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Karius A, Kreppner S, Strnad V, Schweizer C, Lotter M, Fietkau R, Bert C. Inter-observer effects in needle reconstruction for temporary prostate brachytherapy: Dosimetric implications and adaptive CBCT-TRUS registration solutions. Brachytherapy 2024; 23:421-432. [PMID: 38845268 DOI: 10.1016/j.brachy.2024.05.002] [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: 12/12/2023] [Revised: 05/08/2024] [Accepted: 05/08/2024] [Indexed: 07/19/2024]
Abstract
PURPOSE To investigate geometric and dosimetric inter-observer variability in needle reconstruction for temporary prostate brachytherapy. To assess the potential of registrations between transrectal ultrasound (TRUS) and cone-beam computed tomography (CBCT) to support implant reconstructions. METHODS AND MATERIALS The needles implanted in 28 patients were reconstructed on TRUS by three physicists. Corresponding geometric deviations and associated dosimetric variations to prostate and organs at risk (urethra, bladder, rectum) were analyzed. To account for the found inter-observer variability, various approaches (template-based, probe-based, marker-based) for registrations of CBCT to TRUS were investigated regarding the respective needle transfer accuracy in a phantom study. Three patient cases were examined to assess registration accuracy in-vivo. RESULTS Geometric inter-observer deviations >1 mm and >3 mm were found for 34.9% and 3.5% of all needles, respectively. Prostate dose coverage (changes up to 7.2%) and urethra dose (partly exceeding given dose constraints) were most affected by associated dosimetric changes. Marker-based and probe-based registrations resulted in the phantom study in high mean needle transfer accuracies of 0.73 mm and 0.12 mm, respectively. In the patient cases, the marker-based approach was the superior technique for CBCT-TRUS fusions. CONCLUSION Inter-observer variability in needle reconstruction can substantially affect dosimetry for individual patients. Especially marker-based CBCT-TRUS registrations can help to ensure accurate reconstructions for improved treatment planning.
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Affiliation(s)
- Andre Karius
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany.
| | - Stephan Kreppner
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Vratislav Strnad
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Claudia Schweizer
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Michael Lotter
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Rainer Fietkau
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
| | - Christoph Bert
- Department of Radiation Oncology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany; Comprehensive Cancer Center Erlangen-EMN (CCC ER-EMN), Erlangen, Germany
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Thomas H, Chen JJ, Abdul-Baki H, Sabbagh A, Shaheen H, Chau OW, Malik N, Ayoub A, Hassanzadeh C, Hsu IC, Mohamad O. Safety of high-dose rate (HDR) brachytherapy for patients with prostate cancer and history of prior chemoradiation for rectal cancer: A case series. Brachytherapy 2024; 23:173-178. [PMID: 38160102 DOI: 10.1016/j.brachy.2023.11.001] [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: 08/30/2023] [Revised: 11/06/2023] [Accepted: 11/12/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE A history of prior pelvic radiation therapy (RT) for rectal cancer is a relative contraindication for definitive RT for prostate cancer. High-dose-rate (HDR) brachytherapy can significantly limit the dose to surrounding tissues compared to external beam RT. However, there is limited data surrounding its safety in patients with prior pelvic RT. METHODS AND MATERIALS A retrospective chart review was performed at the University of California, San Francisco to identify patients diagnosed with prostate cancer with a history of pelvic RT for rectal cancer who were treated with high-dose-rate brachytherapy (HDR-BT) between 2006 and 2022. Inclusion criteria were biopsy-confirmed prostate cancer with no evidence of distant disease on clinical examination or imaging, and at least one post-treatment clinic appointment. RESULTS Seven patients were treated with salvage HDR-BT at a median interval of 17.7 years after RT for rectal cancer. HDR-BT doses included 3600 cGy in six fractions (n = 5), 2700 cGy in 2 fractions (n=1), or 2800 cGy in four fractions (n = 1). There was no acute grade ≥2 gastrointestinal toxicity, and 1 patient developed late grade 2 rectal bleeding. Two patients developed acute grade 2 genitourinary toxicity consisting of urinary frequency and urgency, which persisted through long-term follow up. At a median follow up of 29.5 months after HDR brachytherapy, one patient developed regional and distant failure, and another had seminal vesicle recurrence. CONCLUSIONS HDR-BT is a safe treatment for patients with prostate cancer who previously received RT for rectal cancer. Further studies are needed to better characterize the long-term toxicity of HDR-RT in this population.
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Affiliation(s)
- Horatio Thomas
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Jie Jane Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Hasan Abdul-Baki
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Ali Sabbagh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Haitham Shaheen
- Department of Clinical Oncology, Faculty of Medicine, Suez Canal University, Egypt
| | - Oi Wai Chau
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Nauman Malik
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alan Ayoub
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Comron Hassanzadeh
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA; Department of Urology, University of California San Francisco, San Francisco, CA.
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Thomas H, Chen JJ, Shaheen H, Sabbagh A, Abdul-Baki H, Chau OW, Malik N, Ayoub A, Hassanzadeh C, Hsu IC, Mohamad O. Safety of high-dose-rate brachytherapy in patients with prostate cancer and inflammatory bowel disease: A case series. J Contemp Brachytherapy 2024; 16:1-5. [PMID: 38584887 PMCID: PMC10993899 DOI: 10.5114/jcb.2024.135645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 01/08/2024] [Indexed: 04/09/2024] Open
Abstract
Introduction Inflammatory bowel disease (IBD) is a relative contraindication to external beam radiation therapy (EBRT) for prostate cancer patients due to fear of increased risk of gastrointestinal (GI) toxicity. High-dose-rate (HDR) brachytherapy, capable of minimizing radiation dose to surrounding tissues, is a feasible alternative. Given limited data, this study examined the safety profile of HDR brachytherapy in this setting. Material and methods We conducted a retrospective review of patients with localized prostate cancer and IBD treated with HDR brachytherapy at the University of California San Francisco (UCSF), between 2010 and 2022. Eligibility criteria included biopsy-proven prostate cancer, no distant metastases, absence of prior pelvic radiotherapy, IBD diagnosis, and at least one follow-up visit post-treatment. Results Eleven patients were included, with a median follow-up of 28.7 months. The median dose administered was 2700 cGy (range, 1500-3150 cGy) over 2 fractions (range, 1-3 fractions). Two patients also received EBRT. Rectal spacers (SpaceOAR) were applied in seven patients. All patients experienced acute genitourinary (GU) toxicity, ten of which were grade 1 and one was grade 2. Eight patients experienced late grade 1 GU toxicity, and three patients had late grade 2 GU toxicity. GI toxicities were similarly low-grade, with six grade 1 acute toxicity, no grade 2 or higher acute toxicity, six grade 1 late toxicity, and one late grade 2 GI toxicity. No grade 3 or higher acute or late GI or GU toxicities were reported. Conclusions HDR brachytherapy appears to be a safe and tolerable treatment modality for patients with prostate cancer and IBD, with minimal acute and late GI and GU toxicity. These findings warrant multi-institutional validation due to small sample size.
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Affiliation(s)
- Horatio Thomas
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Jie Jane Chen
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Haitham Shaheen
- Department of Clinical Oncology, Faculty of Medicine, Suez Canal University, Egypt
| | - Ali Sabbagh
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Hasan Abdul-Baki
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Oi Wai Chau
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Nauman Malik
- Department of Radiation Oncology, University of Toronto, Toronto, Canada
| | - Alan Ayoub
- University of Zagreb School of Medicine, Zagreb, Croatia
| | - Comron Hassanzadeh
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, USA
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
| | - Osama Mohamad
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA, USA
- Department of Urology, University of California San Francisco, San Francisco, CA, USA
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Lavallee MC, Cantin A, Aubin S, Lefebvre M, Marrier AS, Bouchard I, Fiset C, Villeneuve-Gauthier A, Foster W, Martin AG, Carignan D, Beaulieu L, Vigneault E. US-guided EM tracked system for HDR brachytherapy: A first in-men randomized study for whole prostate treatment. Brachytherapy 2024; 23:64-72. [PMID: 37806788 DOI: 10.1016/j.brachy.2023.08.003] [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: 04/03/2023] [Revised: 07/10/2023] [Accepted: 08/09/2023] [Indexed: 10/10/2023]
Abstract
PURPOSE An electromagnetic tracking device (EMT) has been integrated in an HDR 3D ultrasound guidance system for prostate HDR. The aim of this study was to compare the efficiency of HDR workflows with and without EM tracking. METHODS AND MATERIALS A total of 58 patients with a 15 Gy HDR prostate boost were randomized in two arms and two operation room (OR) procedures using: (1) the EMT investigational device, and (2) the Oncentra prostate system (OCP). OR times were compared for both techniques. RESULTS The overall procedure median time was about 20% shorter for EMT (63 min) compared to OCP (79 min). The US acquisition and contouring was longer for OCP compared to EMT (23 min vs. 16 min). The catheter reconstruction's median times were 23 min and 13 min for OCP and EMT respectively. For the automatic reconstruction with EMT, 62% of cases required no or few manual corrections. Using the EM technology in an OR environment was challenging. In some cases, interferences or the stiffness of the stylet introduced errors in the reconstruction of catheters. The last step was the dosimetry with median times of 11 min (OCP) and 15.5 min (EMT). Finally, it was observed that there was no learning curve associated with the introduction of this new technology. CONCLUSIONS The EMT device offers an efficient solution for automatic catheter reconstruction for HDR prostate while reducing the possibility of mis-reconstructed catheters caused by issues of visualization in the US images. Because of that, the overall OR times was shorter when using the EMT system.
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Affiliation(s)
- Marie-Claude Lavallee
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada; Département de physique, de génie physique et d'optique, Université Laval, Québec, Canada
| | - Audrey Cantin
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada
| | - Sylviane Aubin
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada
| | - Martine Lefebvre
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada
| | | | | | - Cedric Fiset
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada
| | | | - William Foster
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada
| | - Andre-Guy Martin
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada; CRCHU de Québec and Centre de recherche sur le cancer de l'Université Laval, Québec, Canada
| | - Damien Carignan
- CRCHU de Québec and Centre de recherche sur le cancer de l'Université Laval, Québec, Canada
| | - Luc Beaulieu
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada; CRCHU de Québec and Centre de recherche sur le cancer de l'Université Laval, Québec, Canada; Département de physique, de génie physique et d'optique, Université Laval, Québec, Canada
| | - Eric Vigneault
- CHU de Québe - Université Laval, Radiation Oncology, Québec, Canada; CRCHU de Québec and Centre de recherche sur le cancer de l'Université Laval, Québec, Canada.
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Houlihan OA, Workman G, Hounsell AR, Prise KM, Jain S. In vivo dosimetry in pelvic brachytherapy. Br J Radiol 2022; 95:20220046. [PMID: 35635803 PMCID: PMC10996950 DOI: 10.1259/bjr.20220046] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 11/05/2022] Open
Abstract
ADVANCES IN KNOWLEDGE This paper describes the potential role for in vivo dosimetry in the reduction of uncertainties in pelvic brachytherapy, the pertinent factors for consideration in clinical practice, and the future potential for in vivo dosimetry in the personalisation of brachytherapy.
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Affiliation(s)
- Orla Anne Houlihan
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Geraldine Workman
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Alan R Hounsell
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
- Radiotherapy Physics, Northern Ireland Cancer Centre, Belfast
Health and Social Care Trust,
Belfast, UK
| | - Kevin M Prise
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
| | - Suneil Jain
- Department of Clinical Oncology, Northern Ireland Cancer
Centre, Belfast Health and Social Care Trust,
Belfast, UK
- Patrick G. Johnston Centre for Cancer Research, Queen's
University Belfast, Belfast,
UK
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Unresectable bulky chest wall recurrent breast cancer controlled with CT-guided interstitial high-dose-rate brachytherapy and external beam radiotherapy with adjuvant hormonal therapy - case report. J Contemp Brachytherapy 2021; 13:451-457. [PMID: 34484361 PMCID: PMC8407259 DOI: 10.5114/jcb.2021.108600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/30/2021] [Indexed: 11/19/2022] Open
Abstract
Purpose Bulky chest wall recurrence after mastectomy presents a therapeutic challenge because of high-dose of radiation required to control the disease, and its proximity to low-tolerance organs at risk. We report a case of successful computed tomography (CT)-guided high-dose-rate (HDR) salvage interstitial brachytherapy (ISBT) boost. Material and methods A 70-year-old female initially presented with a tumor in right breast, and was treated with mastectomy and adjuvant chemotherapy, followed by hormonal therapy for 5 years without adjuvant radiotherapy. In 2018, 20 years after the initial treatment, she developed unresectable chest wall recurrence that measured 10.5 cm × 7.3 cm × 4.5 cm, with bone and parietal pleura invasion. Biopsy revealed invasive pleomorphic lobular carcinoma [estrogen receptor (ER)-positive, progesterone receptor (PR)-negative, HER2-negative]. There was no evidence of metastatic disease. Results The patient underwent external beam radiotherapy (EBRT) plus ISBT. After EBRT of 50 Gy in 25 fractions was completed, CT-guided ISBT was performed as an outpatient treatment. HDR dose was 16 Gy delivered in 2 fractions with 2 implants. Dose was prescribed to gross tumor volume. ISBT plans were created using inverse planning simulated annealing (IPSA) algorithm. Gross tumor volume D90% plus EBRT dose was 82 Gy equivalent dose of 2 Gy (EQD2), assuming α/β of 4 for breast carcinoma. The patient continued on hormonal therapy. At the 30-month follow-up, the patient remains in remission. The tumor could not be detected by magnetic resonance imaging (MRI) or positron emission tomography (PET). There were no severe treatment-related complications. Conclusions CT-guided HDR ISBT boost can be a useful modality in individualizing treatment strategies for breast cancer patients with unresectable bulky chest wall recurrence.
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Lavallée MC, Cantin A, Monéger F, Lefebvre M, Foster W, Vigneault E, Beaulieu L. Commissioning of an intra-operative US guided prostate HDR system integrating an EM tracking technology. Brachytherapy 2021; 20:1296-1304. [PMID: 34272132 DOI: 10.1016/j.brachy.2021.05.163] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 05/05/2021] [Accepted: 05/31/2021] [Indexed: 11/17/2022]
Abstract
PURPOSE Ultrasound-based planning for high-dose-rate prostate brachytherapy is commonly used in the clinic, mainly because it offers fast real-time image-guided capability at a relatively low cost. The main difficulty with US planning is the catheter reconstruction due to artefacts (from multiple catheters) and echogenicity. Electromagnetic tracking (EMT) system offers a fast and accurate solution for automatic reconstruction of catheters using the EMT technology. In this study, the commissioning and performance evaluation of the new real-time prostate high-dose-rate brachytherapy investigational system from Philips Disease Management Solutions integrating EMT was performed before its clinical integration. METHOD AND MATERIALS The Philips' clinical investigational system includes a treatment planning software (TPS) that was commissioned based on AAPM TG53 and TG56 recommendations for the use of TPS in brachytherapy. First, the CIRS - model 045A - QA phantom was used to evaluate the ultrasound (US) image quality and 3D image handling. Distances, volumes, and dimensions of the structures inside the phantom were measured and compared to the actual values. The calibration reproducibility and accuracy of the electromagnetic (EM) sensor used to track the US probe (rotation and translation) were performed using a specifically designed QA tool mounted on the probe and immersed in a salted water tank. This was performed for 3 different B&K 8848 US probes to evaluate the sensitivity of EM calibration to the probe geometric properties (manufacturing process). The new TPS performance was compared to that in OncentraBrachy (OcB) V4.5.5 (Elekta) using 30 clinical cases as part of a retrospective study. Following the system commissioning, clinical workflows were explored; tests were performed with the brachytherapy team on phantoms and finally implemented in the clinic. RESULTS US image quality evaluation showed a mean difference with actual dimensions (lengths, widths and distances) of 0.4 mm (±0.3 mm) and mean difference in volume sizes of 0.2 cc (±0.2 cc). Then, the calibration of the US-to-EM coordinate system was performed for 3 different probes. For each probe, 3 measurements were acquired for every position of the calibration tool and measurements were repeated 3 times for a total of 27 measurements per probe per plane. The error was slightly higher in transverse mode compared to sagittal mode with mean values of 0.6 ± 0.2 mm and 0.3 ± 0.1 mm respectively. 30 clinical cases were used to compare the new TPS performance to OcB (IPSA). Optimized plans obtained with both systems were all clinically acceptable, but the plans from the Philips system have slightly higher V150% values, V200% values and dose to organs at risk. In the case of organs at risk, plans could have been manually modified to reduce the dose. Philips' system had a larger number of active dwell positions and longer treatment times. CONCLUSIONS The first clinical version of Philips' system was proven to be stable, accurate and precise. The fully integrated EM tracking technology opens the way for automated catheter reconstruction and on-the-fly dynamical replanning.
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Affiliation(s)
| | | | - Fanny Monéger
- CRCHU de Quebec and Centre de recherche en Cancérologie Université Laval, Québec, Canada; Polytech Clermont-Ferrand, Département de génie physique, Aubière, France
| | | | | | - Eric Vigneault
- CHU de Québec, Radiation Oncology, Québec, Canada; CRCHU de Quebec and Centre de recherche en Cancérologie Université Laval, Québec, Canada
| | - Luc Beaulieu
- CHU de Québec, Radiation Oncology, Québec, Canada; CRCHU de Quebec and Centre de recherche en Cancérologie Université Laval, Québec, Canada; Département de physique, de génie physique et d'optique, Université Laval, Québec, Canada
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Toxicity and clinical outcomes of single-fraction high-dose-rate brachytherapy combined with external beam radiotherapy for high-/very high-risk prostate cancer: A dosimetric analysis of toxicity. Jpn J Radiol 2020; 38:1197-1208. [DOI: 10.1007/s11604-020-01023-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 07/21/2020] [Indexed: 01/24/2023]
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Rodgers JR, Bax J, Surry K, Velker V, Leung E, D'Souza D, Fenster A. Intraoperative 360-deg three-dimensional transvaginal ultrasound during needle insertions for high-dose-rate transperineal interstitial gynecologic brachytherapy of vaginal tumors. J Med Imaging (Bellingham) 2019; 6:025001. [PMID: 30989088 DOI: 10.1117/1.jmi.6.2.025001] [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: 11/21/2018] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
Brachytherapy, a type of radiotherapy, may be used to place radioactive sources into or in close proximity to tumors, providing a method for conformally escalating dose in the tumor and the local area surrounding the malignancy. High-dose-rate interstitial brachytherapy of vaginal tumors requires precise placement of multiple needles through holes in a plastic perineal template to deliver treatment while optimizing dose and avoiding overexposure of nearby organs at risk (OARs). Despite the importance of needle placement, image guidance for adaptive, intraoperative needle visualization, allowing misdirected needles to be identified and corrected during insertion, is not standard practice. We have developed a 360-deg three-dimensional (3-D) transvaginal ultrasound (TVUS) system using a conventional probe with a template-compatible custom sonolucent vaginal cylinder and propose its use for intraoperative needle guidance during interstitial gynecologic brachytherapy. We describe the 3-D TVUS mechanism and geometric validation, present mock phantom procedure results, and report on needle localization accuracy in patients. For the six patients imaged, landmark anatomical features and all needles were clearly visible. The implementation of 360-deg 3-D TVUS through a sonolucent vaginal cylinder provides a technique for visualizing needles and OARs intraoperatively during interstitial gynecologic brachytherapy, enabling implants to be assessed and providing the potential for image guidance.
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Affiliation(s)
- Jessica Robin Rodgers
- University of Western Ontario, School of Biomedical Engineering, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
| | - Jeffrey Bax
- University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
| | - Kathleen Surry
- London Health Sciences Centre, Department of Medical Physics, London Regional Cancer Program, London, Ontario, Canada
| | - Vikram Velker
- London Health Sciences Centre, Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Eric Leung
- Sunnybrook Health Sciences Centre, Department of Radiation Oncology, Odette Cancer Centre, Toronto, Ontario, Canada
| | - David D'Souza
- London Health Sciences Centre, Department of Radiation Oncology, London Regional Cancer Program, London, Ontario, Canada
| | - Aaron Fenster
- University of Western Ontario, School of Biomedical Engineering, London, Ontario, Canada.,University of Western Ontario, Robarts Research Institute, London, Ontario, Canada
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Phase I study of dose escalation to dominant intraprostatic lesions using high-dose-rate brachytherapy. J Contemp Brachytherapy 2018; 10:193-201. [PMID: 30038638 PMCID: PMC6052382 DOI: 10.5114/jcb.2018.76881] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 05/18/2018] [Indexed: 01/02/2023] Open
Abstract
Purpose Radiation dose escalation for prostate cancer improves biochemical control but is limited by toxicity. Magnetic resonance spectroscopic imaging (MRSI) can define dominant intraprostatic lesions (DIL). This phase I study evaluated dose escalation to MRSI-defined DIL using high-dose-rate (HDR) brachytherapy. Material and methods Enrollment was closed early due to low accrual. Ten patients with prostate cancer (T2a-3b, Gleason 6-9, PSA < 20) underwent pre-treatment MRSI, and eight patients had one to three DIL identified. The eight enrolled patients received external beam radiation therapy to 45 Gy and HDR brachytherapy boost to the prostate of 19 Gy in 2 fractions. MRSI images were registered to planning CT images and DIL dose-escalated up to 150% of prescription dose while maintaining normal tissue constraints. The primary endpoint was genitourinary (GU) toxicity. Results The median total DIL volume was 1.31 ml (range, 0.67-6.33 ml). Median DIL boost was 130% of prescription dose (range, 110-150%). Median urethra V120 was 0.15 ml (range, 0-0.4 ml) and median rectum V75 was 0.74 ml (range, 0.1-1.0 ml). Three patients had acute grade 2 GU toxicity, and two patients had late grade 2 GU toxicity. No patients had grade 2 or higher gastrointestinal toxicity, and no grade 3 or higher toxicities were noted. There were no biochemical failures with median follow-up of 4.9 years (range, 2-8.5 years). Conclusions Dose escalation to MRSI-defined DIL is feasible. Toxicity was low but incompletely assessed due to limited patients’ enrollment.
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Smith RL, Hanlon M, Panettieri V, Millar JL, Matheson B, Haworth A, Franich RD. An integrated system for clinical treatment verification of HDR prostate brachytherapy combining source tracking with pretreatment imaging. Brachytherapy 2018; 17:111-121. [DOI: 10.1016/j.brachy.2017.08.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 07/29/2017] [Accepted: 08/09/2017] [Indexed: 10/18/2022]
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13
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Needle migration and dosimetric impact in high-dose-rate brachytherapy for prostate cancer evaluated by repeated MRI. Brachytherapy 2018; 17:50-58. [DOI: 10.1016/j.brachy.2017.08.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2017] [Revised: 07/31/2017] [Accepted: 08/08/2017] [Indexed: 11/30/2022]
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Nicolae A, Murgic J, Kruljac I, Dubnitzky L, D'Alimonte L, Lu L, Cumal A, Law N, Morton G, Loblaw A, Chung HT, Ravi A. Dosimetric impact of inter-observer catheter reconstruction variability in ultrasound-based high-dose-rate prostate brachytherapy. Brachytherapy 2017; 17:306-312. [PMID: 29239812 DOI: 10.1016/j.brachy.2017.10.015] [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: 07/11/2017] [Revised: 10/17/2017] [Accepted: 10/18/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE To investigate the dosimetric impact of interobserver catheter reconstruction variability in transrectal ultrasound-guided prostate high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS Twenty consecutive patients with intermediate- or high-risk prostate cancer were treated with a single, 15-Gy HDR brachytherapy boost as part of this study. The treated plan was used as the study reference plan (PR). Three expert treatment planners (observers) manually reconstructed the catheter paths on the static three-dimensional transrectal ultrasound images, and new plans were generated from the updated positions (POBS); subsequently, the dwell time and positions from the POBS plans were superimposed on the PR catheter paths to evaluate the dosimetric effect of the interobserver variations (PEVAL). Plans from each group were stratified by observer and by number of catheters (12 or 16) and then compared using a one-way Kruskal-Wallis H test with post hoc Mann-Whitney U tests reserved for significant variations (α = 0.05). RESULTS Greater than 98.9% of catheter reconstruction variations were <3 mm. When stratified by observer, there was a significant decrease (p << 0.05) in planning target volume (PTV) V100% and increases in the urethral Dmax between the POBS plans propagated to the PR catheter paths and dosimetry evaluated and PR plans only. Stratification of plans by catheter number showed nonclinically significant decreases in PTV V100%, and D90% and increases in urethral Dmax for the 12-catheter plans. CONCLUSIONS Limiting interobserver variability, and its effects on prostate HDR brachytherapy plan quality, is critical to achieving good dosimetric outcomes; small variations in catheter reconstruction may translate to inadequate PTV coverage, excessive urethral dose, or both.
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Affiliation(s)
- Alexandru Nicolae
- Department of Medical Physics, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Jure Murgic
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Ivan Kruljac
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Lior Dubnitzky
- Department of Physics, Ryerson University, Toronto, ON, Canada
| | - Laura D'Alimonte
- Department of Radiation Therapy, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Lin Lu
- Department of Radiation Therapy, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Aaron Cumal
- Department of Radiation Therapy, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Niki Law
- Department of Radiation Therapy, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Gerard Morton
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Andrew Loblaw
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada
| | - Hans T Chung
- Department of Radiation Oncology, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada.
| | - Ananth Ravi
- Department of Medical Physics, Sunnybrook Odette Cancer Center, University of Toronto, Toronto, ON, Canada.
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Ng IWS, Tey JCS, Soon YY, Tseng MSF, Chen D, Lim KHC. Outcomes of Asian patients with localized prostate cancer treated with combined intensity modulated radiation therapy (IMRT) and high dose rate (HDR) brachytherapy: A single institution experience. Asia Pac J Clin Oncol 2017; 14:e386-e391. [DOI: 10.1111/ajco.12819] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2017] [Accepted: 09/27/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Ivy Wei Shan Ng
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
| | - Jeremy Chee Seong Tey
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
| | - Yu Yang Soon
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
| | - Michelle Shu Fen Tseng
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
| | - Desiree Chen
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
| | - Keith Hsiu Chin Lim
- Department of Radiation Oncology; National Cancer Institute; National University Hospital; National University Health Systems, Singapore; Singapore
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16
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A novel urethral sparing technique for high-dose-rate prostate brachytherapy after transurethral resection of the prostate. Brachytherapy 2017; 16:1113-1118. [PMID: 28869143 DOI: 10.1016/j.brachy.2017.07.017] [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: 05/17/2017] [Revised: 07/17/2017] [Accepted: 07/31/2017] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to assess retrospectively the variability of the urethral dose optimized using a Foley catheter versus urethral contrast injected using a new modified triple-lumen catheter, in CT-based high-dose-rate (HDR) prostate brachytherapy of posttransurethral resection of prostate (TURP) patients. METHODS AND MATERIALS At our institution, there were six post-TURP patients with prostate carcinoma between July 2014 and April 2016 who underwent transperineal interstitial HDR brachytherapy (16 needles). A custom modified triple-lumen catheter was placed to inject contrast into the TURP defect. Three-dimensional optimal plans using inverse planning simulated annealing algorithm was generated according to radiation therapy oncology group dose requirements. Alternative plans were retroactively generated for comparison using standard technique based on a Foley catheter as a urethral constraint volume for each patient with the same weighting factors. We compared the dosimetry parameters in each planning using Wilcoxon's ranked sum nonparametric test. RESULTS The median followup of all patients was 17.5 months. No significant genitourinary or gastrointestinal toxicity was noted using this technique. In the dosimetric analysis, the prostate V100 values and TURP urethral V100 were significantly different between plans with and without the contrast (V100 [mean]: 92.4 [%] vs. 94.4 [%], p = 0.046; TURP UV100 [mean]: 1.4 cc vs. 2.2 cc, p = 0.028). There were no statistical differences in the mean values of planning target volume V150%, V200%, and D90, and each bladder V75 and rectum V75. CONCLUSIONS Post-TURP HDR brachytherapy with urethral contrast showed significantly more volume effect of the TURP defect than that with a Foley catheter alone. Better visualization of the TURP defect should lead to more accurate urethral sparing administration of HDR brachytherapy which is necessary to prevent urethral complication.
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17
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Smith RL, Haworth A, Panettieri V, Millar JL, Franich RD. 3D catheter reconstruction in HDR prostate brachytherapy for pre-treatment verification using a flat panel detector. Phys Med 2017. [PMID: 28625472 DOI: 10.1016/j.ejmp.2017.06.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
PURPOSE High dose rate prostate brachytherapy is a widely-practiced treatment, delivering large conformal doses in relatively few treatment fractions. Inter- and intra-fraction catheter displacements have been reported. Unrecognized displacement can have a significant impact on dosimetry. Knowledge of the implant geometry at the time of treatment is important for ensuring safe and effective treatment. In this work we demonstrate a method to reconstruct the catheter positions pre-treatment, using a 'shift' imaging technique, and perform registration with the treatment plan for verification relative to the prostate. METHODS Two oblique 'shift' images were acquired of a phantom containing brachytherapy catheters, representing the patient immediately pre-treatment. Using a back projection approach, the catheter paths were reconstructed in 3D and registered with the planned catheter paths. The robustness of the reconstruction and registration process was investigated as a function of phantom rotation. Catheter displacement detection was performed and compared to known applied displacements. RESULTS Reconstruction of the implant geometry in 3D immediately prior to treatment was achieved. A mean reconstruction uncertainty of 0.8mm was determined for all catheters with a mean registration uncertainty of 0.5mm. A catheter displacement detection threshold of 2.2mm was demonstrated. Catheter displacements were all detected to within 0.5mm of the applied displacements. CONCLUSION This technique is robust and sensitive to assess catheter displacements throughout the implant volume. This approach provides a method to detect, in 3D, changes in catheter positions relative to the prostate. The method has sufficient sensitivity to enable clinically significant decisions immediately prior to treatment delivery.
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Affiliation(s)
- Ryan L Smith
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia; School of Science, RMIT University, Melbourne 3000, VIC, Australia.
| | - Annette Haworth
- School of Science, RMIT University, Melbourne 3000, VIC, Australia; School of Physics, University of Sydney, Camperdown 2006, NSW, Australia
| | - Vanessa Panettieri
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia
| | - Jeremy L Millar
- Alfred Health Radiation Oncology, The Alfred Hospital, Melbourne 3004, VIC, Australia; School of Science, RMIT University, Melbourne 3000, VIC, Australia; Central Clinical School, Monash University, Melbourne 3004, Victoria, Australia
| | - Rick D Franich
- School of Science, RMIT University, Melbourne 3000, VIC, Australia
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18
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Yang X, Rossi PJ, Jani AB, Mao H, Zhou Z, Curran WJ, Liu T. Improved prostate delineation in prostate HDR brachytherapy with TRUS-CT deformable registration technology: A pilot study with MRI validation. J Appl Clin Med Phys 2017; 18:202-210. [PMID: 28291925 PMCID: PMC5689894 DOI: 10.1002/acm2.12040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2016] [Revised: 11/01/2016] [Accepted: 11/28/2016] [Indexed: 11/30/2022] Open
Abstract
Accurate prostate delineation is essential to ensure proper target coverage and normal-tissue sparing in prostate HDR brachytherapy. We have developed a prostate HDR brachytherapy technology that integrates intraoperative TRUS-based prostate contour into HDR treatment planning through TRUS-CT deformable registration (TCDR) to improve prostate contour accuracy. In a perspective study of 16 patients, we investigated the clinical feasibility as well as the performance of this TCDR-based HDR approach. We compared the performance of the TCDR-based approach with the conventional CT-based HDR in terms of prostate contour accuracy using MRI as the gold standard. For all patients, the average Dice prostate volume overlap was 91.1 ± 2.3% between the TCDR-based and the MRI-defined prostate volumes. In a subset of eight patients, inter and intro-observer reliability study was conducted among three experienced physicians (two radiation oncologists and one radiologist) for the TCDR-based HDR approach. Overall, a 10 to 40% improvement in prostate volume accuracy can be achieved with the TCDR-based approach as compared with the conventional CT-based prostate volumes. The TCDR-based prostate volumes match closely to the MRI-defined prostate volumes for all 3 observers (mean volume difference: 0.5 ± 7.2%, 1.8 ± 7.2%, and 3.5 ± 5.1%); while CT-based contours overestimated prostate volumes by 10.9 ± 28.7%, 13.7 ± 20.1%, and 44.7 ± 32.1%. This study has shown that the TCDR-based HDR brachytherapy is clinically feasible and can significantly improve prostate contour accuracy over the conventional CT-based prostate contour. We also demonstrated the reliability of the TCDR-based prostate delineation. This TCDR-based HDR approach has the potential to enable accurate dose planning and delivery, and potentially enhance prostate HDR treatment outcome.
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Affiliation(s)
- Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Peter J. Rossi
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Ashesh B. Jani
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Hui Mao
- Department of Radiology and Imaging Sciences and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Zhengyang Zhou
- Department of RadiologyNanjing Drum Tower HospitalNanjingChina
| | - Walter J. Curran
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer InstituteEmory UniversityAtlantaGAUSA
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19
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Intraoperative ultrasound-based planning can effectively replace postoperative CT-based planning for high-dose-rate brachytherapy for prostate cancer. Brachytherapy 2016; 15:399-405. [DOI: 10.1016/j.brachy.2016.04.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2016] [Revised: 04/06/2016] [Accepted: 04/06/2016] [Indexed: 11/17/2022]
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20
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Poder J, Whitaker M. Robustness of IPSA optimized high-dose-rate prostate brachytherapy treatment plans to catheter displacements. J Contemp Brachytherapy 2016; 8:201-7. [PMID: 27504129 PMCID: PMC4965496 DOI: 10.5114/jcb.2016.60499] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Accepted: 05/03/2016] [Indexed: 11/24/2022] Open
Abstract
PURPOSE Inverse planning simulated annealing (IPSA) optimized brachytherapy treatment plans are characterized with large isolated dwell times at the first or last dwell position of each catheter. The potential of catheter shifts relative to the target and organs at risk in these plans may lead to a more significant change in delivered dose to the volumes of interest relative to plans with more uniform dwell times. MATERIAL AND METHODS This study aims to determine if the Nucletron Oncentra dwell time deviation constraint (DTDC) parameter can be optimized to improve the robustness of high-dose-rate (HDR) prostate brachytherapy plans to catheter displacements. A set of 10 clinically acceptable prostate plans were re-optimized with a DTDC parameter of 0 and 0.4. For each plan, catheter displacements of 3, 7, and 14 mm were retrospectively applied and the change in dose volume histogram (DVH) indices and conformity indices analyzed. RESULTS The robustness of clinically acceptable prostate plans to catheter displacements in the caudal direction was found to be dependent on the DTDC parameter. A DTDC value of 0 improves the robustness of planning target volume (PTV) coverage to catheter displacements, whereas a DTDC value of 0.4 improves the robustness of the plans to changes in hotspots. CONCLUSIONS The results indicate that if used in conjunction with a pre-treatment catheter displacement correction protocol and a tolerance of 3 mm, a DTDC value of 0.4 may produce clinically superior plans. However, the effect of the DTDC parameter in plan robustness was not observed to be as strong as initially suspected.
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Affiliation(s)
- Joel Poder
- Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW
- Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW, Australia
| | - May Whitaker
- Radiation Oncology, Chris O'Brien Lifehouse, Camperdown, NSW
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21
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Smith RL, Haworth A, Panettieri V, Millar JL, Franich RD. A method for verification of treatment delivery in HDR prostate brachytherapy using a flat panel detector for both imaging and source tracking. Med Phys 2016; 43:2435. [DOI: 10.1118/1.4946820] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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22
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Hrinivich WT, Hoover DA, Surry K, Edirisinghe C, Montreuil J, D'Souza D, Fenster A, Wong E. Three-dimensional transrectal ultrasound guided high-dose-rate prostate brachytherapy: A comparison of needle segmentation accuracy with two-dimensional image guidance. Brachytherapy 2016; 15:231-9. [DOI: 10.1016/j.brachy.2015.12.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2015] [Revised: 12/09/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022]
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23
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Reynés-Llompart G, Pino F, Modolell I, Gullón C, Pera J, Gutierrez C, Picón C. Impact of prostate catheter displacement in inverse planning–simulated annealing and geometric optimization. Brachytherapy 2016; 15:112-7. [DOI: 10.1016/j.brachy.2015.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 10/14/2015] [Accepted: 10/18/2015] [Indexed: 11/17/2022]
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Peddada AV, Blasi OC, White GA, Monroe AT, Jennings SB, Gibbs GL. Prevention of needle displacement in multifraction high-dose-rate prostate brachytherapy: A prospective volumetric analysis and technical considerations. Pract Radiat Oncol 2015; 5:228-37. [DOI: 10.1016/j.prro.2014.11.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2014] [Revised: 11/07/2014] [Accepted: 11/17/2014] [Indexed: 10/24/2022]
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25
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Prostate volume and implant configuration during 48 hours of temporary prostate brachytherapy: limited effect of oedema. Radiat Oncol 2014; 9:272. [PMID: 25497373 PMCID: PMC4268808 DOI: 10.1186/s13014-014-0272-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Accepted: 11/22/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In pulsed-dose rate prostate brachytherapy the dose is delivered during 48 hours after implantation, making the treatment sensitive to oedematic effects possibly affecting dose delivery. The aim was to study changes in prostate volume during treatment by analysing catheter configurations on three subsequent scans. METHODS Prostate expansion was determined for 19 patients from the change in spatial distribution of the implanted catheters, using three CT-scans: a planning CT (CT1) and two CTs after 24 and 48 hours (CT2, CT3). An additional 4 patients only received one repeat CT (after 24 hours). The mean radial distance (MRD) of all dwell positions to the geometric centre of all dwell positions used was calculated to evaluate volume changes. From three implanted markers changes in inter-marker distances were assessed. The relative shifts of all dwell positions were determined using catheter- and marker-based registrations. Wilcoxon signed-rank tests were performed to compare the results from the different time points. RESULTS The MRDs measured on the two repeat CTs were significantly different from CT1. The mean prostate volume change derived from the difference in MRD was +4.3% (range -9.3% to +15.6%) for CT1-CT2 (p < .05) and +4.4% (range -7.5% to +16.3%) for CT1-CT3 (p < .05). These values represented a mean increase of 1.2 cm(3) in the first 24 hours and 1.5 cm(3) in the subsequent 24 hours. There was no clear sign of prostate expansion from the change in inter-marker distance (CT1-CT2: 0.2 ± 1.8 mm; CT1-CT3: 0.6 ± 2.2 mm). Catheter configuration remained stable; shifts in catheter positions were largest in the C-C direction: 0 ± 1.8 mm for CT1-CT2 and 0 ± 1.4 mm for CT2-CT3. CONCLUSIONS The volume changes derived from catheter displacements were small and therefore considered clinically insignificant. Implant configuration remains stable during 2 days of treatment, confirming the safety of this technique.
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High-dose-rate brachytherapy boost for prostate cancer: rationale and technique. J Contemp Brachytherapy 2014; 6:323-30. [PMID: 25337138 PMCID: PMC4200189 DOI: 10.5114/jcb.2014.45759] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2014] [Revised: 09/23/2014] [Accepted: 09/30/2014] [Indexed: 11/17/2022] Open
Abstract
High-dose-rate brachytherapy (HDR) is a method of conformal dose escalation to the prostate. It can be used as a local boost in combination with external beam radiotherapy, with a high degree of efficacy and low rate of long term toxicity. Data consistently reports relapse free survival rates of greater than 90% for intermediate risk patients and greater than 80% for high risk. Results are superior to those achieved with external beam radiotherapy alone. A wide range of dose and fractionation is reported, however, we have found that a single 15 Gy HDR combined with hypofractionated radiotherapy to a dose of 37.5 Gy in 15 fractions is well tolerated and is associated with a long term relapse-free survival of over 90%. Either CT-based or trans-rectal ultrasound-based planning may be used. The latter enables treatment delivery without having to move the patient with risk of catheter displacement. We have found it to be an efficient and quick method of treatment, allowing catheter insertion, planning, and treatment delivery to be completed in less than 90 minutes. High-dose-rate boost should be considered the treatment of choice for many men with high and intermediate risk prostate cancer.
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Boladeras A, Santorsa L, Gutierrez C, Martinez E, Pera J, Pino F, Suarez JF, Ferrer F, Díaz A, Polo A, Guedea F. External beam radiotherapy plus single-fraction high dose rate brachytherapy in the treatment of locally advanced prostate cancer. Radiother Oncol 2014; 112:227-32. [PMID: 25174299 DOI: 10.1016/j.radonc.2014.07.013] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2013] [Revised: 07/12/2014] [Accepted: 07/14/2014] [Indexed: 11/29/2022]
Abstract
PURPOSE To evaluate the efficacy and toxicity of external beam radiation therapy (EBRT) plus high-dose-rate brachytherapy (HDRB) as a boost in patients (pts) with intermediate or high-risk prostate cancer. METHODS AND MATERIALS From 2002 to July 2012, 377 pts with a diagnosis of intermediate or high-risk prostate cancer were treated with EBRT plus HDRB. Median patient age was 66 years (range, 41-86). Most patients (347 pts; 92%) were classified as high-risk (stage T2c-T3, or PSA>20 ng/mL, or GS ⩾ 8), with 30 patients (8%) considered intermediate risk. All patients underwent EBRT at a prescribed dose of 60.0 Gy (range, 45-70 Gy) to the prostate and seminal vesicles. A total of 120 pts (31%) received a dose of 46 Gy (45-50 Gy) to the true pelvis. All pts received a single-fraction 9 Gy (9-15 Gy) HDR boost. Most patients (353; 94%) were prescribed complete androgen deprivation therapy (ADT). Overall survival (OS), cause-specific survival (CSS), and biochemical relapse-free survival (BRFS) rates were calculated. In the case of BRFS, patients with <26 months of follow-up (n=106) were excluded to minimize the impact of ADT. RESULTS The median follow-up for the entire sample was 50 months (range, 12-126), with 5-year actuarial OS and CSS, respectively, of 88% (95% confidence interval [CI]: 84-92) and 98% (95% CI: 97-99). The 5-year BRFS was 91% (95% CI: 87-95) in the 271 pts with ⩾ 26 months (median, 60 months) of follow-up. Late toxicity included grade 2 and 3 gastrointestinal toxicity in 17 (4.6%) and 6 pts (1.6%), respectively, as well as grades 2 and 3 genitourinary toxicity in 46 (12.2%) and 3 pts (0.8%), respectively. CONCLUSION These long-term outcomes confirm that EBRT plus a single-fraction HDRB boost provides good results in treatment-related toxicity and biochemical control. In addition to the excellent clinical results, this fractionation schedule reduces physician workload, treatment-related expenses, patient discomfort and risks associated with anaesthesia. We believe these findings support the use of single-fractionation boost techniques.
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Affiliation(s)
- Ana Boladeras
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Luigina Santorsa
- Department of Radiation Oncology, Policlinico di Bari, Universitá degli Studi di Bari, Italy
| | - Cristina Gutierrez
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Evelyn Martinez
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Joan Pera
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Francisco Pino
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | | | - Ferran Ferrer
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain
| | - Aurora Díaz
- Department of Radiation Oncology, Grupo Quirón, Madrid, Spain
| | - Alfredo Polo
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - Ferran Guedea
- Department of Radiation Oncology, Catalan Institute of Oncology, University of Barcelona, l'Hospitalet de Llobregat, Spain.
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Poulin E, Fekete CAC, Létourneau M, Fenster A, Pouliot J, Beaulieu L. Adaptation of the CVT algorithm for catheter optimization in high dose rate brachytherapy. Med Phys 2014; 40:111724. [PMID: 24320432 DOI: 10.1118/1.4826335] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE An innovative, simple, and fast method to optimize the number and position of catheters is presented for prostate and breast high dose rate (HDR) brachytherapy, both for arbitrary templates or template-free implants (such as robotic templates). METHODS Eight clinical cases were chosen randomly from a bank of patients, previously treated in our clinic to test our method. The 2D Centroidal Voronoi Tessellations (CVT) algorithm was adapted to distribute catheters uniformly in space, within the maximum external contour of the planning target volume. The catheters optimization procedure includes the inverse planning simulated annealing algorithm (IPSA). Complete treatment plans can then be generated from the algorithm for different number of catheters. The best plan is chosen from different dosimetry criteria and will automatically provide the number of catheters and their positions. After the CVT algorithm parameters were optimized for speed and dosimetric results, it was validated against prostate clinical cases, using clinically relevant dose parameters. The robustness to implantation error was also evaluated. Finally, the efficiency of the method was tested in breast interstitial HDR brachytherapy cases. RESULTS The effect of the number and locations of the catheters on prostate cancer patients was studied. Treatment plans with a better or equivalent dose distributions could be obtained with fewer catheters. A better or equal prostate V100 was obtained down to 12 catheters. Plans with nine or less catheters would not be clinically acceptable in terms of prostate V100 and D90. Implantation errors up to 3 mm were acceptable since no statistical difference was found when compared to 0 mm error (p > 0.05). No significant difference in dosimetric indices was observed for the different combination of parameters within the CVT algorithm. A linear relation was found between the number of random points and the optimization time of the CVT algorithm. Because the computation time decrease with the number of points and that no effects were observed on the dosimetric indices when varying the number of sampling points and the number of iterations, they were respectively fixed to 2500 and to 100. The computation time to obtain ten complete treatments plans ranging from 9 to 18 catheters, with the corresponding dosimetric indices, was 90 s. However, 93% of the computation time is used by a research version of IPSA. For the breast, on average, the Radiation Therapy Oncology Group recommendations would be satisfied down to 12 catheters. Plans with nine or less catheters would not be clinically acceptable in terms of V100, dose homogeneity index, and D90. CONCLUSIONS The authors have devised a simple, fast and efficient method to optimize the number and position of catheters in interstitial HDR brachytherapy. The method was shown to be robust for both prostate and breast HDR brachytherapy. More importantly, the computation time of the algorithm is acceptable for clinical use. Ultimately, this catheter optimization algorithm could be coupled with a 3D ultrasound system to allow real-time guidance and planning in HDR brachytherapy.
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Affiliation(s)
- Eric Poulin
- Département de Physique, de Génie Physique et d'Optique et Centre de recherche sur le cancer de l'Université Laval, Université Laval, Québec, Québec G1V 0A6, Canada and Département de Radio-Oncologie et Axe oncologie du Centre de Recherche du CHU de Québec, CHU de Québec, 11 Co^te du Palais, Québec, Québec G1R 2J6, Canada
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Catheter displacement prior to the delivery of high-dose-rate brachytherapy in the treatment of prostate cancer patients. J Contemp Brachytherapy 2014; 6:161-6. [PMID: 25097556 PMCID: PMC4105648 DOI: 10.5114/jcb.2014.43619] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2013] [Revised: 05/13/2014] [Accepted: 06/26/2014] [Indexed: 11/28/2022] Open
Abstract
Purpose The purpose of this work was to report measured catheter displacement prior to the delivery of high-dose-rate brachytherapy (HDR) in the treatment of prostate cancer. Material and methods Data from 30 prostate cancer patients treated with HDR brachytherapy were analyzed retrospectively. Eighteen transperineal hollow catheters were inserted under transrectal ultrasound guidance. Gold marker seeds were also placed transperineally into the base and apex of the prostate gland. Five treatment fractions of 7.5 Gy each were administered over 3 days. The patient underwent CT scanning prior to each treatment fraction. Catheter displacement was measured from the pre-treatment CT dataset reconstructed at 1.25 mm slice thickness. Results Most of catheters were displaced in the caudal direction. Variations of 18 catheters for each patient were small (standard deviations < 1 mm for all but one patient). Mean displacements relative to the apex marker were 6 ± 4 mm, 12 ± 6 mm, 12 ± 6 mm, 12 ± 6 mm, and 12 ± 6 mm from plan to 1st, 2nd, 3rd, 4th, and 5th fractions, respectively. Conclusions Our results indicate that catheter positions must be confirmed and if required, adjusted, prior to every treatment fraction for the precise treatment delivery of HDR brachytherapy, and to potentially reduce over-dosage to the bulbo-membranous urethra.
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Bharat S, Kung C, Dehghan E, Ravi A, Venugopal N, Bonillas A, Stanton D, Kruecker J. Electromagnetic tracking for catheter reconstruction in ultrasound-guided high-dose-rate brachytherapy of the prostate. Brachytherapy 2014; 13:640-50. [PMID: 24929641 DOI: 10.1016/j.brachy.2014.05.012] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2014] [Revised: 04/08/2014] [Accepted: 05/06/2014] [Indexed: 11/18/2022]
Abstract
PURPOSE The accurate delivery of high-dose-rate brachytherapy is dependent on the correct identification of the position and shape of the treatment catheters. In many brachytherapy clinics, transrectal ultrasound (TRUS) imaging is used to identify the catheters. However, manual catheter identification on TRUS images can be time consuming, subjective, and operator dependent because of calcifications and distal shadowing artifacts. We report the use of electromagnetic (EM) tracking technology to map the position and shape of catheters inserted in a tissue-mimicking phantom. METHODS AND MATERIALS The accuracy of the EM system was comprehensively quantified using a three-axis robotic system. In addition, EM tracks acquired from catheters in a phantom were compared with catheter positions determined from TRUS and CT images to compare EM system performance to standard clinical imaging modalities. The tracking experiments were performed in a controlled laboratory environment and also in a typical brachytherapy operating room to test for potential EM distortions. RESULTS The robotic validation of the EM system yielded a mean accuracy of <0.5 mm for a clinically acceptable field of view in a nondistorting environment. The EM-tracked catheter representations were found to have an accuracy of <1 mm when compared with TRUS- and CT-identified positions, both in the laboratory environment and in the brachytherapy operating room. The achievable accuracy depends to a large extent on the calibration of the TRUS probe, geometry of the tracked devices relative to the EM field generator, and locations of surrounding clinical equipment. To address the issue of variable accuracy, a robust calibration algorithm has been developed and integrated into the workflow. The proposed mapping technique was also found to improve the workflow efficiency of catheter identification. CONCLUSIONS The high baseline accuracy of the EM system, the consistent agreement between EM-tracked, TRUS- and CT-identified catheters, and the improved workflow efficiency illustrate the potential value of using EM tracking for catheter mapping in high-dose-rate brachytherapy.
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Affiliation(s)
- Shyam Bharat
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY.
| | - Cynthia Kung
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY
| | - Ehsan Dehghan
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY
| | - Ananth Ravi
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Niranjan Venugopal
- Department of Radiation Oncology, Sunnybrook Health Sciences Center, Toronto, ON, Canada
| | - Antonio Bonillas
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY
| | - Doug Stanton
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY
| | - Jochen Kruecker
- Department of Ultrasound Imaging and Interventions, Philips Research North America, Briarcliff Manor, NY
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Hsu ICJ, Yamada Y, Assimos DG, D'Amico AV, Davis BJ, Frank SJ, Gottschalk AR, Gustafson GS, McLaughlin PW, Nguyen PL, Rosenthal SA, Taira AV, Vapiwala N, Merrick G. ACR Appropriateness Criteria high-dose-rate brachytherapy for prostate cancer. Brachytherapy 2014; 13:27-31. [DOI: 10.1016/j.brachy.2013.11.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2013] [Revised: 11/04/2013] [Accepted: 11/25/2013] [Indexed: 10/25/2022]
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Batchelar D, Gaztañaga M, Schmid M, Araujo C, Bachand F, Crook J. Validation study of ultrasound-based high-dose-rate prostate brachytherapy planning compared with CT-based planning. Brachytherapy 2014; 13:75-9. [DOI: 10.1016/j.brachy.2013.08.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2013] [Revised: 07/07/2013] [Accepted: 08/16/2013] [Indexed: 10/26/2022]
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Even AJG, Nuver TT, Westendorp H, Hoekstra CJ, Slump CH, Minken AW. High-dose-rate prostate brachytherapy based on registered transrectal ultrasound and in-room cone-beam CT images. Brachytherapy 2013; 13:128-36. [PMID: 24041955 DOI: 10.1016/j.brachy.2013.08.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 07/25/2013] [Accepted: 08/01/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To present a high-dose-rate (HDR) brachytherapy procedure for prostate cancer using transrectal ultrasound (TRUS) to contour the regions of interest and registered in-room cone-beam CT (CBCT) images for needle reconstruction. To characterize the registration uncertainties between the two imaging modalities and explore the possibility of performing the procedure solely on TRUS. METHODS AND MATERIALS Patients were treated with a TRUS/CBCT-based HDR brachytherapy procedure. For 100 patients, dosimetric results were analyzed. For 40 patients, registration uncertainties were examined by determining differences in fiducial marker positions on TRUS and registered CBCT. The accuracy of needle reconstruction on TRUS was investigated by determining the position differences of needle tips on TRUS and CBCT. The dosimetric impact of reregistration and needle reconstruction on TRUS only was studied for 8 patients. RESULTS The average prostate V100 was 97.8%, urethra D10 was 116.3%, and rectum D1 cc was 66.4% of the prescribed dose. For 85% of the patients, registration inaccuracies were within 3 mm. Large differences were found between needle tips on TRUS and CBCT, especially in cranial-caudal direction, with a maximum of 10.4 mm. Reregistration resulted in a maximum V100 reduction of 0.9%, whereas needle reconstruction on TRUS only gave a maximum reduction of 9.4%. CONCLUSIONS HDR prostate brachytherapy based on TRUS combined with CBCT is an accurate method. Registration uncertainties, and consequently dosimetric inaccuracies, are small compared with the uncertainties of performing the procedure solely based on static TRUS images. CBCT imaging is a requisite in our current procedure.
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Affiliation(s)
- Aniek J G Even
- Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer, The Netherlands; MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - Tonnis T Nuver
- Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer, The Netherlands; Department of Radiation Oncology, Radiotherapeutic Institute RISO, Deventer, The Netherlands.
| | - Hendrik Westendorp
- Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer, The Netherlands; Department of Radiation Oncology, Radiotherapeutic Institute RISO, Deventer, The Netherlands
| | - Carel J Hoekstra
- Department of Radiation Oncology, Radiotherapeutic Institute RISO, Deventer, The Netherlands
| | - Cornelis H Slump
- MIRA Institute for Biomedical Technology and Technical Medicine, University of Twente, Enschede, The Netherlands
| | - André W Minken
- Department of Medical Physics, Radiotherapeutic Institute RISO, Deventer, The Netherlands; Department of Radiation Oncology, Radiotherapeutic Institute RISO, Deventer, The Netherlands
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Giantsoudi D, Baltas D, Karabis A, Mavroidis P, Zamboglou N, Tselis N, Shi C, Papanikolaou N. A gEUD-based inverse planning technique for HDR prostate brachytherapy: feasibility study. Med Phys 2013; 40:041704. [PMID: 23556874 DOI: 10.1118/1.4793766] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
PURPOSE The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization. METHODS The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators. RESULTS Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D10 or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume. CONCLUSIONS Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.
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Affiliation(s)
- D Giantsoudi
- Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78229, USA.
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Pinnaduwage DS, Cunha JA, Weinberg V, Krishnamurthy D, Nash M, Hsu IC, Pouliot J. A dosimetric evaluation of using a single treatment plan for multiple treatment fractions within a given applicator insertion in gynecologic brachytherapy. Brachytherapy 2013; 12:487-94. [DOI: 10.1016/j.brachy.2013.02.003] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 01/21/2013] [Accepted: 02/06/2013] [Indexed: 10/26/2022]
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Online correction of catheter movement using CT in high-dose-rate prostate brachytherapy. Brachytherapy 2013; 12:260-6. [PMID: 23453680 DOI: 10.1016/j.brachy.2012.08.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Revised: 08/27/2012] [Accepted: 08/28/2012] [Indexed: 11/21/2022]
Abstract
PURPOSE To present a clinical procedure that readjusts catheters to its planned positions based on pretreatment computed tomography (CT) for patients undergoing high-dose-rate (HDR) prostate brachytherapy, and evaluate the magnitude and dosimetric impact of the adjustments. METHODS AND MATERIALS Patients received a pretreatment verification CT (vCT) before each fraction. The vCT dataset was imported to the treatment-planning system and fused to the planning CT (pCT) by rigid-body registration based on the implanted fiducials within the prostate. Catheter positions in the vCT were then compared with catheter positions in the pCT in a reconstructed plane through each catheter. Any catheter with difference in penetration larger than 3 mm was manually adjusted by a radiation oncologist before treatment. To evaluate treatment quality, the patient's plan was applied to the vCT off-line and dose delivered to prostate and normal structures were compared with their planned value. RESULTS Forty-four fractions of 13 consecutive patients were treated using this method. Thirty-nine fractions had at least one catheter adjusted before treatment. A total of 651 catheters were assessed, and 194 catheters (30%) were adjusted by an average amount of 5.8 ± 1.9 mm. In eight fractions the prostate D90 would have decreased by more than 10% from the planned value (with a maximum of 32%) if the catheter displacements were not rectified. After the adjustment, the maximum deviation of D90 was 10.6%. The improvement in D90 is 24% per 1 cm of time-averaged adjustment. CONCLUSIONS Interfraction catheter motion occurs without any particular pattern. Using pretreatment CTs and restoring each catheter to its planned position ensures that the delivered treatment closely matches the treatment plan and therefore enhances the overall quality of the HDR treatment. The procedure can be readily implemented in any clinical setting.
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Schmid M, Crook JM, Batchelar D, Araujo C, Petrik D, Kim D, Halperin R. A phantom study to assess accuracy of needle identification in real-time planning of ultrasound-guided high-dose-rate prostate implants. Brachytherapy 2013; 12:56-64. [DOI: 10.1016/j.brachy.2012.03.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2011] [Revised: 02/13/2012] [Accepted: 03/13/2012] [Indexed: 11/25/2022]
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Siauw T, Cunha A, Berenson D, Atamturk A, Hsu IC, Goldberg K, Pouliot J. NPIP: A skew line needle configuration optimization system for HDR brachytherapy. Med Phys 2012; 39:4339-46. [PMID: 22830767 DOI: 10.1118/1.4728226] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE In this study, the authors introduce skew line needle configurations for high dose rate (HDR) brachytherapy and needle planning by integer program (NPIP), a computational method for generating these configurations. NPIP generates needle configurations that are specific to the anatomy of the patient, avoid critical structures near the penile bulb and other healthy structures, and avoid needle collisions inside the body. METHODS NPIP consisted of three major components: a method for generating a set of candidate needles, a needle selection component that chose a candidate needle subset to be inserted, and a dose planner for verifying that the final needle configuration could meet dose objectives. NPIP was used to compute needle configurations for prostate cancer data sets from patients previously treated at our clinic. NPIP took two user-parameters: a number of candidate needles, and needle coverage radius, δ. The candidate needle set consisted of 5000 needles, and a range of δ values was used to compute different needle configurations for each patient. Dose plans were computed for each needle configuration. The number of needles generated and dosimetry were analyzed and compared to the physician implant. RESULTS NPIP computed at least one needle configuration for every patient that met dose objectives, avoided healthy structures and needle collisions, and used as many or fewer needles than standard practice. These needle configurations corresponded to a narrow range of δ values, which could be used as default values if this system is used in practice. The average end-to-end runtime for this implementation of NPIP was 286 s, but there was a wide variation from case to case. CONCLUSIONS The authors have shown that NPIP can automatically generate skew line needle configurations with the aforementioned properties, and that given the correct input parameters, NPIP can generate needle configurations which meet dose objectives and use as many or fewer needles than the current HDR brachytherapy workflow. Combined with robot assisted brachytherapy, this system has the potential to reduce side effects associated with treatment. A physical trial should be done to test the implant feasibility of NPIP needle configurations.
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Affiliation(s)
- Timmy Siauw
- Department of Civil and Environmental Engineering, University of California, Berkeley, CA, USA.
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Urethra low-dose tunnels: Validation of and class solution for generating urethra-sparing dose plans using inverse planning simulated annealing for prostate high-dose-rate brachytherapy. Brachytherapy 2012; 11:348-53. [DOI: 10.1016/j.brachy.2011.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2010] [Revised: 02/03/2011] [Accepted: 07/26/2011] [Indexed: 11/20/2022]
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Yamada Y, Rogers L, Demanes DJ, Morton G, Prestidge BR, Pouliot J, Cohen GN, Zaider M, Ghilezan M, Hsu IC. American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy. Brachytherapy 2012; 11:20-32. [PMID: 22265435 DOI: 10.1016/j.brachy.2011.09.008] [Citation(s) in RCA: 230] [Impact Index Per Article: 19.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2011] [Revised: 09/23/2011] [Accepted: 09/23/2011] [Indexed: 01/26/2023]
Abstract
PURPOSE A well-established body of literature supports the use of high-dose-rate (HDR) brachytherapy as definitive treatment for localized prostate cancer. Most of the articles describe HDR as a boost with adjuvant external beam radiation, but there is a growing experience with HDR monotherapy. METHODS AND MATERIALS The American Brachytherapy Society has convened a group of expert practitioners and physicists to develop guidelines for the use of HDR in the management of prostate cancer. This involved an extensive literature review and input from an expert panel. RESULTS Despite a wide variation in doses and fractionation reported, HDR brachytherapy provides biochemical control rates of 85-100%, 81-100%, and 43-93% for low-, intermediate-, and high-risk prostate cancers, respectively. Severe toxicity is rare, with most authors reporting less than 5% Grade 3 or higher toxicity. Careful attention to patient evaluation for appropriate patient selection, meticulous technique, treatment planning, and delivery are essential for successful treatment. CONCLUSION The clinical outcomes for HDR are excellent, with high rates of biochemical control, even for high-risk disease, with low morbidity. HDR monotherapy, both for primary treatment and salvage, are promising treatment modalities.
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Affiliation(s)
- Yoshiya Yamada
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, NY 10065, USA.
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Shukla P, Chopra S, Engineer R, Mahantshetty U, Paul SN, Phurailatpam R, SV J, Shrivastava SK. Quality Assurance of Multifractionated Pelvic Interstitial Brachytherapy for Postoperative Recurrences of Cervical Cancers: A Prospective Study. Int J Radiat Oncol Biol Phys 2012; 82:e617-22. [DOI: 10.1016/j.ijrobp.2011.11.018] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2011] [Revised: 10/18/2011] [Accepted: 11/03/2011] [Indexed: 01/19/2023]
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Yoshida K, Ueda M, Takenaka T, Yamazaki H, Kotsuma T, Aramoto K, Miyake S, Koretsune Y, Ban C, Tanaka E. Daily CT measurement of needle applicator displacement during multifractionated high-dose-rate interstitial brachytherapy for postoperative recurrent uterine cancer. JOURNAL OF RADIATION RESEARCH 2012; 53:295-300. [PMID: 22240942 DOI: 10.1269/jrr.11165] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
We investigated daily needle applicator displacement during multifractionated high-dose-rate interstitial brachytherapy (HDR-ISBT) for postoperative recurrent uterine cancer. Eight patients with postoperative recurrent uterine cancer received HDR-ISBT with or without external beam radiotherapy using our unique ambulatory technique. To analyze displacement, we obtained daily computed tomography (CT) images for 122 flexible needle applicators at 21, 45, 69, and 93 hours after implantation. Displacement was defined as the length between the center of gravity of titanium markers and the needle applicator tips along the daily CT axis. For cases in which displacement was not corrected, we also calculated the dose that covered 90% of the clinical target volume (D90(CTV)) using a dose-volume histogram (DVH). Median caudal needle applicator displacement at 21, 45, 69, and 93 hours was 3, 2, 4, and 5 mm, respectively. More than 15 mm displacement was observed for 2% (2 of 122) and 17% (10 of 60) of needle applicators at 21 and 93 hours, respectively. Cases in which dwell positions were not changed to correct the treatment plan, 2 of 8 patients showed more than 10% reduction in D90(CTV) values compared with the initial treatment plan. Correction of dwell positions of the treatment source improves treatment DVH for multifractionated HDR-ISBT.
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Affiliation(s)
- Ken Yoshida
- Department of Radiation Oncology, National Hospital Organization Osaka National Hospital, Osaka-city, Osaka 540-0006, Japan.
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Effect of using different U/S probe Standoff materials in image geometry for interventional procedures: the example of prostate. J Contemp Brachytherapy 2011; 3:209-19. [PMID: 23346130 PMCID: PMC3551363 DOI: 10.5114/jcb.2011.26472] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2011] [Revised: 10/20/2011] [Accepted: 11/10/2011] [Indexed: 11/17/2022] Open
Abstract
Purpose This study investigates the distortion of geometry of catheters and anatomy in acquired U/S images, caused by utilizing various stand-off materials for covering a transrectal bi-planar ultrasound probe in HDR and LDR prostate brachytherapy, biopsy and other interventional procedures. Furthermore, an evaluation of currently established water-bath based quality assurance (QA) procedures is presented. Material and methods Image acquisitions of an ultrasound QA setup were carried out at 5 MHz and 7 MHz. The U/S probe was covered by EA 4015 Silicone Standoff kit, or UA0059 Endocavity balloon filled either with water or one of the following: 40 ml of Endosgel®, Instillagel®, Ultraschall gel or Space OAR™ gel. The differences between images were recorded. Consequently, the dosimetric impact of the observed image distortion was investigated, using a tissue equivalent ultrasound prostate phantom – Model number 053 (CIRS Inc., Norfolk, VA, USA). Results By using the EA 4015 Silicone Standoff kit in normal water with sound speed of 1525 m/s, a 3 mm needle shift was observed. The expansion of objects appeared in radial direction. The shift deforms also the PTV (prostate in our case) and other organs at risk (OARs) in the same way leading to overestimation of volume and underestimation of the dose. On the other hand, Instillagel® and Space OAR™ “shrinks” objects in an ultrasound image for 0.65 mm and 0.40 mm, respectively. Conclusions The use of EA 4015 Silicone Standoff kit for image acquisition, leads to erroneous contouring of PTV and OARs and reconstruction and placement of catheters, which results to incorrect dose calculation during prostate brachytherapy. Moreover, the reliability of QA procedures lies mostly in the right temperature of the water used for accurate simulation of real conditions of transrectal ultrasound imaging.
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A novel method for accurate needle-tip identification in trans-rectal ultrasound-based high-dose-rate prostate brachytherapy. Brachytherapy 2011; 10:466-73. [PMID: 21549646 DOI: 10.1016/j.brachy.2011.02.214] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2010] [Revised: 02/24/2011] [Accepted: 02/28/2011] [Indexed: 11/24/2022]
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Influence of catheters on predicted tumour control probability and severity of acute genitourinary toxicity during high-dose-rate brachytherapy prostate boost. JOURNAL OF RADIOTHERAPY IN PRACTICE 2011. [DOI: 10.1017/s1460396910000312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractPurpose: High-dose-rate brachytherapy (HDR) boost is an effective method for dose escalation when treating prostate cancer. Optimal number and location of catheters play key role in radiation dose delivery. We studied the impact of catheters and associated trauma on the dose uncertainties and urethral toxicity.Methods and Materials: Between July 2008 to August 2009, 50 patients with prostate cancer were treated with 46 Gy of external irradiation of whole pelvis (2 Gy per fraction) and two HDR brachytherapy fractions (each 14 Gy) at the end of 10 fractions of external beam. All brachytherapy implants were planned using real-time, ultrasound-based planning system. Variables were prostate and urethral volumes, number of catheters and their mean distance from base of bladder and dose volume histogram parameters. All data were collected during first implant only. The toxicities were graded according to Radiation Therapy Oncology Group Toxicity Criteria. Statistical analysis was done on SPSS version 17.0.Results: The mean number of catheters implanted was 12.38 (8–19), and number of attempts per needle to achieve desired position was 1.6 (range = 0–5). Mean distance between the catheters tips to contrast filled bladder was 3.2 mm (1–8 mm) after the adjustment. Distances >5 mm showed lower doses to prostate and lower predicted tumour control probability (TCP) (p < 0.01). No correlation was found between numbers of catheters implanted, attempts per catheter and severity of acute genitourinary (GU) toxicity. Significant correlation was found between severity of acute GU toxicity and urethral V130, V150 (p < 0.001).Conclusion: Dose decline and subsequently lower TCP were seen for the greater distances between the needles and bladder. Acute GU toxicity increased with higher urethral, but severity of acute GU toxicity does not increase with increase in prostate/urethral volumes, number of catheters needles and attempts.
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Whitaker M, Hruby G, Lovett A, Patanjali N. Prostate HDR brachytherapy catheter displacement between planning and treatment delivery. Radiother Oncol 2011; 101:490-4. [PMID: 21889221 DOI: 10.1016/j.radonc.2011.08.004] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Revised: 08/03/2011] [Accepted: 08/05/2011] [Indexed: 10/15/2022]
Abstract
BACKGROUND AND PURPOSE HDR brachytherapy is used as a conformal boost for treating prostate cancer. Given the large doses delivered, it is critical that the volume treated matches that planned. Our outpatient protocol comprises two 9 Gy fractions, two weeks apart. We prospectively assessed catheter displacement between CT planning and treatment delivery. MATERIALS AND METHODS Three fiducial markers and the catheters were implanted under transrectal ultrasound guidance. Metal marker wires were inserted into 4 reference catheters before CT; marker positions relative to each other and to the marker wires were measured from the CT scout. Measurements were repeated immediately prior to treatment delivery using pelvic X-ray with marker wires in the same reference catheters. Measurements from CT scout and film were compared. For displacements of 5mm or more, indexer positions were adjusted prior to treatment delivery. RESULTS Results are based on 48 implants, in 25 patients. Median time from planning CT to treatment delivery was 254 min (range 81-367 min). Median catheter displacement was 7.5mm (range -2.9-23.9 mm), 67% of implants had displacement of 5mm or greater. Displacements were predominantly caudal. CONCLUSIONS Catheter displacement can occur in the 1-3h between the planning CT scan and treatment. It is recommended that departments performing HDR prostate brachytherapy verify catheter positions immediately prior to treatment delivery.
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Affiliation(s)
- May Whitaker
- Department of Radiation Oncology, Sydney Cancer Centre, NSW, Australia.
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Crook J. The role of brachytherapy in the definitive management of prostate cancer. Cancer Radiother 2011; 15:230-7. [DOI: 10.1016/j.canrad.2011.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/22/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
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Mikami M, Yoshida K, Takenaka T, Yamazaki H, Kotsuma T, Yoshida M, Aramoto K, Yamada S, Ban C, Tanaka E, Honda K. Daily computed tomography measurement of needle applicator displacement during high-dose-rate interstitial brachytherapy for previously untreated uterine cervical cancer. Brachytherapy 2011; 10:318-24. [PMID: 21236738 DOI: 10.1016/j.brachy.2010.11.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2010] [Revised: 11/02/2010] [Accepted: 11/15/2010] [Indexed: 11/16/2022]
Abstract
PURPOSE We investigated daily needle applicator displacement during high-dose-rate interstitial brachytherapy. METHODS AND MATERIALS Ten patients with previously untreated uterine cervical cancer received 30Gy in five fractions during 3 days of high-dose-rate interstitial brachytherapy combined with external beam radiotherapy using our unique ambulatory technique. To analyze displacement, we obtained daily computed tomography (CT) images for 147 flexible needle applicators at 21 and 45h after implantation. The distance was defined as the length between the center of gravity of titanium markers and the needle applicator tips along the daily CT axis. We adapted dwell positions of the treatment source to cover clinical target volume with a 15-mm cranial margin. RESULTS The median displacement was 1mm (range, -6 to 12mm) at 21h and 2mm (range, -9 to 14mm) at 45h, respectively. Statistically significant caudal displacement was observed only between the displacement at 0 and 21h (p<0.0001), and not between the displacement at 21 and 45h (p=0.1). In cases with displacement of 3mm or more, we changed dwell positions to correct the treatment plan. We corrected 45 applicators (31%) at 21h and 67 (46%) at 45h. CONCLUSIONS We investigated needle applicator displacement in our ambulatory technique using daily CT examination and considered that a 15-mm cranial margin was sufficient to cover clinical target volume.
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Affiliation(s)
- Mari Mikami
- Department of Radiology, National Hospital Organization Osaka National Hospital, Osaka, Japan.
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Use of cone-beam imaging to correct for catheter displacement in high dose-rate prostate brachytherapy. Brachytherapy 2010; 10:299-305. [PMID: 21190903 DOI: 10.1016/j.brachy.2010.11.007] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 11/02/2010] [Accepted: 11/16/2010] [Indexed: 11/21/2022]
Abstract
PURPOSE To determine the magnitude of catheter displacement between time of planning and time of treatment delivery for patients undergoing high dose-rate (HDR) brachytherapy, the dosimetric impact of catheter displacement, and the ability to improve dosimetry by catheter readjustment. METHODS AND MATERIALS Twenty consecutive patients receiving single fraction HDR brachytherapy underwent kilovoltage cone-beam CT in the treatment room before treatment. If catheter displacement was apparent, catheters were adjusted and imaging repeated. Both sets of kilovoltage cone-beam CT image sets were coregistered off-line with the CT data set used for planning with rigid fusion of anatomy based on implanted fiducials. Catheter displacement was measured on both sets of images and dosimetry calculated. RESULTS Mean internal displacement of catheters was 11mm. This would have resulted in a decrease in mean volume receiving 100% of prescription dose (V(100)) from the planned 97.6% to 77.3% (p<0.001), a decrease of the mean dose to 90% of the prostate (D(90)) from 110.5% to 72.9% (p<0.001), and increase in dose to 10% of urethra (urethra D(10)) from 118% to 125% (p=0.0094). Each 1cm of catheter displacement resulted in a 20% decrease in V(100) and 36% decrease in D(90). Catheter readjustment resulted in a final treated mean V(100) of 90.2% and D(90) of 97.4%, both less than planned. Mean urethra D(10) remained higher at126% (p=0.0324). CONCLUSIONS Significantly, internal displacement of HDR catheters commonly occurs between time of CT planning and treatment delivery, even when only a single fraction is used. The adverse effects on dosimetry can be partly corrected by readjustment of catheter position.
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Hsu IC, Bae K, Shinohara K, Pouliot J, Purdy J, Ibbott G, Speight J, Vigneault E, Ivker R, Sandler H. Phase II trial of combined high-dose-rate brachytherapy and external beam radiotherapy for adenocarcinoma of the prostate: preliminary results of RTOG 0321. Int J Radiat Oncol Biol Phys 2010; 78:751-8. [PMID: 20207506 PMCID: PMC2946454 DOI: 10.1016/j.ijrobp.2009.08.048] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2009] [Revised: 07/29/2009] [Accepted: 08/21/2009] [Indexed: 10/19/2022]
Abstract
PURPOSE To estimate the rate of late Grade 3 or greater genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) after treatment with external beam radiotherapy and prostate high-dose-rate (HDR) brachytherapy. METHODS AND MATERIALS Each participating institution submitted computed tomography-based HDR brachytherapy dosimetry data electronically for credentialing and for each study patient. Patients with locally confined Stage T1c-T3b prostate cancer were eligible for the present study. All patients were treated with 45 Gy in 25 fractions using external beam radiotherapy and one HDR implant delivering 19 Gy in two fractions. All AEs were graded according to the Common Terminology Criteria for Adverse Events, version 3.0. Late GU/GI AEs were defined as those occurring >9 months from the start of the protocol treatment, in patients with ≥18 months of potential follow-up. RESULTS A total of 129 patients from 14 institutions were enrolled in the present study. Of the 129 patients, 125 were eligible, and AE data were available for 112 patients at analysis. The pretreatment characteristics of the patients were as follows: Stage T1c-T2c, 91%; Stage T3a-T3b, 9%; prostate-specific antigen level ≤10 ng/mL, 70%; prostate-specific antigen level >10 but ≤20 ng/mL, 30%; and Gleason score 2-6, 10%; Gleason score 7, 72%; and Gleason score 8-10, 18%. At a median follow-up of 29.6 months, three acute and four late Grade 3 GU/GI AEs were reported. The estimated rate of late Grade 3-5 GU and GI AEs at 18 months was 2.56%. CONCLUSION This is the first prospective, multi-institutional trial of computed tomography-based HDR brachytherapy and external beam radiotherapy. The technique and doses used in the present study resulted in acceptable levels of AEs.
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Affiliation(s)
- I-Chow Hsu
- University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA 94143-1708, USA.
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