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Mohamad O, Nicosia L, Mathier E, Riggenbach E, Zamboglou C, Aebersold DM, Alongi F, Shelan M. Focal brachytherapy as definitive treatment for localized prostate cancer: A systematic review and meta-analysis. Brachytherapy 2024; 23:309-320. [PMID: 38431441 DOI: 10.1016/j.brachy.2024.01.011] [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: 05/19/2023] [Revised: 12/06/2023] [Accepted: 01/18/2024] [Indexed: 03/05/2024]
Abstract
PURPOSE In this systematic review and meta-analysis, we describe the oncologic and toxicity outcomes of definitive focal brachytherapy for prostate cancer. METHODS AND MATERIALS A PROSPERO registered study (CRD42023410170) was conducted following the Preferred Reporting Items for Systematic reviews and Meta-analyses (PRISMA) guidelines. PubMed, Embase, and The Cochrane Library were searched for studies between 2000 and 2022. Two authors independently performed the initial search. Biochemical recurrence-free survival (bRFS) was defined as the primary endpoint for the meta-analysis. Generalized linear mixed-effects models were conducted to calculate effect size and quantify heterogeneity. We also describe the side effects and local recurrence patterns of focal brachytherapy. RESULTS Ten studies were identified and included 315 patients treated using focal brachytherapy as a definitive treatment. Mean (SD) age was 67.65 (7.9) years and mean (SD) PSA was 7.15 (2.7) ng/mL. Most patients (n = 236, 75%) underwent LDR Brachytherapy and 25% received HDR brachytherapy. Among the participants, 147 (46.5%) had a Gleason score ≤6, and 169 (53.5%) had a Gleason score ≥7. Only 11 (3.5%) patients received ADT. Overall, bRFS rate at median follow-up 4 years (Range: 1-6.42 years) was 91% (95% confidence interval [CI], 82-95%). Acute Grade ≤ 2 GU and GI toxicities were reported in 22 (7%) and 11 (3.5%) patients, respectively. Late Grade ≤ 2 GU and GI toxicity were reported in 6 (2%) and 14 (4.4%) patients, respectively. One case of prostate hemorrhage due to improper foley removal was noted but otherwise no acute or late Grade 3 or higher GI or GU toxicity related to radiotherapy was reported. CONCLUSION Overall, definitive focal brachytherapy has a favorable toxicity profile. Oncologic outcomes are yet to mature. The evidence is limited by the small number of studies with low patients' number, across study heterogeneity, and possibility of publication bias.
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Affiliation(s)
- Osama Mohamad
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX
| | - Luca Nicosia
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Etienne Mathier
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Elena Riggenbach
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Constantinos Zamboglou
- Department of Radiation Oncology, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany; German Oncology Center, University Hospital of the European University, Limassol, Cyprus
| | - Daniel M Aebersold
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fillipo Alongi
- Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Italy
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
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2
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Zhang Z, Zhang N, Cheng G. Application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer. LA RADIOLOGIA MEDICA 2023; 128:588-600. [PMID: 37138200 DOI: 10.1007/s11547-023-01632-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 04/12/2023] [Indexed: 05/05/2023]
Abstract
BACKGROUND Three-dimensional (3D) imaging has an important role in brachytherapy and the treatment of cervical cancer. The main imaging methods used in the cervical cancer brachytherapy include magnetic resonance imaging (MRI), computer tomography (CT), ultrasound (US), and positron emission tomography (PET). However, single-imaging methods have certain limitations compared to multi-imaging. The application of multi-imaging can make up for the shortcomings and provide a more suitable imaging selection for brachytherapy. PURPOSE This review details the situation and scope of existing multi-imaging combination methods in cervical cancer brachytherapy and provides a reference for medical institutions. MATERIALS AND METHODS Searched the literature related to application of three-dimensional multi-imaging combination in brachytherapy of cervical cancer in PubMed/Medline and Web of Science electronic databases. Summarized the existing combined imaging methods and the application of each method in cervical cancer brachytherapy. CONCLUSION The current imaging combination methods mainly include MRI/CT, US/CT, MRI/US, and MRI/PET. The combination of two imaging tools can be used for applicator implantation guidance, applicator reconstruction, target and organs at risk (OAR) contouring, dose optimization, prognosis evaluation, etc., which provides a more suitable imaging choice for brachytherapy.
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Affiliation(s)
- Zhaoming Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Ning Zhang
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China
| | - Guanghui Cheng
- Department of Radiation Oncology, China-Japan Union Hospital of Jilin University, No.126 Xiantai Street, Changchun, China.
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van Luijtelaar A, Fütterer JJ, Bomers JG. Minimally invasive magnetic resonance image-guided prostate interventions. Br J Radiol 2021; 95:20210698. [PMID: 34723623 PMCID: PMC8978246 DOI: 10.1259/bjr.20210698] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Whole gland prostate cancer treatment, i.e. radical prostatectomy or radiation therapy, is highly effective but also comes with a significant impact on quality of life and possible overtreatment in males with low to intermediate risk disease. Minimal-invasive treatment strategies are emerging techniques. Different sources of energy are used to aim for targeted treatment in order to reduce treatment-related complications and morbidity. Imaging plays an important role in targeting and monitoring of treatment approaches preserving parts of the prostatic tissue. Multiparametric magnetic resonance imaging (mpMRI) is widely used during image-guided interventions due to the multiplanar and real-time anatomical imaging while providing an improved treatment accuracy. This review evaluates the available image-guided prostate cancer treatment options using MRI or magnetic resonance imaging/transrectal ultrasound (MRI/TRUS)-fusion guided imaging. The discussed minimal invasive image-guided prostate interventions may be considered as safe and feasible partial gland ablation in patients with (recurrent) prostate cancer. However, most studies focusing on minimally invasive prostate cancer treatments only report early stages of research and subsequent high-level evidence is still needed. Ensuring a safe and appropriate utilization in patients that will benefit the most, and applied by physicians with relevant training, has become the main challenge in minimally invasive prostate cancer treatments.
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Affiliation(s)
- Annemarijke van Luijtelaar
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jurgen J Fütterer
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Joyce Gr Bomers
- Department of Radiology and Nuclear Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
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4
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Lei Y, Wang T, Fu Y, Roper J, Jani AB, Liu T, Patel P, Yang X. Catheter position prediction using deep-learning-based multi-atlas registration for high-dose rate prostate brachytherapy. Med Phys 2021; 48:7261-7270. [PMID: 34480801 DOI: 10.1002/mp.15206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 07/26/2021] [Accepted: 08/28/2021] [Indexed: 12/19/2022] Open
Abstract
PURPOSE High-dose-rate (HDR) prostate brachytherapy involves treatment catheter placement, which is currently empirical and physician dependent. The lack of proper catheter placement guidance during the procedure has left the physicians to rely on a heuristic thinking-while-doing technique, which may cause large catheter placement variation and increased plan quality uncertainty. Therefore, the achievable dose distribution could not be quantified prior to the catheter placement. To overcome this challenge, we proposed a learning-based method to provide HDR catheter placement guidance for prostate cancer patients undergoing HDR brachytherapy. METHODS The proposed framework consists of deformable registration via registration network (Reg-Net), multi-atlas ranking, and catheter regression. To model the global spatial relationship among multiple organs, binary masks of the prostate and organs-at-risk are transformed into distance maps, which describe the distance of each local voxel to the organ surfaces. For a new patient, the generated distance map is used as fixed image. Reg-Net is utilized to deformably register the distance maps from multi-atlas set to match this patient's distance map and then bring catheter maps from multi-atlas to this patient via spatial transformation. Several criteria, namely prostate volume similarity, multi-organ semantic image similarity, and catheter position criteria (far from the urethra and within the partial prostate), are used for multi-atlas ranking. The top-ranked atlas' deformed catheter positions are selected as the predicted catheter positions for this patient. Finally, catheter regression is used to refine the final catheter positions. A retrospective study on 90 patients with a fivefold cross-validation scheme was used to evaluate the proposed method's feasibility. In order to investigate the impact of plan quality from the predicted catheter pattern, we optimized the source dwell position and time for both the clinical catheter pattern and predicted catheter pattern with the same optimization settings. Comparisons of clinically relevant dose volume histogram (DVH) metrics were completed. RESULTS For all patients, on average, both the clinical plan dose and predicted plan dose meet the common dose constraints when prostate dose coverage is kept at V100 = 95%. The plans from the predicted catheter pattern have slightly higher hotspot in terms of V150 by 5.0% and V200 by 2.9% on average. For bladder V75, rectum V75, and urethra V125, the average difference is close to zero, and the range of most patients is within ±1 cc. CONCLUSION We developed a new catheter placement prediction method for HDR prostate brachytherapy based on a deep-learning-based multi-atlas registration algorithm. It has great clinical potential since it can provide catheter location estimation prior to catheter placement, which could reduce the dependence on physicians' experience in catheter implantation and improve the quality of prostate HDR treatment plans. This approach merits further clinical evaluation and validation as a method of quality control for HDR prostate brachytherapy.
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Affiliation(s)
- Yang Lei
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tonghe Wang
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Yabo Fu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Justin Roper
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Tian Liu
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Pretesh Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
| | - Xiaofeng Yang
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, Georgia, USA
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Espensen CA, Kiilgaard JF, Klemp K, Gothelf A, Appelt AL, Fog LS. 3D image-guided treatment planning for Ruthenium-106 brachytherapy of choroidal melanomas. Acta Ophthalmol 2021; 99:e654-e660. [PMID: 33340258 DOI: 10.1111/aos.14663] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 10/11/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND Current standard treatment procedures for Ruthenium-106 (Ru-106) brachytherapy for choroidal melanomas do not use 3D image-guided treatment planning. We evaluated the potential impact of introducing 3D treatment planning and quantified the theoretical clinical benefits in terms of tumour control probability (TCP) and normal tissue complication probability (NTCP). MATERIALS AND METHODS Treatment plans for thirty-two patients were optimized using 3D image-guided treatment planning and compared to the original 2D clinical plans. Optimization of plans was done in an image-based treatment planning system by optimizing the plaque position and treatment time such that the entire tumour received the prescribed dose of 100 Gy. TCP and NTCP for 2D clinical plans and optimized 3D image-guided plans were estimated from published outcome prediction models and compared within patients using Wilcoxon signed-rank test. RESULTS The median minimum tumour dose (D99% ) for 2D clinical plans was 93 Gy (range: 23-158 Gy), corresponding to 5-year TCP of 75% (IQR 61-86%), while median tumour D99% for optimized 3D image-guided plans was 115 Gy (range 103-141 Gy), corresponding to TCP of 82% (IQR 80-84%). This was a statistically significant increase in estimated TCP (median increase in TCP 8% (IQR: -5-23, p = 0.006). While the dose to normal tissue increased somewhat, there was no significant change in NTCP. CONCLUSION 3D treatment planning theoretically allows for improved tumour dose delivery for Ru-106 brachytherapy of choroidal melanomas, resulting in a significant increase in expected tumour control compared to traditional approaches using 2D calculations. The deliverability of optimized plans, and potential increased risk of late complications, will have to be confirmed in future clinical studies.
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Affiliation(s)
- Charlotte A. Espensen
- Department of Oncology Section of Radiotherapy Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Jens F. Kiilgaard
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Kristian Klemp
- Department of Ophthalmology Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Anita Gothelf
- Department of Oncology Section of Radiotherapy Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
| | - Ane L. Appelt
- Leeds Institute of Medical Research at St James’s, University of Leeds Leeds Cancer Centre University of LeedsSt James’s University Hospital Leeds UK
- Leeds Cancer Centre St James’s University Hospital Leeds UK
| | - Lotte S. Fog
- The Alfred Hospital Alfred Health Radiation Oncology Melbourne Victoria Australia
- The Peter MacCallum Cancer Centre Melbourne Victoria Australia
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6
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McGeachy P, Watt E, Husain S, Martell K, Martinez P, Sawhney S, Thind K. MRI-TRUS registration methodology for TRUS-guided HDR prostate brachytherapy. J Appl Clin Med Phys 2021; 22:284-294. [PMID: 34318581 PMCID: PMC8364261 DOI: 10.1002/acm2.13292] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 04/26/2021] [Accepted: 05/05/2021] [Indexed: 11/15/2022] Open
Abstract
Purpose High‐dose‐rate (HDR) prostate brachytherapy is an established technique for whole‐gland treatment. For transrectal ultrasound (TRUS)‐guided HDR prostate brachytherapy, image fusion with a magnetic resonance image (MRI) can be performed to make use of its soft‐tissue contrast. The MIM treatment planning system has recently introduced image registration specifically for HDR prostate brachytherapy and has incorporated a Predictive Fusion workflow, which allows clinicians to attempt to compensate for differences in patient positioning between imaging modalities. In this study, we investigate the accuracy of the MIM algorithms for MRI‐TRUS fusion, including the Predictive Fusion workflow. Materials and Methods A radiation oncologist contoured the prostate gland on both TRUS and MRI. Four registration methodologies to fuse the MRI and the TRUS images were considered: rigid registration (RR), contour‐based (CB) deformable registration, Predictive Fusion followed by RR (pfRR), and Predictive Fusion followed by CB deformable registration (pfCB). Registrations were compared using the mean distance to agreement and the Dice similarity coefficient for the prostate as contoured on TRUS and the registered MRI prostate contour. Results Twenty patients treated with HDR prostate brachytherapy at our center were included in this retrospective evaluation. For the cohort, mean distance to agreement was 2.1 ± 0.8 mm, 0.60 ± 0.08 mm, 2.0 ± 0.5 mm, and 0.59 ± 0.06 mm for RR, CB, pfRR, and pfCB, respectively. Dice similarity coefficients were 0.80 ± 0.05, 0.93 ± 0.02, 0.81 ± 0.03, and 0.93 ± 0.01 for RR, CB, pfRR, and pfCB, respectively. The inclusion of the Predictive Fusion workflow did not significantly improve the quality of the registration. Conclusions The CB deformable registration algorithm in the MIM treatment planning system yielded the best geometric registration indices. MIM offers a commercial platform allowing for easier access and integration into clinical departments with the potential to play an integral role in future focal therapy applications for prostate cancer.
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Affiliation(s)
- Philip McGeachy
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Elizabeth Watt
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada
| | - Siraj Husain
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Kevin Martell
- Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Radiation Oncology, Tom Baker Cancer Centre, Calgary, AB, Canada
| | - Pedro Martinez
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
| | - Summit Sawhney
- Department of Radiology and Diagnostic Imaging, University of Calgary, Calgary, AB, Canada
| | - Kundan Thind
- Department of Medical Physics, Tom Baker Cancer Centre, Calgary, AB, Canada.,Department of Oncology, University of Calgary, Calgary, AB, Canada.,Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada
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7
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Fallara G, Capogrosso P, Maggio P, Taborelli A, Montorsi F, Dehò F, Salonia A. Erectile function after focal therapy for localized prostate cancer: a systematic review. Int J Impot Res 2020; 33:418-427. [PMID: 32999435 DOI: 10.1038/s41443-020-00357-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/20/2020] [Accepted: 09/21/2020] [Indexed: 12/17/2022]
Abstract
Focal therapy modalities achieved interest in the management of prostate cancer (PCa) over the last a few years. This systematic review was aimed to investigate erectile function after focal therapy for localized PCa. Twenty-six out of 1287 reports were identified through a database systematic search in MEDLINE, EMBASE, and Web of Science, supplemented with hand search, on June 1st, 2020, according to PRISMA guidelines. Focal therapy modalities investigated were cryotherapy, high-intensity focused ultrasound (HIFU), photodynamic therapy (TOOKAD), irreversible electroporation (IRE), and focal radiotherapy (RT) (i.e. brachytherapy or stereotactic RT). Overall, reported sexual function outcomes after these treatment modalities were generally good, with many studies reporting a complete recovery of EF at 1-year follow-up. However, the quality of current evidence is affected both by the lack of well-conducted comparative studies and by a significant heterogeneity in terms of study design, study population, erectile and sexual function assessment modalities.
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Affiliation(s)
- Giuseppe Fallara
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Paolo Capogrosso
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy.
| | - Paolo Maggio
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Alessandro Taborelli
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
| | - Federico Dehò
- Unit of Urology; ASST Sette Laghi-Circolo e Fondazione Macchi Hospital, Varese, Italy, University of Insubria, Varese, Italy
| | - Andrea Salonia
- Division of Experimental Oncology/Unit of Urology; URI; IRCCS Ospedale San Raffaele, Milan, Italy.,University Vita-Salute San Raffaele, Milan, Italy
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8
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Morozov A, Taratkin M, Barret E, Singla N, Bezrukov E, Chinenov D, Enikeev M, Gomez Rivas J, Shpikina A, Enikeev D. A systematic review of irreversible electroporation in localised prostate cancer treatment. Andrologia 2020; 52:e13789. [DOI: 10.1111/and.13789] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2020] [Revised: 06/26/2020] [Accepted: 07/04/2020] [Indexed: 12/17/2022] Open
Affiliation(s)
- Andrey Morozov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Mark Taratkin
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Eric Barret
- Department of Urology Institut Mutualiste Montsouris Paris France
| | - Nirmish Singla
- Department of Urology University of Texas Southwestern Medical Center Dallas TX USA
| | - Evgeniy Bezrukov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Denis Chinenov
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | - Mikhail Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
| | | | - Anastasia Shpikina
- International School ‘Medicine of the Future’ Sechenov University Moscow Russia
| | - Dmitry Enikeev
- Institute for Urology and Reproductive Health Sechenov University Moscow Russia
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9
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Wang T, Zhou J, Tian S, Wang Y, Patel P, Jani AB, Langen KM, Curran WJ, Liu T, Yang X. A planning study of focal dose escalations to multiparametric MRI-defined dominant intraprostatic lesions in prostate proton radiation therapy. Br J Radiol 2020; 93:20190845. [PMID: 31904261 PMCID: PMC7066949 DOI: 10.1259/bjr.20190845] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 12/05/2019] [Accepted: 12/23/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES The purpose of this study is to investigate the dosimetric effect and clinical impact of delivering a focal radiotherapy boost dose to multiparametric MRI (mp-MRI)-defined dominant intraprostatic lesions (DILs) in prostate cancer using proton therapy. METHODS We retrospectively investigated 36 patients with pre-treatment mp-MRI and CT images who were treated using pencil beam scanning (PBS) proton radiation therapy to the whole prostate. DILs were contoured on co-registered mp-MRIs. Simultaneous integrated boost (SIB) plans using intensity-modulated proton therapy (IMPT) were created based on conventional whole-prostate-irradiation for each patient and optimized with additional DIL coverage goals and urethral constraints. DIL dose coverage and organ-at-risk (OAR) sparing were compared between conventional and SIB plans. Tumor control probability (TCP) and normal tissue complication probability (NTCP) were estimated to evaluate the clinical impact of the SIB plans. RESULTS Optimized SIB plans significantly escalated the dose to DILs while meeting OAR constraints. SIB plans were able to achieve 125, 150 and 175% of prescription dose coverage in 74, 54 and 17% of 36 patients, respectively. This was modeled to result in an increase in DIL TCP by 7.3-13.3% depending on α / β and DIL risk level. CONCLUSION The proposed mp-MRI-guided DIL boost using proton radiation therapy is feasible without violating OAR constraints and demonstrates a potential clinical benefit by improving DIL TCP. This retrospective study suggested the use of IMPT-based DIL SIB may represent a strategy to improve tumor control. ADVANCES IN KNOWLEDGE This study investigated the planning of mp-MRI-guided DIL boost in prostate proton radiation therapy and estimated its clinical impact with respect to TCP and NTCP.
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Affiliation(s)
- Tonghe Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Jun Zhou
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Sibo Tian
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Yinan Wang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Pretesh Patel
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Ashesh B. Jani
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Katja M. Langen
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Walter J. Curran
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Tian Liu
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
| | - Xiaofeng Yang
- Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta 30322, Georgia
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10
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Feng ST, Huang M, Dong Z, Xu L, Li Y, Jia Y, Cai H, Shen B, Li ZP. MRI T2-Weighted Imaging and Fat-Suppressed T2-Weighted Imaging Image Fusion Technology Improves Image Discriminability for the Evaluation of Anal Fistulas. Korean J Radiol 2019; 20:429-437. [PMID: 30799574 PMCID: PMC6389820 DOI: 10.3348/kjr.2018.0260] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2018] [Accepted: 11/02/2018] [Indexed: 12/16/2022] Open
Affiliation(s)
- Shi Ting Feng
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Mengqi Huang
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zhi Dong
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Ling Xu
- Faculty of Medicine and Dentistry, University of Western Australia, Perth, Australia
| | - Yin Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Yingmei Jia
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Huasong Cai
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Bingqi Shen
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China
| | - Zi Ping Li
- Department of Radiology, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, China.
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11
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Fischbach F, Hass P, Schindele D, Genseke P, Geisendorf L, Stehning C, Schostak M, Brunner T, Pech M, Fischbach K. MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL). Eur Radiol 2019; 30:2072-2081. [PMID: 31828412 DOI: 10.1007/s00330-019-06505-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 10/08/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The aim of the study was to establish the setup and workflow for delivering focal MRI-guided high-dose-rate (HDR) brachytherapy for prostate cancer (PCA) and to assess patient comfort and safety aspects of MRI-guided single-fraction HDR. METHODS Patients with histologically proven focal low- to intermediate-risk PCA with a single PIRADS 4/5 lesion were treated with percutaneous interstitial HDR brachytherapy in a single fraction with a minimum dose for the gross tumor volume of 20 Gy while sparing the organ at risk (OAR). Using a 3T-MRI, brachytherapy catheters were placed transgluteal in freehand technique. No antibiotic therapy or general analgesics were administered. Patient data, procedure time, patient discomfort, and complications were recorded. Quarterly PSA controls, biannual follow-up imaging, and annual re-biopsy were planned. RESULTS So far, 9 patients were successfully treated and followed for 6 months. Mean intervention time was 34 min. Using the VAS scale, the pain reported for the intervention ranged from 2 to 3. Short-term follow-up showed no acute genitourinary or gastrointestinal toxicity so far. None of the patients displayed signs of infection. PSA levels in all patients decreased significantly. On follow up no residual PCA was detected treated region so far. PSA levels in all patients decreased significantly. On follow-up, no residual PCA was detected so far. CONCLUSIONS MR-guided single-fraction focal HDR brachytherapy for localized PCA is feasible as well as safe for the individual patient. Catheters can be placed accurately and maximum therapeutic dose distribution can be restricted to the tumor. Countersigning the minimally invasive character of the procedure, no general anesthesia or antibiosis is necessary. KEY POINTS • MR-guided focal HDR brachytherapy allows an accurate placement of catheters with maximum therapeutic dose distribution restricted to the tumor. • No major anesthesia or antibiosis is necessary emphasizing the minimal invasive character of the procedure. • Patients with low- and intermediate-risk prostate carcinoma in particular may benefit to halt disease progression whereas treatment-related morbidity is reduced compared with radical therapy.
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Affiliation(s)
- Frank Fischbach
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany.
| | - Peter Hass
- Department of Radiotherapy, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Daniel Schindele
- Department of Urology, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Philipp Genseke
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Lisa Geisendorf
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | | | - Martin Schostak
- Department of Urology, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Thomas Brunner
- Department of Radiotherapy, Otto von Guericke University, Medical School, Magdeburg, Germany
| | - Maciej Pech
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
| | - Katharina Fischbach
- Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany
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Wang T, Press RH, Giles M, Jani AB, Rossi P, Lei Y, Curran WJ, Patel P, Liu T, Yang X. Multiparametric MRI-guided dose boost to dominant intraprostatic lesions in CT-based High-dose-rate prostate brachytherapy. Br J Radiol 2019; 92:20190089. [PMID: 30912959 DOI: 10.1259/bjr.20190089] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVE The purpose of this study is to investigate the dosimetric feasibility of delivering focal dose to multiparametric (mp) MRI-defined DILs in CT-based high-dose-rate (HDR) prostate brachytherapy with MR/CT registration and estimate its clinical benefit. METHODS We retrospectively investigated a total of 17 patients with mp-MRI and CT images acquired pre-treatment and treated by HDR prostate brachytherapy. 21 dominant intraprostatic lesions (DILs) were contoured on mp-MRI and propagated to CT images using a deformable image registration method. A boost plan was created for each patient and optimized on the original needle pattern. In addition, separate plans were generated using a virtually implanted needle around the DIL to mimic mp-MRI guided needle placement. DIL dose coverage and organ-at-rick (OAR) sparing were compared with original plan results. Tumor control probability (TCP) was estimated to further evaluate the clinical impact on the boost plans. RESULTS Overall, optimized boost plans significantly escalated dose to DILs while meeting OAR constraints. The addition of mp-MRI guided virtual needles facilitate increased coverage of DIL volumes, achieving a V150 > 90% in 85 % of DILs compared with 57 % of boost plan without an additional needle. Compared with original plan, TCP models estimated improvement in DIL control by 28 % for patients with external-beam treatment and by 8 % for monotherapy patients. CONCLUSION With MR/CT registration, the proposed mp-MRI guided DIL boost in CT-based HDR brachytherapy is feasible without violating OAR constraints, and indicates significant clinical benefit in improving TCP of DIL. It may represent a strategy to personalize treatment delivery and improve tumor control. ADVANCES IN KNOWLEDGE This study investigated the feasibility of mp-MRI guided DIL boost in HDR prostate brachytherapy with CT-based treatment planning, and estimated its clinical impact by TCP and NTCP estimation.
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Affiliation(s)
- Tonghe Wang
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Robert H Press
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Matt Giles
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Ashesh B Jani
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Peter Rossi
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Yang Lei
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Walter J Curran
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Pretesh Patel
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Tian Liu
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
| | - Xiaofeng Yang
- 1 Department of Radiation Oncology and Winship Cancer Institute, Emory University , Atlanta, GA , USA
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13
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The Role of Magnetic Resonance Imaging in Brachytherapy. Clin Oncol (R Coll Radiol) 2018; 30:728-736. [DOI: 10.1016/j.clon.2018.07.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/14/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022]
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14
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Tamihardja J, Zenk M, Flentje M. MRI-guided localization of the dominant intraprostatic lesion and dose analysis of volumetric modulated arc therapy planning for prostate cancer. Strahlenther Onkol 2018; 195:145-152. [PMID: 30209535 DOI: 10.1007/s00066-018-1364-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 08/23/2018] [Indexed: 01/10/2023]
Abstract
PURPOSE Primary radiation therapy is a curative treatment option for prostate cancer. The aim of this study was to evaluate the detection of the dominant intraprostatic lesion (DIL) with magnetic resonance imaging (MRI) for radiotherapy treatment planning, the comparison with transrectal ultrasound (TRUS)-guided biopsies and the examination of the dose distribution in relation to the DIL location. MATERIALS AND METHODS In all, 54 patients with treatment planning MRI for primary radiotherapy of prostate cancer from 03/2015 to 03/2017 at the Universitätsklinikum Würzburg were identified. The localization of the DIL was based on MRI with T2- and diffusion-weighted imaging. After registration of the MR image sets within Pinnacle3 (Philips Radiation Oncology Systems, Fitchburg, WI, USA), the dose distribution was analyzed. The location of the DIL was compared to the pathology reports in a side-based manner. RESULTS The DIL mean dose (Dmean) was 77.51 ± 0.77 Gy and in 50/51 cases within the tolerance range or exceeded the prescribed dose. There was a significant difference in Dmean between ventral (n = 21) and dorsal (n = 30) DIL (77.87 ± 0.67 vs. 77.26 ± 0.77 Gy; p = 0.005). MRI-guided localization showed an accuracy and sensitivity of up to 78.8% and 82.1% for inclusion of secondary lesions, respectively. CONCLUSION Up to 82.1% of histologically verified intraprostatic lesions were identified in the context of MRI-guided radiotherapy treatment planning. As expected, dorsal DIL tend to be minimally underdosed in comparison to ventral DIL. Adequate dose coverage was achieved in over 98% of patients.
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Affiliation(s)
- Jörg Tamihardja
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany.
| | - Maria Zenk
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
| | - Michael Flentje
- Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany
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15
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Pesapane F, Patella F, Fumarola EM, Zanchetta E, Floridi C, Carrafiello G, Standaert C. The prostate cancer focal therapy. Gland Surg 2018; 7:89-102. [PMID: 29770305 PMCID: PMC5938267 DOI: 10.21037/gs.2017.11.08] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2017] [Accepted: 10/31/2017] [Indexed: 12/21/2022]
Abstract
Despite prostate cancer (PCa) is the leading form of non-cutaneous cancer in men, most patients with PCa die with disease rather than of the disease. Therefore, the risk of overtreatment should be considered by clinicians who have to distinguish between patients with high risk PCa (who would benefit from radical treatment) and patients who may be managed more conservatively, such as through active surveillance or emerging focal therapy (FT). The aim of FT is to eradicate clinically significant disease while protecting key genito-urinary structures and function from injury. While effectiveness studies comparing FT with conventional care options are still lacking, the rationale supporting FT relies on evidence-based advances such as the understanding of the index lesion's central role in the natural history of the PCa and the improvement of multiparametric magnetic resonance imaging (mpMRI) in the detection and risk stratification of PCa. In this literature review, we want to highlight the rationale for FT in PCa management and the current evidence on patient eligibility. Furthermore, we summarize the best imaging modalities to localize the target lesion, describe the current FT techniques in PCa, provide an update on their oncological outcomes and highlight trends for future research.
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Affiliation(s)
- Filippo Pesapane
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Francesca Patella
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Enrico Maria Fumarola
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Edoardo Zanchetta
- Postgraduation School in Radiodiagnostics, Università degli Studi di Milano, Milan, Italy
| | - Chiara Floridi
- Azienda Ospedaliera Fatebenefratelli e Oftalmico, Milan, Italy
| | - Gianpaolo Carrafiello
- Department of Health Sciences, Diagnostic and Interventional Radiology, San Paolo Hospital, University of Milan, Milan, Italy
| | - Chloë Standaert
- Department of Radiology, Ghent University Hospital, Ghent, Belgium
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16
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Graff P, Portalez D, Lusque A, Brun T, Aziza R, Khalifa J, Roumiguié M, Quintyn Ranty ML, Filleron T, Bachaud JM, Malavaud B. IDEAL 2a Phase II Study of Ultrafocal Brachytherapy for Low- and Intermediate-risk Prostate Cancer. Int J Radiat Oncol Biol Phys 2018; 102:903-911. [PMID: 29510957 DOI: 10.1016/j.ijrobp.2018.01.066] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2017] [Revised: 01/11/2018] [Accepted: 01/22/2018] [Indexed: 12/19/2022]
Abstract
PURPOSE Focal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterized index tumors (ITs). We assessed the feasibility of low-dose-rate ultrafocal brachytherapy. METHODS AND MATERIALS The present study was an institutional review board-approved European Clinical Trials Database-registered phase II protocol. Patients referred (October 2013 to August 2016) for active surveillance (prostate-specific antigen <10 ng/mL, cT1c-cT2a, Gleason score on referring biopsy specimens ≤6 (3+3), ≤3 positive biopsy cores, ≤50% of cancer) were preselected. Inclusion was confirmed when complementary image-guided biopsy findings informed a single Prostate Imaging Reporting and Data System (PI-RADS) ≥3, Gleason score ≤7a (3+4) lesion. A ultrasound-visible ancillary marker was positioned within the IT using a magnetic resonance imaging (MRI)/3-dimensional transrectal ultrasound (TRUS) elastic fusion-guided system (Koelis). Ultrafocal transperineal delivery of 125I seeds used classic 2-dimensional TRUS (Bard-FlexFocus) and dose optimization (Variseed Treatment Planning System). Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering ≥95% of the prescribed dose (160 Gy) to the IT (primary objective). Adverse events (Common Terminology Criteria for Adverse Events) and quality of life (5-item International Index of Erectile Function, International Prostate Symptom Score) were recorded. One-year control biopsy specimens were obtained from the IT and untreated segments. RESULTS Of the 44 preselected patients, 27 did not meet the inclusion criteria. Of the 17 ultrafocal brachytherapy-treated patients, 16 met the primary objective (per protocol success). The prescription dose was delivered to 14.5% ± 6.4% of the prostate volume, resulting in negligible urethral and rectal irradiation and toxicity. No recurrence was evidenced on the 1-year follow-up MRI studies or IT biopsy specimens. Seven nonclinically significant cancers and one Gleason score 7a (3+4) cancer (salvage prostatectomy) were observed in the untreated parenchyma. CONCLUSIONS Recent technology has allowed for selective and effective brachytherapy of small MRI targets.
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Affiliation(s)
- Pierre Graff
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France.
| | - Daniel Portalez
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Amélie Lusque
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Thomas Brun
- Department of Biophysics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Richard Aziza
- Department of Radiology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jonathan Khalifa
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Mathieu Roumiguié
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | | | - Thomas Filleron
- Department of Biostatistics, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Jean-Marc Bachaud
- Department of Radiation Oncology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer de Toulouse, Toulouse, France
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17
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van der Poel HG, van den Bergh RCN, Briers E, Cornford P, Govorov A, Henry AM, Lam TB, Mason MD, Rouvière O, De Santis M, Willemse PPM, van Poppel H, Mottet N. Focal Therapy in Primary Localised Prostate Cancer: The European Association of Urology Position in 2018. Eur Urol 2018; 74:84-91. [PMID: 29373215 DOI: 10.1016/j.eururo.2018.01.001] [Citation(s) in RCA: 118] [Impact Index Per Article: 19.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 01/02/2018] [Indexed: 11/16/2022]
Abstract
Radical treatment of localised prostate cancer is recognised to be an unnecessary intervention or overtreatment in many men. Consequently, there has been a rapid uptake in the use of focal ablative therapies. However, there are several biological and practical concerns about such approaches as they have yet to be proved as robust treatment options. In particular, the multifocal nature of prostate cancer argues against unifocal treatment, while limitations in imaging can preclude the accurate identification of the number, location, and extent of prostate cancer foci. To date, a number of ablative options have reported results on mainly low-risk disease. Most series are relatively immature, with a lack of consistent follow-up, and the morbidity of retreatment is often not considered. The authors consider focal therapy to be an investigational modality, and encourage prospective recording of outcomes and recruitment of suitable patients. PATIENT SUMMARY Focal therapy of prostate cancer is the targeted destruction of cancer within a specific part of the prostate gland, sparing the rest of the prostate and nearby tissue. This procedure could potentially reduce side effects when compared with established standard treatments, such as surgery or radiotherapy, which treat the entire prostate. Studies show that for most men with low-risk cancer, active surveillance is the preferred treatment option. However, the available data regarding all forms of focal therapy are still poor and inconclusive. Consequently, due to both the lack of clear results associated with focal therapy and the difficulties in detecting all cancerous areas of the prostate, focal therapy should be considered an investigational modality only.
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Affiliation(s)
- Henk G van der Poel
- Department of Urology, Netherlands Cancer Institute, Amsterdam, The Netherlands.
| | | | | | - Philip Cornford
- Royal Liverpool and Broadgreen Hospitals NHS Trust, Liverpool, UK
| | - Alex Govorov
- Department of Urology, Moscow State University of Medicine and Dentistry, Moscow, Russia
| | - Ann M Henry
- Leeds Cancer Centre, St. James's University Hospital, Leeds, UK
| | - Thomas B Lam
- Academic Urology Unit, University of Aberdeen, Aberdeen, UK; Department of Urology, Aberdeen Royal Infirmary, Aberdeen, UK
| | - Malcolm D Mason
- Division of Cancer & Genetics, School of Medicine Cardiff University, Velindre Cancer Centre, Cardiff, UK
| | - Olivier Rouvière
- Hospices Civils de Lyon, Radiology Department, Edouard Herriot Hospital, Lyon, France
| | - Maria De Santis
- Clinical Trials Unit, University of Warwick, UK; Department of Urology, Medical University of Vienna, Vienna, Austria
| | | | | | - Nicolas Mottet
- Department of Urology, University Hospital, St. Etienne, France
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18
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Poulin E, Boudam K, Pinter C, Kadoury S, Lasso A, Fichtinger G, Ménard C. Validation of MRI to TRUS registration for high-dose-rate prostate brachytherapy. Brachytherapy 2018; 17:283-290. [PMID: 29331575 DOI: 10.1016/j.brachy.2017.11.018] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2017] [Revised: 11/27/2017] [Accepted: 11/30/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE The objective of this study was to develop and validate an open-source module for MRI to transrectal ultrasound (TRUS) registration to support tumor-targeted prostate brachytherapy. METHODS AND MATERIALS In this study, 15 patients with prostate cancer lesions visible on multiparametric MRI were selected for the validation. T2-weighted images with 1-mm isotropic voxel size and diffusion weighted images were acquired on a 1.5T Siemens imager. Three-dimensional (3D) TRUS images with 0.5-mm slice thickness were acquired. The investigated registration module was incorporated in the open-source 3D Slicer platform, which can compute rigid and deformable transformations. An extension of 3D Slicer, SlicerRT, allows import of and export to DICOM-RT formats. For validation, similarity indices, prostate volumes, and centroid positions were determined in addition to registration errors for common 3D points identified by an experienced radiation oncologist. RESULTS The average time to compute the registration was 35 ± 3 s. For the rigid and deformable registration, respectively, Dice similarity coefficients were 0.87 ± 0.05 and 0.93 ± 0.01 while the 95% Hausdorff distances were 4.2 ± 1.0 and 2.2 ± 0.3 mm. MRI volumes obtained after the rigid and deformable registration were not statistically different (p > 0.05) from reference TRUS volumes. For the rigid and deformable registration, respectively, 3D distance errors between reference and registered centroid positions were 2.1 ± 1.0 and 0.4 ± 0.1 mm while registration errors between common points were 3.5 ± 3.2 and 2.3 ± 1.1 mm. Deformable registration was found significantly better (p < 0.05) than rigid registration for all parameters. CONCLUSIONS An open-source MRI to TRUS registration platform was validated for integration in the brachytherapy workflow.
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19
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Focal therapy for prostate cancer: the technical challenges. J Contemp Brachytherapy 2017; 9:383-389. [PMID: 28951759 PMCID: PMC5611463 DOI: 10.5114/jcb.2017.69809] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2017] [Accepted: 08/24/2017] [Indexed: 12/16/2022] Open
Abstract
Focal therapy for prostate cancer has been proposed as an alternative treatment to whole gland therapy, offering the opportunity for tumor dose escalation and/or reduced toxicity. Brachytherapy, either low-dose-rate or high-dose-rate, provides an ideal approach, offering both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines on target volume delineation, treatment planning margins, treatment planning approaches, and many other technical issues that should be considered before implementing a focal brachytherapy program. Without consensus guidelines, there is the potential for a diversity of practices to develop, leading to challenges in interpreting outcome data from multiple centers. This article provides an overview of the technical considerations for the implementation of a clinical service, and discusses related topics that should be considered in the design of clinical trials to ensure precise and accurate methods are applied for focal brachytherapy treatments.
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20
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Beaulieu L, Racine E, Han DY, Vigneault E, Hsu IC, Cunha JAM. Real-time electromagnetic tracking-based treatment platform for high-dose-rate prostate brachytherapy: Clinical workflows and end-to-end validation. Brachytherapy 2017; 17:103-110. [PMID: 28576644 DOI: 10.1016/j.brachy.2017.04.247] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 04/12/2017] [Accepted: 04/19/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE New technologies were integrated into a novel treatment platform combining electromagnetically (EM) tracked catheters, a 3D ultrasound (3DUS) imaging device, and a new treatment planning system to provide a real-time prostate high-dose-rate (HDR) brachytherapy treatment system. This work defines workflows for offline CT and online 3DUS planning scenarios and preclinical end-to-end validation of the platform. METHODS AND MATERIALS The platform is composed of an EM-tracked stylet, a EM-tracked 3DUS probe, and an EM-tracked template guide, all used with the NDI Aurora field generator (NDI, Ontario, Canada). The treatment planning system performs continuous position and angular readings from all three EM sensors into a streamlined environment that allows for (1) contouring; (2) planning; (3) catheter insertion guidance and reconstruction; (4) QA of catheter path and tip position; and (5) exporting to an afterloader. Data were gathered on the times required for the various key steps of the 3DUS-based workflow. RESULTS The complete 3DUS-based workflow on 16-catheter implant phantoms took approximately 15 min. This time is expected to increase for actual patients. Plan generation is fast (7.6 ± 2.5s) and the initial catheter reconstruction with updated dose distribution is obtained at no (time) cost as part of the insertion process. Subsequent catheter reconstruction takes on average 10.5 ± 3.1s per catheter, representing less than 3 min for a 16-catheter implant. CONCLUSIONS This preclinical study suggests that EM technology could help to significantly streamline real-time US-based high-dose-rate prostate brachytherapy.
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Affiliation(s)
- Luc Beaulieu
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada; Department of Radiation Oncology, University of California San Francisco, San Francisco.
| | - Emmanuel Racine
- Département de physique, de génie physique et d'optique et Centre de recherche sur le cancer de l'Université Laval, CHU de Québec, Québec, Québec, Canada; Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - Dae Yup Han
- Department of Radiation Oncology, University of California San Francisco, San Francisco
| | - Eric Vigneault
- Département de radio-oncologie et Centre de recherche du CHU de Québec, CHU de Québec - Université Laval, Québec, Québec, Canada
| | - I-Chow Hsu
- Department of Radiation Oncology, University of California San Francisco, San Francisco
| | - J Adam M Cunha
- Department of Radiation Oncology, University of California San Francisco, San Francisco
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21
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Wang J, Tanderup K, Cunha A, Damato AL, Cohen GN, Kudchadker RJ, Mourtada F. Magnetic resonance imaging basics for the prostate brachytherapist. Brachytherapy 2017; 16:715-727. [PMID: 28396178 DOI: 10.1016/j.brachy.2017.03.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2016] [Revised: 02/23/2017] [Accepted: 03/04/2017] [Indexed: 11/27/2022]
Abstract
Magnetic resonance imaging (MRI) is increasingly being used in radiation therapy, and integration of MRI into brachytherapy in particular is becoming more common. We present here a systematic review of the basic physics and technical aspects of incorporating MRI into prostate brachytherapy. Terminology and MRI system components are reviewed along with typical work flows in prostate high-dose-rate and low-dose-rate brachytherapy. In general, the brachytherapy workflow consists of five key components: diagnosis, implantation, treatment planning (scan + plan), implant verification, and delivery. MRI integration is discussed for diagnosis; treatment planning; and MRI-guided brachytherapy implants, in which MRI is used to guide the physical insertion of the brachytherapy applicator or needles. Considerations and challenges for establishing an MRI brachytherapy program are also discussed.
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Affiliation(s)
- Jihong Wang
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX.
| | - Kari Tanderup
- Department of Oncology, Aarhus University Hospital, Aarhus, Denmark
| | - Adam Cunha
- Department of Radiation Oncology, University of California-San Francisco, CA
| | - Antonio L Damato
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Gil'ad N Cohen
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Rajat J Kudchadker
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX
| | - Firas Mourtada
- Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX; Department of Radiation Oncology, Helen F. Graham Cancer Center, Newark, DE; Department of Radiation Oncology, Bodine Cancer Center, Thomas Jefferson University, Philadelphia, PA.
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22
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Prostate magnetic resonance imaging for brachytherapists: Anatomy and technique. Brachytherapy 2017; 16:679-687. [PMID: 28237429 DOI: 10.1016/j.brachy.2016.12.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Revised: 11/23/2016] [Accepted: 12/30/2016] [Indexed: 12/31/2022]
Abstract
PURPOSE To present an overview of mp MRI techniques necessary for high-resolution imaging of prostate. METHODS We summarize examples from our clinical experience and concepts from the current literature that illustrate normal prostate anatomy on multiparametric MRI (mp MRI). RESULTS Our experience regarding optimal mp MRI image acquisition is provided, as well as a summary of prostate and periprostatic anatomy and anatomical variants that pose challenges for BT. CONCLUSIONS mp MRI provides unparalleled assessment of the prostate and periprostatic anatomy, making it the most appropriate imaging modality to facilitate prostate BT treatment planning, implantation, and followup. This work provides an introduction to prostate mp MR imaging, anatomy, and anatomical variants essential for successful integration mp MRI into prostate brachytherapy practice.
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Clinical use of magnetic resonance imaging across the prostate brachytherapy workflow. Brachytherapy 2017; 16:734-742. [PMID: 28153700 DOI: 10.1016/j.brachy.2016.11.012] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2016] [Revised: 11/08/2016] [Accepted: 11/29/2016] [Indexed: 11/21/2022]
Abstract
MRI produces better soft tissue contrast than does ultrasonography or computed tomography for visualizing male pelvic anatomy and prostate cancer. Better visualization of the tumor and organs at risk could allow better conformation of the dose to the target volumes while at the same time minimizing the dose to critical structures and the associated toxicity. Although the use of MRI for prostate brachytherapy would theoretically result in an improved therapeutic ratio, its implementation been slow, mostly because of technical challenges. In this review, we describe the potential role of MRI at different steps in the treatment workflow for prostate brachytherapy: for patient selection, treatment planning, in the operating room, or for postimplant assessment. We further present the current clinical experience with MRI-guided prostate brachytherapy, both for permanent seed implantation and high-dose-rate brachytherapy.
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Soni PD, Berlin A, Venkatesan AM, McLaughlin PW. Magnetic resonance imaging-guided functional anatomy approach to prostate brachytherapy. Brachytherapy 2016; 16:698-714. [PMID: 28040380 DOI: 10.1016/j.brachy.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To provide an MRI based functional anatomy guide to prostate brachytherapy. METHODS AND MATERIALS We performed a narrative review of periprostatic functional anatomy and the significance of this anatomy in prostate brachytherapy treatment planning. RESULTS MRI has improved delineation of gross tumor and critical periprostatic structures that have been implicated in toxicity. Furthermore, MRI has revealed the significant anatomic variants and the dynamic nature of these structures that can have significant implications for treatment planning and dosimetry. CONCLUSIONS The MRI-based functional anatomy approach to prostate brachytherapy takes into account extent of disease, its relation to the patient's individual anatomy, and functional baseline to optimize the therapeutic ratio of prostate cancer treatment.
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Affiliation(s)
- Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
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