicator material will advance the field of brachytherapy dosimetry to become more clinically accurate. Improved dose-optimising toolkits contribute to the real-time and adaptive planning portfolio that harmonises and expedites the entire image-guided brachytherapy process. Traditional planning strategies remain relevant to validate emerging technologies and should continue to be incorporated in practice, particularly for cervical cancer. Overall, technological developments need commissioning and validation to make the best use of the advanced features by understanding their strengths and limitations. Brachytherapy has become high-tech and modern by respecting tradition and remaining accessible to all.
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Affiliation(s)
- D Berger
- International Atomic Energy Agency, Vienna International Centre, Vienna, Austria.
| | - S Van Dyk
- Radiation Therapy Services, Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - L Beaulieu
- Service de Physique Médicale et Radioprotection, et Axe Oncologie du Centre de Recherche du CHU de Québec, CHU de Québec, Québec, Canada; Département de Physique, de Génie Physique et d'Optique et Centre de Recherche sur le Cancer, Université Laval, Québec, Canada
| | - T Major
- Radiotherapy Centre, National Institute of Oncology, Budapest, Hungary; Department of Oncology, Semmelweis University, Budapest, Hungary
| | - T Kron
- Peter MacCallum Cancer Centre and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia; Centre for Medical Radiation Physics, University of Wollongong, Wollongong, Australia
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2
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Frank SJ. A CALL TO ARMS: The Case for MRI-Assisted Radiosurgery (MARS) vs. Stereotactic Body Radiation Therapy or Robotic-Assisted Radical Prostatectomy. Brachytherapy 2023; 22:12-14. [PMID: 36725197 DOI: 10.1016/j.brachy.2022.09.158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Accepted: 09/28/2022] [Indexed: 01/31/2023]
Affiliation(s)
- Steven J Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Sanders JW, Kudchadker RJ, Tang C, Mok H, Venkatesan AM, Thames HD, Frank SJ. Prospective Evaluation of Prostate and Organs at Risk Segmentation Software for MRI-based Prostate Radiation Therapy. Radiol Artif Intell 2022; 4:e210151. [PMID: 35391775 DOI: 10.1148/ryai.210151] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 12/20/2021] [Accepted: 01/05/2022] [Indexed: 12/24/2022]
Abstract
The segmentation of the prostate and surrounding organs at risk (OARs) is a necessary workflow step for performing dose-volume histogram analyses of prostate radiation therapy procedures. Low-dose-rate prostate brachytherapy (LDRPBT) is a curative prostate radiation therapy treatment that delivers a single fraction of radiation over a period of days. Prior studies have demonstrated the feasibility of fully convolutional networks to segment the prostate and surrounding OARs for LDRPBT dose-volume histogram analyses. However, performance evaluations have been limited to measures of global similarity between algorithm predictions and a reference. To date, the clinical use of automatic segmentation algorithms for LDRPBT has not been evaluated, to the authors' knowledge. The purpose of this work was to assess the performance of fully convolutional networks for prostate and OAR delineation on a prospectively identified cohort of patients who underwent LDRPBT by using clinically relevant metrics. Thirty patients underwent LDRPBT and were imaged with fully balanced steady-state free precession MRI after implantation. Custom automatic segmentation software was used to segment the prostate and four OARs. Dose-volume histogram analyses were performed by using both the original automatically generated contours and the physician-refined contours. Dosimetry parameters of the prostate, external urinary sphincter, and rectum were compared without and with the physician refinements. This study observed that physician refinements to the automatic contours did not significantly affect dosimetry parameters. Keywords: MRI, Neural Networks, Radiation Therapy, Radiation Therapy/Oncology, Genital/Reproductive, Prostate, Segmentation, Dosimetry Supplemental material is available for this article. © RSNA, 2022.
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Affiliation(s)
- Jeremiah W Sanders
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Rajat J Kudchadker
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Chad Tang
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Henry Mok
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Aradhana M Venkatesan
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Howard D Thames
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
| | - Steven J Frank
- Departments of Imaging Physics (J.W.S.), Radiation Physics (R.J.K.), Radiation Oncology (C.T., H.M., S.J.F.), Diagnostic Radiology (A.M.V.), and Biostatistics (H.D.T.), The University of Texas MD Anderson Cancer Center, 1515 Holcombe Blvd, Houston, TX 77030
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PSR: Unified Framework of Parameter-Learning-Based MR Image Superresolution. JOURNAL OF HEALTHCARE ENGINEERING 2021; 2021:5591660. [PMID: 33968351 PMCID: PMC8084653 DOI: 10.1155/2021/5591660] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/27/2021] [Accepted: 04/09/2021] [Indexed: 11/23/2022]
Abstract
Magnetic resonance imaging has significant applications for disease diagnosis. Due to the particularity of its imaging mechanism, hardware imaging suffers from resolution and reaches its limit, and higher radiation intensity and longer radiation time will cause damage to the human body. The problem is expected to be solved by a superresolution algorithm, especially the image superresolution based on sparse reconstruction has good performance. Dictionary generation is a key issue that affects the performance of superresolution algorithms, and dictionary performance is affected by dictionary construction parameters: balance parameters, dictionary size, overlapping block size, and a number of training sample blocks. In response to this problem, we propose an optimal dictionary construction parameter search method through the experiment to find the optimal dictionary construction parameters on the MR image and compare them with the dictionary obtained by multiple sets of random dictionary construction parameters. The dictionary we searched for the optimal parameters of the dictionary construction training has more powerful feature expressions, which can improve the superresolution effect of MR images.
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Focal low-dose-rate prostate brachytherapy for low- and intermediate-risk prostate cancer. J Contemp Brachytherapy 2021; 12:554-561. [PMID: 33437303 PMCID: PMC7787206 DOI: 10.5114/jcb.2020.101688] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 09/09/2020] [Indexed: 01/10/2023] Open
Abstract
Purpose To prospectively investigate the efficacy and feasibility of focal low-dose-rate (LDR) prostate brachytherapy for low- and intermediate-risk prostate cancer. Material and methods Between October 2014 and May 2019, nineteen low- and intermediate-risk prostate cancer patients who presented with abnormality on both diffusion-weighted and T2-weighted magnetic resonance imaging (MRI) underwent focal LDR brachytherapy at our institution. Focal gross tumor volume (F-GTV) was delineated on transrectal ultrasound, based on abnormality seen on fused T2-weighted MRI. F-GTV was expanded by 5 mm, as a safety margin, to create focal clinical target volume (F-CTV). Prescribed dose to F-CTV was 145 Gy. Biochemical recurrence (BCR) was determined using Phoenix criterion (prostate specific antigen nadir + 2 ng/ml). Pre- and post-implant dosimetry data were compared using non-parametric Wilcoxon’s rank sum test. Treatment-related toxicities were evaluated using common terminology criteria for adverse events. Results Mean F-CTV D90% was significantly lower in the post-implant evaluation than in intraoperative planning (p = 0.004). On post-implant dosimetry, the mean D90% for F-GTV and mean V100% for the entire prostate were 222 Gy and 35%, respectively. Median follow-up time for all patients was 31 months. BCR occurred in one patient after 23 months. Kaplan-Meier 2-year BCR-free rate was 92.9% (95% confidence interval [CI]: 79.4-100%). No patients had grade 1 or greater gastrointestinal toxicity. Three patients who were taking α-blockers to treat benign prostatic hyperplasia (present before brachytherapy), experienced no treatment-related genitourinary toxicities. Two patients suffered from temporary grade 2 urinary frequency. None of the remaining patients experienced grade 2 or higher genitourinary toxicity. Conclusions Focal LDR prostate brachytherapy appears acceptable for MRI-based index tumors, with a low cumulative incidence of BCR. Such brachytherapy might offer a feasible minimally invasive therapeutic option for localized prostate cancer.
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Prada PJ, Cardenal J, García Blanco A, Andreescu J, Ferri M, Anchuelo J, Diaz de Cerio I, Sierrasesumaga N, Vázquez A, Pacheco M, Ruiz Arrebola S. Focal high-dose-rate brachytherapy for localized prostate cancer: toxicity and preliminary biochemical results. Strahlenther Onkol 2020; 196:222-228. [PMID: 31942652 DOI: 10.1007/s00066-019-01561-3] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 11/25/2019] [Indexed: 10/25/2022]
Abstract
BACKGROUND This study aimed to evaluate the outcomes and the toxicity of focal high-dose-rate (HDR) brachytherapy in selected localized prostate cancer patients. METHODS Fifty patients were treated with focal high-dose-rate brachytherapy between March 2013 and November 2017, representing 5% of the cases treated by our group during this period. Only patients with very limited and localized tumors, according to strict criteria, were selected for the procedure. The prescribed dose for the focal volume was 24 Gy. RESULTS The treated volume corresponded to a mean value of 32% of the total prostatic volume. The mean focal D90 in our series was 23 Gy (range 16-26 Gy). The mean initial IPSS was 8.2 (range 0-26), at 6 months 7.5 (range 0-23), and at 24 months 6.7 (range 0-18). No acute or late urinary retention was seen. When the ICIQ-SF score was 0 at the end of treatment, it remained nil thereafter at 1 and 2 years for all patients. No intraoperative or perioperative complications occurred. No rectal toxicity was reported after treatment. Of the total patients identified as potent, only three patients had a very slight decrease of the mean IIEF5. The mean initial PSA was 6.9 ng/mL (range 1.9-13.4). At the last follow-up visit, the mean PSA was 3 ng/ml (range 0.48-8.11). CONCLUSION HDR focal brachytherapy in selected patients with low intermediate-risk prostate cancer could achieve the same satisfactory results in terms of relapse-free survival as conventional whole prostate brachytherapy with less toxicity.
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Affiliation(s)
- Pedro J Prada
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain.
| | - Juan Cardenal
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Ana García Blanco
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Jon Andreescu
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - María Ferri
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Javier Anchuelo
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Ivan Diaz de Cerio
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Nicolas Sierrasesumaga
- Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, C/Avd. Valdecilla s/n, 39008, Santander, Cantabria, Spain
| | - Andrés Vázquez
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Maite Pacheco
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
| | - Samuel Ruiz Arrebola
- Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain
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Lee SL, Ravi A, Morton G, Loblaw A, Tseng CL, Haider M, Murgic J, Nicolae A, Semple M, Chung HT. Changes in ADC and T2-weighted MRI-derived radiomic features in patients treated with focal salvage HDR prostate brachytherapy for local recurrence after previous external-beam radiotherapy. Brachytherapy 2019; 18:567-573. [PMID: 31126856 DOI: 10.1016/j.brachy.2019.04.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Revised: 04/02/2019] [Accepted: 04/17/2019] [Indexed: 01/30/2023]
Abstract
PURPOSE To explore the changes in T2-weighted (T2w) and apparent diffusion coefficient (ADC) magnetic resonance imaging -derived radiomic features of the gross tumor volume (GTV) from focal salvage high-dose-rate prostate brachytherapy (HDRB) and to correlate with clinical parameters. MATERIALS AND METHODS Eligible patients included those with biopsy-confirmed local recurrence that correlated with MRI (T2w, ADC). Patients received 27 Gy in 2 fractions separated by 1 week to a quadrant consisting of the GTV. The MRI was repeated 1 year after HDRB. GTVs, planning target volumes, and normal prostate tissue control volumes were identified on the pre- and post-HDRB MRIs. Radiomic features from each GTV were extracted, and principle component analysis identified features with the highest variance. RESULTS Pre- and post-HDRB MRIs were obtained from 14 trial patients. Principle component analysis showed that 18 and 17 features contributed to 93% and 86% of the variance observed in the T2w and ADC data, respectively. Sixteen T2w features and 1 ADC GTV feature were different from the control volumes in the pre-HDRB images (p < 0.05). Ten T2w and 7 ADC GTV post-HDRB features were different from those of pre-HDRB (p < 0.05). CONCLUSIONS Exploratory analysis reveals several radiomic features in the T2w and ADC image GTVs that distinguish the GTV from healthy prostate tissue and change significantly after salvage HDRB.
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Affiliation(s)
- Sangjune Laurence Lee
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Ananth Ravi
- Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada; Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Chia-Lin Tseng
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Masoom Haider
- Department of Medical Imaging, Mount Sinai Hospital, Toronto, Ontario, Canada; Department of Medical Imaging, University of Toronto, Toronto, Ontario, Canada
| | - Jure Murgic
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada
| | - Alexandru Nicolae
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Mark Semple
- Department of Medical Physics, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Hans T Chung
- Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada; Department of Radiation Oncology, University of Toronto, Toronto, Ontario, Canada.
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Espenel S, Limkin E, Garcia MA, Langrand-Escure J, Vallard A, Chargari C, Magné N. [Brachytherapy: When needs overtake care offer]. Bull Cancer 2019; 106:584-589. [PMID: 31084914 DOI: 10.1016/j.bulcan.2019.03.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2018] [Revised: 03/19/2019] [Accepted: 03/19/2019] [Indexed: 01/01/2023]
Abstract
Brachytherapy has the unique characteristic of being able to deliver high doses to a very localized volume, and remains one of the radiotherapy techniques that has an unparalleled therapeutic index. However, its use has been declining in the past years. Globally, only 55 to 88 % of patients with locally advanced cervical cancer benefit from utero-vaginal brachytherapy, despite the fact that it is proven to enhance both progression-free and overall survival. A decline in the use of low dose rate brachytherapy has likewise been described in the treatment of low-risk and favorable intermediate-risk prostate cancers. Several factors could explain this. First, the radiation oncologists who have the proficiency to perform brachytherapy seems to be inadequate, as it is a technique that requires training and expertise for optimal applications. In many cancer care centers, the caseload is insufficient to provide this experience. Second, the increasing use of technically advanced external beam radiation therapy, such as intensity modulated radiation therapy, offers an easier substitute with more lucrative benefits, resulting in decreased utilization of brachytherapy. However, when brachytherapy is not delivered, a poorer survival rate is reported in locally advanced cervical cancer, and is suggested in intermediate and high-risk prostate cancer. The increasing level of evidence of treatment with brachytherapy necessitates an improvement in its accessibility by having more radiation oncologists as well as cancer centers equipped to perform the procedure.
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Affiliation(s)
- Sophie Espenel
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France; Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Elaine Limkin
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Max-Adrien Garcia
- Institut de cancérologie Lucien-Neuwirth, département de santé publique, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Julien Langrand-Escure
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Alexis Vallard
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France
| | - Cyrus Chargari
- Institut Gustave-Roussy, département de radiothérapie, 114, rue Edouard-Vaillant, 94800 Villejuif, France
| | - Nicolas Magné
- Institut de cancérologie Lucien-Neuwirth, département de radiothérapie, 108 bis, avenue Albert-Raimond, BP 60008, 42271 Saint-Priest-en-Jarez cedex, France.
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Grisotto S, Cerrotta A, Pappalardi B, Carrara M, Messina A, Tenconi C, Valdagni R, Fallai C. Pre-implant magnetic resonance and transrectal ultrasound imaging in high-dose-rate prostate brachytherapy: comparison of prostate volumes, craniocaudal extents, and contours. J Contemp Brachytherapy 2018; 10:285-290. [PMID: 30237811 PMCID: PMC6142648 DOI: 10.5114/jcb.2018.77947] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/17/2018] [Indexed: 11/17/2022] Open
Abstract
PURPOSE The purpose of this study was to compare the prostate contours drawn by two radiation oncologists and one radiologist on magnetic resonance (MR) and transrectal ultrasound (TRUS) images. TRUS intra- and inter-fraction variability as well as TRUS vs. MR inter-modality and inter-operator variability were studied. MATERIAL AND METHODS Thirty patients affected by localized prostate cancer and treated with interstitial high-dose-rate (HDR) prostate brachytherapy at the National Cancer Institute in Milan were included in this study. Twenty-five patients received an exclusive two-fraction (14 Gy/fraction) treatment, while the other 5 received a single 14 Gy fraction as a boost after external beam radiotherapy. The prostate was contoured on TRUS images acquired before (virtual US) and after (real US) needle implant by two radiation oncologists, whereas on MR prostate was independently contoured by the same radiation oncologists (MR1, MR2) and by a dedicated radiologist (MR3). Absolute differences of prostate volumes (│ΔV│) and craniocaudal extents (│Δdz│) were evaluated. The Dice's coefficient (DC) was calculated to quantify spatial overlap between MR contours. RESULTS Significant difference was found between Vvirtual and Vlive (p < 0.001) for the first treatment fractions and between VMR1 and VMR2 (p = 0.043). Significant difference between cranio-caudal extents was found between dzvirtual and dzlive (p < 0.033) for the first treatment fractions, between dzvirtual of the first treatment fractions and dzMR1 (p < 0.001) and between dzMR1 and dzMR3 (p < 0.01). Oedema might be responsible for some of the changes in US volumes. Average DC values resulting from the comparison MR1 vs. MR2, MR1 vs. MR3 and MR2 vs. MR3 were 0.95 ± 0.04 (range, 0.82-0.99), 0.87 ± 0.04 (range, 0.73-0.91) and 0.87 ± 0.04 (range, 0.72-0.91), respectively. CONCLUSIONS Our results demonstrate the importance of a multiprofessional approach to TRUS-guided HDR prostate brachytherapy. Specific training in MR and US prostate imaging is recommended for centers that are unfamiliar with HDR prostate brachytherapy.
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Affiliation(s)
- Simone Grisotto
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Annamaria Cerrotta
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Brigida Pappalardi
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Mauro Carrara
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Antonella Messina
- Diagnostic Imaging Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Chiara Tenconi
- Medical Physics Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
| | - Riccardo Valdagni
- Radiotherapy 1 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Prostate Program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
- Department of Medicine and Surgery, Universita’ degli Studi, Milan, Italy
| | - Carlo Fallai
- Radiotherapy 2 Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan
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Blanchard P, Graff-Cailleaud P, Bossi A. [Prostate brachytherapy: New techniques, new indications]. Cancer Radiother 2018; 22:352-358. [PMID: 29858134 DOI: 10.1016/j.canrad.2017.11.012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 11/11/2017] [Accepted: 11/27/2017] [Indexed: 01/01/2023]
Abstract
Prostate brachytherapy has been for a long time one of the standard treatments for low risk prostate cancer, with high rates of biochemical control and low levels of urinary and sexual late toxicity compared to other available techniques, namely external beam radiotherapy and radical prostatectomy. The aim of this article is to review the recent innovations of prostate brachytherapy, which suggest a bright future for the technique. We will discuss the extension of indications of permanent implant brachytherapy to favorable intermediate-risk patients, the use of novel isotopes such as Palladium 103 and Cesium 131, and the benefit of brachytherapy as a boost following external beam radiotherapy for intermediate and high-risk patients. We will also discuss the rise of high dose rate brachytherapy, as a boost or monotherapy, the increasing use of MRI for patient selection and treatment planning, as well as the development of brachytherapy as a means of focal therapy.
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Affiliation(s)
- P Blanchard
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France; Inserm unité 1018, Oncostat, CESP, 16, avenue Paul-Vaillant-Couturier, 94807 Villejuif cedex, France.
| | - P Graff-Cailleaud
- Département de radiothérapie, institut universitaire du cancer de Toulouse - Oncopole, avenue Hubert-Curien, 31100 Toulouse, France
| | - A Bossi
- Département de radiothérapie, Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif, France
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Graff P, Portalez D, Lusque A, Brun T, Aziza R, Khalifa J, Roumiguié M, Quintyn Ranty ML, Filleron T, Bachaud JM, Malavaud B. IDEAL 2a Phase II Study of Ultrafocal Brachytherapy for Low- and Intermediate-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 102:903-911. [PMID: 29510957 DOI: 10.1016/j.ijrobp.2018.01.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/11/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Focal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterized index tumors (ITs). We assessed the feasibility of low-dose-rate ultrafocal brachytherapy. METHODS AND MATERIALS The present study was an institutional review board-approved European Clinical Trials Database-registered phase II protocol. Patients referred (October 2013 to August 2016) for active surveillance (prostate-specific antigen <10 ng/mL, cT1c-cT2a, Gleason score on referring biopsy specimens ≤6 (3+3), ≤3 positive biopsy cores, ≤50% of cancer) were preselected. Inclusion was confirmed when complementary image-guided biopsy findings informed a single Prostate Imaging Reporting and Data System (PI-RADS) ≥3, Gleason score ≤7a (3+4) lesion. A ultrasound-visible ancillary marker was positioned within the IT using a magnetic resonance imaging (MRI)/3-dimensional transrectal ultrasound (TRUS) elastic fusion-guided system (Koelis). Ultrafocal transperineal delivery of 125I seeds used classic 2-dimensional TRUS (Bard-FlexFocus) and dose optimization (Variseed Treatment Planning System). Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering ≥95% of the prescribed dose (160 Gy) to the IT (primary objective). Adverse events (Common Terminology Criteria for Adverse Events) and quality of life (5-item International Index of Erectile Function, International Prostate Symptom Score) were recorded. One-year control biopsy specimens were obtained from the IT and untreated segments. RESULTS Of the 44 preselected patients, 27 did not meet the inclusion criteria. Of the 17 ultrafocal brachytherapy-treated patients, 16 met the primary objective (per protocol success). The prescription dose was delivered to 14.5% ± 6.4% of the prostate volume, resulting in negligible urethral and rectal irradiation and toxicity. No recurrence was evidenced on the 1-year follow-up MRI studies or IT biopsy specimens. Seven nonclinically significant cancers and one Gleason score 7a (3+4) cancer (salvage prostatectomy) were observed in the untreated parenchyma. CONCLUSIONS Recent technology has allowed for selective and effective brachytherapy of small MRI targets.
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Affiliation(s)
- Pierre Graff
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
| | - Daniel Portalez
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Thomas Brun
- Department of Biophysics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Thomas Filleron
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jean-Marc Bachaud
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
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Poulin E, Boudam K, Pinter C, Kadoury S, Lasso A, Fichtinger G, Ménard C. Validation of MRI to TRUS registration for high-dose-rate prostate brachytherapy. Brachytherapy 2018; 17:283-290. [PMID: 29331575 DOI: 10.1016/j.brachy.2017.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to develop and validate an open-source module for MRI to transrectal ultrasound (TRUS) registration to support tumor-targeted prostate brachytherapy. METHODS AND MATERIALS In this study, 15 patients with prostate cancer lesions visible on multiparametric MRI were selected for the validation. T2-weighted images with 1-mm isotropic voxel size and diffusion weighted images were acquired on a 1.5T Siemens imager. Three-dimensional (3D) TRUS images with 0.5-mm slice thickness were acquired. The investigated registration module was incorporated in the open-source 3D Slicer platform, which can compute rigid and deformable transformations. An extension of 3D Slicer, SlicerRT, allows import of and export to DICOM-RT formats. For validation, similarity indices, prostate volumes, and centroid positions were determined in addition to registration errors for common 3D points identified by an experienced radiation oncologist. RESULTS The average time to compute the registration was 35 ± 3 s. For the rigid and deformable registration, respectively, Dice similarity coefficients were 0.87 ± 0.05 and 0.93 ± 0.01 while the 95% Hausdorff distances were 4.2 ± 1.0 and 2.2 ± 0.3 mm. MRI volumes obtained after the rigid and deformable registration were not statistically different (p > 0.05) from reference TRUS volumes. For the rigid and deformable registration, respectively, 3D distance errors between reference and registered centroid positions were 2.1 ± 1.0 and 0.4 ± 0.1 mm while registration errors between common points were 3.5 ± 3.2 and 2.3 ± 1.1 mm. Deformable registration was found significantly better (p < 0.05) than rigid registration for all parameters. CONCLUSIONS An open-source MRI to TRUS registration platform was validated for integration in the brachytherapy workflow.
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Use of magnetic resonance imaging in low-dose-rate and high-dose-rate prostate brachytherapy from diagnosis to treatment assessment: Defining the knowledge gaps, technical challenges, and barriers to implementation. Brachytherapy 2017; 16:672-678. [DOI: 10.1016/j.brachy.2017.01.014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 01/31/2017] [Indexed: 01/03/2023]
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