1
|
Siavashpour Z, Kiarad R, Aghamiri MR, Babaloui S, Seiri M, Jaberi R. Feasibility of using micro silica bead TLDs for in-Vivo dosimetry of CT-based HDR prostate brachytherapy: An experimental and simulation study. Appl Radiat Isot 2024; 212:111429. [PMID: 38986180 DOI: 10.1016/j.apradiso.2024.111429] [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: 02/06/2024] [Revised: 06/20/2024] [Accepted: 07/06/2024] [Indexed: 07/12/2024]
Abstract
PURPOSE Feasibility of silica-based dosimeters for IVD of HDR prostate brachytherapy. MATERIAL AND METHODS Plastic dosimeter holders and a water-fillable prostate phantom were built in-house. Interstitial prostate brachytherapy and Monte Carlo simulations were performed. The treatment planning, Monte-Carlo simulation, and dosimetry results were compared. RESULTS The relative differences between TLD-TPS, TLD-MCNP, and TPS-MCNP were 0.2-6.9 %, 0.5-6.5 %, and 0.6-6.3 %, respectively. CONCLUSION Micro-silica bead dosimeters can perform offline in situ quality assurance in HDR prostate brachytherapy.
Collapse
Affiliation(s)
- Zahra Siavashpour
- Radiotherapy Oncology Department, Shohada-e Tajrish Educational Hospital, Medical School, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Reza Kiarad
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran.
| | - Mahmoud Reza Aghamiri
- Department of Medical Radiation Engineering, Shahid Beheshti University, Tehran, Iran
| | - Somayyeh Babaloui
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran
| | - Mahnaz Seiri
- Department of Medical Physics and Biomedical Engineering, Faculty of Medicine, Tehran University of Medical Science, Tehran, Iran; Advanced Medical Technologies & Equipment Institute, Tehran University of Medical Science, Tehran, Iran
| | - Ramin Jaberi
- Radiation Oncology Research Center, Iran Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran; Department of Physics, University of Surrey, Guildford, UK
| |
Collapse
|
2
|
Watanabe K, Kamitani N, Ikeda N, Kawata Y, Tokiya R, Hayashi T, Miyaji Y, Tamada T, Katsui K. Long-term outcomes of salvage transurethral high-dose-rate brachytherapy combined with external beam radiation therapy for anastomotic recurrence of prostate cancer after radical prostatectomy: A retrospective analysis. Brachytherapy 2024; 23:179-187. [PMID: 38245406 DOI: 10.1016/j.brachy.2023.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 09/13/2023] [Accepted: 12/05/2023] [Indexed: 01/22/2024]
Abstract
BACKGROUND High-dose-rate brachytherapy (HDR-BT) delivers high-dose radiation to local lesions within a short treatment period. There are no reports of salvage transurethral HDR-BT for biochemical recurrence (BCR) after radical prostatectomy. Thus, we aimed to evaluate the usefulness of salvage transurethral HDR-BT with external beam radiation therapy (EBRT) for anastomotic prostate cancer recurrence. METHODS AND MATERIALS Patients with postoperative prostate cancer who underwent salvage transurethral HDR-BT with EBRT for anastomotic recurrence at our hospital between January 2002 and July 2009 were retrospectively evaluated. The Kaplan-Meier method was used to estimate biochemical freedom from failure (bFFF), cause-specific survival (CSS), and overall survival (OS) rates. RESULTS Nine patients were included in this study. The median follow-up period and age were 13.1 (range 4.3-18.4) years and 67 (range 63-78) years, respectively. The dose of HDR-BT ranged from 13 to 24 Gy per 2 to 5 fractions, while that of EBRT ranged from 30 to 44 Gy per 15 to 22 fractions. The 1-year, 5-year, and 10-year bFFF rates were 77.8%, 41.7%, and 13.9%, respectively. The 10-year and 15-year CSS rates were 100% each. The 10-year and 15-year OS rates were 100% and 64.3%, respectively. Six patients were diagnosed with BCR. Two patients experienced Grade 3 hematuria as a late adverse event. There was no exacerbation of urinary incontinence. CONCLUSIONS No prostate cancer-related deaths were observed, even after a long-term follow-up. Salvage transurethral HDR-BT after radical prostatectomy is safe and feasible and may be a useful treatment option.
Collapse
Affiliation(s)
- Kenta Watanabe
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Nobuhiko Kamitani
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan.
| | - Naoki Ikeda
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Yujiro Kawata
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Ryoji Tokiya
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Takafumi Hayashi
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Yoshiyuki Miyaji
- Department of Urology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Tsutomu Tamada
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| | - Kuniaki Katsui
- Department of Radiology, Kawasaki Medical School, Kurashiki City, Okayama 701-0192, Japan
| |
Collapse
|
3
|
Frank CH, Ramesh P, Lyu Q, Ruan D, Park SJ, Chang AJ, Venkat PS, Kishan AU, Sheng K. Analytical HDR prostate brachytherapy planning with automatic catheter and isotope selection. Med Phys 2023; 50:6525-6534. [PMID: 37650773 PMCID: PMC10635680 DOI: 10.1002/mp.16677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Revised: 06/27/2023] [Accepted: 07/30/2023] [Indexed: 09/01/2023] Open
Abstract
BACKGROUND High dose rate (HDR) brachytherapy is commonly used to treat prostate cancer. Existing HDR planning systems solve the dwell time problem for predetermined catheters and a single energy source. PURPOSE Additional degrees of freedom can be obtained by relaxing the catheters' pre-designation and introducing more source types, and may have a dosimetric benefit, particularly in improving conformality to spare the urethra. This study presents a novel analytical approach to solving the corresponding HDR planning problem. METHODS The catheter and dual-energy source selection problem was formulated as a constrained optimization problem with a non-convex group sparsity regularization. The optimization problem was solved using the fast-iterative shrinkage-thresholding algorithm (FISTA). Two isotopes were considered. The dose rates for the HDR 4140 Ytterbium (Yb-169) source and the Elekta Iridium (Ir-192) HDR Flexisource were modeled according to the TG-43U1 formalism and benchmarked accordingly. Twenty-two retrospective HDR prostate brachytherapy patients treated with Ir-192 were considered. An Ir-192 only (IRO), Yb-169 only (YBO), and dual-source (DS) plan with optimized catheter location was created for each patient with N catheters, where N is the number of catheters used in the clinically delivered plans. The DS plans jointly optimized Yb-169 and Ir-192 dwell times. All plans and the clinical plans were normalized to deliver a 15 Gy prescription (Rx) dose to 95% of the clinical treatment volume (CTV) and evaluated for the CTV D90%, V150%, and V200%, urethra D0.1cc and D1cc, bladder V75%, and rectum V75%. Dose-volume histograms (DVHs) were generated for each structure. RESULTS The DS plans ubiquitously selected Ir-192 as the only treatment source. IRO outperformed YBO in organ at risk (OARs) OAR sparing, reducing the urethra D0.1cc and D1cc by 0.98% (p = 2.22 ∗ 10 - 9 $p\ = \ 2.22*{10^{ - 9}}$ ) and 1.09% (p = 1.22 ∗ 10 - 10 $p\ = \ 1.22*{10^{ - 10}}$ ) of the Rx dose, respectively, and reducing the bladder and rectum V75% by 0.09 (p = 0.0023 $p\ = \ 0.0023$ ) and 0.13 cubic centimeters (cc) (p = 0.033 $p\ = \ 0.033$ ), respectively. The YBO plans delivered a more homogenous dose to the CTV, with a smaller V150% and V200% by 3.20 (p = 4.67 ∗ 10 - 10 $p\ = \ 4.67*{10^{ - 10}}$ ) and 1.91 cc (p = 5.79 ∗ 10 - 10 $p\ = \ 5.79*{10^{ - 10}}$ ), respectively, and a lower CTV D90% by 0.49% (p = 0.0056 $p\ = \ 0.0056$ ) of the prescription dose. The IRO plans reduce the urethral D1cc by 2.82% (p = 1.38 ∗ 10 - 4 $p\ = \ 1.38*{10^{ - 4}}$ ) of the Rx dose compared to the clinical plans, at the cost of increased bladder and rectal V75% by 0.57 (p = 0.0022 $p\ = \ 0.0022$ ) and 0.21 cc (p = 0.019 $p\ = \ 0.019$ ), respectively, and increased CTV V150% by a mean of 1.46 cc (p = 0.010 $p\ = \ 0.010$ ) and CTV D90% by an average of 1.40% of the Rx dose (p = 8.80 ∗ 10 - 8 $p\ = \ 8.80*{10^{ - 8}}$ ). While these differences are statistically significant, the clinical differences between the plans are minimal. CONCLUSIONS The proposed analytical HDR planning algorithm integrates catheter and isotope selection with dwell time optimization for varying clinical goals, including urethra sparing. The planning method can guide HDR implants and identify promising isotopes for specific HDR clinical goals, such as target conformality or OAR sparing.
Collapse
Affiliation(s)
- Catherine Holly Frank
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Pavitra Ramesh
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Qihui Lyu
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Dan Ruan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Sang-June Park
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Albert J. Chang
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Puja S. Venkat
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Amar U. Kishan
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
| | - Ke Sheng
- Department of Radiation Oncology, University of California Los Angeles, Los Angeles, CA 90095
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA 94115
| |
Collapse
|
4
|
Bone Health Management in the Continuum of Prostate Cancer Disease. Cancers (Basel) 2022; 14:cancers14174305. [PMID: 36077840 PMCID: PMC9455007 DOI: 10.3390/cancers14174305] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/26/2022] [Accepted: 08/29/2022] [Indexed: 11/17/2022] Open
Abstract
Prostate cancer (PCa) is the second-leading cause of cancer-related deaths in men. PCa cells require androgen receptor (AR) signaling for their growth and survival. Androgen deprivation therapy (ADT) is the preferred treatment for patients with locally advanced and metastatic PCa disease. Despite their initial response to androgen blockade, most patients eventually will develop metastatic castration-resistant prostate cancer (mCRPC). Bone metastases are common in men with mCRPC, occurring in 30% of patients within 2 years of castration resistance and in >90% of patients over the course of the disease. Patients with mCRPC-induced bone metastasis develop lesions throughout their skeleton; the 5-year survival rate for these patients is 47%. Bone-metastasis-induced early changes in the bone that proceed the osteoblastic response in the bone matrix are monitored and detected via modern magnetic resonance and PET/CT imaging technologies. Various treatment options, such as targeting osteolytic metastasis with bisphosphonates, prednisone, dexamethasone, denosumab, immunotherapy, external beam radiation therapy, radiopharmaceuticals, surgery, and pain medications are employed to treat prostate-cancer-induced bone metastasis and manage bone health. However, these diagnostics and treatment options are not very accurate nor efficient enough to treat bone metastases and manage bone health. In this review, we present the pathogenesis of PCa-induced bone metastasis, its deleterious impacts on vital organs, the impact of metastatic PCa on bone health, treatment interventions for bone metastasis and management of bone- and skeletal-related events, and possible current and future therapeutic options for bone management in the continuum of prostate cancer disease.
Collapse
|
5
|
Grajales D, Picot F, Shams R, Dallaire F, Sheehy G, Alley S, Barkati M, Delouya G, Carrier JF, Birlea M, Trudel D, Leblond F, Ménard C, Kadoury S. Image-guided Raman spectroscopy navigation system to improve transperineal prostate cancer detection. Part 2: in-vivo tumor-targeting using a classification model combining spectral and MRI-radiomics features. JOURNAL OF BIOMEDICAL OPTICS 2022; 27:JBO-220064GR. [PMID: 36085571 PMCID: PMC9459023 DOI: 10.1117/1.jbo.27.9.095004] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 08/12/2022] [Indexed: 06/01/2023]
Abstract
SIGNIFICANCE The diagnosis and treatment of prostate cancer (PCa) are limited by a lack of intraoperative information to accurately target tumors with needles for biopsy and brachytherapy. An innovative image-guidance technique using optical devices could improve the diagnostic yield of biopsy and efficacy of radiotherapy. AIM To evaluate the performance of multimodal PCa detection using biomolecular features from in-situ Raman spectroscopy (RS) combined with image-based (radiomics) features from multiparametric magnetic resonance images (mpMRI). APPROACH In a prospective pilot clinical study, 18 patients were recruited and underwent high-dose-rate brachytherapy. Multimodality image fusion (preoperative mpMRI with intraoperative transrectal ultrasound) combined with electromagnetic tracking was used to navigate an RS needle in the prostate prior to brachytherapy. This resulting dataset consisted of Raman spectra and co-located radiomics features from mpMRI. Feature selection was performed with the constraint that no more than 10 features were retained overall from a combination of inelastic scattering spectra and radiomics. These features were used to train support vector machine classifiers for PCa detection based on leave-one-patient-out cross-validation. RESULTS RS along with biopsy samples were acquired from 47 sites along the insertion trajectory of the fiber-optics needle: 26 were confirmed as benign or grade group = 1, and 21 as grade group >1, according to histopathological reports. The combination of the fingerprint region of the RS and radiomics showed an accuracy of 83% (sensitivity = 81 % and a specificity = 85 % ), outperforming by more than 9% models trained with either spectroscopic or mpMRI data alone. An optimal number of features was identified between 6 and 8 features, which have good potential for discriminating grade group ≥1 / grade group <1 (accuracy = 87 % ) or grade group >1 / grade group ≤1 (accuracy = 91 % ). CONCLUSIONS In-situ Raman spectroscopy combined with mpMRI radiomics features can lead to highly accurate PCa detection for improved in-vivo targeting of biopsy sample collection and radiotherapy seed placement.
Collapse
Affiliation(s)
- David Grajales
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Fabien Picot
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Roozbeh Shams
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Frédérick Dallaire
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Guillaume Sheehy
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Stephanie Alley
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Maroie Barkati
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Guila Delouya
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Jean-Francois Carrier
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Mirela Birlea
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Dominique Trudel
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Frédéric Leblond
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
- Institut du Cancer de Montréal, Montreal, Québec, Canada
| | - Cynthia Ménard
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| | - Samuel Kadoury
- Polytechnique Montréal, Montreal, Québec, Canada
- Centre de recherche du Centre Hospitalier de l’Université de Montréal, Montreal, Québec, Canada
| |
Collapse
|
6
|
Okubo Y, Yamamoto Y, Sato S, Yoshioka E, Suzuki M, Washimi K, Osaka K, Suzuki T, Yokose T, Kishida T, Miyagi Y. Diagnostic significance of reassessment of prostate biopsy specimens by experienced urological pathologists at a high-volume institution. Virchows Arch 2022; 480:979-987. [PMID: 35015130 PMCID: PMC9033711 DOI: 10.1007/s00428-022-03272-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 12/21/2021] [Accepted: 01/05/2022] [Indexed: 01/07/2023]
Abstract
In prostate cancer, accurate diagnosis and grade group (GG) decision based on biopsy findings are essential for determining treatment strategies. Diagnosis by experienced urological pathologists is recommended; however, their contribution to patient benefits remains unknown. Therefore, we analyzed clinicopathological information to determine the significance of reassessment by experienced urological pathologists at a high-volume institution to identify factors involved in the agreement or disagreement of biopsy and surgical GGs. In total, 1325 prostate adenocarcinomas were analyzed, and the GG was changed in 452/1325 (34.1%) cases (359 cases were upgraded, and 93 cases were downgraded). We compared the highest GG based on biopsy specimens, with the final GG based on surgical specimens of 210 cases. The agreement rate between the surgical GG performed and assessed in our institute and the highest biopsy GG assessed by an outside pathologist was 34.8% (73/210); the agreement rate increased significantly to 50% (105/210) when biopsy specimens were reevaluated in our institute (chi-square test, P < 0.01). Multivariate logistic regression analysis showed that only the length of the lesion in the positive core with the highest GG in the biopsy was a significant factor for determining the agreement between biopsy GG and surgical GG, with an odds ratio of 1.136 (95% confidence interval: 1.057-1.221; P < 0.01). Thus, reassessment by experienced urological pathologists at high-volume institutions improved the agreement rate. However, it should be noted there is a high probability of discordance between a small number of lesions or short lesions and surgical GG.
Collapse
Affiliation(s)
- Yoichiro Okubo
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.
| | - Yayoi Yamamoto
- Department of Radiology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Shinya Sato
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.,Molecular Pathology and Genetics Division, Kanagawa Cancer Center Research Institute, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Emi Yoshioka
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Masaki Suzuki
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.,Department of Pathology, University of Tokyo Institute, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kota Washimi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Kimito Osaka
- Department of Urology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Takahisa Suzuki
- Department of Urology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Takeshi Kishida
- Department of Urology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan
| | - Yohei Miyagi
- Department of Pathology, Kanagawa Cancer Center, 2-3-2, Nakao, Asahi-Ku, Yokohama, Kanagawa, 241-8515, Japan.,Department of Pathology, University of Tokyo Institute, 7-3-1 Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| |
Collapse
|
7
|
Grajales D, Kadoury S, Shams R, Barkati M, Delouya G, Béliveau-Nadeau D, Nicolas B, Le WT, Benhacene-Boudam MK, Juneau D, DaSilva JN, Carrier JF, Hautvast G, Ménard C. Performance of an integrated multimodality image guidance and dose-planning system supporting tumor-targeted HDR brachytherapy for prostate cancer. Radiother Oncol 2021; 166:154-161. [PMID: 34861267 DOI: 10.1016/j.radonc.2021.11.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 11/19/2021] [Accepted: 11/22/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND AND PURPOSE Advances in high-dose-rate brachytherapy to treat prostate cancer hinge on improved accuracy in navigation and targeting while optimizing a streamlined workflow. Multimodal image registration and electromagnetic (EM) tracking are two technologies integrated into a prototype system in the early phase of clinical evaluation. We aim to report on the system's accuracy and workflow performance in support of tumor-targeted procedures. MATERIALS AND METHODS In a prospective study, we evaluated the system in 43 consecutive procedures after clinical deployment. We measured workflow efficiency and EM catheter reconstruction accuracy. We also evaluated the system's MRI-TRUS registration accuracy with/without deformation, and with/without y-axis rotation for urethral alignment at initialization. RESULTS The cohort included 32 focal brachytherapy and 11 integrated boost whole-gland implants. Mean procedure time excluding dose delivery was 38 min (range: 21-83) for focal, and 56 min (range: 38-89) for whole-gland implants; stable over time. EM catheter reconstructions achieved a mean difference between computed and measured free-length of 0.8 mm (SD 0.8, no corrections performed), and mean axial manual corrections 1.3 mm (SD 0.7). EM also enabled the clinical use of a non or partially visible catheter in 21% of procedures. Registration accuracy improved with y-axis rotation for urethral alignment at initialization and with the elastic registration (mTRE 3.42 mm, SD 1.49). CONCLUSION The system supported tumor-targeting and was implemented with no demonstrable learning curve. EM reconstruction errors were small, correctable, and improved with calibration and control of external distortion sources; increasing confidence in the use of partially visible catheters. Image registration errors remained despite rotational alignment and deformation, and should be carefully considered.
Collapse
Affiliation(s)
- David Grajales
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | - Samuel Kadoury
- Polytechnique Montréal, Canada; Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | - Maroie Barkati
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Guila Delouya
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Benedicte Nicolas
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada
| | | | | | - Daniel Juneau
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean N DaSilva
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | - Jean-Francois Carrier
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada
| | | | - Cynthia Ménard
- Centre de Recherche du Centre Hospitalier de l'Université de Montréal, Canada; Université de Montréal, Canada.
| |
Collapse
|
8
|
Liu W, Chen B, Zheng H, Xing Y, Chen G, Zhou P, Qian L, Min Y. Advances of Nanomedicine in Radiotherapy. Pharmaceutics 2021; 13:pharmaceutics13111757. [PMID: 34834172 PMCID: PMC8622383 DOI: 10.3390/pharmaceutics13111757] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 09/28/2021] [Accepted: 10/08/2021] [Indexed: 12/14/2022] Open
Abstract
Radiotherapy (RT) remains one of the current main treatment strategies for many types of cancer. However, how to improve RT efficiency while reducing its side effects is still a large challenge to be overcome. Advancements in nanomedicine have provided many effective approaches for radiosensitization. Metal nanoparticles (NPs) such as platinum-based or hafnium-based NPs are proved to be ideal radiosensitizers because of their unique physicochemical properties and high X-ray absorption efficiency. With nanoparticles, such as liposomes, bovine serum albumin, and polymers, the radiosensitizing drugs can be promoted to reach the tumor sites, thereby enhancing anti-tumor responses. Nowadays, the combination of some NPs and RT have been applied to clinical treatment for many types of cancer, including breast cancer. Here, as well as reviewing recent studies on radiotherapy combined with inorganic, organic, and biomimetic nanomaterials for oncology, we analyzed the underlying mechanisms of NPs radiosensitization, which may contribute to exploring new directions for the clinical translation of nanoparticle-based radiosensitizers.
Collapse
Affiliation(s)
- Wei Liu
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (W.L.); (P.Z.)
| | - Bo Chen
- Department of Bio-X Interdisciplinary Science at Hefei National Laboratory (HFNL) for Physical Science at the Microscale, University of Science and Technology of China, Hefei 230026, China; (B.C.); (Y.M.)
| | - Haocheng Zheng
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; (H.Z.); (Y.X.); (G.C.)
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, Hefei 230026, China
| | - Yun Xing
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; (H.Z.); (Y.X.); (G.C.)
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, Hefei 230026, China
| | - Guiyuan Chen
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; (H.Z.); (Y.X.); (G.C.)
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, Hefei 230026, China
| | - Peijie Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (W.L.); (P.Z.)
| | - Liting Qian
- Department of Radiation Oncology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; (W.L.); (P.Z.)
- Correspondence:
| | - Yuanzeng Min
- Department of Bio-X Interdisciplinary Science at Hefei National Laboratory (HFNL) for Physical Science at the Microscale, University of Science and Technology of China, Hefei 230026, China; (B.C.); (Y.M.)
- Department of Endocrinology, The First Affiliated Hospital of USTC, Anhui Provincial Hospital, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230026, China; (H.Z.); (Y.X.); (G.C.)
- CAS Key Lab of Soft Matter Chemistry, University of Science and Technology of China, Hefei 230026, China
- School of Chemistry and Materials Science, University of Science and Technology of China, Hefei 230026, China
| |
Collapse
|
9
|
Aoun F, Mjaess G, Abi Tayeh G, Sarkis J, Lilly E, Khalil N, Chebel R, Albisinni S, Roumeguère T, Peltier A. Focal therapy for prostate cancer: Making the punishment fit the crime. Prog Urol 2021; 31:1080-1089. [PMID: 34538741 DOI: 10.1016/j.purol.2021.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 07/19/2021] [Accepted: 08/07/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Focal therapy is recently gaining popularity as an intermediate option between active surveillance and whole-gland treatment for localized prostate cancer. OBJECTIVE This comprehensive review aims to present the different focal therapy technologies available to date while tackling the rationale for focal treatment, its indications, principles and outcomes of each technique. EVIDENCE ACQUISITION A comprehensive review of the PubMed, Embase, and Web of Science was done. Keywords used for research were: "prostate cancer"; "focal therapy"; "focal treatment"; "High-Intensity Focal Ultrasound"; "cryotherapy"; "photodynamic therapy"; "focal laser ablation"; "irreversible electroporation"; "focal brachytherapy" and "gold nanoparticle directed therapy". Accepted languages were English and French. EVIDENCE SYNTHESIS Choosing the best candidate for focal therapy is crucial (localized small to medium sized Gleason≤7 lesions). Focal high-intensity focal ultrasound has shown excellent survival rates at 5 years, while maintaining good functional outcomes (urinary continence and erectile function). Focal cryotherapy, one of the oldest focal treatments for prostate cancer, has shown good oncologic outcomes, with good continence rates and fair erectile function rates. Focal laser ablation seems a safe and feasible technique, with promising results. Irreversible electroporation has demonstrated good survival outcomes with no biochemical recurrence or disease relapse in the preliminary studies. Focal brachytherapy has a good toxicity profile, a good biochemical outcome, and gives a sustained quality of life. Finally, gold nanoparticle directed therapy is safe and is being studied in current trials. CONCLUSION While proven to be safe in terms of continence and sexual aspects, the challenge remains to better assess oncological outcomes of these techniques in randomized longer follow-up studies.
Collapse
Affiliation(s)
- F Aoun
- Urology department, Jules-Bordet Institute, Brussels, Belgium; Urology department, Hotel-Dieu de France, Beirut, Lebanon.
| | - G Mjaess
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - G Abi Tayeh
- Urology department, Hotel-Dieu de France, Beirut, Lebanon
| | - J Sarkis
- Urology department, Hotel-Dieu de France, Beirut, Lebanon
| | - E Lilly
- Urology department, Hotel-Dieu de France, Beirut, Lebanon
| | - N Khalil
- Urology department, Hotel-Dieu de France, Beirut, Lebanon
| | - R Chebel
- Urology department, Hotel-Dieu de France, Beirut, Lebanon
| | - S Albisinni
- Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - T Roumeguère
- Urology department, Jules-Bordet Institute, Brussels, Belgium; Urology Department, University Clinics of Brussels, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - A Peltier
- Urology department, Jules-Bordet Institute, Brussels, Belgium
| |
Collapse
|
10
|
Martell K, Kollmeier MA. Complications and side effects of high-dose-rate prostate brachytherapy. Brachytherapy 2021; 20:966-975. [PMID: 33612395 DOI: 10.1016/j.brachy.2020.10.007] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/23/2020] [Accepted: 10/23/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE To describe technical challenges and complications encountered during and after high-dose-rate prostate brachytherapy (HDR-BT) and review management of these complications. METHODS AND MATERIALS The authors performed a systematic review of the literature on toxicities encountered after prostate HDR-BT +/- external beam radiotherapy. A total of 397 studies were identified, of which 64 were included. A focused review of literature regarding the management of acute and late toxicities also performed. RESULTS Most acute toxicities include grade 0-2 genitourinary and gastrointestinal toxicity. Overall, Grade 3+ Common Terminology Criteria for Adverse Events toxicity after HDR-BT was low [genitourinary: 0-1%; gastrointestinal 0-3%]. Rates of fistula formation were <1%, and radiation cystitis/proctitis were <14% and more commonly reported in cohorts treated with HDR-BT boost and external beam radiotherapy. CONCLUSIONS HDR-BT both as monotherapy or combined with external beam radiotherapy for prostate cancer is well tolerated. Serious complications are rare.
Collapse
Affiliation(s)
- Kevin Martell
- Department of Oncology, University of Calgary, Calgary, Alberta, Canada.
| | - Marisa A Kollmeier
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY
| |
Collapse
|
11
|
Delpino GP, Borges R, Zambanini T, Joca JFS, Gaubeur I, de Souza ACS, Marchi J. Sol-gel-derived 58S bioactive glass containing holmium aiming brachytherapy applications: A dissolution, bioactivity, and cytotoxicity study. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2020; 119:111595. [PMID: 33321639 DOI: 10.1016/j.msec.2020.111595] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Revised: 09/28/2020] [Accepted: 09/29/2020] [Indexed: 01/06/2023]
Abstract
Bioactive glasses containing rare earth elements have been proposed as promising candidates for applications in brachytherapy of bone cancer. However, their safety relies on a proper dissolution to avoid radioactive materials in the human body, and desirable bioactive properties to regenerate the bone defect caused by the tumor. In this work, we proposed a new series of sol-gel-derived bioactive glasses containing holmium oxide, based on the system (100-x)(58SiO2-33CaO-9P2O5)-xHo2O3 (x = 1.25, 2.5 and 5 wt%). The glasses were characterized regarding their dissolution behavior, bioactivity, and cytotoxicity with pre-osteoblastic cells. Also, in the dissolution experiments, the Arrhenius and Eyring equations were used to obtain some thermodynamic properties of glass dissolution. The results evidenced that the addition of holmium ions in the glass structure decreased the energy barrier of hydrolysis reactions, which favors glass dissolution in an early-stage. However, in the long-term, the strength of Si-O-Ho bonds may be the cause of more stable dissolution. Besides, glasses containing holmium were as bioactive as the 58S bioactive glasses, a highly bioactive composition. Cytotoxicity results showed that all glasses were not cytotoxic, and the composition containing 5 wt.% of Ho2O3 enhanced cell viability. Finally, these results suggest that these glasses are suitable materials for brachytherapy applications due to their proper dissolution behavior, high bioactivity, and high cell viability.
Collapse
Affiliation(s)
| | - Roger Borges
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, SP, Brazil
| | - Telma Zambanini
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, SP, Brazil
| | | | - Ivanise Gaubeur
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, SP, Brazil
| | | | - Juliana Marchi
- Centro de Ciências Naturais e Humanas, Universidade Federal do ABC, Santo André, SP, Brazil.
| |
Collapse
|
12
|
Sachpazidis I, Hense J, Mavroidis P, Gainey M, Baltas D. Investigating the role of constrained CVT and CVT in HIPO inverse planning for HDR brachytherapy of prostate cancer. Med Phys 2019; 46:2955-2968. [PMID: 31055834 DOI: 10.1002/mp.13564] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2018] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 12/15/2022] Open
Abstract
PURPOSE The purpose of this study is to investigate the role of the centroidal Voronoi tessellation (CVT) and constrained CVT (CCVT) in inverse planning in combination with the Hybrid Inverse Planning Optimization (HIPO) algorithm in HDR brachytherapy of prostate cancer. HIPO implemented in Oncentra© Prostate treatment planning system, is used for three-dimensional (3D)-ultrasound-based intraoperative treatment planning in high dose rate brachytherapy. HIPO utilizes a hybrid iterative process to determine the most appropriate placement of a given number of catheters to fulfil predefined dose-volume constraints. The main goals of the current investigation were to identify a way of improving the performance of HIPO inverse planning; accelerating the HIPO, and to evaluate the effect of the two CVT-based initialization methods on the dose distribution in the sub-region of prostate that is not accessible by catheters, when trying to avoid perforation of urethra. METHODS We implemented the CVT algorithm to generate initial catheter configurations before the initialization of the HIPO algorithm. We introduced the CCVT algorithm to improve the dose distribution to the sub-volume of prostate within the bounding box of the urethra contours including its upper vertical extension (U-P). For the evaluation, we considered a total of 15 3D ultrasound-based HDRBT prostate implants. Execution time and treatment plan quality were evaluated based on the dose-volume histograms of prostate (PTV), its sub-volume U-P, and organs at risk (OARs). Furthermore, the conformity index COIN, the homogeneity index HI and the complication-free tumor control probability (P+ ) were used for our treatment plan comparisons. Finally, the plans with the recommended HIPO execution mode were compared to the clinically used intraoperative pre-plans. RESULTS The plan quality achieved with CCVT-based HIPO initialization was superior to the default HIPO initialization method. Focusing on the U-P sub-region of the prostate, the CCVT method resulted in a significant improvement of all dosimetric indices compared to the default HIPO, when both were executed in the adaptive mode. For that recommended HIPO execution mode, and for U-P, CCVT demonstrated in general higher dosimetric indices than CVT. Additionally, the execution time of CCVT initialized HIPO was lower compared to both alternative initialization methods. This is also valid for the values of the aggregate objective function with the differences to the default initialization method being highly significant. Paired non-parametric statistical tests (Wilcoxon signed-rank) showed a significant improvement of dose-volume indices, COIN and P+ for the plans generated by the CCVT-based catheter configuration initialization in HIPO compared to the default HIPO initialization process. Furthermore, in ten out of 15 cases, the CCVT-based HIPO plans fulfilled all the clinical dose-volume constraints in a single trial without any need for further catheter position adaption. CONCLUSION HIPO with CCVT-based initialization demonstrates better performance regarding the aggregate objective function and convergence when compared to the CVT-based and default catheter configuration initialization methods. This improved performance of HIPO inverse planning is clearly not at the cost of the dosimetric and radiobiologically evaluated plan quality. We recommend the use of the CCVT method for HIPO initialization especially in the adaptive planning mode.
Collapse
Affiliation(s)
- Ilias Sachpazidis
- Division of Medical Physics, Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Jürgen Hense
- Division of Medical Physics, Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC, USA
| | - Mark Gainey
- Division of Medical Physics, Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| | - Dimos Baltas
- Division of Medical Physics, Department of Radiation Oncology, Faculty of Medicine, University of Freiburg, Germany.,German Cancer Consortium (DKTK), Partner Site Freiburg, German Cancer Research Center, Heidelberg, Germany
| |
Collapse
|
13
|
Dahn HM, Oliver PA, Allen S, Cherpak A, Syme A, Patil N, Bowes D. Individualized Dose-Escalation of HDR Prostate Brachytherapy Implant to Decrease Required External Beam Radiation Dose: A Retrospective Feasibility Study. Adv Radiat Oncol 2019; 4:641-648. [PMID: 31673657 PMCID: PMC6817543 DOI: 10.1016/j.adro.2019.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2019] [Revised: 04/17/2019] [Accepted: 05/08/2019] [Indexed: 11/18/2022] Open
Abstract
Purpose High-dose-rate brachytherapy (HDR-BT) is commonly combined with external beam radiation therapy (EBRT) for the treatment of localized prostate cancer. Escalating the HDR-BT dose as far as organ-at-risk (OAR) constraints allow, on a personalized basis, would allow for a reduction in EBRT dose while achieving similar total biologic equivalence. The primary objective of this study was to determine the dosimetric feasibility of escalating the HDR-BT dose from 15 Gy to 16 or 17 Gy while continuing to meet OAR constraints from the original 15 Gy plan on an individualized basis. Methods and materials A total of 53 consecutive HDR-BT plans were retrospectively assessed to determine what percentage of plans could be reoptimized to deliver a dose of 16 Gy or 17 Gy, while meeting defined 15-Gy OAR constraints. Factors independently associated with dose escalation were examined. Results Thirty-nine plans (74%) and 2 plans (4%) were successfully escalated to a dose of 16 Gy and 17 Gy, respectively. Rectum V80 and urethra Dmax were independently predictive of the ability to dose escalate to 16 Gy. Conclusions Individualized HDR-BT dose escalation beyond 15 Gy without compromising OAR constraints is dosimetrically feasible. This approach could allow for a corresponding reduction of EBRT fractions (ie, from 15 to 12 fractions) and would be beneficial in terms of resource savings for departments, convenience for patients, and potentially better tolerance of treatment with the expected reduction in biologically equivalent doses to OARs. A clinical trial is being developed to investigate the efficacy and tolerance of personalized HDR-BT/EBRT dose fractionation for localized intracapsular prostate cancer.
Collapse
Affiliation(s)
- Hannah M. Dahn
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
- Corresponding author. Department of Radiation Oncology, Dalhousie University, Room 2200, Main Floor, NSCC, 5820 University Ave, Halifax, B3H 1V7, Canada.
| | | | - Stefan Allen
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - Amanda Cherpak
- Department of Medical Physics, Dalhousie University, Halifax, NS, Canada
| | - Alasdair Syme
- Department of Medical Physics, Dalhousie University, Halifax, NS, Canada
| | - Nikhilesh Patil
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| | - David Bowes
- Department of Radiation Oncology, Dalhousie University, Halifax, NS, Canada
| |
Collapse
|
14
|
Chao M, Bolton D, Lim Joon D, Chan Y, Lawrentschuk N, Ho H, Spencer S, Wasiak J, Guerrieri M, Ow D, Troy A, Pham T, Sengupta S, Tan A, McMillan K, Koufogiannis G, Foroudi F, Ng M, Khoo V. High dose rate brachytherapy boost for prostate cancer: Biochemical control and the impact of transurethral resection of the prostate and hydrogel spacer insertion on toxicity outcomes. J Med Imaging Radiat Oncol 2019; 63:415-421. [DOI: 10.1111/1754-9485.12882] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2018] [Accepted: 03/05/2019] [Indexed: 12/27/2022]
Affiliation(s)
- Michael Chao
- The Austin Hospital Heidelberg Australia
- Ringwood Private Hospital Melbourne Victoria Australia
- University of Melbourne Melbourne Victoria Australia
| | - Damien Bolton
- The Austin Hospital Heidelberg Australia
- Ringwood Private Hospital Melbourne Victoria Australia
- University of Melbourne Melbourne Victoria Australia
| | | | - Yee Chan
- The Austin Hospital Heidelberg Australia
- Ringwood Private Hospital Melbourne Victoria Australia
| | - Nathan Lawrentschuk
- The Austin Hospital Heidelberg Australia
- University of Melbourne Melbourne Victoria Australia
| | - Huong Ho
- Genesis Cancer Care Victoria Ringwood Australia
| | | | - Jason Wasiak
- The Austin Hospital Heidelberg Australia
- University of Melbourne Melbourne Victoria Australia
| | | | - Darren Ow
- The Austin Hospital Heidelberg Australia
| | - Andrew Troy
- The Austin Hospital Heidelberg Australia
- Ringwood Private Hospital Melbourne Victoria Australia
| | - Trung Pham
- The Valley Private Hospital Melbourne Victoria Australia
| | | | - Alwin Tan
- The Bays Hospital Mornington Victoria Australia
| | - Kevin McMillan
- Ringwood Private Hospital Melbourne Victoria Australia
- The Box Hill Hospital Melbourne Victoria Australia
| | | | - Farshad Foroudi
- The Austin Hospital Heidelberg Australia
- University of Melbourne Melbourne Victoria Australia
| | - Michael Ng
- Ringwood Private Hospital Melbourne Victoria Australia
| | - Vincent Khoo
- The Austin Hospital Heidelberg Australia
- University of Melbourne Melbourne Victoria Australia
- Monash University Melbourne Victoria Australia
- Royal Marsden Hospital London UK
| |
Collapse
|
15
|
A method for obtaining three-dimensional measurements of HDR brachytherapy dose distributions using Fricke gel dosimeters and optical computed tomography. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2018; 42:221-226. [DOI: 10.1007/s13246-018-0715-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 11/16/2018] [Indexed: 10/27/2022]
|