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Sample records for iodine-125 prostate brachytherapy

  1. Iodine-125 brachytherapy for prostate cancer: first published Australian experience

    International Nuclear Information System (INIS)

    Joseph, David J.; Woo, Tony C.S.; Haworth, Annette

    2004-01-01

    With the emergence of new imaging and implant'techniques, prostate brachytherapy has become increasingly popular over the last decade. Brachytherapy promises to deliver twice the biologically effective dose as conventional external beam treatments without increasing the dose to tissues surrounding the prostate. However, there are few or no published Australian series of its efficacy in the clinic. We present the experience of one of the first centres in Australia to offer this service to its patients: a series from Sir Charles Gairdner Hospital in Western Australia. We present data on the efficacy of brachytherapy in maintaining prostate specific antigen levels, as well as the rate of urinary, rectal and sexual complications. Our results compare favourably with other brachytherapy and external beam treatment series. We believe that with the increasing trend towards dose escalation and novel therapies, standardized measurements of success and failure need to be better defined, and that randomized trials comparing modalities are needed to improve the management of prostate cancer Copyright (2004) Blackwell Publishing Asia Pty Ltd

  2. Prostate-specific antigen bounce following permanent iodine-125 prostate brachytherapy

    International Nuclear Information System (INIS)

    Azuma, Koji; Kikugawa, Tadahiko; Fukumoto, Tetsuya

    2013-01-01

    The purpose of this study was to evaluate a temporary increase in the prostate-specific antigen (PSA) level, so-called PSA bounce, which occurs following permanent iodine-125 prostate brachytherapy. From June 2006 to July 2011, 64 patients with localized prostate cancer were treated with brachytherapy by using iodine-125 implants. Seventeen patients received neoadjuvant hormonal therapy to reduce the prostate volume. After the treatment, patients were followed up with a PSA measurement every 3 months for the first 2 years and every 6 months thereafter. The median follow-up duration was 34.5 months (range, 3.5 to 64.0 months). PSA bounce was noted in 20 (31%) out of the 64 patients. The median time to PSA bounce was 13.3 months (range, 5.8 to 44.7 months), and 18 (90%) out of the 20 patients experienced an initial PSA increase within 24 months. The median bounce magnitude was 0.25 ng/mL (range, 0.10 to 1.36 ng/mL). PSA failure was observed in 2 (3%) out of the 64 patients, and PSA bounce was not a predictor of PSA recurrence. PSA bounce was significantly associated with post-treatment V100 and D90, but not with clinical stage, pretreatment PSA, Gleason score, neoadjuvant hormonal therapy status, or PSA failure. PSA bounce following brachytherapy is considerably common. No significant difference was found in biochemical failure-free survival between patients with and those without PSA bounce. Physicians must take PSA bounce following radiotherapy into consideration in order to avoid unnecessary salvage hormonal treatment. (author)

  3. Iodine-125 thin seeds decrease prostate swelling during transperineal interstitial permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Beydoun, Nadine; Bucci, Joseph A.; Chin, Yaw S.; Malouf, David

    2014-01-01

    Prostate swelling following seed implantation is a well-recognised phenomenon. The purpose of this intervention was to assess whether using thinner seeds reduces post-implant swelling with permanent prostate brachytherapy. Eighteen consecutive patients eligible for prostate seed brachytherapy underwent seed implantation using iodine-125 (I-125) thin seeds. Operative time, dosimetry, prostate swelling and toxicity were assessed and compared with standard I-125 stranded seed controls, sourced from the department's brachytherapy database. A learning curve was noted with the thin seeds in terms of greater bending and deviation of needles from their intended path. This translated into significantly longer total operative time (88 vs 103 minutes; P=0.009, 95% confidence interval (CI) 4.1-24.3) and time per needle insertion (2.6 vs 3.7 minutes; P<0.001, 95% CI 0.5-1.3) for the thin seeds. Day 30 prostate volumes were significantly smaller in the thin seed group compared with standard seeds (40.9cc vs 46.8cc; P=0.001, 95% CI 1.5-5.6). The ratio of preoperative transrectal ultrasound to day 30 post-implant CT volume was also smaller in the thin seed group (1.2±0.1 for standard seeds vs 1.1±0.1 for thin seeds). Post-implant dosimetric parameters were comparable for both groups. No significant differences were seen in acute urinary morbidity or quality of life between the two groups. I-125 thin seeds are associated with an initial learning curve, with longer operative time, even for experienced brachytherapists. The significant reduction in day 30 prostate volumes with the thin seeds has useful implications in terms of optimising dose coverage to the prostate in the early period post-implantation, as well as improving the accuracy of post-implant dosimetric assessments.

  4. Use of brachytherapy with permanent implants of iodine-125 in localized prostate cancer

    International Nuclear Information System (INIS)

    Bladou, F.; Serment, G.; Salem, N.; Simonian, M.; Rosello, R.; Ternier, F.

    2002-01-01

    Approximately 15,000 cases of early stage prostate cancer T1 and T2 are diagnosed every year in France by testing for PSA and performing prostatic biopsies. The treatment of these localized forms is based in most cases on radical prostatectomy or nn external beam radiotherapy. Although the ontological results obtained by these two therapeutic methods are satisfactory and equivalent in the long term, the side effects can be important. For a number of years, trans-perineal brachytherapy using permanent implants of iodine -125 or palladium-103 has proved itself as an alternative therapy with equivalent medium to long-term results. The low urinary, digestive and sexual side effects of prostate brachytherapy are important reasons for the enthusiasm among patients and the medical community for this therapy and the growing number of applications and centres which practice it. In September 1998 we started the prostate brachytherapy programmes- in Marseilles with close collaboration between the department of urology of the Hopital Salvator, and the departments of radiotherapy, medical imaging and medical physics of the Institut Paoli-Calmettes. To date, around 250 patients with localized adenocarcinoma of the prostate have benefited from this alternative therapy in our centre. Preliminary results, with a 3 year-follow-up, are comparable to results published in the literature by pioneer teams. (authors)

  5. Urethral and bladder dosimetry of total and focal salvage Iodine-125 prostate brachytherapy : Late toxicity and dose constraints

    NARCIS (Netherlands)

    Peters, Max; Van Der Voort Van Zyp, Jochem; Hoekstra, Carel; Westendorp, Hendrik; Van De Pol, Sandrine; Moerland, Marinus; Maenhout, Metha; Kattevilder, Rob; Van Vulpen, Marco

    2015-01-01

    Introduction Salvage Iodine-125 brachytherapy (I-125-BT) constitutes a curative treatment approach for patients with organ-confined recurrent prostate cancer after primary radiotherapy. Currently, focal salvage (FS) instead of whole-gland or total salvage (TS) is being investigated, to reduce severe

  6. Radiation exposure to operating room staff during prostate brachytherapy using iodine-125 seeds

    International Nuclear Information System (INIS)

    Gagna, G.; Amabile, J.C.; Laroche, P.; Gauron, C.

    2011-01-01

    The French defense radiation protection service (SPRA) and the French national institute for research and safety (INRS) conducted a joint study to assess the radiation exposure to operating room staff during prostate brachytherapy using iodine-125 seeds at the Val-de-Grace military hospital. The purpose of the study was the assessment of the effective doses, the equivalent doses to the extremities and lens received by a novice team, the different ambient dose equivalent rates measurements and the delineation of areas. After six brachy-therapies, all the recorded doses with whole-body InLight R OSL and nanoDot R dosimeters remained below the detection limit for the whole staff. The dose rate measured at the end of implantation by an AT1123 R survey meter is about 170 μSv/h at the perineum of the patient. The controlled area limit is estimated to be about 20 cm from the patient perineum. From these results, the authors propose recommendations for the categorization of workers, the delineation of areas and the dose monitoring procedures. This study demonstrates that real-time ultrasound-guided trans-perineal prostate brachytherapy delivers low dose to the operators because of the radioactive source characteristics and the instrumentation providing an effective radiation protection for the surgical team. (authors)

  7. Prostate-Specific Antigen Bounce After Permanent Iodine-125 Prostate Brachytherapy-An Australian Analysis

    International Nuclear Information System (INIS)

    Zwahlen, Daniel R.; Smith, Ryan; Andrianopoulos, Nick; Matheson, Bronwyn; Royce, Peter; Millar, Jeremy L.

    2011-01-01

    Purpose: To report on prostate-specific antigen (PSA) 'bounces' after 125 I prostate brachytherapy to review the relationship to biochemical control and correlate both clinical and dosimetric variables. Methods and Materials: We analyzed 194 hormone-naive patients with a follow-up of ≥3 years. Four bounce definitions were applied: an increase of ≥0.2 ng/mL (definition I), ≥0.4 ng/mL (definition II), ≥15% (definition III), and ≥35% (definition IV) of a previous value with spontaneous return to the prebounce level or lower. Results: Using definition I, II, III, and IV, a bounce was detected in 50%, 34%, 11%, and 9% of patients, respectively. The median time to onset was 14-16 months, the duration was 12-21.5 months, and the magnitude of the increase was 0.5-2 ng/mL. A magnitude of >2 ng/mL, fulfilling the criteria for biochemical failure (BF) according to the American Society for Therapeutic Radiology and Oncology Phoenix definition, was detected in 11.3%, 16.9%, 47.6%, and 50% using definitions I, II, III, and IV, respectively; 11 patients (5.7%) had true BF. The PSA bounces occurred earlier than BF (p < 0.001). The prediction of BF remains controversial and is probably unrelated to biochemical control. The only statistically significant factor predictive of a PSA bounce was younger age (definitions I and II). Conclusion: PSA bounces are common after brachytherapy. All definitions resulted in a high number of false-positive calls for BF during the first 2 years. The definition of an increase of ≥0.2 ng/mL should be preferred because of the lowest number of false-positive results for BF. Patients experiencing a PSA bounce during the first 2 years after brachytherapy should undergo surveillance every 3-6 months. Additional investigations are recommended for elevated postimplant PSA levels that have not corrected by 3 years of follow-up.

  8. Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherapy

    Directory of Open Access Journals (Sweden)

    Carlos Antônio da Silva Franca

    2014-04-01

    Full Text Available Objective To evaluate the relationship between two year PSA nadir (PSAn after brachytherapy and biochemical recurrence rates in prostate cancer patients. Materials and Methods In the period from January 1998 to August 2007, 120 patients were treated with iodine-125 brachytherapy alone. The results analysis was based on the definition of biochemical recurrence according to the Phoenix Consensus. Results Biochemical control was observed in 86 patients (71.7%, and biochemical recurrence, in 34 (28.3%. Mean PSAn was 0.53 ng/ml. The mean follow-up was 98 months. The patients were divided into two groups: group 1, with two year PSAn < 0.5 ng/ml after brachytherapy (74 patients; 61.7%, and group 2, with two year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%. Group 1 presented biochemical recurrence in 15 patients (20.3%, and group 2, in 19 patients (43.2% (p < 0.02. The analysis of biochemical disease-free survival at seven years, stratified by the two groups, showed values of 80% and 64% (p < 0.02, respectively. Conclusion Levels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly correlated with a poor prognosis. This fact may help to identify patients at risk for disease recurrence.

  9. Physical basics and clinical realization of interstitial brachytherapy of the prostate with iodine 125

    International Nuclear Information System (INIS)

    Kaulich, T.W.; Nuesslin, F.; Lamprecht, U.; Bamberg, M.; Paulsen, F.; Loeser, W.; Bichler, K.H.; Kahmann, F.; Henkel, T.O.; Maurer, U.

    2002-01-01

    Background: Interstitial brachytherapy with I-125 seeds can be used for successful treatment of early stage prostate cancer. There is presented the technique of permanent transperineal implantation of I-125 seeds with intraoperative treatment planning which is suited for the treatment of prostate cancer up to the clinical stage of T2a. Material and methods: Some weeks before the implantation of the seeds the prostate volume is determined using transrectal ultrasound (TRUS) so as to estimate the required number of I-125 seeds. At the outset of the treatment the prostate is stabilized by two perineally inserted needles. Subsequently there is carried out an ultrasound guide treatment planning that allows to optimize the distribution of the seeds within the prostate. In interstitial brachytherapy we use RAPID STRANDs trademark , i.e. the I-125 seeds are embedded in vicryl suture at distances of 1 cm. During implantation of the I-125 seeds the transversal placement of the applicator needles is controlled by TRUS and the cranio-caudal placement of the applicator needles is controlled using the fluoroscopic unit as well as TRUS. About 4 weeks after the implantation of the seeds there is carried out a postoperative computation of the dose distribution of the implant using CT imaging. Results: The procedure possesses the advantage that ultrasound imaging, treatment planning and seed implantation are carried out with the prostate remaining in an unaltered position. During implantation the combined imaging of TRUS and fluoroscopy allows a safe placement of the seeds within the prostate. Conclusion: The methods for the calculation of the actually attained dose distribution must still be optimized, because the postoperative examination of the individual results has so far been possible only with difficulties resulting from methodological inconveniences. (orig.) [de

  10. Interstitial brachytherapy of localised prostate cancer using iodine 125 permanent implants

    International Nuclear Information System (INIS)

    Peiffert, D.

    2005-01-01

    Brachytherapy with permanent implants is a validated method of treatment of prostate adenocarcinomas of favourable prognosis. Its technology is based on endorectal ultrasonography and on per-operative visualisation of the implant and the dose distribution. A strict selection of the patients is necessary before this localised treatment. An active collaboration between urologists, radio-physicists and radiation oncologists is necessary during all the process of selection, treatment and follow-up of the patients. An assessment of the carcinological and functional results is necessary. Recommendations are formalized by a joint collaboration between members of the AFU and of the SFRO. (author)

  11. Iodine 125 prostate brachytherapy: prognostic factors for long-term urinary, digestive and sexual toxicities

    International Nuclear Information System (INIS)

    Doyen, J.; Mohammed Ali, A.; Ginot, A.; Ferre, M.; Castelli, J.; Hannoun-Levi, J.M.; Chamorey, E.; Mohammed Ali, A.; Quintens, H.; Amiel, J.

    2009-01-01

    Purpose For patients with good urinary function and presenting with a low risk prostate cancer, prostate brachytherapy using iodine implants represents one of the techniques of reference. This retrospective analysis investigates urinary (U), digestive (D) and sexual (S) toxicities and their prognostic factors of duration. Material and methods From August 2000 to November 2007, 176 patients presenting with prostate adenocarcinoma underwent interstitial brachytherapy. Urinary, digestive and sexual toxicities were classified according to Common toxicities criteria for adverse events, version 3.0 (C.T.C.A.E. V 3.0). For each toxicity (U, D, S), the number of complications U (dysuria, nicturia), D (proctitis, diarrhea) and S (sexual dysfunction, loss of libido) was listed and analyzed according to criteria related to the patient, implant, dosimetric data and characteristics of the toxicity. Prognostic factors identified in univariate analysis (U.V.A.) (Log Rank) were further analyzed in multivariate analysis (M.V.A.) (Cox model). Results With a median follow-up of 26 months (1-87), 147 patients (83.5 %) presented urinary toxicities. Among them, 29.5 % (86 patients) and 2.4 % (seven patients) presented grade 2 and 3 U toxicity respectively. In U.V.A., urinary grade toxicity greater than or equal to 2 (p = 0.037), the presence of initial U symptoms (p = 0.027) and more than two urinary toxicities (p 0.00032) were recognized as prognostic factors. The number of U toxicities was the only prognostic factor in M.V.A. (p = 0.04). D toxicity accounted for 40.6 % (71 patients). Among them, 3 % (six patients) were grade 2. None were grade 3. Two factors were identified as prognostic factors either in U.V.A. and M.V.A.: the number of D toxicities greater than or equal to 2 (univariate analysis: p = 0,00129, multivariate analysis: p = 0,002) and age less than or equal to 65 years (univariate analysis: p = 0,004, multivariate analysis: p 0,007). Eighty-three patients (47

  12. DNA-PKcs Expression Is a Predictor of Biochemical Recurrence After Permanent Iodine 125 Interstitial Brachytherapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Molina, Sarah [Department of Pathology, INSERM UMR1069, CHU/Université de Tours, Tours (France); Department of Radiation Oncology, CHU/Université de Poitiers, Poitiers (France); Guerif, Stéphane; Garcia, Alexandre [Department of Radiation Oncology, CHU/Université de Poitiers, Poitiers (France); Debiais, Céline [Department of Pathology, CHU/Université de Poitiers, Poitiers (France); Irani, Jacques [Department of Urology, CHU/Université de Poitiers, Poitiers (France); Fromont, Gaëlle, E-mail: gaelle.fromont-hankard@univ-tours.fr [Department of Pathology, INSERM UMR1069, CHU/Université de Tours, Tours (France)

    2016-07-01

    Purpose: Predictive factors for biochemical recurrence (BCR) in localized prostate cancer (PCa) after brachytherapy are insufficient to date. Cellular radiosensitivity depends on DNA double-strand breaks, mainly repaired by the nonhomologous end-joining (NHEJ) system. We analyzed whether the expression of NHEJ proteins can predict BCR in patients treated by brachytherapy for localized PCa. Methods and Materials: From 983 PCa cases treated by brachytherapy between March 2000 and March 2012, 167 patients with available biopsy material suitable for in situ analysis were included in the study. The median follow-up time was 47 months. Twenty-nine patients experienced BCR. All slides were reviewed to reassess the Gleason score. Expression of the key NHEJ proteins DNA-PKcs, Ku70, and Ku80, and the proliferation marker Ki67, was studied by immunohistochemistry performed on tissue microarrays. Results: The Gleason scores after review (P=.06) tended to be associated with BCR when compared with the score initially reported (P=.74). Both the clinical stage (P=.02) and the pretreatment prostate-specific antigen level (P=.01) were associated with biochemical failure. Whereas the expression of Ku80 and Ki67 were not predictive of relapse, positive DNA-PKcs nuclear staining (P=.003) and higher Ku70 expression (P=.05) were associated with BCR. On multivariate analysis, among pretreatment variables, only DNA-PKcs (P=.03) and clinical stage (P=.02) remained predictive of recurrence. None of the patients without palpable PCa and negative DNA-PKcs expression experienced biochemical failure, compared with 32% of men with palpable and positive DNA-PKcs staining that recurred. Conclusions: Our results suggest that DNA-PKcs could be a predictive marker of BCR after brachytherapy, and this might be a useful tool for optimizing the choice of treatment in low-risk PCa patients.

  13. Automation system for quality control in manufacture of iodine-125 sealed sources used in brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Somessari, Samir L.; Feher, Anselmo; Sprenger, Francisco E.; Rostellato, Maria E.C.M.; Moura, Joao A.; Costa, Osvaldo L.; Calvo, Wilson A.P., E-mail: somessar@ipen.b, E-mail: afeher@ipen.b, E-mail: sprenger@ipen.b, E-mail: elisaros@ipen.b, E-mail: olcosta@ipen.b, E-mail: wapcalvo@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2011-07-01

    The objective of this work is to develop an automation system for Quality Control in the production of Iodine-125 sealed sources, after undergoing the process of laser beam welding. These sources, also known as Iodine-125 seeds are used, successfully, in the treatment of cancer by brachytherapy, with low-dose rates. Each small seed is composed of a welded titanium capsule with 0.8 mm diameter and 4.5 mm in length, containing Iodine-125 adsorbed on an internal silver wire. The seeds are implanted in the human prostate to irradiate the tumor and treat the cancerous cells. The technology to automate the quality control system in the manufacture of Iodine-125 seeds consists in developing and associate mechanical parts, electronic components and pneumatic circuits to control machines and processes. The automation technology for Iodine-125 seed production developed in this work employs programmable logic controller, step motors, drivers of control, electrical-electronic interfaces, photoelectric sensors, interfaces of communication and software development. Industrial automation plays an important role in the production of Iodine-125 seeds, with higher productivity and high standard of quality, facilitating the implementation and operation of processes with good manufacturing practices. Nowadays, the Radiation Technology Center at IPEN-CNEN/SP imports and distributes 36,000 Iodine-125 seeds per year for clinics and hospitals in the whole country. However, the Brazilian potential market is of 8,000 Iodine-125 seeds per month. Therefore, the local production of these radioactive seeds has become a priority for the Institute, aiming to reduce the price and increase the supply to the population in Brazil. (author)

  14. Automation system for quality control in manufacture of iodine-125 sealed sources used in brachytherapy

    International Nuclear Information System (INIS)

    Somessari, Samir L.; Feher, Anselmo; Sprenger, Francisco E.; Rostellato, Maria E.C.M.; Moura, Joao A.; Costa, Osvaldo L.; Calvo, Wilson A.P.

    2011-01-01

    The objective of this work is to develop an automation system for Quality Control in the production of Iodine-125 sealed sources, after undergoing the process of laser beam welding. These sources, also known as Iodine-125 seeds are used, successfully, in the treatment of cancer by brachytherapy, with low-dose rates. Each small seed is composed of a welded titanium capsule with 0.8 mm diameter and 4.5 mm in length, containing Iodine-125 adsorbed on an internal silver wire. The seeds are implanted in the human prostate to irradiate the tumor and treat the cancerous cells. The technology to automate the quality control system in the manufacture of Iodine-125 seeds consists in developing and associate mechanical parts, electronic components and pneumatic circuits to control machines and processes. The automation technology for Iodine-125 seed production developed in this work employs programmable logic controller, step motors, drivers of control, electrical-electronic interfaces, photoelectric sensors, interfaces of communication and software development. Industrial automation plays an important role in the production of Iodine-125 seeds, with higher productivity and high standard of quality, facilitating the implementation and operation of processes with good manufacturing practices. Nowadays, the Radiation Technology Center at IPEN-CNEN/SP imports and distributes 36,000 Iodine-125 seeds per year for clinics and hospitals in the whole country. However, the Brazilian potential market is of 8,000 Iodine-125 seeds per month. Therefore, the local production of these radioactive seeds has become a priority for the Institute, aiming to reduce the price and increase the supply to the population in Brazil. (author)

  15. Use of brachytherapy with permanent implants of iodine-125 in localized prostate cancer; La curietherapie par implants permanents d'I-125 dans le cancer localise de la prostate

    Energy Technology Data Exchange (ETDEWEB)

    Bladou, F.; Serment, G. [Hopital Salvador, Service d' Urologie, 13 - Marseille (France); Salem, N.; Simonian, M. [Hopital Salvador, Dept. de Radiotherapie, 13 - Marseille (France); Rosello, R.; Ternier, F. [Institut Paoli-Calmettes, Dept. de Radiologie, 13 - Marseille (France)

    2002-07-01

    Approximately 15,000 cases of early stage prostate cancer T1 and T2 are diagnosed every year in France by testing for PSA and performing prostatic biopsies. The treatment of these localized forms is based in most cases on radical prostatectomy or nn external beam radiotherapy. Although the ontological results obtained by these two therapeutic methods are satisfactory and equivalent in the long term, the side effects can be important. For a number of years, trans-perineal brachytherapy using permanent implants of iodine -125 or palladium-103 has proved itself as an alternative therapy with equivalent medium to long-term results. The low urinary, digestive and sexual side effects of prostate brachytherapy are important reasons for the enthusiasm among patients and the medical community for this therapy and the growing number of applications and centres which practice it. In September 1998 we started the prostate brachytherapy programmes- in Marseilles with close collaboration between the department of urology of the Hopital Salvator, and the departments of radiotherapy, medical imaging and medical physics of the Institut Paoli-Calmettes. To date, around 250 patients with localized adenocarcinoma of the prostate have benefited from this alternative therapy in our centre. Preliminary results, with a 3 year-follow-up, are comparable to results published in the literature by pioneer teams. (authors)

  16. Radiation exposure to operating room staff during prostate brachytherapy using iodine-125 seeds; Exposition radiologique de l'equipe operatoire au cours de curietherapies de prostate par implants permanents d'iode-125

    Energy Technology Data Exchange (ETDEWEB)

    Gagna, G.; Amabile, J.C.; Laroche, P. [Service de protection radiologique des armees (SPRA), 1 bis rue du Lieutenant Raoul Batany, 92141 Clamart Cedex (France); Gauron, C. [Institut national de recherche et de securite (INRS), Departement Etudes et Assistance Medicales, 30 rue Olivier Noyer, 75680 Paris Cedex 14 (France)

    2011-04-15

    The French defense radiation protection service (SPRA) and the French national institute for research and safety (INRS) conducted a joint study to assess the radiation exposure to operating room staff during prostate brachytherapy using iodine-125 seeds at the Val-de-Grace military hospital. The purpose of the study was the assessment of the effective doses, the equivalent doses to the extremities and lens received by a novice team, the different ambient dose equivalent rates measurements and the delineation of areas. After six brachy-therapies, all the recorded doses with whole-body InLight{sup R} OSL and nanoDot{sup R} dosimeters remained below the detection limit for the whole staff. The dose rate measured at the end of implantation by an AT1123{sup R} survey meter is about 170 {mu}Sv/h at the perineum of the patient. The controlled area limit is estimated to be about 20 cm from the patient perineum. From these results, the authors propose recommendations for the categorization of workers, the delineation of areas and the dose monitoring procedures. This study demonstrates that real-time ultrasound-guided trans-perineal prostate brachytherapy delivers low dose to the operators because of the radioactive source characteristics and the instrumentation providing an effective radiation protection for the surgical team. (authors)

  17. Development of an encapsulation method using plasma arc welding to produce iodine-125 seeds for brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Feher, Anselmo; Calvo, Wilson A.P.; Rostelato, Maria E.C.M.; Zeituni, Carlos A.; Somessari, Samir L.; Costa, Osvaldo L.; Moura, Joao A.; Moura, Eduardo S.; Souza, Carla D.; Rela, Paulo R., E-mail: afeher@ipen.b, E-mail: wapcalvo@ipen.b, E-mail: elisaros@ipen.b, E-mail: somessar@ipen.b, E-mail: olcosta@ipen.b, E-mail: esmoura@ipen.b, E-mail: cdsouza@ipen.b, E-mail: prela@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2011-07-01

    The prostate cancer, which is the second cause of death by cancer in men, overcome only by lung cancer is public health problem in Brazil. Brachytherapy is among the possible available treatments for prostate cancer, in which small seeds containing Iodine-125 radioisotope are implanted into the prostate gland. The seed consists of a titanium sealed capsule with 0.8 mm external diameter and 4.5 mm length, containing a central silver wire with adsorbed Iodine-125. The Plasma Arc Welding (PAW) is one of the viable techniques for sealing process. The equipment used in this technique is less costly than in other processes, such as, Laser Beam Welding (LBW). The main purpose of this work was the development of an encapsulation method using PAW. The development of this work has presented the following phases: cutting and cleaning titanium tube, determination of the welding parameters, development of a titanium tube holding device for PAW, sealed sources validation according to ISO 2919 - Sealed Radioactive Sources - General Requirements and Classification, and metallographic assays. The developed procedure to seal Iodine-125 seeds using PAW has shown high efficiency, satisfying all the established requirements of ISO 2919. The results obtained in this work will give the possibility to establish a routine production process according to the orientations presented in resolution RDC 17 - Good Manufacturing Practices to Medical Products defined by the ANVISA - National Agency of Sanitary Surveillance. (author)

  18. Development of an encapsulation method using plasma arc welding to produce iodine-125 seeds for brachytherapy

    International Nuclear Information System (INIS)

    Feher, Anselmo; Calvo, Wilson A.P.; Rostelato, Maria E.C.M.; Zeituni, Carlos A.; Somessari, Samir L.; Costa, Osvaldo L.; Moura, Joao A.; Moura, Eduardo S.; Souza, Carla D.; Rela, Paulo R.

    2011-01-01

    The prostate cancer, which is the second cause of death by cancer in men, overcome only by lung cancer is public health problem in Brazil. Brachytherapy is among the possible available treatments for prostate cancer, in which small seeds containing Iodine-125 radioisotope are implanted into the prostate gland. The seed consists of a titanium sealed capsule with 0.8 mm external diameter and 4.5 mm length, containing a central silver wire with adsorbed Iodine-125. The Plasma Arc Welding (PAW) is one of the viable techniques for sealing process. The equipment used in this technique is less costly than in other processes, such as, Laser Beam Welding (LBW). The main purpose of this work was the development of an encapsulation method using PAW. The development of this work has presented the following phases: cutting and cleaning titanium tube, determination of the welding parameters, development of a titanium tube holding device for PAW, sealed sources validation according to ISO 2919 - Sealed Radioactive Sources - General Requirements and Classification, and metallographic assays. The developed procedure to seal Iodine-125 seeds using PAW has shown high efficiency, satisfying all the established requirements of ISO 2919. The results obtained in this work will give the possibility to establish a routine production process according to the orientations presented in resolution RDC 17 - Good Manufacturing Practices to Medical Products defined by the ANVISA - National Agency of Sanitary Surveillance. (author)

  19. Development of an automation system for iodine-125 brachytherapy seed production by (Nd:YAG) laser welding

    International Nuclear Information System (INIS)

    Somessari, Samir Luiz

    2010-01-01

    The aim of this work is to develop an automation system for iodine-125 radioactive seed production by (Nd:YAG) laser welding, which has been used successfully in Low Dose Rate (LDR) brachytherapy treatment. This small seed consists of a welded titanium capsule, with 0.8mm in diameter and 4.5mm in length, containing iodine-125 adsorbed onto a silver rod. The iodine-125 seeds are implanted into the human prostate to irradiate the tumor for cancer treatment. Nowadays, the Radiation Technology Center, at IPEN-CNEN/SP imports and distributes 36,000 iodine-125 seeds per year, for the clinics and hospitals in the country. However, the Brazilian market potential is now over 8,000 iodine-125 seeds per month. The local production of these iodine-125 radioactive sources becomes a priority for the Institute, in order to reduce the price and the problems of prostate cancer management. It will permit to spread their use to a largest number of patients in Brazil. On the other hand, the industrial automation plays an important role for iodine-125 seeds in order to increase the productivity, with high quality and assurance, avoiding human factors, implementing and operating with Good Manufacturing Practices (GMP). The technology consists of appliance electronic and electro-mechanical parts and components to control machines and processes. The automation system technology for iodine-125 seed production developed in this work was mainly assembled employing Programmable Logic Controller (PLC), stepper motors, drivers, (Nd:YAG) laser welding machine, photoelectric sensors and supervisory. (author)

  20. Development of an automation system for iodine-125 brachytherapy seed production by ND:YAG laser welding

    International Nuclear Information System (INIS)

    Somessari, Samir L.; Feher, Anselmo; Sprenger, Francisco E.; Rostellato, Maria Elisa C.M.; Costa, Fabio E.; Calvo, Wilson A.P.

    2009-01-01

    The aim of this work is to develop an automation system for iodine-125 radioactive seed production by Nd:YAG laser welding, which has been used successfully in low dose rate brachytherapy treatment. This small seed consists of a welded titanium capsule, with 0.8 mm in diameter and 4.5 mm in length, containing iodine-125 adsorbed onto a silver rod. The iodine-125 seeds are implanted into the human prostate to irradiate the tumor for cancer treatment. Nowadays, the Radiation Technology Center, at IPEN-CNEN/SP imports and distributes 36,000 iodine-125 seeds per year, for the clinics and hospitals in the country. However, the Brazilian market potential is now over 8,000 iodine-125 seeds per month. The local production of these iodine-125 radioactive sources became a priority for the Institute, in order to reduce the price and the problems of prostate cancer management. It will permit to spread their use to a larger number of patients in Brazil. On the other hand, the industrial automation plays an important role for iodine-125 seeds in order to increase the productivity, with high quality and assurance, avoiding human factors, implementing and operating with good manufacturing practices. The technology consists of appliance electronic and electro-mechanical parts and components to control machines and processes. The automation system technology for iodine-125 seed production developed in this work was mainly assembled employing a Programmable Logic Controller, a stepper motor, an Nd:YAG laser welding machine and a supervisory. (author)

  1. Dosimetric study in iodine-125 seeds for brachytherapy application

    International Nuclear Information System (INIS)

    Zeituni, Carlos Alberto

    2008-01-01

    The demand for iodine-125 seeds for use in brachytherapy treatments has experienced an increase along recent years in Brazil and all over the world. All iodine-125 seed must have its operational parameters measured and/or calculated every time changes in the production process are carried out. A complete dosimetric measurement is very expensive, and it is recommended that this procedure must be repeated at least once a year. Thus, this work developed a methodology for the entire dosimetric process. This methodology is based on the scarce information available in the literature, once almost all the methodology used in large industrial laboratories is commercial secret. The proposed methodology was tested using seeds of Amersham-Oncura-Ge Healthcare, which is the largest seed manufactory in the world. In this new methodology, an automatic reader was employed in order to reduce the time required in the selection process of the TLD-100 dosimeters used and a postprocessing of the obtained spectra was carried out. A total of 142 dosimeters were used and only 29 have been selected using the new methodology. Measurements were performed using slabs of Solid Water RW1 to simulate measuring in the 'water', using three different experimental apparatus and each measurement was repeated at least three times. The TLD-100 calibration was performed using a Dermopan II - Siemens. The measured values showed a good agreement with the ones available in the literature. Finally, these measured values were compared with calculated ones obtained by a semiempirical simulation program, showing a good agreement and, therefore, demonstrating the validity of the proposed methodology regarding dosimetric calculations. (author)

  2. The Importance of Prostate-specific Antigen (PSA) Nadir and Early Identification of PSA Relapse after 10 Years of Prostate Iodine 125 Seed Brachytherapy in Edinburgh.

    Science.gov (United States)

    McLaren, D B; Kerr, G; Law, A B; Brush, J P; Keanie, J; Malik, J; Keough, W; Ronaldson, T; Lee, J; Kehoe, T

    2015-09-01

    To analyse our 5 and 10 year prostate brachytherapy outcome data and to assess the impact of PSA nadir on relapse free survival and whether an alternative definition of PSA relapse could detect men destined to fail by the Phoenix definition at an earlier time point. 474 men were treated over a 10 year period between 20012 and 2011 and divided into 2 five year cohorts for the purpose of the analysis. The risk of relapse is strongly predicted by post treat prostate-specific antigen (PSA) nadir. After 3 years post-treatment, PSA nadir plus 0.4 ng/ml identified men at risk of relapse 17 months earlier than the Phoenix definition. The Phoenix definition of nadir plus 2.0 ng/ml does not allow the early identification of men destined to relapse. The initiation of salavage therapy at the earliest opportunity could potentially affect subsequent survival and an outline randomised controlled trial proposal is presented. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

  3. Focal salvage iodine-125 brachytherapy for prostate cancer recurrences after primary radiotherapy: A retrospective study regarding toxicity, biochemical outcome and quality of life

    International Nuclear Information System (INIS)

    Peters, Max; Maenhout, Metha; Voort van Zyp, Jochem R.N. van der; Moerland, Marinus A.; Moman, Maaike R.; Steuten, Lotte M.G.; Deursen, Marijke J.H. van; Vulpen, Marco van

    2014-01-01

    Purpose: Whole-gland salvage for recurrent prostate cancer (PCa) shows high failure and toxicity rates. Early and adequate localization of recurrences enables focal salvage, thereby potentially improving functional outcomes, while maintaining cancer control. Materials and methods: Retrospective analysis yielded 20 focal salvage I125 brachytherapy patients for locally recurrent PCa after primary radiotherapy. Tumor was defined by multiparametric MRI and correspondence with transrectal biopsies. Dose data were obtained intra-operatively. The tumor was prescribed ⩾144 Gy. Toxicity was scored by the Common Terminology Criteria for Adverse Events version 4 (CTCAE-4). Biochemical failure (BF) was defined using the Phoenix criteria (PSA-nadir + 2.0 ng/ml). Quality of life (QoL) was measured by SF-36 Health Survey and European Organization of Research and Treatment of Cancer (EORTC) C30+3 and PR25 questionnaires. Results: With a median follow-up of 36 months (range 10–45), six patients experienced BF, of which three had no initial response. Grade 3 genitourinary (GU) toxicity occurred in one patient (a urethral stricture). The five previously potent patients retained erectile function. QoL remained decreased with regard to urinary symptoms. Conclusion: Focal salvage I125 brachytherapy showed one grade 3 GU toxicity in the 20 treated patients. Biochemical response and QoL were acceptable

  4. Comparative studies on permanent prostate brachytherapy: pre-plan and real-time transrectal ultrasound guided iodine-125 seed implants at Korle-Bu Teaching Hospital, Ghana

    International Nuclear Information System (INIS)

    Kalolo, L.T.

    2013-06-01

    This research was carried out to investigate and compare the real-time and pre-plan implant at the Radiotherapy Department of the Korle Bu Teaching Hospital, Ghana. Prowess Panther 4.5 treatment planning system and variseed 7.2 software were used for pre-plan and real-time implant respectively. The study was conducted for eighty three (83) patients treated for prostate cancer through real-time implant brachytherapy between september, 2008 to April, 2013. Thirty one patients (31) patients whose ultrasound images were available were selected for the pre-plan study. The slices of ultrasound images were re-drawn on transparent A-4 sheets and later on scanned, contoured and registered in the treatment planning system (prowess 4.5). After planning, the volume to be implanted, total number of needles, seeds and the total activity of the source were displayed. Comparison was done withe the pre-plan and real-time implant. In both cases the variation was below 5% as recommended in dosimetry. About 30% - 40% of the imported seeds were left un-used due to over-estimation of seeds ordered from the manufacturer (BARD Company-USA). Hence this work (pre-plan) aims to solve this problem. The comparison for dosimetric parameters was assessed for prostate, urethra and rectum as (V 95%, V 100%, V 150%, D90Gy, D90%), (D90Gy, D90%, D30Gy, D30% ) and (V 100%, D30Gy and D30%) respectively and the variation were within the limit of ± 5%. Comparison of dosimetric values for this work were done with other institutions, like Karolinska university hospital, Sweden, The institute of Curie/ hospital Cochin Group Paris-France and European recommendations. The values reported at Korle - Bu teaching hospital (this work) were in good agreement with the international guidelines. (au)

  5. Assessment of the risks associated with Iodine-125 handling production sources for brachytherapy

    International Nuclear Information System (INIS)

    Souza, Daiane C.B.; Rostelato, Maria Elisa C.; Vicente, Roberto; Zeituni, Carlos A.; Tiezzi, Rodrigo; Costa, Osvaldo L.; Souza, Carla D.; Peleias Junior, Fernando S.; Rodrigues, Bruna T.; Souza, Anderson S.; Batista, Talita Q.; Melo, Emerson R.; Camargo, Anderson R.; Karam Junior, Dib

    2015-01-01

    In Brazil, prostate cancer is the second most frequent disease, with an estimated 68,800 new cases in 2013. This type of cancer can be treated with brachytherapy, which uses sealed sources of Iodine-125 implanted permanently in the prostate. These sources are currently imported at a high cost, making public treatment in large scale impractical. To reduce costs and to meet domestic demand, the laboratory for production of brachytherapy sources at the Nuclear and Energy Research Institute (IPEN) is currently nationalizing the production of this radioisotope. Iodine is quite volatile making the handling of its radioactive isotopes potentially dangerous. The aim of this paper is to evaluate the risks to which workers are exposed during the production and handling of the sources. The research method consisted initially of a literature review on the toxicity of iodine, intake limits, related physical risks, handling of accidents, generation of radioactive wastes, etc. The results allowed for establishing safety and radioprotection policies in order to ensure efficient and safe production in all stages and the implementation of good laboratory practices. (author)

  6. Iodine-125 orbital brachytherapy with a prosthetic implant in situ

    Energy Technology Data Exchange (ETDEWEB)

    Stannard, Clare [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Radiation Oncology; Maree, Gert; Munro, Roger [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Medical Physics; Lecuona, Karin [Groote Schuur Hospital and Cape Town Univ. (South Africa). Dept. of Ophthalmology; Sauerwein, Wolfgang [Universitaetsklinikum Essen (Germany). Strahlenklinik, NCTeam

    2011-05-15

    Purpose: Brachytherapy is one method of irradiating the orbit after enucleation of an eye with a malignant tumor that has a potential to recur. It consists of 6 trains of I-125 seeds placed around the periphery of the orbit, a shorter central train, and a metal disc, loaded with seeds, placed beneath the eyelids. The presence of a prosthetic orbital implant requires omission of the central train and adjustment of the activity of the seeds in the anterior orbit around the prosthesis. Patients and Methods: This is a retrospective review of the technical modifications and outcome of 12 patients treated in this manner: 6 with retinoblastoma, 5 with malignant melanoma, and 1 with an intraocular rhabdomyosarcoma. The median dose was 35.5 Gy in 73 hours for retinoblastoma and 56 Gy in 141 hours for malignant melanoma. Patients with retinoblastoma and rhabdomyosarcoma also received chemotherapy. Results: The tubes can be placed satisfactorily around the prosthesis. The increased activity in the anterior half of the tubes produced comparable dose distributions. There have been no orbital recurrences, no extrusion of the prosthesis, and cosmesis is good. Conclusion: Insertion of a prosthetic implant at the time of enucleation greatly enhances the subsequent cosmetic appearance. This should be encouraged unless there is frank tumor in the orbit. Orbital brachytherapy without the central train continues to give excellent local control. The short treatment time and good cosmesis are added advantages. The patient is spared the expense and inconvenience of removing and replacing the prosthetic implant. (orig.)

  7. Study and methodology development for quality control in the production process of iodine-125 radioactive sealed sources applied to brachytherapy

    International Nuclear Information System (INIS)

    Moura, Joao Augusto

    2009-01-01

    Today cancer is the second cause of death by disease in several countries, including Brazil. Excluding skin cancer, prostate cancer is the most incident in the population. Prostate tumor can be treated by several ways, including brachytherapy, which consists in introducing sealed radioactive sources (Iodine - 125 seeds) inside the tumor. The target region of treatment receives a high radiation dose, but healthy neighbor tissues receive a significantly reduced radiation dose. The seed is made of a welding sealed titanium capsule, 0.8 mm external diameter and 4.5 mm length, enclosing a 0.5 mm diameter silver wire with Iodine-125 adsorbed. After welded, the seeds have to be submitted to a leak test to prevent any radioactive material release. The aims of this work were: (a) the study of the different leakage test methods applied to radioactive seeds and recommended by the ISO 997820, (b) the choice of the appropriate method and (c) the flowchart determination of the process to be used during the seeds production. The essays exceeded the standards with the use of ultra-sound during immersion and the corresponding benefits to leakage detection. Best results were obtained with the immersion in distilled water at 20 degree C for 24 hours and distilled water at 70 degree C for 30 minutes. These methods will be used during seed production. The process flowchart has all the phases of the leakage tests according to the sequence determined in the experiments. (author)

  8. Relationship between two year PSA nadir and biochemical recurrence in prostate cancer patients treated with iodine-125 brachytherapy; A relacao entre PSA nadir de dois anos e recidiva bioquimica no tratamento do cancer de prostata com braquiterapia de semente de iodo-125

    Energy Technology Data Exchange (ETDEWEB)

    Franca, Carlos Antonio da Silva; Vieira, Sergio Lannes; Penna, Antonio Belmiro Rodrigues Campbell, E-mail: carlosfranca@cremerj.org.br [Instituto Brasileiro de Oncologia (IBO), Rio de Janeiro, RJ (Brazil); Radioterapia Botafogo, Rio de janeiro, RJ (Brazil); Carvalho, Antonio Carlos Pires [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil); Bernabe, Antonio Jose Serrano [Radioterapia Botafogo, Rio de janeiro, RJ (Brazil)

    2014-03-15

    Objective: to evaluate the relationship between two year PSA nadir (PSAn) after brachytherapy and biochemical recurrence rates in prostate cancer patients. Materials and methods: In the period from January 1998 to August 2007, 120 patients were treated with iodine-125 brachytherapy alone. The results analysis was based on the definition of biochemical recurrence according to the Phoenix Consensus. Results: biochemical control was observed in 86 patients (71.7%), and biochemical recurrence, in 34 (28.3%). Mean PSAn was 0.53 ng/ml. The mean follow-up was 98 months. The patients were divided into two groups: group 1, with two year PSAn < 0.5 ng/ml after brachytherapy (74 patients; 61.7%), and group 2, with two year PSAn ≥ 0.5 ng/ml after brachytherapy (46 patients; 38.3%). Group 1 presented biochemical recurrence in 15 patients (20.3%), and group 2, in 19 patients (43.2%) (p < 0.02). The analysis of biochemical disease-free survival at seven years, stratified by the two groups, showed values of 80% and 64% (p < 0.02), respectively. Conclusion: levels of two year PSAn ≥ 0.5 ng/ml after brachytherapy are strongly correlated with a poor prognosis. This fact may help to identify patients at risk for disease recurrence. (author)

  9. Iodine 125 prostate brachytherapy: prognostic factors for long-term urinary, digestive and sexual toxicities;Curietherapie de prostate par iode 125: facteurs pronostiques de longue duree de toxicite urinaire, digestive et sexuelle

    Energy Technology Data Exchange (ETDEWEB)

    Doyen, J.; Mohammed Ali, A.; Ginot, A.; Ferre, M.; Castelli, J.; Hannoun-Levi, J.M. [Centre Antoine-Lacassagne, Dept. de Radiotherapie Oncologique, 06 - Nice (France); Chamorey, E. [Centre Antoine-Lacassagne, Unite de Statistiques Medicales, 06 - Nice (France); Mohammed Ali, A. [Faculte de Medecine, SOHAG (Egypt); Quintens, H.; Amiel, J. [CHU Pasteur, Service d' Urologie, 06 - Nice (France)

    2009-12-15

    Purpose For patients with good urinary function and presenting with a low risk prostate cancer, prostate brachytherapy using iodine implants represents one of the techniques of reference. This retrospective analysis investigates urinary (U), digestive (D) and sexual (S) toxicities and their prognostic factors of duration. Material and methods From August 2000 to November 2007, 176 patients presenting with prostate adenocarcinoma underwent interstitial brachytherapy. Urinary, digestive and sexual toxicities were classified according to Common toxicities criteria for adverse events, version 3.0 (C.T.C.A.E. V 3.0). For each toxicity (U, D, S), the number of complications U (dysuria, nicturia), D (proctitis, diarrhea) and S (sexual dysfunction, loss of libido) was listed and analyzed according to criteria related to the patient, implant, dosimetric data and characteristics of the toxicity. Prognostic factors identified in univariate analysis (U.V.A.) (Log Rank) were further analyzed in multivariate analysis (M.V.A.) (Cox model). Results With a median follow-up of 26 months (1-87), 147 patients (83.5 %) presented urinary toxicities. Among them, 29.5 % (86 patients) and 2.4 % (seven patients) presented grade 2 and 3 U toxicity respectively. In U.V.A., urinary grade toxicity greater than or equal to 2 (p = 0.037), the presence of initial U symptoms (p = 0.027) and more than two urinary toxicities (p 0.00032) were recognized as prognostic factors. The number of U toxicities was the only prognostic factor in M.V.A. (p = 0.04). D toxicity accounted for 40.6 % (71 patients). Among them, 3 % (six patients) were grade 2. None were grade 3. Two factors were identified as prognostic factors either in U.V.A. and M.V.A.: the number of D toxicities greater than or equal to 2 (univariate analysis: p = 0,00129, multivariate analysis: p = 0,002) and age less than or equal to 65 years (univariate analysis: p = 0,004, multivariate analysis: p 0,007). Eighty-three patients (47

  10. The development of a human eye model for ophthalmic iodine-125 brachytherapy dosimetry

    International Nuclear Information System (INIS)

    Mourao, A.P.; Campos, T.P.R.

    2008-01-01

    Full text: Radiotherapy is used to treat malign tumors. Radiotherapy is an alternative to enucleation in ocular tumors. However, the irradiation of ocular region can bring damages due high doses, mainly in the crystalline lens and in the bone tissue in growth phase. Brachytherapy instead of teletherapy looks for reducing doses in the crystalline lens and the adjacent tissues of the ocular globe (orbital region), minimizing side effects. Herein, some encapsulated radioisotopes in radioactive seeds applied to the ocular brachytherapy are available. Thus, a three-dimensional computational voxel model of the ocular region with its heterogeneous tissues, globe and adjacent tissues is developed. This computational model is used to simulate orbital irradiation with radioactive seeds positioned on the sclera surface through the MCNP5 code. The computational simulation allows evaluating how doses are spatially distributed in the orbital volume in treatments with the radioactive seeds of iodine-125. Therefore, the results allow comparing the spatial doses distribution obtained through the MCNP5 simulation for those two distinct types of radioactive seeds. Bench markets from literature validates the proposed simulations. (author)

  11. Development of computational models for the simulation of isodose curves on dosimetry films generated by iodine-125 brachytherapy seeds

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Adriano M.; Meira-Belo, Luiz C.; Reis, Sergio C.; Grynberg, Suely E., E-mail: amsantos@cdtn.b [Center for Development of Nuclear Technology (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

    2011-07-01

    The interstitial brachytherapy is one modality of radiotherapy in which radioactive sources are placed directly in the region to be treated or close to it. The seeds that are used in the treatment of prostate cancer are generally cylindrical radioactive sources, consisting of a ceramic or metal matrix, which acts as the carrier of the radionuclide and as the X-ray marker, encapsulated in a sealed titanium tube. This study aimed to develop a computational model to reproduce the film-seed geometry, in order to obtain the spatial regions of the isodose curves produced by the seed when it is put over the film surface. The seed modeled in this work was the OncoSeed 6711, a sealed source of iodine-125, which its isodose curves were obtained experimentally in previous work with the use of dosimetric films. For the films modeling, compositions and densities of the two types of dosimetric films were used: Agfa Personal Monitoring photographic film 2/10, manufactured by Agfa-Geavaert; and the model EBT radiochromic film, by International Specialty Products. The film-seed models were coupled to the Monte Carlo code MCNP5. The results obtained by simulations showed to be in good agreement with experimental results performed in a previous work. This indicates that the computational model can be used in future studies for other seeds models. (author)

  12. Post-operative treatment of malignant salivary gland tumours of the palate with iodine-125 brachytherapy

    International Nuclear Information System (INIS)

    Stannard, Clare E.; Hering, Egbert; Hough, Jan; Knowles, Ruth; Munro, Roger; Hille, Jos

    2004-01-01

    Background and purpose: Malignant minor salivary gland tumours are usually small and clinically indistinguishable from benign lesions. Surgery is the treatment of choice with post-operative radiotherapy for involved margins or unfavourable histology. We assessed the results of a series of such patients treated with iodine-125 brachytherapy in the form of a temporary applicator or implant. Patients and methods: There were nine patients with T1/T2 tumours of the hard and/or soft palate that had been excised. All had close or involved margins. Six were treated with a dental applicator alone, two with an applicator and additional I-125 seeds in tubes and one with an implant alone. The applicator consists of two layers of plastic made from a dental impression enclosing a predetermined number of I-125 seeds, 9-39, glued to one surface and a layer of ash metal to protect the tongue. It was inserted 1-3 months post-operatively and delivered 35-62 Gy, median 56 Gy, at 5-7 mm depth over 58-156 h, median 120 h, at 0.26-0.67 Gy/h, median 0.45 Gy/h. Results: The patients have been followed up for 32-158 months, median 50 months, and there were no recurrences. The applicator was well tolerated. A confluent mucositis developed which lasted 3-4 weeks. One patient developed a mucosal ulcer which healed spontaneously. Conclusions: Brachytherapy is an effective way of delivering post-operative radiotherapy to the hard and soft palate in patients with malignant salivary gland tumours that have been incompletely excised or have unfavourable histology. Local control is excellent, treatment time is short and morbidity is minimal

  13. SU-E-T-12: A Comparative Dosimetric Study of Pre and Post Prostate Iodine-125 Permanent Seed Implants

    Energy Technology Data Exchange (ETDEWEB)

    Liu, X; Rahimian, J; Goy, B; Cosmatos, H; Qian, Y [Kaiser Permanente, Los Angeles, CA (United States)

    2015-06-15

    Purpose: Post-implant dosimetry has become the gold standard for prostate implant evaluation. The goal of this research is to compare the dosimetry between pre-plan and post-plan in permanent prostate seed implant brachytherapy. Methods: A retrospective study of 91 patients treated with Iodine-125 prostate seed implant between year 2012∼2014 were performed. All plans were created using a VariSeed 8.0 planning system. Pre-plan ultrasound images were acquired using 0.5 cm slice thickness. Post-plan CT images acquired about 1–4 weeks after implant, fused with the preplan ultrasound images. The prostate and urethra contours were generated using the fusion of ultrasound and CT images. Iodine-125 seed source activities varied between 0.382 to 0.414 mCi per seed. The loading patterns varied slightly between patients depending on the prostate size. Statistical analysis of pre and post plans for prostate and urethra volumes, V100%, V150% and D90, and urethra D10 were performed and reported. Results: The pre and post implant average prostate size was 36.90cc vs. 38.58cc; V100% was 98.33% vs. 96.89%; V150% was 47.09% vs. 56.95%; D90 was 116.35Gy vs. 116.12Gy, urethra volume was 1.72cc vs. 1.85cc, urethra D10% was 122.0% vs. 135.35%, respectively. There was no statistically significant difference between the pre and post-plan values for D90(p-value=0.43). However, there are significant differences between other parameters most likely due to post surgical edema; prostate size (p-value= 0.00015); V100% (p-value=3.7803E-07); V150% (p-value=1.49E-09); urethra volume (p-value= 2.77E-06); Urethra D10 (p-value=7.37E-11). Conclusion: The post-plan dosimetry using CT image set showed similar D90 dose coverage to the pre-plan using the ultrasound image dataset. The study showed that our prostate seed implants have consistently delivered adequate therapeutic dose to the prostate while sparing urethra. Future studies to correlate dose versus biochemical response using patients’ PSA

  14. Iodine 125 seed migration after prostate brachytherapy: a study of 170 patients; Migration des grains d'iode 125 apres curietherapie prostatique: etude d'une serie de 170 patients

    Energy Technology Data Exchange (ETDEWEB)

    Chauveinc, L.; Osseili, A.; Rosenwald, J.C.; Cosset, J.M. [Institut Curie, Dept. d' Oncologie-Radiotherapie, 75 - Paris (France); Flam, T. [Hopital Cochin, Service d' Urologie, 75 - Paris (France); Thiounn, N. [Hopital Necker, Service d' Urologie, 75 - Paris (France); Savignoni, A. [Institut Curie, Service de Statistiques, 75 - Paris (France)

    2004-08-01

    Purpose. To study the number of migrating seeds, the anatomical site of migration and possible predictive parameters of migration, after prostate cancer brachytherapy using a loose-seed (I125) implantation technique. Patients and methods. The charts of the 170 patients consecutively treated by the Institut Curie/Hospital Cochin/Hospital Necker Group between September 1, 2001 and August 31, 2002, were analysed. All seeds having migrated to the lungs and seen on the chest X-ray systematically performed at 2 months, have been recorded, as well as the seeds lost by the urines (after sieving) or in the sperm (condom). Results. Among 12,179 implanted seeds, 44 were found to have migrated (0.36%). Most of the migrating seeds (32/44; 73%), were found in the lungs. Overall, one or several seed migrations were observed in 35 patients (21% of the total number of patients in this series). In the majority of cases (77prostate volume, but those two parameters were closely linked in our series). More specifically, a significant relationship (P = 0.02) could be demonstrated between the number of seeds implanted at the periphery of the prostate and the number of seeds migrating to the lungs. Conclusion. The percentage of migrating seeds observed in this series is low. actually one of the lowest found in the literature when using the loose-seed technique. There was no clinical consequences and the loss of-usually only one seed is very unlikely to alter the quality of the dose distribution. However, the predominance of pulmonary migrations in our series led us to slightly modify our implantation technique. We now try to avoid too 'peripheral' seed implantations, due to the risk of migration towards the peri-prostatic veins, and subsequently to the lungs. (author)

  15. Iodine-125 brachytherapy as upfront and salvage treatment for brain metastases. A comparative analysis

    Energy Technology Data Exchange (ETDEWEB)

    Romagna, Alexander; Schwartz, Christoph; Tonn, Joerg-Christian; Kreth, Friedrich-Wilhelm [Ludwig-Maximilians-University, Department of Neurosurgery, Munich (Germany); Egensperger, Rupert [Ludwig-Maximilians-University, Center for Neuropathology and Prion Research, Munich (Germany); Watson, Juliana; Belka, Claus; Nachbichler, Silke Birgit [Ludwig-Maximilians-University, Department of Radiation-Oncology, Munich (Germany)

    2016-11-15

    Outcome and toxicity profiles of salvage stereotactic ablative radiation strategies for recurrent pre-irradiated brain metastases are poorly defined. This study compared risk-benefit profiles of upfront and salvage iodine-125 brachytherapy (SBT) for small brain metastases. As the applied SBT treatment algorithm required histologic proof of metastatic brain disease in all patients, we additionally aimed to elucidate the value of biopsy before SBT. Patients with small untreated (n = 20) or pre-irradiated (n =28) suspected metastases intended for upfront or salvage SBT, respectively, were consecutively included. Temporary iodine-125 implants were used (median reference dose: 50 Gy, median dose rate: 15 cGy/h). Cumulative biologically effective doses (BED) were calculated and used for risk assessment. Treatment toxicity was classified according to Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Upfront SBT was initiated in 20 patients and salvage SBT in 23. In 5 patients, salvage SBT was withheld because of proven radiation-induced lesions. Treatment groups exhibited similar epidemiologic data except for tumor size (which was slightly smaller in the salvage group). One-year local/distant tumor control rates after upfront and salvage SBT were similar (94 %/65 % vs. 87 %/57 %, p = 0.45, respectively). Grade I/II toxicity was suffered by 2 patients after salvage SBT (cumulative BED: 192.1 Gy{sub 3} and 249.6 Gy{sub 3}). No toxicity-related risk factors were identified. SBT combines diagnostic yield with effective treatment in selected patients. The low toxicity rate in the salvage group points to protective radiobiologic characteristics of continuous low-dose rate irradiation. Upfront and salvage SBT are similarly effective and safe. Histologic reevaluation should be reconsidered after previous radiotherapy to avoid under- or overtreatment. (orig.) [German] Daten zu Risiko und Effizienz ablativer

  16. Outcomes of Iodine-125 Plaque Brachytherapy for Uveal Melanoma With Intraoperative Ultrasonography and Supplemental Transpupillary Thermotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Badiyan, Shahed N. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri (United States); Rao, Rajesh C. [Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri (United States); Apicelli, Anthony J.; Acharya, Sahaja; Verma, Vivek; Garsa, Adam A.; DeWees, Todd; Speirs, Christina K.; Garcia-Ramirez, Jose; Esthappan, Jacqueline; Grigsby, Perry W. [Department of Radiation Oncology, Mallinckrodt Institute of Radiology, St. Louis, Missouri (United States); Harbour, J. William, E-mail: JWHarbour@med.miami.edu [Department of Ophthalmology and Visual Sciences, Washington University School of Medicine, St. Louis, Missouri (United States); Ocular Oncology Service, Department of Ophthalmology, Bascom Palmer Eye Institute and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, Florida (United States)

    2014-03-15

    Purpose: To assess the impact on local tumor control of intraoperative ultrasonographic plaque visualization and selective application of transpupillary thermotherapy (TTT) in the treatment of posterior uveal melanoma with iodine-125 (I-125) episcleral plaque brachytherapy (EPB). Methods and Materials: Retrospective analysis of 526 patients treated with I-125 EPB for posterior uveal melanoma. Clinical features, dosimetric parameters, TTT treatments, and local tumor control outcomes were recorded. Statistical analysis was performed using Cox proportional hazards and Kaplan-Meier life table method. Results: The study included 270 men (51%) and 256 women (49%), with a median age of 63 years (mean, 62 years; range, 16-91 years). Median dose to the tumor apex was 94.4 Gy (mean, 97.8; range, 43.9-183.9) and to the tumor base was 257.9 Gy (mean, 275.6; range, 124.2-729.8). Plaque tilt >1 mm away from the sclera at plaque removal was detected in 142 cases (27%). Supplemental TTT was performed in 72 patients (13.7%). One or 2 TTT sessions were required in 71 TTT cases (98.6%). After a median follow-up of 45.9 months (mean, 53.4 months; range, 6-175 months), local tumor recurrence was detected in 19 patients (3.6%). Local tumor recurrence was associated with lower dose to the tumor base (P=.02). Conclusions: Ultrasound-guided plaque localization of I-125 EPB is associated with excellent local tumor control. Detection of plaque tilt by ultrasonography at plaque removal allows supplemental TTT to be used in patients at potentially higher risk for local recurrence while sparing the majority of patients who are at low risk. Most patients require only 1 or 2 TTT sessions.

  17. Study and parameters survey for iodine-125 source dosimetry to be applied in brachytherapy; Estudo e levantamentos de parametros para dosimetria de fontes de iodo-125 aplicadas em braquiterapia

    Energy Technology Data Exchange (ETDEWEB)

    Moura, Eduardo Santana de

    2011-07-01

    The use of brachytherapy technique with iodine-125 seeds to prostate cancer treatment has been used for decades with good clinical outcomes. To aim the Brazilian population necessities, IPEN-CNEN/SP developed the iodine-125 seed prototype with national technology. The objectives of this work are the development and the study of dosimetric procedures associates with the experimental acquisition of the useful parameters for the iodine-125 dosimetric characterization and to evaluate if the developed procedures, in this work, have the basic conditions to determinate the dosimetric analysis, that are fundamental for clinical procedures. The dosimeters selected for the analysis are the TLD-100 (LiF:Mg,Ti), initially these dosimeters were submitted for two selection steps to choose the dosimeters more reproducible for the dosimetric analysis. The two steps were the selection by the mass of the dosimeters and the reproducibility after four irradiation series in a Cobalt-60 irradiator (CTR-IPEN). Afterwards these steps, the dosimeters were irradiated in linear accelerator with 6 MV energy (Service of Radiotherapy - Hospital Israelita Albert Einstein) to yield the individual calibration factors to each dosimeter. After, the dosimeters were used to the irradiations with iodine-125 seed, 6711 model, (GE-Healthcare). The irradiations and others analysis with iodine-125 seeds yield the useful values for the determination of the parameters suggested by the AAPM (American Association of Physicists in Medicine): constant of dose rate, geometry function, dose radial function and anisotropy function. The results showed good agreement with the values published by the literature, for the same iodine- 125 model, this fact confirms that the realized parameters will be able to be used for the IPEN-CNEN iodine-125 seeds dosimetry and quality control. (author)

  18. Patterns of failure after iodine-125 seed implantation for prostate cancer

    International Nuclear Information System (INIS)

    Lamb, David S.; Greig, Lynne; Russell, Grant L.; Nacey, John N.; Broome, Kim; Studd, Rod; Delahunt, Brett; Iupati, Douglas; Jain, Mohua; Rooney, Colin; Murray, Judy; Lamb, Peter J.; Bethwaite, Peter B.

    2014-01-01

    Purpose: To determine the site of relapse when biochemical failure (BF) occurs after iodine-125 seed implantation for prostate cancer. Materials and methods: From 2001–2009, 500 men underwent implantation in Wellington, New Zealand. Men who sustained BF were placed on relapse guidelines that delayed restaging and intervention until the prostate-specific antigen (PSA) was ⩾20 ng/mL. Results: Most implants (86%) had a prostate D90 of ⩾90%, and multivariate analysis showed that this parameter was not a variable that affected the risk of BF. Of 21 BFs that occurred, the site of failure was discovered to be local in one case and distant in nine cases. Restaging failed to identify the site of relapse in two cases. In nine cases the trigger for restaging had not been reached. Conclusions: If post-implant dosimetry is generally within the optimal range, distant rather than local failure appears to be the main cause of BF. Hormone treatment is therefore the most commonly indicated secondary treatment intervention (STI). Delaying the start of STI prevents the unnecessary treatment of men who undergo PSA ‘bounce’ and have PSA dynamics initially mimicking those of BF

  19. Ocular Response of Choroidal Melanoma With Monosomy 3 Versus Disomy 3 After Iodine-125 Brachytherapy

    International Nuclear Information System (INIS)

    Marathe, Omkar S.; Wu, Jeffrey; Lee, Steve P.; Yu Fei; Burgess, Barry L.; Leu Min; Straatsma, Bradley R.; McCannel, Tara A.

    2011-01-01

    Purpose: To report the ocular response of choroidal melanoma with monosomy 3 vs. disomy 3 after 125 I brachytherapy. Methods and Materials: We evaluated patients with ciliochoroidal melanoma managed with fine needle aspiration biopsy immediately before plaque application for 125 I brachytherapy between January 1, 2005 and December 31, 2008. Patients with (1) cytopathologic diagnosis of melanoma, (2) melanoma chromosome 3 status identified by fluorescence in situ hybridization, and (3) 6 or more months of follow-up after brachytherapy were sorted by monosomy 3 vs. disomy 3 and compared by Kruskal-Wallis test. Results: Among 40 ciliochoroidal melanomas (40 patients), 15 had monosomy 3 and 25 had disomy 3. Monosomy 3 melanomas had a median greatest basal diameter of 12.00 mm and a median tumor thickness of 6.69 mm before brachytherapy; at a median of 1.75 years after brachytherapy, median thickness was 3.10 mm. Median percentage decrease in tumor thickness was 48.3%. Disomy 3 melanomas had a median greatest basal diameter of 10.00 mm and median tumor thickness of 3.19 mm before brachytherapy; at a median of 2.00 years after brachytherapy, median tumor thickness was 2.37 mm. The median percentage decrease in tumor thickness was 22.7%. Monosomy 3 melanomas were statistically greater in size than disomy 3 melanomas (p < 0.001) and showed a greater decrease in tumor thickness after brachytherapy (p = 0.006). Conclusion: In this study, ciliochoroidal melanomas with monosomy 3 were significantly greater in size than disomy 3 melanoma and showed a significantly greater decrease in thickness at a median of 1.75 years after brachytherapy. The greater decrease in monosomy 3 melanoma thickness after brachytherapy is consistent with other malignancies in which more aggressive pathology has been shown to be associated with a greater initial response to radiotherapy.

  20. Ocular Response of Choroidal Melanoma With Monosomy 3 Versus Disomy 3 After Iodine-125 Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Marathe, Omkar S. [David Geffen School of Medicine, University of Los Angeles, Los Angeles, CA (United States); Wu, Jeffrey; Lee, Steve P. [Department of Radiation Oncology, University of Los Angeles, Los Angeles, CA (United States); Yu Fei; Burgess, Barry L. [Department of Ophthalmology, The Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); Leu Min [Department of Radiation Oncology, University of Los Angeles, Los Angeles, CA (United States); Straatsma, Bradley R. [Department of Ophthalmology, The Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); McCannel, Tara A., E-mail: TMcCannel@jsei.ucla.edu [Department of Ophthalmology, Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); Jonsson Comprehensive Cancer Center, University of Los Angeles, Los Angeles, CA (United States)

    2011-11-15

    Purpose: To report the ocular response of choroidal melanoma with monosomy 3 vs. disomy 3 after {sup 125}I brachytherapy. Methods and Materials: We evaluated patients with ciliochoroidal melanoma managed with fine needle aspiration biopsy immediately before plaque application for {sup 125}I brachytherapy between January 1, 2005 and December 31, 2008. Patients with (1) cytopathologic diagnosis of melanoma, (2) melanoma chromosome 3 status identified by fluorescence in situ hybridization, and (3) 6 or more months of follow-up after brachytherapy were sorted by monosomy 3 vs. disomy 3 and compared by Kruskal-Wallis test. Results: Among 40 ciliochoroidal melanomas (40 patients), 15 had monosomy 3 and 25 had disomy 3. Monosomy 3 melanomas had a median greatest basal diameter of 12.00 mm and a median tumor thickness of 6.69 mm before brachytherapy; at a median of 1.75 years after brachytherapy, median thickness was 3.10 mm. Median percentage decrease in tumor thickness was 48.3%. Disomy 3 melanomas had a median greatest basal diameter of 10.00 mm and median tumor thickness of 3.19 mm before brachytherapy; at a median of 2.00 years after brachytherapy, median tumor thickness was 2.37 mm. The median percentage decrease in tumor thickness was 22.7%. Monosomy 3 melanomas were statistically greater in size than disomy 3 melanomas (p < 0.001) and showed a greater decrease in tumor thickness after brachytherapy (p = 0.006). Conclusion: In this study, ciliochoroidal melanomas with monosomy 3 were significantly greater in size than disomy 3 melanoma and showed a significantly greater decrease in thickness at a median of 1.75 years after brachytherapy. The greater decrease in monosomy 3 melanoma thickness after brachytherapy is consistent with other malignancies in which more aggressive pathology has been shown to be associated with a greater initial response to radiotherapy.

  1. [Which modality for prostate brachytherapy?].

    Science.gov (United States)

    Bossi, A

    2010-10-01

    Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20 years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. For both techniques, several topics still need to be clarified dealing with a recent enlargement of indications (HDR alone for low-risk, iodine-125 seeds boost for intermediate-high-risk cancers), or with technical aspects (loose seeds versus linked ones, number of fractions and dose for HDR protocols), while dosimetric issues have only recently been addressed by cooperatives groups. Last but not least, there is a real need to address and clearly characterize the correct definition of biochemical disease control both for iodine permanent implant and for HDR implant. New challenges are facing the prostate-brachytherapy community in the near future: local relapse after external beam radiotherapy are currently managed by several salvage treatments (prostatectomy, cryo, high intensity focused ultrasounds [HIFU]) but the role of reirradiation by brachytherapy is also actively investigated. Focal therapy has gained considerable interest in the last 5 years aiming at treating only the area of cancer foci inside the prostate and preserving nearby healthy tissues. Encouraging results have been obtained with the so-called "minimally invasive" approaches and both permanent seed implantation and HDR brachytherapy techniques may be worthwhile testing in this setting because of their capability of exactly sculpting the dose inside the prostatic

  2. Iodine-125 seeds for cancer treatment

    Energy Technology Data Exchange (ETDEWEB)

    Rostelato, Maria E.C.M.; Zeituni, Carlos A.; Feher, Anselmo; Moura, Joao A.; Moura, Eduardo S.; Nagatomi, Helio R.; Manzoli, Jose E.; Souza, Carla D., E-mail: elisaros@ipen.b, E-mail: czeituni@pobox.co, E-mail: afeher@ipen.b, E-mail: jmoura31@yahoo.com.b, E-mail: esmoura@ipen.b, E-mail: hrnagato@ipen.b, E-mail: jemanzoli@ipen.b, E-mail: cdsouza@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Karam, Dib, E-mail: dib.karan@usp.b [Universidade de Sao Paulo (USP), SP (Brazil). Escola de Artes, Ciencias e Humanidades

    2009-07-01

    In Brazil, cancer has become one of the major public health problems. An estimate by the Health Ministry showed that 466,430 people had the disease in the country in 2008. The prostate cancer is the second largest death cause among men. The National Institute of Cancer estimated the occurrence of 50,000 new cases for 2009. Some of these patients are treated with Brachytherapy, using Iodine-125 seeds. By this technique, small seeds with Iodine-125, a radioactive material, are implanted in the prostate. The advantages of radioactive seed implants are the preservation of healthy tissues and organs near the prostate, besides the low rate of impotence and urinary incontinence. The Energy and Nuclear Research Institute - IPEN, which belongs to the Nuclear Energy National Commission - CNEN, established a program for the development of the technique and production of Iodine-125 seeds in Brazil. The estimate for the 125-Iodine seeds demand is of 8,000 seeds/month and the laboratory to be implanted will need this production capacity. The purpose of this paper is to explain the project status and show some data about the seeds used in the country. The project will be divided in two phases: technological development of a prototype and a laboratory implementation for the seeds production. (author)

  3. Dosimetric and Late Radiation Toxicity Comparison Between Iodine-125 Brachytherapy and Stereotactic Radiation Therapy for Juxtapapillary Choroidal Melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Krema, Hatem, E-mail: htmkrm19@yahoo.com [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Heydarian, Mostafa [Department of Radiation Medicine, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Beiki-Ardakani, Akbar [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Weisbrod, Daniel [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Xu, Wei [Department of Biostatistics, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Laperriere, Normand J.; Sahgal, Arjun [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)

    2013-07-01

    Purpose: To compare the dose distributions and late radiation toxicities for {sup 125}I brachytherapy (IBT) and stereotactic radiation therapy (SRT) in the treatment of juxtapapillary choroidal melanoma. Methods: Ninety-four consecutive patients with juxtapapillary melanoma were reviewed: 30 have been treated with IBT and 64 with SRT. Iodine-125 brachytherapy cases were modeled with plaque simulator software for dosimetric analysis. The SRT dosimetric data were obtained from the Radionics XKnife RT3 software. Mean doses at predetermined intraocular points were calculated. Kaplan-Meier estimates determined the actuarial rates of late toxicities, and the log–rank test compared the estimates. Results: The median follow-up was 46 months in both cohorts. The 2 cohorts were balanced with respect to pretreatment clinical and tumor characteristics. Comparisons of radiation toxicity rates between the IBT and SRT cohorts yielded actuarial rates at 50 months for cataracts of 62% and 75% (P=.1), for neovascular glaucoma 8% and 47% (P=.002), for radiation retinopathy 59% and 89% (P=.0001), and for radiation papillopathy 39% and 74% (P=.003), respectively. Dosimetric comparisons between the IBT and SRT cohorts yielded mean doses of 12.8 and 14.1 Gy (P=.56) for the lens center, 17.6 and 19.7 Gy (P=.44) for the lens posterior pole, 13.9 and 10.8 Gy (P=.30) for the ciliary body, 61.9 and 69.7 Gy (P=.03) for optic disc center, and 48.9 and 60.1 Gy (P<.0001) for retina at 5-mm distance from tumor margin, respectively. Conclusions: Late radiation-induced toxicities were greater with SRT, which is secondary to the high-dose exposure inherent to the technique as compared with IBT. When technically feasible, IBT is preferred to treat juxtapapillary choroidal melanoma.

  4. The Efficacy and Safety of Iodine-125 Brachytherapy Combined with Chemotherapy in Treatment of Advanced Lung Cancer: A Meta-Analysis

    International Nuclear Information System (INIS)

    Qiu, H.; Wang, J.; Ji, J.; Ma, G.; Zhang, L.; Shao, Z.

    2017-01-01

    The aim of this study was to systematically review the efficacy and safety of iodine-125 brachytherapy combined with chemotherapy in patients with advanced lung cancer. PubMed, MEDLINE, EBSCO, FMJS and Web of Science were searched to obtain randomized controlled trials (RCTs), published in English and Chinese, until February 2016. The evaluating indicators were complete response (CR), partial response (PR), stable disease (SD), progressive disease (PD), overall response rate (ORR), disease control rate (DCR), one-year overall survival, two-year overall survival and adverse events. Revman 5.2 software was used for data syntheses and analyses. A total of 296 patients enrolled in 5 RCTs were ultimately included in this study based on our selection criteria, and 150 patients received chemotherapy alone, while another 146 patients received the combination therapy of iodine-125 brachytherapy and chemotherapy. The results showed that iodine-125 brachytherapy combined with chemotherapy was superior to chemotherapy alone in CR (risk ratio [RR] = 3.66, 95% confidence interval [CI]: 2.08 to 6.44, p<0.001), PR (RR = 1.47, 95% CI: 1.16 to 1.86, p=0.001), ORR (RR = 1.85, 95% CI: 1.54 to 2.22, p<0.001), DCR (RR = 1.19, 95% CI: 1.10 to 1.29, p<0.001), one-year overall survival (RR = 1.46, 95% CI: 1.12 to 1.92, p=0.006) and PD (RR = 0.20, 95% CI: 0.09 to 0.43, p<0.001); meanwhile, there was no significant difference in two-year overall survival (RR = 1.30, 95% CI: 0.72 to 2.37, p=0.39). In terms of adverse events, the combination therapy significantly increased the incidence of pneumothorax (RR = 4.93, 95% CI: 1.94 to 12.55, p=<0.001); however, no significant differences were found in the incidence of other adverse events. This study indicated that the combination therapy of iodine-125 brachytherapy and chemotherapy could improve the therapeutic efficacy of advanced lung cancer without increasing the incidence of adverse events, except pneumothorax. (author)

  5. Iodine 125 Brachytherapy With Vitrectomy and Silicone Oil in the Treatment of Uveal Melanoma: 1-to-1 Matched Case-Control Series

    Energy Technology Data Exchange (ETDEWEB)

    McCannel, Tara A., E-mail: TMcCannel@jsei.ucla.edu; McCannel, Colin A.

    2014-06-01

    Purpose: We initially reported the radiation-attenuating effect of silicone oil 1000 centistokes for iodine 125. The purpose of this report was to compare the clinical outcomes in case patients who had iodine 125 brachytherapy with vitrectomy and silicone oil 1000 centistokes with the outcomes in matched control patients who underwent brachytherapy alone. Methods and Materials: Consecutive patients with uveal melanoma who were treated with iodine 125 plaque brachytherapy and vitrectomy with silicone oil with minimum 1-year follow-up were included. Control patients who underwent brachytherapy alone were matched for tumor size, location, and sex. Baseline patient and tumor characteristics and tumor response to radiation, final visual acuity, macular status, central macular thickness by ocular coherence tomography (OCT), cataract progression, and metastasis at last follow-up visit were compared. Surgical complications were also determined. Results: Twenty case patients met the inclusion criteria. The average follow-up time was 22.1 months in case patients and 19.4 months in control patients. The final logMAR vision was 0.81 in case patients and 1.1 in control patients (P=.071); 8 case patients and 16 control patients had abnormal macular findings (P=.011); and the average central macular thickness by OCT was 293.2 μm in case patients and 408.5 μm in control patients (P=.016). Eleven case patients (55%) and 1 control patient (5%) had required cataract surgery at last follow-up (P=.002). Four patients in the case group and 1 patient in the control group experienced metastasis (P=.18). Among the cases, intraoperative retinal tear occurred in 3 patients; total serous retinal detachment and macular hole developed in 1 case patient each. There was no case of rhegmatogenous retinal detachment, treatment failure, or local tumor dissemination in case patients or control patients. Conclusions: With up to 3 years of clinical follow-up, silicone oil during brachytherapy

  6. Iodine 125 Brachytherapy With Vitrectomy and Silicone Oil in the Treatment of Uveal Melanoma: 1-to-1 Matched Case-Control Series

    International Nuclear Information System (INIS)

    McCannel, Tara A.; McCannel, Colin A.

    2014-01-01

    Purpose: We initially reported the radiation-attenuating effect of silicone oil 1000 centistokes for iodine 125. The purpose of this report was to compare the clinical outcomes in case patients who had iodine 125 brachytherapy with vitrectomy and silicone oil 1000 centistokes with the outcomes in matched control patients who underwent brachytherapy alone. Methods and Materials: Consecutive patients with uveal melanoma who were treated with iodine 125 plaque brachytherapy and vitrectomy with silicone oil with minimum 1-year follow-up were included. Control patients who underwent brachytherapy alone were matched for tumor size, location, and sex. Baseline patient and tumor characteristics and tumor response to radiation, final visual acuity, macular status, central macular thickness by ocular coherence tomography (OCT), cataract progression, and metastasis at last follow-up visit were compared. Surgical complications were also determined. Results: Twenty case patients met the inclusion criteria. The average follow-up time was 22.1 months in case patients and 19.4 months in control patients. The final logMAR vision was 0.81 in case patients and 1.1 in control patients (P=.071); 8 case patients and 16 control patients had abnormal macular findings (P=.011); and the average central macular thickness by OCT was 293.2 μm in case patients and 408.5 μm in control patients (P=.016). Eleven case patients (55%) and 1 control patient (5%) had required cataract surgery at last follow-up (P=.002). Four patients in the case group and 1 patient in the control group experienced metastasis (P=.18). Among the cases, intraoperative retinal tear occurred in 3 patients; total serous retinal detachment and macular hole developed in 1 case patient each. There was no case of rhegmatogenous retinal detachment, treatment failure, or local tumor dissemination in case patients or control patients. Conclusions: With up to 3 years of clinical follow-up, silicone oil during brachytherapy

  7. Brazilian demand for Iodine-125 seeds in cancer treatment after a decade of medical procedures

    Energy Technology Data Exchange (ETDEWEB)

    Costa, Osvaldo L. da; Souza, Daiane C.B. de; Feher, Anselmo; Moura, João A.; Souza, Carla D.; Oliveira, Henrique B. de; Peleiras Junior, Fernando S.; Zeituni, CArlos A.; Rostelaro, Maria E.C.M., E-mail: olcosta@ipen.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2017-07-01

    Iodine-125 and palladium-103 are radionuclides employed to made medical devices used in cancer treatment known as brachytherapy seeds. These radioactive sealed sources are applied in brain and ophthalmic cancer as a temporary implant to irradiate the tumor and in permanent implants to prostatic cancer. Brazilian Nuclear Energy Commission (CNEN) has the monopoly in Brazil of iodine-125 brachytherapy seeds distribution which is executed for Nuclear and Energy Research Institute (IPEN-CNEN/SP). Along a decade of use in Brazil more than 240 thousand seeds were implanted in patients or used to treat cancer tumors. In this article the Brazilian demand for iodine-125 brachytherapy seeds is analyzed. The demand behavior along a decade of using loose, strand, ophthalmic and brain brachytherapy seeds are shown. The annual quantity of seeds demanded by Brazil has dropped since 2012. The loose seeds which represented until 30% from total brachytherapy seeds used in Brazil decreased to less than 3%. The brain brachytherapy seeds had low demand along the decade and presented zero demand in several years. Concurrent treatment techniques are listed and main trends are discussed. The influence of Brazilian economic crisis and the demand behavior of the main hospitals and clinics that use Iodine-125 brachytherapy are shown. (author)

  8. Statistical differences and systematic effect on measurement procedure in thermoluminescent dosimetry of the Iodine-125 brachytherapy seed

    Energy Technology Data Exchange (ETDEWEB)

    Zeituni, Carlos A.; Moura, Eduardo S.; Rostelato, Maria Elisa C.M.; Manzoli, Jose E.; Moura, Joao Augusto; Feher, Anselmo, E-mail: czeituni@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP) Sao Paulo, SP (Brazil); Karam, Dib [Universidade de Sao Paulo (USP Leste), Sao Paulo, SP (Brazil). Escola de Artes, Ciencias e Humanidades

    2009-07-01

    In order to provide the dosimetry for Iodine-125 seed production in Brazil, Harshaw thermoluminescent dosimeters (TLD-100) will be used. Even if measurements with TLD-100 of the same batch of fabrication are performed, the response will not be the same. As a consequence, they must be measured one by one. These dosimeters are LiF type with a micro-cube (1 mm x 1 mm x 1 mm) shape. Irradiations were performed using Iodine-125 seeds to guarantee the same absorbed dose of 5 Gy in each dosimeter. It has been used a Solid Water Phantom with three concentrically circle with 20 mm, 50 mm and 70 mm diameters. The angle of positions used was 0 deg, 30 deg, 60 deg and 90 deg. Of course there are 2 positions in 0 deg and 90 deg and 4 positions in 30 deg and 60 deg. These complete procedures were carried out five times in order to compare the data and minimize the systematic error. The iodine-125 seed used in the experiment was take off in each measure and put again turning his position 180 deg to guarantee the systematic error was minimized. This paper presents also a little discussion about the statistical difference in the measurement and the calculation procedure to determine the systematic error in these measurements. (author)

  9. Study of dosimetric parameters for iodine-125 brachytherapy sources development from IPEN-CNEN/SP using Monte Carlo method

    International Nuclear Information System (INIS)

    Oliveira, Tiago Batista de

    2016-01-01

    Expectations of the World Health Organization for the year 2030 are that the number of cancer deaths is approximately 13.2 million, reflecting the high proportion of this disease in global health issue. With respect to prostate cancer, according to the National Cancer Institute, the number of cases diagnosed worldwide in 2012 was approximately 1.1 million, while in Brazil the data demonstrated the incidence of 68,000 new cases. The treatment of cancer can be performed with surgery (prostatectomy) or radiation therapy. Among radiotherapy, we can highlight the brachytherapy technique, which consists in the introduction of small radioactive sources (seeds) within the prostate, which is delivered a high dose value in the treatment volume and low dose in the surrounding tissues. In Brazil, the medical profession estimates a demand of approximately 8000 seeds / month, and the unit cost of each seed at least US $ 26.00. The AAPM protocol TG-43 recommend the dose-rate constant, radial dose function and anisotropy function for dosimetric analysis LDR brachytherapy seeds. In this work, Monte Carlo simulations were performed in order to assess the dosimetric parameters of the OncoSeed-6711, manufactured by Oncura-GEHealthcare, and a seed developed by Radiation Technology Center, using the MCNP5 code. A 6711 seed, an IPEN seed and the 30 x 30 x 30cm 3 phantom filled with water were modeled to simulate the dose distribution. The 6711 seed parameters were compared with literature, and the results presented relative error less than 0.1% for Λ. In comparison with the 6711 seed, the IPEN model seed dosimetric parameters were similar, account the statistical uncertainty. (author)

  10. Use of iodine-125 brachytherapy in treatment of choroidal melanomas, technic and preliminary analysis of 78 patients

    International Nuclear Information System (INIS)

    Quetin, P.; Schumacher, C.; Schraub, S.; Meyer, L.; Polto, F.; Sahel, J.; Magnenet, P.; Andres, E.

    2001-01-01

    Purpose. - Iodine 125 curietherapy is one of the conservative treatments of uveal melanoma. The technique used to achieve these results was simplified through the physical characteristics of the radioelement and the optimized-dosimetry program employed. Patients and methods. - 78 patients with choroidal melanoma were treated with iodine 125. About 100 Gy were delivered to the superior pole of the tumour. The minimal length of follow-up was 17 months and the average, 67 months. Results. -There was 88% local control, leading to lowered visual acuity in 76 % of the cases. Radiation retinopathy, directly related to proximity to the macula, is the principle etiology. Seven patients died of hepatic metastasis, five patients were enucleated. Four patients were further treated with proton-therapy to make up for non-control locally. Conclusion. -One dose of 100 Gy to the superior pole of the tumor seemed to lead to good local control, with the exception of complications related to proximity to the macula and the optic nerve. In this attempt to optimize irradiation, the time lapse between any benefit in local control derived from irradiation and post-therapeutic complications observed remains insufficient to evaluate any relationship. (authors)

  11. Prescribing to tumor apex in episcleral plaque iodine-125 brachytherapy for medium-sized choroidal melanoma: A single-institutional retrospective review.

    Science.gov (United States)

    Vonk, David Thomas; Kim, Yongbok; Javid, Cameron; Gordon, John D; Stea, Baldassarre

    2015-01-01

    To report an institutional experience with episcleral plaque brachytherapy for medium-sized uveal melanoma. Variations in prescription dose point and dose rate were compared with Collaborative Ocular Melanoma Study (COMS) Group. A retrospective review was performed for 116 patients treated with iodine-125 plaque brachytherapy. About 85 Gy was prescribed to either the tumor apex (108 patients) or at 5 mm (8 patients) with dose rate ranging from 50.6 to 98.2 cGy/h. Patients were followed up for local tumor control, eye preservation, and vision retention. Dose and dose rate to tumor and sensitive structures were calculated. Multivariate and univariate analyses were performed to investigate correlation between clinical outcomes and dose/dose rate variables. Patients in this study were slightly older with worse visual acuity at baseline, but tumor size and position and ratio of ciliary body involvement were comparable to COMS population. Outcomes data were comparable to COMS: 95.3% local tumor control at 5 years and 77.7% vision preservation at 3 years. Only 4 patients needed enucleation because of tumor growth. Significant correlation was found between enucleation and tumor height and maximal scleral dose/dose rate as well as vision retention and tumor height and macula dose/dose rate. For tumors with <5 mm height, prescribing to tumor apex enabled to decrease dose to all sensitive structures without any loss of local control. Although dose rate was lowered to 50.6 cGy/h from the American Brachytherapy Society guidelines (60-105 cGy/h) because of limited availability of operating room (i.e., weekly), there was no difference in either local tumor control or complications. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  12. Quality Assurance Procedure Development in Iodine-125 Seeds Production

    International Nuclear Information System (INIS)

    Moura, J.A.; Moura, E.S.; Sprenger, F.E.

    2009-01-01

    Brachytherapy using Iodine-125 seeds has been used in prostate cancer treatment. In the quality control routine during seed production, leak tests are made to detect any leakage of radioactive material from inside the titanium shield. Leak tests are made according to the International Standard Organization- Radiation protection - sealed radioactive sources - ISO 9978 standard, and require liquid transfer between recipients. If any leakage happens, there will be contamination of the liquid and tubing. This study aims to establish decontamination routines for tubing, allowing its repeated use, in the automated assay process

  13. Prostate brachytherapy

    Science.gov (United States)

    ... the prostate. The doctor may use a computerized robot to do this. The radioactive material is removed ... M. is also a founding member of Hi-Ethics and subscribes to the principles of the Health ...

  14. Experimental radiotherapy of the R1H rhabdomyosarcoma of the rat: combined use of interstitial iodine-125-brachytherapy and fractionated X-irradiation

    International Nuclear Information System (INIS)

    Doll, D.

    1995-01-01

    The study described here investigated into the therapeutic effects that split-dose x-radiation combined with interstitial iodine-125 brachytherapy would have on two different lines of the R1H rhabdomyosarcoma of the rat. The following parameters were examined: local tumour control rate; growth delay; net growth delay; position, movement and loss of seeds; tumour shape. The following results were obtained: The local tumour control rate for tumours externally treated with two seeds was by 42 Gy higher than that determined for the group treated with external irradiation alone. A procedure was developed to calculate the most appropriate distance for the seeds on the basis of tumour axes and volumes. The relationship between growth delay and mean maximum distance of the seed from the tumour margin could be ascertained on a quantitative basis. The influence of the tumour shape on the result of treatment was confirmed. Although the seeds were still active at the time of recidivation and treatment was not yet terminated, it was possible to show that the tumour bed effect, which tends to distort the growth delay calculations and may even occur in externally treated seed animals, could largely be avoided in the evaluation of this study. (orig./MG) [de

  15. Long-Term Results of Brachytherapy With Temporary Iodine-125 Seeds in Children With Low-Grade Gliomas

    International Nuclear Information System (INIS)

    Korinthenberg, Rudolf; Neuburger, Daniela; Trippel, Michael; Ostertag, Christoph; Nikkhah, Guido

    2011-01-01

    Purpose: To retrospectively review the results of temporary I-125 brachytherapy in 94 children and adolescents with low-grade glioma. Methods and Materials: Treatment was performed in progressive tumors roughly spherical in shape with a diameter of up to 5 cm, including 79 astrocytomas, 5 oligodendrogliomas, 4 oligoastrocytomas, 1 ependymoma, and 5 other tumors. Location was suprasellar/chiasmal in 44, thalamic/basal ganglia in 18, hemispheric in 15, midbrain/pineal region in 13, and lower brainstem in 3. Initially, 8% of patients were free of symptoms, 47% were symptomatic but not disabled, and 30% were slightly, 6% moderately, and 3% severely disabled. Results: 5- and 10-year survival was 97% and 92%. The response to I-125 brachytherapy over the long term was estimated after a median observation period of 38.4 (range, 6.4-171.0) months. At that time, 4 patients were in complete, 27 in partial, and 18 in objective remission; 15 showed stable and 30 progressive tumors. Treatment results did not correlate with age, sex, histology, tumor size, location, or demarcation of the tumor. Secondary treatment became necessary in 36 patients, including 19 who underwent repeated I-125 brachytherapy. At final follow-up, the number of symptom-free patients had risen to 21%. Thirty-eight percent showed symptoms without functional impairment, 19% were slightly and 11% moderately disabled, and only 4% were severely disabled. Conclusions: Response rates similar to those of conventional radiotherapy or chemotherapy can be anticipated with I-125 brachytherapy in tumors of the appropriate size and shape. We believe it to be a useful contribution to the treatment of low-grade gliomas in children.

  16. Prostate cancer brachytherapy

    International Nuclear Information System (INIS)

    Abreu, Carlos Eduardo Vita; Silva, Joao L. F.; Srougi, Miguel; Nesrallah, Adriano

    1999-01-01

    The transperineal brachytherapy with 125 I/Pd 103 seed implantation guided by transurethral ultrasound must be presented as therapeutical option of low urinary morbidity in patients with localized prostate cancer. The combined clinical staging - including Gleason and initial PSA - must be encouraged, for definition of a group of low risk and indication of exclusive brachytherapy. Random prospective studies are necessary in order to define the best role of brachytherapy, surgery and external beam radiation therapy

  17. Comparative cost-effectiveness of focal and total salvage (125)I brachytherapy for recurrent prostate cancer after primary radiotherapy

    NARCIS (Netherlands)

    Peters, Max; Piena, Marjanne A; Steuten, Lotte M G; van der Voort van Zyp, Jochem R N; Moerland, Rien; van Vulpen, Marco

    2016-01-01

    PURPOSE: Focal salvage (FS) iodine 125 ((125)I) brachytherapy could be an effective treatment for locally radiorecurrent prostate cancer (PCa). Toxicity is often reduced compared to total salvage (TS) while cancer control can be maintained, which could increase cost-effectiveness. The current study

  18. An analysis of brachytherapy with computed tomography-guided permanent implantation of Iodine-125 seeds for recurrent nonkeratin nasopharyngeal carcinoma

    Directory of Open Access Journals (Sweden)

    Shen X

    2015-05-01

    Full Text Available Xinying Shen,1,2 Yong Li,2 Yanfang Zhang,2 Jian Kong,2 Yanhao Li1 1Department of Interventional Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, 2Department of Interventional Radiology, Shenzhen People’s Hospital, The Second Clinical Medical College of Jinan University, Shenzhen, People’s Republic of China Background: 125I seed implantation is a new method in treatment of nasopharyngeal carcinoma (NPC, and it is worthwhile to evaluate its feasibility. In this study, we performed brachytherapy with computed tomography (CT-guided permanent implantation of 125I seeds in the treatment of patients with the recurrence of NPC.Methods: A total 30 patients (20 male and ten female at the median age of 55 (range 25–80 years were diagnosed with recurrent nonkeratin NPC, with a total 38 lesions and a short disease-free interval (median ~11 months after primary radiotherapy alone or combined with chemotherapy. Patients received CT scan, starting from 2 months after the treatment. Follow-up was conducted for ~2–38 months to observe the local control rate and overall survival rate. We also analyzed the possible correlation between survival periods and the status of recurrent tumors.Results: The local control rates at 6, 12, 24, 30, and 36 months after the procedure of 125I seed implantation were 86.8%, 73.7%, 26.3%, 15.8%, and 5.3%, respectively. The overall 1-, 2-, and 3-year survival rates were 80.0% (24/30, 30.0% (9/30, and 6.7% (2/30, respectively, with a median survival period of 18 months (17.6±8.6 months. Interestingly, the survival periods of the patients who had primary radiotherapy with or without chemotherapy were 15.8±7.9 and 24.3±7.9 months, respectively. Kaplan–Meier survival analysis demonstrated that χ2 (log rank was 7.555, with very significant difference (P<0.01. The survival periods of patients in tumor stages I, II, III, and IV were 25.4±8.7, 19.8±9.4, 16.1±4.5, and 12.8±7.8 months, respectively, with

  19. Mock iodine-125 radiation source

    International Nuclear Information System (INIS)

    Coffey, D.L.

    1976-01-01

    An intimate mixture of americium-241 and iodine-129 provides an energy spectrum that reliably simulates the spectrum of iodine-125 in a well-type detector. As such, it may be used as a long-lived standard to calibrate instruments such as well scintillation spectrometers in which measurements are to be made involving iodine-125

  20. Clinical outcome of intermediate risk prostate cancer treated with iodine 125 mono-therapy: The Hotel-Dieu of Quebec experience

    International Nuclear Information System (INIS)

    Zebentout, O.; Apardian, R.; Beaulieu, L.; Harel, F.; Martin, A.G.; Vigneault, E.; Beaulieu, L.; Harel, F.; Beaulieu, L.

    2010-01-01

    Purpose To describe the biochemical failure-free survival (B.F.F.S.), G.U. toxicity and erectile dysfunction in intermediate risk prostate cancer treated with iodine 125 mono-therapy ( 125 I). Patients and methods Between October 1994 and October 2007, 1282 patients were treated with 125 I at the Hotel Dieu de Quebec. Two hundred patients were intermediate risk prostate cancer. One hundred and fifty-seven had enough follow-up to be evaluated in this study. Biochemical failure-free survival is reported using Phoenix definition. Acute and late G.U. toxicity was described using the International Prostate Symptoms Score (I.P.S.S.) as well as with the rate of bladder catheter. Erectile dysfunction was also reported. Results The mean age of the patients was 65.6 years (S.D. = 6 years) and the mean pretreatment P.S.A. was 8.7 ng/ml. About half of the patients (51%) were T2b/T2c. About 44.6% had a P.S.A. greater than 10 and 4.5% had Gleason score of 7/10. More than half of the patients received a short course of hormones of less than 6 months for cyto-reduction (57.4%). The median follow-up was 60 months. Biochemical failure-free survival at 60-month and 96-month were 87.1% and 81% according to Phoenix definition. The mean I.P.S.S. rose from 5 immediately after the implant to 15 1 month after and then slowly decreased to 8 at 24 months. Acute urinary retention with bladder catheter occurred in 10.9% of patients. Only 4.3% presented erectile dysfunction at 5 months post-implant. Conclusion 125 I mono-therapy for intermediate risk prostate implant gives biochemical failure-free survivals at 5 years and 8 years comparable to those obtained with high dose external beam radiotherapy. G.U. toxicity and erectile dysfunction were low and acceptable. Therefore, the use of 125 I alone in this group of patients could be presented and discussed with the patient in the waiting of phase III validation. (authors)

  1. Combination of bilateral pelvic lymphadenectomy, permanent iodine-125 implantation, and percutaneous irradiation of the locally confined prostatic cancer. Pt. 1

    International Nuclear Information System (INIS)

    Thiel, H.J.; Mueller, R.; Schrott, K.M.; Erlangen-Nuernberg Univ., Erlangen; Erlangen-Nuernberg Univ., Erlangen

    1987-01-01

    Since the beginning of 1981, 32 patients at an age of 52 to 72 years who suffered from a locally confined adenocarcinoma of the prostate were treated by permanent implantation of I-125 seeds. 25 patients were evaluated after a median observation period of 30 months. The first group consisting of 19 patients was submitted to a combined percutaneous and interstitial treatment, the other 6 patients were initially treated only by interstitial therapy because of severe complications observed in the meantime. After bilateral pelvic staging lymphadenectomy, permanent I-125 seeds were implanted into the patients of stage T 1 , T 2 , early T 3 and pN 0-1 , in case of microscopic lymph node manifestation without capsular perforation also into patients of stage pN 2 and pN 4 . 8 weeks later the patients received a moving beam irradiation with 10 MV photons at the linear accelerator. The centre of the prostate was faded out by a specially constructed H absorber in such a way that the prescribed target dose of 36 Gy in 4 weeks to the 90%-isodose was only applied to a spherical surface around the implant. 1 patient died perioperatively from an embolism due to phlebothrombosis of the thigh. 22 out of the other 24 patients are in complete remission, 1 patient had a local recurrence in the right seminal vesicle which appeared 28 months after primary therapy, and 1 patient developed skeletal metastases. The objective side effects and late complications of our combined treatment are considerable with respect to their incidence as well as their severity: a slight or medium radioproctitis was found after a latent period of 1 to 2 years in 28% (5/18) of cases, after a latent time of about 1 1/2 to 2 years another 28% (5/18) developed subsequently to a proctitis an urethral stricture and an ulcer situated on the anterior rectum wall facing the prostate, and 4 patients presented finally a prostato-rectal fistula. (orig.) [de

  2. Brachytherapy and radical prostatectomy in patients with early prostate cancer

    Directory of Open Access Journals (Sweden)

    Adriana Souza Sérgio Ferreira

    2015-10-01

    Full Text Available Summary Objective: this study analyzes the survival of prostate cancer patients cared for at a hospital in Minas Gerais, Brazil according to one of the following treatments: iodine-125 seed implantation or radical prostatectomy. From January 2002 to December 2005, 129 patients underwent either brachytherapy (64 patients or surgery (65 patients. Methods: all had prostate-specific antigen, Gleason scores and clinical stage recorded prior to treatment. Biochemical relapse was defined as prostate-specific antigen (PSA>0.4ng/mL for radical prostatectomy, and any elevation equal or higher than 2ng/mL over the PSA nadir for implanted patients. To analyze the effect of treatment on biochemical recurrence-free survival (BRFS, Kaplan-Meier curves and Cox regression were generated. Mean follow-up time was 56.1 months for patients with the implant, and 26.6 months for those operated on. BRFS in 5 years was 69% (95% CI: 58.18-77.45 for the whole cohort. Discussion: when stratified according to treatment, survival of patients who had undergone brachytherapy (79.70% was higher to those operated on (44.30%; pvalue= 0.0056. Upon multivariate analysis, independent predictors were iPSA (HR: 2.91, 95% CI: 1,32-6,42, Gleason score (HR: 2.18, 95% CI: 1,00-4,81 and treatment modality (HR: 2.61, 95% CI: 1.18-5,75. Risk of biochemical failure was higher with surgery than brachytherapy, which may be related to the failure criteria adopted, which is different for each therapy, as well as the high rate of histological progression between preoperative prostate biopsy and surgical specimen. Conclusion: it was found that brachytherapy is a good therapeutic option for low risk prostate cancer.

  3. Prediction of PSA bounce after permanent prostate brachytherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Kanai, Kunimitsu; Nakashima, Jun; Sugawara, Akitomo

    2009-01-01

    We aimed to calculate the frequency and features of the development of a prostate-specific antigen (PSA) bounce after prostate brachytherapy alone, to correlate the bounce with clinical and dosimetric factors and to identify factors that predict PSA bounce. PSA bounce was evaluated in 86 patients with T1-T2 prostate cancer who underwent radioactive seed implantation using iodine-125 (I-125) without hormonal therapy or external-beam radiation therapy (EBRT) from September 2004 to December 2007. A PSA bounce was defined as a rise of at least 0.4 ng/ml greater than a previous PSA level with a subsequent decline equal to, or less than, the initial nadir. Calculated by the Kaplan-Meier method, the incidence of PSA bounce at a 2-year follow-up was 26%. Median time to the PSA bounce was 15 months. Univariate analysis demonstrated that age, dose received by 90% of the prostate gland (D90), volume of gland receiving 100% of the prescribed dose (V100), and V150 were significantly associated with the PSA bounce, while pretreatment PSA level, Gleason score, pretreatment prostate volume, clinical T stage, and V200 were not. In multivariate analysis, age 67 years or less and D90 more than 180 Gy were identified as independent factors for predicting the PSA bounce (P<0.05). PSA bounce is not a rare phenomenon after prostate brachytherapy. It is more common in younger patients and patients receiving higher doses of radiation. (author)

  4. Dose optimization in simulated permanent interstitial implant of prostate brachytherapy

    International Nuclear Information System (INIS)

    Faria, Fernando Pereira de

    2006-01-01

    Any treatment of cancer that uses some modality of radiotherapy is planned before being executed. In general the goal in radiotherapy is to irradiate the target to be treated minimizing the incidence of radiation in healthy surrounding tissues. The planning differ among themselves according to the modality of radiotherapy, the type of cancer and where it is located. This work approaches the problem of dose optimization for the planning of prostate cancer treatment through the modality of low dose-rate brachytherapy with Iodine 125 or Palladium 103 seeds. An algorithm for dose calculation and optimization was constructed to find the seeds configuration that better fits the relevant clinical criteria such as as the tolerated dose by the urethra and rectum and the desired dose for prostate. The algorithm automatically finds this configuration from the prostate geometry established in two or three dimensions by using images of ultrasound, magnetic resonance or tomography and from the establishment of minimum restrictions to the positions of the seeds in the prostate and needles in a template. Six patterns of seeds distribution based on clinical criteria were suggested and tested in this work. Each one of these patterns generated a space of possible seeds configurations for the prostate tested by the dose calculation and optimization algorithm. The configurations that satisfied the clinical criteria were submitted to a test according to an optimization function suggested in this work. The configuration that produced maximum value for this function was considered the optimized one. (author)

  5. Erectile function after prostate brachytherapy

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Galbreath, Robert W.; Anderson, Richard L.; Kurko, Brian S.; Lief, Jonathan H.; Allen, Zachariah A.

    2005-01-01

    Purpose: To evaluate erectile function after permanent prostate brachytherapy using a validated patient-administered questionnaire and to determine the effect of multiple clinical, treatment, and dosimetric parameters on penile erectile function. Methods and materials: A total of 226 patients with preimplant erectile function determined by the International Index of Erectile Function (IIEF) questionnaire underwent permanent prostate brachytherapy in two prospective randomized trials between February 2001 and January 2003 for clinical Stage T1c-T2c (2002 American Joint Committee on Cancer) prostate cancer. Of the 226 patients, 132 were potent before treatment and, of those, 128 (97%) completed and returned the IIEF questionnaire after brachytherapy. The median follow-up was 29.1 months. Potency was defined as an IIEF score of ≥13. The clinical, treatment, and dosimetric parameters evaluated included patient age; preimplant IIEF score; clinical T stage; pretreatment prostate-specific antigen level; Gleason score; elapsed time after implantation; preimplant nocturnal erections; body mass index; presence of hypertension or diabetes mellitus; tobacco consumption; the volume of the prostate gland receiving 100%, 150%, and 200% of the prescribed dose (V 100/150/200 ); the dose delivered to 90% of the prostate gland (D 90 ); androgen deprivation therapy; supplemental external beam radiotherapy (EBRT); isotope; prostate volume; planning volume; and radiation dose to the proximal penis. Results: The 3-year actuarial rate of potency preservation was 50.5%. For patients who maintained adequate posttreatment erectile function, the preimplant IIEF score was 29, and in patients with brachytherapy-related ED, the preimplant IIEF score was 25. The median time to the onset of ED was 5.4 months. After brachytherapy, the median IIEF score was 20 in potent patients and 3 in impotent patients. On univariate analysis, the preimplant IIEF score, patient age, presence of nocturnal

  6. Refining prostate seed brachytherapy: Comparing high-, intermediate-, and low-activity seeds for I-125 permanent seed prostate brachytherapy.

    Science.gov (United States)

    Delouya, Guila; Bahary, Pascal; Carrier, Jean-François; Larouche, Renée-Xavière; Hervieux, Yannick; Béliveau-Nadeau, Dominic; Donath, David; Taussky, Daniel

    2015-01-01

    To analyze the difference in prostate coverage and dose to the rectum in men with prostate carcinoma treated with permanent seed brachytherapy with different seed activities. Forty-nine patients treated with iodine-125 permanent seed prostate brachytherapy with low-activity seeds of 0.30-0.37 mCi were identified. For each of these patients, 2 patients with similar prostate volume (±2 cc) were paired: one treated with intermediate seed activity (0.44-0.46 mCi) and one with high seed activity (0.60-0.66 mCi). The doses to prostate and rectum were compared using CT on Day 30. A total of 147 patients divided into the three seed activity groups were analyzed. Mean prostate volume was 35.7 cc (standard deviation [SD], 11.70). Compared with low-activity seeds, implants with high-activity seeds consisted of an average of 22 seeds and 4.7 needles less. The dose to the prostate (prostate volume receiving 100% of the prescribed dose [V100], prostate volume receiving 150% of the prescribed dose, and minimal dose covering 90% of the prostate volume expressed in Gy) was not higher on Day 30 (p = 0.58-0.97). The mean volume (in cubic centimeters) of rectal wall receiving 100% of the prescribed dose (V100) increased with activity: low activity, 0.34 cc (SD, 0.49), intermediate activity, 0.47 cc (SD, 0.48), and high activity, 0.72 cc (SD, 0.79) (p = 0.009). There was a trend (p = 0.073) toward a higher frequency of clinically unfavorable rectal dosimetry (V100 > 1.3 cc) in patients with high-activity seeds (16.7%) compared with low-activity (6.3%) or intermediate-activity (4.2%) seeds. High-activity seeds do not result in a higher dose to the prostate but in a higher dose to the rectum. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  7. Development of prostate voxel models for brachytherapy treatment

    International Nuclear Information System (INIS)

    Santos, Adriano M.; Reis, Lucas P.; Grynberg, Suely E.

    2011-01-01

    The tools developed recently in the areas of computer graphics and animation movies to computer games allow the creation of new voxel anthropomorphic phantoms with better resolution and thus, more anatomical details. These phantoms can be used in nuclear applications, especially in radiation protection for estimating doses in cases of occupational or accidental radioactive incidents, and in medical and biological applications. For dose estimates, the phantoms are coupled to a Monte Carlo code, which will be responsible for the transport of radiation in this environment. This study aimed to develop a computational tool to estimate the isodose curves in the prostate after brachytherapy seed implants. For this, we have created a model called FANTPROST in the shape of a 48 mm side cube, with a standard prostate inserted in the center of this cube with different distributions of brachytherapy seeds in this volume. The prostate, according to this model, was obtained from the phantom voxels MASH2 developed by Numerical Dosimetry Group, Department of Nuclear Energy - Federal University of Pernambuco. The modeling of the seeds, added to FANTPROST, was done through the use of geometric information of Iodine-125 Amersham 6711 commercial seed. The simulations were performed by the code MCNP5 for spatial distributions containing different amounts of seeds within the FANTPROST. The obtained curves allowed an estimation of the behavior of the maximum dose that decreases with distance, showing that this tool can be used for a more accurate analysis of the effects produced by the presence of such seeds in the prostate and its vicinity. (author)

  8. Development of prostate voxel models for brachytherapy treatment

    Energy Technology Data Exchange (ETDEWEB)

    Santos, Adriano M.; Reis, Lucas P.; Grynberg, Suely E., E-mail: amsantos@cdtn.b [Center for Development of Nuclear Technology (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil)

    2011-07-01

    The tools developed recently in the areas of computer graphics and animation movies to computer games allow the creation of new voxel anthropomorphic phantoms with better resolution and thus, more anatomical details. These phantoms can be used in nuclear applications, especially in radiation protection for estimating doses in cases of occupational or accidental radioactive incidents, and in medical and biological applications. For dose estimates, the phantoms are coupled to a Monte Carlo code, which will be responsible for the transport of radiation in this environment. This study aimed to develop a computational tool to estimate the isodose curves in the prostate after brachytherapy seed implants. For this, we have created a model called FANTPROST in the shape of a 48 mm side cube, with a standard prostate inserted in the center of this cube with different distributions of brachytherapy seeds in this volume. The prostate, according to this model, was obtained from the phantom voxels MASH2 developed by Numerical Dosimetry Group, Department of Nuclear Energy - Federal University of Pernambuco. The modeling of the seeds, added to FANTPROST, was done through the use of geometric information of Iodine-125 Amersham 6711 commercial seed. The simulations were performed by the code MCNP5 for spatial distributions containing different amounts of seeds within the FANTPROST. The obtained curves allowed an estimation of the behavior of the maximum dose that decreases with distance, showing that this tool can be used for a more accurate analysis of the effects produced by the presence of such seeds in the prostate and its vicinity. (author)

  9. Autoradiography for iodine-125 seeds

    International Nuclear Information System (INIS)

    Alberti, W.; Divoux, S.; Pothmann, B.; Tabor, P.; Hermann, K.P.; Harder, D.

    1993-01-01

    To study the interior design of model 6702 and 6711 iodine-125 seeds, contact autoradiographs were performed using mammography film. Improved resolution was obtained using a pin-hole camera with a hole of 0.1 mm x 0.1 mm. With these techniques, qualitative determination of the relative activity distribution within each seed was possible. The number of the activated resin spheres and the positions of the centers of these spheres can be exactly determined. A model calculation shows that variations in the arrangement of the activated spheres within a seed have a moderate influence on the dose distribution at source distances below 10 mm. Knowing the exact source configuration may be useful when comparing dose calculations with measured data for model 6702 125 I seeds which are currently employed in ophthalmic plaque and implant therapy of other tumors. 16 refs., 5 figs., 2 tabs

  10. Influence of radioactive sources discretization in the Monte Carlo computational simulations of brachytherapy procedures: a case study on the procedures for treatment of prostate cancer

    International Nuclear Information System (INIS)

    Barbosa, Antonio Konrado de Santana; Vieira, Jose Wilson; Costa, Kleber Souza Silva; Lima, Fernando Roberto de Andrade

    2011-01-01

    Radiotherapy computational simulation procedures using Monte Carlo (MC) methods have shown to be increasingly important to the improvement of cancer fighting strategies. One of the biases in this practice is the discretization of the radioactive source in brachytherapy simulations, which often do not match with a real situation. This study had the aim to identify and to measure the influence of radioactive sources discretization in brachytherapy MC simulations when compared to those that do not present discretization, using prostate brachytherapy with Iodine-125 radionuclide as model. Simulations were carried out with 108 events with both types of sources to compare them using EGSnrc code associated to MASH phantom in orthostatic and supine positions with some anatomic adaptations. Significant alterations were found, especially regarding bladder, rectum and the prostate itself. It can be concluded that there is a need to discretized sources in brachytherapy simulations to ensure its representativeness. (author)

  11. Prostate brachytherapy - discharge

    Science.gov (United States)

    ... nausea or vomiting Any new or unusual symptoms Alternative Names Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge References D'Amico AV, Nguyen PL, Crook JM, et al. Radiation therapy for prostate cancer. In: Wein AJ, Kavoussi LR, Partin AW, Peters CA, ...

  12. External beam radiation therapy and a low-dose-rate brachytherapy boost without or with androgen deprivation therapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Strom, Tobin J.; Hutchinson, Sean Z.; Shrinath, Kushagra; Cruz, Alex A.; Figura, Nicholas B.; Nethers, Kevin; Biagioli, Matthew C.; Fernandez, Daniel C.; Heysek, Randy V.; Wilder, Richard B., E-mail: richard.wilder@moffitt.org [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States)

    2014-07-15

    Purpose: To assess outcomes with external beam radiation therapy (EBRT) and a low-dose-rate (LDR) brachytherapy boost without or with androgen deprivation therapy (ADT) for prostate cancer. Materials and Methods: From January 2001 through August 2011, 120 intermediate-risk or high-risk prostate cancer patients were treated with EBRT to a total dose of 4,500 cGy in 25 daily fractions and a palladium-103 LDR brachytherapy boost of 10,000 cGy (n = 90) or an iodine-125 LDR brachytherapy boost of 11,000 cGy (n = 30). ADT, consisting of a gonadotropin-releasing hormone agonist ± an anti-androgen, was administered to 29/92 (32%) intermediate-risk patients for a median duration of 4 months and 26/28 (93%) high-risk patients for a median duration of 28 months. Results: Median follow-up was 5.2 years (range, 1.1-12.8 years). There was no statistically-significant difference in biochemical disease-free survival (bDFS), distant metastasis-free survival (DMFS), or overall survival (OS) without or with ADT. Also, there was no statistically-significant difference in bDFS, DMFS, or OS with a palladium-103 vs. an iodine-125 LDR brachytherapy boost. Conclusions: There was no statistically-significant difference in outcomes with the addition of ADT, though the power of the current study was limited. The Radiation Therapy Oncology Group 0815 and 0924 phase III trials, which have accrual targets of more than 1,500 men, will help to clarify the role ADT in locally-advanced prostate cancer patients treated with EBRT and a brachytherapy boost. Palladium-103 and iodine-125 provide similar bDFS, DMFS, and OS. (author)

  13. Influence of modifications in the positioning of phantoms in the Monte Carlo computational simulation of the prostate brachytherapy

    International Nuclear Information System (INIS)

    Barbosa, Antonio Konrado de Santana; Vieira, Jose Wilson; Costa, Kleber Souza Silva; Lima, Fernando Roberto de Andrade

    2011-01-01

    Radiotherapy simulation procedures using Monte Carlo methods have shown to be increasingly important to the improvement of cancer fighting strategies. Within this context, brachytherapy is one of the most used methods to ensure better life quality when compared to other therapeutic modalities. These procedures are planned with the use of sectional exams with the patient in lying position. However, it is known that alteration of body posture after the procedure has an influence in the localization of many organs. This study had the aim to identify and to measure the influence of such alterations in MC brachytherapy simulations. In order to do so, prostate brachytherapy with the use of Iodine-125 radionuclide was chosen as model. Simulations were carried out with 108 events using EGSnrc code associated to MASH phantom in orthostatic and supine positions. Significant alterations were found, especially regarding bladder, small intestine and testicles. (author)

  14. Evolution of dosimetry constraints to reduce the acute urinary toxicity after prostate brachytherapy with iodine 125 of 395 localised cancers

    International Nuclear Information System (INIS)

    Guerif, S.; Bonvalet, L.; Goudona, J.B.; Glandier, C.

    2007-01-01

    The incidence reduction of urethritis and its length are correlated with a reduction of the urethral D90 and D30 on our selection. The future progress will pass through a targeted therapy on a macroscopic tumoral volume by keeping the V100 to reduce the urethral D90 and the D30. We study now, the possibility to boost the macroscopic tumoral volume seen on MRI with a coverage one V100 between 145 and 150 Gy, a D90 inferior to 160 Gy and an minimal urethral D30. (N.C.)

  15. Interstitial prostate brachytherapy. LDR-PDR-HDR

    International Nuclear Information System (INIS)

    Kovacs, Gyoergy; Hoskin, Peter

    2013-01-01

    The first comprehensive overview of interstitial brachytherapy for the management of local or locally advanced prostate cancer. Written by an interdisciplinary team who have been responsible for the successful GEC-ESTRO/EAU Teaching Course. Discusses in detail patient selection, the results of different methods, the role of imaging, and medical physics issues. Prostate brachytherapy has been the subject of heated debate among surgeons and the proponents of the various brachytherapy methods. This very first interdisciplinary book on the subject provides a comprehensive overview of innovations in low dose rate (LDR), high dose rate (HDR), and pulsed dose rate (PDR) interstitial brachytherapy for the management of local or locally advanced prostate cancer. In addition to detailed chapters on patient selection and the use of imaging in diagnostics, treatment guidance, and implantation control, background chapters are included on related medical physics issues such as treatment planning and quality assurance. The results obtained with the different treatment options and the difficult task of salvage treatment are fully discussed. All chapters have been written by internationally recognized experts in their fields who for more than a decade have formed the teaching staff responsible for the successful GEC-ESTRO/EAU Prostate Brachytherapy Teaching Course. This book will be invaluable in informing residents and others of the scientific background and potential of modern prostate brachytherapy. It will also prove a useful source of up-to-date information for those who specialize in prostate brachytherapy or intend to start an interstitial brachytherapy service.

  16. Segmental Urethral Dosimetry and Urinary Toxicity in Patients With No Urinary Symptoms Before Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Thomas, Carys; Keyes, Mira; Liu, Mitchell; Moravan, Veronika

    2008-01-01

    Purpose: To determine whether segmental urethral dosimetry is predictive for the degree of urinary morbidity after prostate brachytherapy in patients with no urinary symptoms before prostate brachytherapy. Methods and Materials: Between May 2000 and November 2005, 1,107 patients underwent iodine-125 monotherapy with urethral sparing techniques. A total of 166 patients fulfilled the selection criteria: baseline (International Prostate Symptom Score) IPSS ≤5, no androgen deprivation therapy, and prostate ultrasound planning volumes (PUTV) <45 mL. The median follow-up was 44 months. Urinary morbidity was defined by maximum increase in IPSS, time to IPSS resolution, maximum Radiation Therapy Oncology Group (RTOG) score, time to RTOG resolution, and urinary retention. Surrogate deviated urethra was contoured and doses calculated at the base, mid-prostate, apex, and urogenital diaphragm. Univariate and multivariate analysis was used to evaluate urethral and prostate dosimetry, age, PUTV, and number of needles for their association with urinary morbidity. Results: Urethral dose was fairly constant in all urethra segments except prostate base, where the variation in does was large. On multivariate analysis, higher urethral base D50, V100, and larger PUTV were predictive for higher maximum increase in IPSS. Higher urethral base V100 and larger PUTV predicted for prolonged IPSS resolution. Higher urethral base D50 and larger needle number predicted for longer RTOG resolution. Higher urethral base V100 predicted for RTOG ≥2 toxicity. Conclusions: Radiation dose to the urethral base, larger PUTV, and needle number, predicted for increased urinary toxicity after prostate brachytherapy. Correlation between urinary morbidity and urethral base dosimetry may reflect a large variation in urethral dose observed at the prostate base

  17. PSA bounce phenomenon after transperineal interstitial permanent prostate brachytherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Morita, Masashi; Lederer, J.L.; Fukagai, Takashi; Yoshida, Hideki; Shimada, Makoto

    2004-01-01

    We described the temporarily increase phenomenon in prostate-specific antigen level (PSA bounce) after transperineal interstitial permanent prostate brachytherapy (TIPPB) for localized prostate cancer. From December 1998 to May 2003, 500 consecutive patients with localized prostate cancer were treated with TIPPB using iodine-125 or palladium-103. We examined 200 patients who have more than 2-year PSA follow-up. Median follow-up length was 1,069 days (range, 712-1,411 days). No patient received neoadjuvant or adjuvant hormone therapy. PSA determinations were performed every 3 months for the first 2 years after procedure, and every 6 months hereafter. PSA bounce was defined as an increase of 0.1 ng/ml or greater above the preceding PSA level after implant followed by a subsequent decrease below that level. The American Society for Therapeutic Radiology and Oncology (ASTRO) consensus panel criteria 1996 were used to define biochemical failure. PSA bounce was observed in 40% (80/200) of the cases receiving TIPPB. The median time to PSA bounce was 13 months from the day of implant. The median magnitude of the PSA bounce was 0.3 ng/ml from the pre-bounce level. Twelve cases demonstrated biochemical failure according to the ASTRO consensus guidelines of three consecutive rises in PSA. Ten of these subsequently showed a drop in PSA, consistent with biologic control of their disease. Two cases remain classified as apparent biochemical failures. A transient rise in the PSA following TIPPB, the so-called ''bounce'' is a common occurrence. The apparent PSA control of ten of twelve cases failing by the ASTRO criteria raises some concern. Further observation will be necessary to determine ways to discriminate these from true disease progression. (author)

  18. Local anesthesia for prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Simpson, Colleen; Roof, James; Arthurs, Sandy; Korssjoen, Tammy; Sutlief, Steven

    1999-01-01

    Purpose: To demonstrate the technique and feasibility of prostate brachytherapy performed with local anesthesia only. Methods and Materials: A 5 by 5 cm patch of perineal skin and subcutaneous tissue is anesthetized by local infiltration of 10 cc of 1% lidocaine with epinephrine, using a 25-gauge 5/8-inch needle. Immediately following injection into the subcutaneous tissues, the deeper tissues, including the pelvic floor and prostate apex, are anesthetized by injecting 15 cc lidocaine solution with approximately 8 passes of a 20-gauge 1.0-inch needle. Following subcutaneous and peri-apical lidocaine injections, the patient is brought to the simulator suite and placed in leg stirrups. The transrectal ultrasound (TRUS) probe is positioned to reproduce the planning images and a 3.5- or 6.0-inch, 22-gauge spinal needle is inserted into the peripheral planned needle tracks, monitored by TRUS. When the tips of the needles reach the prostatic base, about 1 cc of lidocaine solution is injected in the intraprostatic track, as the needle is slowly withdrawn, for a total volume of 15 cc. The implants are done with a Mick Applicator, inserting and loading groups of two to four needles, so that a maximum of only about four needles are in the patient at any one time. During the implant procedure, an additional 1 cc of lidocaine solution is injected into one or more needle tracks if the patient experiences substantial discomfort. The total dose of lidocaine is generally limited to 500 mg (50 ml of 1% solution). Results: To date, we have implanted approximately 50 patients in our simulator suite, using local anesthesia. Patients' heart rate and diastolic blood pressure usually showed moderate changes, consistent with some discomfort. The time from first subcutaneous injection and completion of the source insertion ranged from 35 to 90 minutes. Serum lidocaine levels were below or at the low range of therapeutic. There has been only one instance of acute urinary retention in the

  19. [Permanent implant prostate cancer brachytherapy: 2013 state-of-the art].

    Science.gov (United States)

    Cosset, J-M; Hannoun-Lévi, J-M; Peiffert, D; Delannes, M; Pommier, P; Pierrat, N; Nickers, P; Thomas, L; Chauveinc, L

    2013-04-01

    With an experience of more than 25 years for the pioneers (and more than 14 years in France), permanent implant brachytherapy using iodine 125 seeds (essentially) is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. The possible extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group has now been confirmed by several studies. Moreover, for the other patients in the intermediate-risk group and for the patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best ways to escalate the dose. Different permanent implant brachytherapy techniques have been proposed; preplanning or real-time procedure, loose or stranded seeds (or both), manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints, which have been recently redefined by the international societies, such as the GEC-ESTRO group. Mid- and long-term results, which are now available in the literature, indicate relapse-free survival rates of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3 to 5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome, which may significantly alter the quality of life of the patients, and last several months. In spite of those drawbacks, with excellent long-term results, low rates of incontinence and impotence, and emerging new indications (focal brachytherapy, salvage brachytherapy after localized failure of an external irradiation), permanent implant prostate brachytherapy can be expected to be proposed to an increasing number of patients

  20. Considerações radiodosimétricas da braquiterapia ocular com iodo-125 e rutênio/ródio-106 Radiodosimetric considerations on ocular brachytherapy with iodine-125 and ruthenium/rhodium-106

    Directory of Open Access Journals (Sweden)

    Arnaldo Prata Mourão

    2009-02-01

    Full Text Available OBJETIVO: Analisar, por meio de um modelo computacional da região ocular, as características da distribuição da dose utilizando placas contendo iodo-125 e rutênio/ródio-106. MATERIAIS E MÉTODOS: Foi utilizado um modelo computacional de voxels da região ocular incluindo os diversos tecidos, com a placa posicionada sobre a esclera. O código Monte Carlo foi utilizado para simular a irradiação. A distribuição da dose é apresentada por curvas de isodoses. RESULTADOS: As simulações computacionais apresentam a distribuição da dose no interior do bulbo e nas estruturas externas. Os resultados permitem comparar a distribuição espacial das doses geradas por partículas beta e por fótons. As simulações mostram que a aplicação de sementes de iodo-125 implica alta dose no cristalino, enquanto o rutênio/ródio-106 produz alta dose na superfície da esclera. CONCLUSÃO: A dose no cristalino depende da espessura do tumor, da posição e do diâmetro da placa, e do radionuclídeo utilizado. No presente estudo, a fonte de rutênio/ródio-106 é recomendada para tumores de dimensões reduzidas. A irradiação com iodo-125 gera doses maiores no cristalino do que a irradiação com rutênio/ródio-106. O valor máximo de dose no cristalino corresponde a 12,75% do valor máximo de dose com iodo-125 e apenas 0,005% para rutênio/ródio-106.OBJECTIVE: To analyze dose distribution utilizing plaques with iodine-125 and ruthenium/rhodium-106 in a computational model of the ocular region. MATERIALS AND METHODS: A voxel-based computational model including the different tissues of the ocular region was utilized with the plaque positioned on the sclera. The Monte Carlo code was utilized for simulating irradiation. The dose distribution is demonstrated by isodoses curves. RESULTS: Computational simulations demonstrate the dose distribution inside the ocular bulb as well as in adjacent outside structures. The results have allowed the authors to compare

  1. Iodine-125 radiation of posterior uveal melanoma

    International Nuclear Information System (INIS)

    Packer, S.

    1987-01-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula

  2. Iodine-125 radiation of posterior uveal melanoma

    Energy Technology Data Exchange (ETDEWEB)

    Packer, S.

    1987-12-01

    Twenty-eight cases of posterior choroidal melanoma were treated with iodine-125 in gold eye plaques. Eleven cases were located within 3.0 mm of the optic nerve (group A), nine were within 3.0 mm of the fovea (group B), and eight were within 3.0 mm of the optic nerve and fovea (group C). The mean follow-up of group A was 46.3 months; group B, 25.5 months; and group C, 42.7 months. Complications included macular edema, cataract and tumor growth. Visual acuity remained within two lines of that tested preoperatively for 4 of 11 patients in group A, 4 of 9 in group B, and 5 of 8 in group C. These results with iodine-125 suggest it as an appropriate treatment for patients with choroidal melanoma located near optic nerve and/or macula.

  3. Development of a patient-reported questionnaire for collecting toxicity data following prostate brachytherapy

    International Nuclear Information System (INIS)

    Farnell, Damian J.J.; Mandall, Paula; Anandadas, Carmel; Routledge, Jaqueline; Burns, Meriel P.; Logue, John P.; Wylie, James P.; Swindell, Ric; Livsey, Jac; West, Catharine M.L.; Davidson, Susan E.

    2010-01-01

    Purpose: To improve a questionnaire used to collect patient-reported outcomes from patients with early stage prostate cancer treated with brachytherapy. A secondary aim was to adapt the Late Effects of Normal Tissue (LENT) subjective toxicity questionnaire for use to collect Common Terminology Criteria for Adverse Events (CTCAE) data, the current preferred platform for assessing radiation toxicity. Materials and methods: Three hundred and seventy-seven patients were treated with permanent iodine-125 seed implant brachytherapy for early prostate cancer. Toxicity data were collected before and at nine time points post-treatment (0-36 months). Compliance rates for patients completing individual items and item-subsection correlation coefficients were calculated. A factor analysis was carried out to analyse responses to the questionnaire and identify less informative questions, which could be removed. Cronbach's α coefficient was used to measure reliability. Results: Two thousand one hundred and eighty-eight questionnaires were analysed. There was poor compliance for questions specifically relating to operations and bowel medication. We found that the division of the questionnaire into subsections based on anatomical site was reasonable and that certain items could be safely removed. The high mean value for Cronbach's α across all questionnaires (0.752; 95% CI: 0.726-0.779) indicated that the questionnaire was reliable. Fifteen of the 44 questions were removed from the original questionnaires. Questions on urinary incontinence severity, management of urinary and bowel incontinence, effects of reduced flow of urine and the effects of symptoms on activity of daily living and change in sexual function were required to adapt the LENT subjective questionnaire for use to collect CTCAE data. Conclusions: A questionnaire, validated over 6 years to collect LENT subjective data were adapted and is a reliable approach for collecting CTCAE data after prostate brachytherapy.

  4. American Brachytherapy Society recommendations for reporting morbidity after prostate brachytherapy

    International Nuclear Information System (INIS)

    Nag, Subir; Ellis, Rodney J.; Merrick, Gregory S.; Bahnson, Robert; Wallner, Kent; Stock, Richard

    2002-01-01

    Purpose: To standardize the reporting of brachytherapy-related prostate morbidity to guide ongoing clinical practice and future investigations. Methods: Members of the American Brachytherapy Society (ABS) with expertise in prostate brachytherapy performed a literature review and, guided by their clinical experience, formulated specific recommendations for reporting on morbidity related to prostate brachytherapy. Results: The ABS recommends using validated, patient-administered health-related quality-of-life instruments for the determination of baseline and follow-up data regarding bowel, urinary, and sexual function. Both actuarial and crude incidences should be reported, along with the temporal resolution of specific complications, and correlated with the doses to the normal tissues. The International Prostate Symptom Score is recommended to assess urinary morbidity, and any dysuria, gross hematuria, urinary retention, incontinence, or medication use should be quantified. Likewise, the ''Sexual Health Inventory for Men,'' which includes the specific erectile questions of the International Index of Erectile Function, is the preferred instrument for reporting sexual function, and the loss of sexual desire, incidence of hematospermia, painful orgasm (orgasmalgia), altered orgasm intensity, decreased ejaculatory volume, use of erectile aids, and use of hormones for androgen deprivation should be quantified. The ABS recommends adoption of the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer acute and late radiation morbidity scoring scheme for reporting rectal morbidity and noting the incidence of rectal steroid, laser, or antidiarrheal use. Conclusion: It is important to focus on health-related quality-of-life issues in the treatment of prostate cancer, because the control rates are very similar between appropriate treatment modalities. The ABS recommends using the International Prostate Symptom Score, International Index of

  5. Establishing High-Quality Prostate Brachytherapy Using a Phantom Simulator Training Program

    International Nuclear Information System (INIS)

    Thaker, Nikhil G.; Kudchadker, Rajat J.; Swanson, David A.; Albert, Jeffrey M.; Mahmood, Usama; Pugh, Thomas J.; Boehling, Nicholas S.; Bruno, Teresa L.; Prestidge, Bradley R.; Crook, Juanita M.; Cox, Brett W.; Potters, Louis; Moran, Brian J.; Keyes, Mira; Kuban, Deborah A.; Frank, Steven J.

    2014-01-01

    Purpose: To design and implement a unique training program that uses a phantom-based simulator to teach the process of prostate brachytherapy (PB) quality assurance and improve the quality of education. Methods and Materials: Trainees in our simulator program were practicing radiation oncologists, radiation oncology residents, and fellows of the American Brachytherapy Society. The program emphasized 6 core areas of quality assurance: patient selection, simulation, treatment planning, implant technique, treatment evaluation, and outcome assessment. Using the Iodine 125 ( 125 I) preoperative treatment planning technique, trainees implanted their ultrasound phantoms with dummy seeds (ie, seeds with no activity). Pre- and postimplant dosimetric parameters were compared and correlated using regression analysis. Results: Thirty-one trainees successfully completed the simulator program during the period under study. The mean phantom prostate size, number of seeds used, and total activity were generally consistent between trainees. All trainees met the V100 >95% objective both before and after implantation. Regardless of the initial volume of the prostate phantom, trainees' ability to cover the target volume with at least 100% of the dose (V100) was not compromised (R=0.99 pre- and postimplant). However, the V150 had lower concordance (R=0.37) and may better reflect heterogeneity control of the implant process. Conclusions: Analysis of implants from this phantom-based simulator shows a high degree of consistency between trainees and uniformly high-quality implants with respect to parameters used in clinical practice. This training program provides a valuable educational opportunity that improves the quality of PB training and likely accelerates the learning curve inherent in PB. Prostate phantom implantation can be a valuable first step in the acquisition of the required skills to safely perform PB

  6. Palladium-103 brachytherapy for prostate carcinoma

    International Nuclear Information System (INIS)

    Blasko, John C.; Grimm, Peter D.; Sylvester, John E.; Badiozamani, Kas Ray; Hoak, David; Cavanagh, William

    2000-01-01

    Purpose: A report of biochemical outcomes for patients treated with palladium-103 (Pd-103) brachytherapy over a fixed time interval. Methods and Materials: Two hundred thirty patients with clinical stage T1-T2 prostate cancer were treated with Pd-103 brachytherapy and followed with prostate-specific antigen (PSA) determinations. Kaplan-Meier estimates of biochemical failure on the basis of two consecutive elevations of PSA were utilized. Multivariate risk groups were constructed. Aggregate PSA response by time interval was assessed. Results: The overall biochemical control rate achieved at 9 years was 83.5%. Failures were local 3.0%; distant 6.1%; PSA progression only 4.3%. Significant risk factors contributing to failure were serum PSA greater than 10 ng/ml and Gleason sum of 7 or greater. Five-year biochemical control for those exhibiting neither risk factor was 94%; one risk factor, 82%; both risk factors, 65%. When all 1354 PSA determinations obtained for this cohort were considered, the patients with a proportion of PSAs ≤ 0.5 ng/ml continued to increase until at least 48 months post-therapy. These data conformed to a median PSA half-life of 96.2 days. Conclusions: Prostate brachytherapy with Pd-103 achieves a high rate of biochemical and clinical control in patients with clinically organ-confined disease. PSA response following brachytherapy with low-dose-rate isotopes is protracted

  7. Prostate brachytherapy in Ghana: our initial experience

    Directory of Open Access Journals (Sweden)

    James Edward Mensah

    2016-10-01

    Full Text Available Purpose: This study presents the experience of a brachytherapy team in Ghana with a focus on technology transfer and outcome. The team was initially proctored by experienced physicians from Europe and South Africa. Material and methods : A total of 90 consecutive patients underwent either brachytherapy alone or brachytherapy in combination with external beam radiotherapy for prostate carcinoma between July 2008 and February 2014 at Korle Bu Teaching Hospital, Accra, Ghana. Patients were classified as low-risk, intermediate, and high-risk according to the National Comprehensive Cancer Network (NCCN criteria. All low-risk and some intermediate risk group patients were treated with seed implantation alone. Some intermediate and all high-risk group patients received brachytherapy combined with external beam radiotherapy. Results: The median patient age was 64.0 years (range 46-78 years. The median follow-up was 58 months (range 18-74 months. Twelve patients experienced biochemical failure including one patient who had evidence of metastatic disease and died of prostate cancer. Freedom from biochemical failure rates for low, intermediate, and high-risk cases were 95.4%, 90.9%, and 70.8%, respectively. Clinical parameters predictive of biochemical outcome included: clinical stage, Gleason score, and risk group. Pre-treatment prostate specific antigen (PSA was not a statistically significant predictor of biochemical failure. Sixty-nine patients (76.6% experienced grade 1 urinary symptoms in the form of frequency, urgency, and poor stream. These symptoms were mostly self-limiting. Four patients needed catheterization for urinary retention (grade 2. One patient developed a recto urethral fistula (grade 3 following banding for hemorrhoids. Conclusions : Our results compare favorably with those reported by other institutions with more extensive experience. We believe therefore that, interstitial permanent brachytherapy can be safely and effectively

  8. Influence of radioactive sources discretization in the Monte Carlo computational simulations of brachytherapy procedures: a case study on the procedures for treatment of prostate cancer; Influencia da discretizacao das fontes radioativas nas simulacoes computacionais Monte Carlo de procedimentos de braquiterapia: um estudo de caso sobre os procedimentos para tratamento do cancer de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Antonio Konrado de Santana; Vieira, Jose Wilson [Instituto Federal de Educacao, Ciencia e Tecnologia (IFPE), Recife, PE (Brazil); Costa, Kleber Souza Silva [Faculdade Integrada de Pernambuco (FACIPE), Recife, PE (Brazil); Lima, Fernando Roberto de Andrade, E-mail: falima@cnen.gov.b [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

    2011-07-01

    Radiotherapy computational simulation procedures using Monte Carlo (MC) methods have shown to be increasingly important to the improvement of cancer fighting strategies. One of the biases in this practice is the discretization of the radioactive source in brachytherapy simulations, which often do not match with a real situation. This study had the aim to identify and to measure the influence of radioactive sources discretization in brachytherapy MC simulations when compared to those that do not present discretization, using prostate brachytherapy with Iodine-125 radionuclide as model. Simulations were carried out with 108 events with both types of sources to compare them using EGSnrc code associated to MASH phantom in orthostatic and supine positions with some anatomic adaptations. Significant alterations were found, especially regarding bladder, rectum and the prostate itself. It can be concluded that there is a need to discretized sources in brachytherapy simulations to ensure its representativeness. (author)

  9. Automated intraoperative calibration for prostate cancer brachytherapy

    International Nuclear Information System (INIS)

    Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor

    2011-01-01

    Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 ± 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 ± 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 ± 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 ± 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

  10. Erectile function after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Galbreath, Robert W.; Stipetich, Robin L.; Abel, Laurie J.; Lief, Jonathan H.

    2002-01-01

    Purpose: To determine the incidence of potency preservation after permanent prostate brachytherapy using a validated patient-administered questionnaire and to evaluate the effect of multiple clinical and treatment parameters on penile erectile function. Methods and Materials: Four hundred twenty-five patients underwent permanent prostate brachytherapy from April 1995 to October 1999. Two hundred nine patients who were potent before brachytherapy and who at the time of the survey were not receiving hormonal therapy were mailed the specific erectile questions of the International Index of Erectile Function (IIEF) questionnaire with a self-addressed stamped envelope. The questionnaire consisted of 5 questions, with a maximal score of 25. Of the 209 patients, 181 (87%) completed and returned the questionnaire. The mean and median follow-up was 40.4±14.9 and 40.6 months, respectively (range 19-75). Preimplant erectile function was assigned using a three-tiered scoring system (2 = erections always or nearly always sufficient for vaginal penetration; 1 = erections sufficient for vaginal penetration but considered suboptimal; 0 = the inability to obtain erections and/or erections inadequate for vaginal penetration). Postimplant potency was defined as an IIEF score ≥11. The clinical parameters evaluated for erectile function included patient age, preimplant potency, clinical T-stage, pretreatment prostate-specific antigen level, Gleason score, elapsed time after implantation, hypertension, diabetes mellitus, and tobacco consumption. Treatment parameters included radiation dose to the prostate gland, use of hormonal manipulation, use of supplemental external beam radiotherapy (EBRT), choice of isotope, prostate volume, and planning volume. The efficacy of sildenafil citrate in brachytherapy-induced erectile dysfunction (ED) was also evaluated. Results: Pretreatment erectile function scores of 2 and 1 were assigned to 125 and 56 patients, respectively. With a 6-year follow

  11. Influence of modifications in the positioning of phantoms in the Monte Carlo computational simulation of the prostate brachytherapy; Influencia de alteracoes no posicionamento de fantomas nas simulacoes computacionais Monte Carlo de braquiterapia de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Barbosa, Antonio Konrado de Santana; Vieira, Jose Wilson, E-mail: konrado.radiologia@gmail.co, E-mail: jose.wilson59@uol.com.b [Instituto Federal de Educacao, Ciencia e Tecnologia (IFPE), Recife, PE (Brazil); Costa, Kleber Souza Silva [Faculdade Integrada de Pernambuco (FACIPE), Recife, PE (Brazil); Lima, Fernando Roberto de Andrade, E-mail: falima@cnen.gov.b [Centro Regional de Ciencias Nucleares do Nordeste (CRCN-NE/CNEN-PE), Recife, PE (Brazil)

    2011-07-01

    Radiotherapy simulation procedures using Monte Carlo methods have shown to be increasingly important to the improvement of cancer fighting strategies. Within this context, brachytherapy is one of the most used methods to ensure better life quality when compared to other therapeutic modalities. These procedures are planned with the use of sectional exams with the patient in lying position. However, it is known that alteration of body posture after the procedure has an influence in the localization of many organs. This study had the aim to identify and to measure the influence of such alterations in MC brachytherapy simulations. In order to do so, prostate brachytherapy with the use of Iodine-125 radionuclide was chosen as model. Simulations were carried out with 108 events using EGSnrc code associated to MASH phantom in orthostatic and supine positions. Significant alterations were found, especially regarding bladder, small intestine and testicles. (author)

  12. Sexual function after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Galbreath, R.W.; Merrick, G.S.; Butler, W.M.; Stipetich, R.L.; Abel, L.J.; Lief, J.H.

    2001-01-01

    Purpose: To determine the incidence of potency preservation following permanent prostate brachytherapy and to evaluate the effect of multiple clinical and treatment parameters on penile erectile function. Materials and Methods: 425 patients underwent permanent prostate brachytherapy from April 1995 to October 1999. 209 patients who were potent prior to brachytherapy and currently not receiving hormonal manipulation were mailed an International Index of Erectile Function (IIEF) questionnaire with a pre-addressed stamped envelope. 180 patients completed and returned the questionnaire. Median patient follow-up was 39 months (range 18-74 months). Pre-implant erectile function was assigned using a three-tiered scoring system (2 = erections always or nearly always sufficient for vaginal penetration; 1 = erections sufficient for vaginal penetration but considered suboptimal; 0 = the inability to obtain erections and/or erections inadequate for vaginal penetration). Post-implant potency was defined as an IIEF score >11. Clinical parameters evaluated for sexual function included patient age, clinical T stage, elapsed time since implantation, hypertension, diabetes mellitus, and tobacco consumption. Evaluated treatment parameters included the utilization of neoadjuvant hormonal manipulation and the choice of isotope. The efficacy of sildenafil citrate in brachytherapy induced erectile dysfunction (ED) was also evaluated. Results: A pre-treatment erectile function score of 2 and 1 were assigned to 126 and 54 patients respectively. With 6 year follow up, 39% of patients maintained potency following prostate brachytherapy with a plateau on the curve. Post-implant preservation of potency (IIEF>11) correlated with pre-implant erectile function (50% versus 14% for pre-implant scores of 2 and 1 respectively, p≤0.0001), patient age (56%, 38%, and 23% for patients <60 years of age, 60-69 years of age, and ≥70 years of age respectively, p=0.012) and a history of diabetes mellitus

  13. Image-robot coupling for the prostate brachytherapy

    International Nuclear Information System (INIS)

    Coelen, V.; Lartigau, E.; Merzouki, R.

    2009-01-01

    The results allows to contemplate a robot use in the prostate brachytherapy but equally in other applications such prostate biopsy. The tests to come are going to be directed towards on the use of a prostate phantom in order to calibrate the ultrasonography. thereafter, we contemplate the conception of an intelligent gripping system placed on the robot arm and allowing a good control in closed loop of the brachytherapy needle placement and allowing the setting up of an online monitoring. (N.C.)

  14. Study on iodine-125 production technique

    International Nuclear Information System (INIS)

    Liu Yishu; Han Dongqiao; Lu Changlong; Sun Wenhao; Bao Jianying; Wang Aimin

    1999-11-01

    125 I is produced with natural xenon as target material. The target preparation process is presented. Required xenon is frozen in 100 ml aluminum container by liquid nitrogen and sealed by cold-welding for irradiation in reactor. I - can be adsorbed on Platinum Coated Copper (PCC) in the media of dilute sulfuric acid, pH 3 PCC. In the range of its adsorption capacity, the adsorption efficiency of iodine-125 on PCC is greater than 99.9%. All the radioiodine can be adsorbed on PCC quantifiably and the impurities pass through the column. The elution efficiency of 125 I from PCC column greatly depends on the concentration of eluant NaOH, the amount of adsorbed 125 I - and flow rate as well. The aluminum dissolved from Al container has no apparent effects on both adsorption and elution efficiency. The contents of adsorbent material Cu and Pt is extremely low ( 125 I produced by using PCC chromatographic technique can meet the requirement of RIA kits labelling and other uses

  15. Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice

    Directory of Open Access Journals (Sweden)

    Haveman Jaap

    2007-09-01

    Full Text Available Abstract Background High-dose radiotherapy is standard treatment for patients with brain cancer. However, in preclinical research external beam radiotherapy is limited to heterotopic murine models– high-dose radiotherapy to the murine head is fatal due to radiation toxicity. Therefore, we developed a stereotactic brachytherapy mouse model for high-dose focal irradiation of experimental intracerebral (orthotopic brain tumors. Methods Twenty-one nude mice received a hollow guide-screw implanted in the skull. After three weeks, 5 × 105 U251-NG2 human glioblastoma cells were injected. Five days later, a 2 mCi iodine-125 brachytherapy seed was inserted through the guide-screw in 11 randomly selected mice; 10 mice received a sham seed. Mice were euthanized when severe neurological or physical symptoms occurred. The cumulative irradiation dose 5 mm below the active iodine-125 seeds was 23.0 Gy after 13 weeks (BEDtumor = 30.6 Gy. Results In the sham group, 9/10 animals (90% showed signs of lethal tumor progression within 6 weeks. In the experimental group, 2/11 mice (18% died of tumor progression within 13 weeks. Acute side effects in terms of weight loss or neurological symptoms were not observed in the irradiated animals. Conclusion The intracerebral implantation of an iodine-125 brachytherapy seed through a stereotactic guide-screw in the skull of mice with implanted brain tumors resulted in a significantly prolonged survival, caused by high-dose irradiation of the brain tumor that is biologically comparable to high-dose fractionated radiotherapy– without fatal irradiation toxicity. This is an excellent mouse model for testing orthotopic brain tumor therapies in combination with radiation therapy.

  16. Experimental iodine-125 seed irradiation of intracerebral brain tumors in nude mice

    International Nuclear Information System (INIS)

    Verhoeff, Joost JC; Stalpers, Lukas JA; Coumou, Annet W; Koedooder, Kees; Lavini, Cristina; Van Noorden, Cornelis JF; Haveman, Jaap; Vandertop, William P; Furth, Wouter R van

    2007-01-01

    High-dose radiotherapy is standard treatment for patients with brain cancer. However, in preclinical research external beam radiotherapy is limited to heterotopic murine models– high-dose radiotherapy to the murine head is fatal due to radiation toxicity. Therefore, we developed a stereotactic brachytherapy mouse model for high-dose focal irradiation of experimental intracerebral (orthotopic) brain tumors. Twenty-one nude mice received a hollow guide-screw implanted in the skull. After three weeks, 5 × 10 5 U251-NG2 human glioblastoma cells were injected. Five days later, a 2 mCi iodine-125 brachytherapy seed was inserted through the guide-screw in 11 randomly selected mice; 10 mice received a sham seed. Mice were euthanized when severe neurological or physical symptoms occurred. The cumulative irradiation dose 5 mm below the active iodine-125 seeds was 23.0 Gy after 13 weeks (BED tumor = 30.6 Gy). In the sham group, 9/10 animals (90%) showed signs of lethal tumor progression within 6 weeks. In the experimental group, 2/11 mice (18%) died of tumor progression within 13 weeks. Acute side effects in terms of weight loss or neurological symptoms were not observed in the irradiated animals. The intracerebral implantation of an iodine-125 brachytherapy seed through a stereotactic guide-screw in the skull of mice with implanted brain tumors resulted in a significantly prolonged survival, caused by high-dose irradiation of the brain tumor that is biologically comparable to high-dose fractionated radiotherapy– without fatal irradiation toxicity. This is an excellent mouse model for testing orthotopic brain tumor therapies in combination with radiation therapy

  17. Irradiation of malignant eyelid melanoma with iodine 125 plaque

    International Nuclear Information System (INIS)

    Stanowsky, A.; Krey, H.F.; Kopp, J.; Kanitz, W.; Wagner, T.

    1990-01-01

    We used contact irradiation with iodine 125 seeds to treat a large, exulcerative, nodular, amelanotic malignant eyelid melanoma with metastasis to the regional lymph nodes in an 80-year-old man. The procedure was similar to iodine 125 plaque irradiation of malignant choroidal melanoma; special equipment, however, was needed to protect the eye from radiation exposure. The response of the malignant eyelid melanoma to iodine 125 plaque irradiation was similar to that of malignant melanomas of the choroid. No complications were observed in a follow-up period of 15 months

  18. Irradiation of malignant eyelid melanoma with iodine 125 plaque

    Energy Technology Data Exchange (ETDEWEB)

    Stanowsky, A.; Krey, H.F.; Kopp, J.; Kanitz, W.; Wagner, T. (Eye Clinic, Central Clinic, Augsburg (West Germany))

    1990-07-15

    We used contact irradiation with iodine 125 seeds to treat a large, exulcerative, nodular, amelanotic malignant eyelid melanoma with metastasis to the regional lymph nodes in an 80-year-old man. The procedure was similar to iodine 125 plaque irradiation of malignant choroidal melanoma; special equipment, however, was needed to protect the eye from radiation exposure. The response of the malignant eyelid melanoma to iodine 125 plaque irradiation was similar to that of malignant melanomas of the choroid. No complications were observed in a follow-up period of 15 months.

  19. Treatment of the prostate cancer with high dose rate brachytherapy

    International Nuclear Information System (INIS)

    Martinez, Alvaro; Torres Silva, Felipe

    2002-01-01

    The prostate cancer treatment in early stages is controversial. The high dose rate brachytherapy has been used like monotherapy or boost with external beam radiotherapy in advanced disease. This paper describes the technique and the advantages over other modalities

  20. Predictors of Metastatic Disease After Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Forsythe, Kevin [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan [Department of Radiation Oncology, New York-Presbyterian Hospital, New York, NY (United States); Stone, Nelson [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G., E-mail: richard.stock@moutsinai.org [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

    2012-06-01

    Purpose: To identify predictors of metastatic disease after brachytherapy treatment for prostate cancer. Methods and Materials: All patients who received either brachytherapy alone (implant) or brachytherapy in combination with external beam radiation therapy for treatment of localized prostate cancer at The Mount Sinai Hospital between June 1990 and March 2007 with a minimum follow-up of 2 years were included. Univariate and multivariable analyses were performed on the following variables: risk group, Gleason score (GS), clinical T stage, pretreatment prostate-specific antigen level, post-treatment prostate-specific antigen doubling time (PSA-DT), treatment type (implant vs. implant plus external beam radiation therapy), treatment era, total biological effective dose, use of androgen deprivation therapy, age at diagnosis, and race. PSA-DT was analyzed in the following ordinate groups: 0 to 90 days, 91 to 180 days, 180 to 360 days, and greater than 360 days. Results: We included 1,887 patients in this study. Metastases developed in 47 of these patients. The 10-year freedom from distant metastasis (FFDM) rate for the entire population was 95.1%. Median follow-up was 6 years (range, 2-15 years). The only two significant predictors of metastatic disease by multivariable analyses were GS and PSA-DT (p < 0.001 for both variables). Estimated 10-year FFDM rates for GS of 6 or less, GS of 7, and GS of 8 or greater were 97.9%, 94.3%, and 76.1%, respectively (p < 0.001). Estimated FFDM rates for PSA-DT of 0 to 90 days, 91 to 180 days, 181 to 360 days, and greater than 360 days were 17.5%, 67.9%, 74%, and 94.8%, respectively (p < 0.001). Estimated 10-year FFDM rates for the low-, intermediate-, and high-risk groups were 98.6%, 96.2%, and 86.7%, respectively. A demographic shift to patients presenting with higher-grade disease in more recent years was observed. Conclusions: GS and post-treatment PSA-DT are both statistically significant independent predictors of metastatic

  1. Methods for prostate stabilization during transperineal LDR brachytherapy

    International Nuclear Information System (INIS)

    Podder, Tarun; Yu Yan; Sherman, Jason; Rubens, Deborah; Strang, John; Messing, Edward; Ng, Wan-Sing

    2008-01-01

    In traditional prostate brachytherapy procedures for a low-dose-rate (LDR) radiation seed implant, stabilizing needles are first inserted to provide some rigidity and support to the prostate. Ideally this will provide better seed placement and an overall improved treatment. However, there is much speculation regarding the effectiveness of using regular brachytherapy needles as stabilizers. In this study, we explored the efficacy of two types of needle geometries (regular brachytherapy needle and hooked needle) and several clinically feasible configurations of the stabilization needles. To understand and assess the prostate movement during seed implantation, we collected in vivo data from patients during actual brachytherapy procedures. In vitro experimentation with tissue-equivalent phantoms allowed us to further understand the mechanics behind prostate stabilization. We observed superior stabilization with the hooked needles compared to the regular brachytherapy needles (more than 40% in bilateral parallel needle configuration). Prostate movement was also reduced significantly when regular brachytherapy needles were in an angulated configuration as compared to the parallel configuration (more than 60%). When the hooked needles were angulated for stabilization, further reduction in prostate displacement was observed. In general, for convenience of dosimetric planning and to avoid needle collision, all needles are desired to be in a parallel configuration. In this configuration, hooked needles provide improved stabilization of the prostate. On the other hand, both regular and hooked needles appear to be equally effective in reducing prostate movement when they are in angulated configurations, which will be useful in seed implantation using a robotic system. We have developed nonlinear spring-damper model for the prostate movement which can be used for adapting dosimetric planning during brachytherapy as well as for developing more realistic haptic devices and

  2. Sexual Function and the Use of Medical Devices or Drugs to Optimize Potency After Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Whaley, J. Taylor; Levy, Lawrence B. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Swanson, David A. [Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Pugh, Thomas J. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Kudchadker, Rajat J.; Bruno, Teresa L. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Frank, Steven J., E-mail: sjfrank@mdnaderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

    2012-04-01

    Purpose: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. Methods and Materials: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. Results: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. Conclusions: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

  3. Sexual Function and the Use of Medical Devices or Drugs to Optimize Potency After Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Whaley, J. Taylor; Levy, Lawrence B.; Swanson, David A.; Pugh, Thomas J.; Kudchadker, Rajat J.; Bruno, Teresa L.; Frank, Steven J.

    2012-01-01

    Purpose: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. Methods and Materials: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. Results: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. Conclusions: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

  4. The american brachytherapy society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis

    International Nuclear Information System (INIS)

    Nag, Subir; Bice, William; Wyngaert, Keith de; Prestidge, Bradley; Stock, Richard; Yu Yan

    2000-01-01

    Purpose: The purpose of this report is to establish guidelines for postimplant dosimetric analysis of permanent prostate brachytherapy. Methods: Members of the American Brachytherapy Society (ABS) with expertise in prostate dosimetry evaluation performed a literature review and supplemented with their clinical experience formulated guidelines for performing and analyzing postimplant dosimetry of permanent prostate brachytherapy. Results: The ABS recommends that postimplant dosimetry should be performed on all patients undergoing permanent prostate brachytherapy for optimal patient care. At present, computed tomography (CT)-based dosimetry is recommended, based on availability cost and the ability to image the prostate as well as the seeds. Additional plane radiographs should be obtained to verify the seed count. Until the ideal postoperative interval for CT scanning has been determined, each center should perform dosimetric evaluation of prostate implants at a consistent postoperative interval. This interval should be reported. Isodose displays should be obtained at 50%, 80%, 90%, 100%, 150%, and 200% of the prescription dose and displayed on multiple cross-sectional images of the prostate. A dose-volume histogram (DVH) of the prostate should be performed and the D 90 (dose to 90% of the prostate gland) reported by all centers. Additionally, the D 80, D 100, the fractional V 80, V 90, V 100, V 150, and V 200, (i.e., the percentage of prostate volume receiving 80%, 90%, 100%, 150%, and 200% of the prescribed dose, respectively), the rectal, and urethral doses should be reported and ultimately correlated with clinical outcome in the research environment. On-line real-time dosimetry, the effects of dose heterogeneity, and the effects of tissue heterogeneity need further investigation. Conclusion: It is essential that postimplant dosimetry should be performed on all patients undergoing permanent prostate brachytherapy. Guidelines were established for the performance

  5. Factors influencing outcome of I-125 prostate cancer brachytherapy

    NARCIS (Netherlands)

    Hinnen, K.A.

    2011-01-01

    Brachytherapy is becoming an increasingly popular prostate cancer treatment, probably due to the specific advantages of the procedure, such as the minimal invasiveness and the lower chance of impotence and incontinence. Nonetheless, because of the long follow-up that is required to obtain prostate

  6. DOSIMETRIC STUDY IN IODINE-125 SEEDS FOR BRACHYTHERAPY APPLICATION

    OpenAIRE

    Carlos Alberto Zeituni

    2008-01-01

    A demanda por sementes de iodo-125 para uso em braquiterapia tem crescido muito ao longo dos últimos anos, tanto no Brasil quanto no mundo. Toda semente de iodo-125 deve ter seus parâmetros operacionais medidos e/ou calculados todas as vezes que for efetuada alguma modificação na produção. Um levantamento dosimétrico completo custa bastante caro, e recomenda-se que seja refeito pelo menos uma vez por ano. Neste contexto, o presente trabalho desenvolveu uma metodologia para todo o processo dos...

  7. Gracilis muscle interposition with primary rectal without urethral repair for moderate sized rectourethral fistula caused by brachytherapy for prostate cancer: a case report

    Directory of Open Access Journals (Sweden)

    Samalavicius Narimantas

    2012-09-01

    Full Text Available Abstract Introduction There is a 0.16% chance of a rectourethral fistula after prostate brachytherapy monotherapy using Palladium-103 or Iodine-125 implants. We present an unusual case report of a rectourethral fistula following brachyradiotherapy monotherapy for prostate adenocarcinoma. It was also associated with unusual management of the fistula. Case presentation A 58-year-old Caucasian man underwent brachyradiotherapy monotherapy as definitive treatment for verified intracapsular prostate adenocarcinoma receiving 56 Iodine-125 implants using a transrectal ultrasound-guided technique. The patient started to complain of severe perineal pain and mild rectal bleeding 15Â months after brachyradiotherapy. A biopsy of mucosa of his anterior rectal wall was performed. A moderate sized rectourethral fistula was confirmed 23Â months after implantation of Iodine-125 seeds. Laparoscopic sigmoidostomy and suprapubic cystostomy were then performed. Long-term cortisone applications in combination with 30 sessions of hyperbaric oxygen therapy, and antibacterial therapies were initiated due to necrotic infection. A gracilis muscle interposition to create a partition between the patient's rectum and urethra in conjunction with primary rectal repair but without urethral repair were performed 6 months later. The 3cm rectal defect was repaired via a 3cm-long horizontal perineal incision. The 1.5cm urethral defect just below the prostate was not repaired. The patient underwent an optic internal urethrotomy 3Â months later for a 1.5cm-long urethral stricture. Several planned preventive urethral buginages were performed to avoid urethral stricture recurrence. At 12Â months postoperatively, there were no signs of a fistula and cancer recurrence. He now has a normal voiding and anal continence. Conclusion Severe rectal pain, bleeding, and local anterior necrotic proctitis are predictors of a rectourethral fistula. Urinary and fecal diversion is the first

  8. Dose optimization in simulated permanent interstitial implant of prostate brachytherapy; Otimizacao de dose em implantes intersticiais permanentes simulados de braquiterapia de prostata

    Energy Technology Data Exchange (ETDEWEB)

    Faria, Fernando Pereira de

    2006-07-01

    Any treatment of cancer that uses some modality of radiotherapy is planned before being executed. In general the goal in radiotherapy is to irradiate the target to be treated minimizing the incidence of radiation in healthy surrounding tissues. The planning differ among themselves according to the modality of radiotherapy, the type of cancer and where it is located. This work approaches the problem of dose optimization for the planning of prostate cancer treatment through the modality of low dose-rate brachytherapy with Iodine 125 or Palladium 103 seeds. An algorithm for dose calculation and optimization was constructed to find the seeds configuration that better fits the relevant clinical criteria such as as the tolerated dose by the urethra and rectum and the desired dose for prostate. The algorithm automatically finds this configuration from the prostate geometry established in two or three dimensions by using images of ultrasound, magnetic resonance or tomography and from the establishment of minimum restrictions to the positions of the seeds in the prostate and needles in a template. Six patterns of seeds distribution based on clinical criteria were suggested and tested in this work. Each one of these patterns generated a space of possible seeds configurations for the prostate tested by the dose calculation and optimization algorithm. The configurations that satisfied the clinical criteria were submitted to a test according to an optimization function suggested in this work. The configuration that produced maximum value for this function was considered the optimized one. (author)

  9. Interstitial rotating shield brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Adams, Quentin E.; Xu, Jinghzu; Breitbach, Elizabeth K.; Li, Xing; Rockey, William R.; Kim, Yusung; Wu, Xiaodong; Flynn, Ryan T.; Enger, Shirin A.

    2014-01-01

    Purpose: To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT). Methods: A wire-mounted 62 GBq 153 Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 μm thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535 μm thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0–5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%. Results: The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D 98% ), I-RSBT reduced urethral D 0.1cc below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D 1cc was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D 1cc was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq 153 Gd sources. Conclusions: For the case considered, the proposed 153 Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29%–44% if the clinician allows

  10. Role of brachytherapy in the treatment of localized prostate cancer

    Directory of Open Access Journals (Sweden)

    A. D. Kaprin

    2015-01-01

    Full Text Available The review is devoted to application of brachytherapy for treating the localized prostate cancer (PC. Statistics for incidence and detectability of this pathology and its dynamics for recent years are represented. Brief analysis of other methods which are conveniently used for treatment of PC, such as radical prostatectomy and external-beam radiotherapy, was performed. Advantages and disadvantages of these methods have been discussed. Brief history about the development of brachytherapy from first experience to wide-spread use in clinical practice is reported. The detailed review of series of large trials from Russia and other countries for efficiency and safety of brachytherapy in patients with prostate cancer for recent 15 years is also represented. Two types of brachytherapy in current clinical oncology i.e. low-dose technique with permanent implantation of microsources and high-dose temporary isotope implantation, specifics of its application in different groups of patients have been described. The procedure of brachytherapy and its three main steps i.e. planning, implantation and control assessment after implantation have been characterized in details. The conclusion about benefits of using of brachytherapy in the treatment of prostate cancer as minimally invasive and efficient method was made. 

  11. Prostate specific antigen (PSA) kinetics after 125I seed implantation (permanent Brachytherapy) for localized prostate cancer

    International Nuclear Information System (INIS)

    Ebara, Shin; Katayama, Norihisa; Manabe, Daisuke

    2007-01-01

    Prostatic specific antigen (PSA) bounce (over 0.1 ng/ml) was observed in 25.7% of patients (18 of 70) within 30 month after brachytherapy in our series. Several reports demonstrated that PSA bounce was observed in 30-50% of patients, observed within 2 years after brachytherapy and continued following 1 year. PSA bounce should be considered when assessing a patient with a rising PSA level before PSA nadir was achieved 4-5 years after brachytherapy. (author)

  12. Quality asurance of iodinated (125 I) human fibrinogen

    International Nuclear Information System (INIS)

    Vines, E.J.

    1980-05-01

    The radiopharmaceutical iodinated ( 125 I) human fibrinogen is currently used for the detection of deep vein thrombosis in the legs, a fairly common post-surgical complication. A comprehensive quality assurance programme for ( 125 I) - human fibrinogen has been determined for routine use at the Australian Radiation Laboratory, with adaptions necessary for hospital quality control testing

  13. The Effect of Dose and Quality Assurance in Early Prostate Cancer Treated with Low Dose Rate Brachytherapy as Monotherapy.

    Science.gov (United States)

    Henry, A M; Rodda, S L; Mason, M; Musunuru, H; Al-Qaisieh, B; Bownes, P; Smith, J; Franks, K; Carey, B; Bottomley, D

    2015-07-01

    To examine the relationship between post-implant computed tomography dosimetry and long-term prostate-specific antigen relapse-free survival in patients treated with iodine 125 (I-125) low dose rate prostate brachytherapy as monotherapy and, second, to audit recent practice against Royal College of Radiologists' (RCR) guidelines after the re-introduction of post-implant dosimetry for all patients in our centre. Between March 1995 and September 2007, 2157 consecutive patients with localised prostate cancer underwent I-125 permanent prostate brachytherapy as monotherapy in a single UK centre. All patients were transrectal ultrasound planned delivering a 145 Gy (TG 43) minimum peripheral dose. None received supplemental external beam radiotherapy. Post-implant computed tomography-based dosimetry was undertaken between 4 and 6 weeks after treatment and was available for 711 (33%). Outcomes were analysed in terms of the relationship of D90 to prostate-specific antigen relapse-free survival (nadir 2+ definition) and all patients had a minimum follow-up of 5 years. For contemporary patients from 2011, quality metrics from post-implant computed tomography as defined by RCR guidelines are presented. A mean D90 of 138.7 Gy (standard deviation 24.7) was achieved for the historic cohort. Biochemical control at 10 years was 76% in patients with D90 > 140 Gy and 68% in those with D90 standard deviation) D90 has increased from 154 (15.3) Gy in 2011 to 164 (13.5) Gy in 2013. Similarly, an increase in the mean (standard deviation) V100 from 92 (4.4) to 95 (3.2) % is noted over time. No difference between clinicians was noted. D90 values of less than 140 Gy continue to be predictive of increased risk of recurrence of prostate cancer across risk groups with longer follow-up. Quality assurance can be used to ensure improved and consistent implant quality in a team with multiple clinicians. Copyright © 2015 The Royal College of Radiologists. Published by Elsevier Ltd. All rights

  14. Potency after permanent prostate brachytherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Potters, Louis; Torre, Taryn; Fearn, Paul A.; Leibel, Steven A.; Kattan, Michael W.

    2001-01-01

    Purpose: The evaluation of potency preservation after treatment of localized prostate cancer with transperineal permanent prostate brachytherapy (PPB) and the efficacy of sildenafil were studied. Methods and Materials: This study comprised 482 patients who were able to maintain an erection suitable for intercourse before treatment from a cohort of 1166 patients with clinically localized prostate cancer treated with PPB. All patients have been followed prospectively, and actuarial analysis was performed to assess potency preservation over time. Patients treated with sildenafil were evaluated as to its efficacy. Results: The median follow-up of this cohort was 34 months (6-92), with a median age of 68 years (47-80). Potency was preserved in 311 of the 482 patients, with a 5-year actuarial potency rate of 52.7%. The 5-year actuarial potency rate for patients treated with PPB as monotherapy was 76%, and, for those treated with combination external beam radiotherapy (EBT) + PPB, 56% (p=0.08). Patients treated with neoadjuvant androgen deprivation (NAAD) + PPB had a 5-year potency rate of 52%, whereas those with combination EBT + PPB + NAAD had a potency rate of 29% (p=0.13). Cox regression analysis identified that pretreatment use of NAAD and patient age predicted for impotence (p=0.0001 and 0.04, respectively). Of 84 patients treated with sildenafil, 52 had a successful outcome (62%). The response to sildenafil was significantly better in those patients not treated with NAAD (p=0.04). Conclusions: The actuarial potency rates at 5 years for patients treated with PPB are lower than generally acknowledged, except for those patients treated with PPB as monotherapy. Patients who received sildenafil exhibited improved potency in a majority of cases

  15. Brachytherapy treatment planning algorithm applied to prostate cancer

    Science.gov (United States)

    Herrera-Rodríguez, M. R.; Martínez-Dávalos, A.

    2000-10-01

    An application of Genetic Algorithms (GAs) for treatment planning optimization in prostate brachytherapy is presented. The importance of multi-objective selection criteria based on the contour of the volume of interest and radiosensitive structures such as the rectum and urethra is discussed. First results are obtained for a simple test case which presents radial symmetry.

  16. Dose to the bladder neck is the most important predictor for acute and late toxicity after low-dose-rate prostate brachytherapy: implications for establishing new dose constraints for treatment planning.

    Science.gov (United States)

    Hathout, Lara; Folkert, Michael R; Kollmeier, Marisa A; Yamada, Yoshiya; Cohen, Gil'ad N; Zelefsky, Michael J

    2014-10-01

    To identify an anatomic structure predictive for acute (AUT) and late (LUT) urinary toxicity in patients with prostate cancer treated with low-dose-rate brachytherapy (LDR) with or without external beam radiation therapy (EBRT). From July 2002 to January 2013, 927 patients with prostate cancer (median age, 66 years) underwent LDR brachytherapy with Iodine 125 (n=753) or Palladium 103 (n=174) as definitive treatment (n=478) and as a boost (n=449) followed by supplemental EBRT (median dose, 50.4 Gy). Structures contoured on the computed tomographic (CT) scan on day 0 after implantation included prostate, urethra, bladder, and the bladder neck, defined as 5 mm around the urethra between the catheter balloon and the prostatic urethra. AUT and LUT were assessed with the Common Terminology Criteria for Adverse Events, version4. Clinical and dosimetric factors associated with AUT and LUT were analyzed with Cox regression and receiver operating characteristic analysis to calculate area under the receiver operator curve (ROC) (AUC). Grade ≥2 AUT and grade ≥2 LUT occurred in 520 patients (56%) and 154 patients (20%), respectively. No grade 4 toxicities were observed. Bladder neck D2cc retained a significant association with AUT (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.03-1.04; PLUT (HR, 1.01; 95% CI, 1.00-1.03; P=.014) on multivariable analysis. In a comparison of bladder neck with the standard dosimetric variables by use of ROC analysis (prostate V100 >90%, D90 >100%, V150 >60%, urethra D20 >130%), bladder neck D2cc >50% was shown to have the strongest prognostic power for AUT (AUC, 0.697; PLUT (AUC, 0.620; P50% was the strongest predictor for grade ≥2 AUT and LUT in patients treated with LDR brachytherapy. These data support inclusion of bladder neck constraints into brachytherapy planning to decrease urinary toxicity. Copyright © 2014 Elsevier Inc. All rights reserved.

  17. Predictive factors for acute and late urinary toxicity after permanent interstitial brachytherapy in Japanese patients

    International Nuclear Information System (INIS)

    Tanimoto, Ryuta; Bekku, Kensuke; Katayama, Norihisa

    2013-01-01

    The objectives of this study were to describe the frequency of and to determine predictive factors associated with Radiation Therapy Oncology Group urinary toxicity in prostate brachytherapy patients. From January 2004 to April 2011, 466 consecutive Japanese patients underwent permanent iodine-125-seed brachytherapy (median follow up 48 months). International Prostate Symptom Score and Radiation Therapy Oncology Group toxicity data were prospectively collected. Prostate volume, International Prostate Symptom Score before and after brachytherapy, and postimplant analysis were examined for an association with urinary toxicity, defined as Radiation Therapy Oncology Group urinary toxicity of Grade 1 or higher. Logistic regression analysis was used to examine the factors associated with urinary toxicity. The rate of Radiation Therapy Oncology Group urinary toxicity grade 1 or higher at 1, 6, 12, 24, 36 and 48 months was 67%, 40%, 21%, 31%, 27% and 28%, respectively. Grade 2 or higher urinary toxicity was less than 1% at each time-point. International Prostate Symptom Score was highest at 3 months and returned to normal 12 months after brachytherapy. On multivariate analysis, patients with a larger prostate size, greater baseline International Prostate Symptom Score, higher prostate V100, higher prostate V150, higher prostate D90 and a greater number of seeds had more acute urinary toxicities at 1 month and 12 months after brachytherapy. On multivariate analysis, significant predictors for urinary toxicity at 1 month and 12 months were a greater baseline International Prostate Symptom Score and prostate V100. Most urinary symptoms are tolerated and resolved within 12 months after prostate brachytherapy. Acute and late urinary toxicity after brachytherapy is strongly related to the baseline International Prostate Symptom Score and prostate V100. (author)

  18. The dosimetry of prostate brachytherapy-induced urethral strictures

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Tollenaar, Bryan G.; Galbreath, Robert W.; Lief, Jonathan H.

    2002-01-01

    Purpose: There is a paucity of data regarding the incidence of urethral strictures after prostate brachytherapy. In this study, we evaluate multiple clinical, treatment, and dosimetric parameters to identify factors associated with the development of brachytherapy-induced urethral strictures. Methods and Materials: 425 patients underwent transperineal ultrasound-guided prostate brachytherapy using either 103 Pd or 125 I for clinical T1b/T3a NxM0 (1997, American Joint Committee on Cancer) adenocarcinoma of the prostate gland from April 1995 to October 1999. No patient was lost to follow-up. 221 patients were implanted with 103 Pd and 204 patients with 125 I. The median patient age was 68 years (range 48-81 years). The median follow-up was 35.2 months (range 15-72 months). Follow-up was calculated from the day of implantation. Thirteen patients developed brachytherapy-induced strictures, and all strictures involved the membranous urethra. A control group of 35 patients was rigorously matched to the stricture patients in terms of treatment approach; i.e., choice of isotope, plus or minus radiation therapy, and plus or minus hormonal manipulation. Nine of the 13 stricture patients had detailed Day 0 urethral dosimetry available for review. The apex of the prostate gland and the membranous urethra were defined by CT evaluation. Urethral dosimetry was reported for the prostatic urethra, the apical slice of the prostate gland, and the membranous urethra which was defined as extending 20 mm in length. Results: The 5-year actuarial risk of a urethral stricture was 5.3%, with a median time to development of 26.6 months (range 7.8-44.1 months). Of multiple clinical and treatment parameters evaluated, only the duration of hormonal manipulation (>4 months, p=0.011) was predictive for the development of a urethral stricture. The radiation dose to the membranous urethra was significantly greater in patients with strictures than those without: 97.6%±20.8% vs. 81.0%±19.8% of

  19. Study of two different radioactive sources for prostate brachytherapy treatment

    International Nuclear Information System (INIS)

    Pereira Neves, Lucio; Perini, Ana Paula; Souza Santos, William de; Caldas, Linda V.E.; Belinato, Walmir

    2015-01-01

    In this study we evaluated two radioactive sources for brachytherapy treatments. Our main goal was to quantify the absorbed doses on organs and tissues of an adult male patient, submitted to a brachytherapy treatment with two radioactive sources. We evaluated a 192 Ir and a 125 I radioactive sources. The 192 Ir radioactive source is a cylinder with 0.09 cm in diameter and 0.415 cm long. The 125 I radioactive source is also a cylinder, with 0.08 cm in diameter and 0.45 cm long. To evaluate the absorbed dose distribution on the prostate, and other organs and tissues of an adult man, a male virtual anthropomorphic phantom MASH, coupled in the radiation transport code MCNPX 2.7.0, was employed.We simulated 75, 90 and 102 radioactive sources of 125 I and one of 192 Ir, inside the prostate, as normally used in these treatments, and each treatment was simulated separately. As this phantom was developed in a supine position, the displacement of the internal organs of the chest, compression of the lungs and reduction of the sagittal diameter were all taken into account. For the 192 Ir, the higher doses values were obtained for the prostate and surrounding organs, as the colon, gonads and bladder. Considering the 125 I sources, with photons with lower energies, the doses to organs that are far from the prostate were lower. All values for the dose rates are in agreement with those recommended for brachytherapy treatments. Besides that, the new seeds evaluated in this work present usefulness as a new tool in prostate brachytherapy treatments, and the methodology employed in this work may be applied for other radiation sources, or treatments. (authors)

  20. Study of two different radioactive sources for prostate brachytherapy treatment

    Energy Technology Data Exchange (ETDEWEB)

    Pereira Neves, Lucio; Perini, Ana Paula [Instituto de Fisica, Universidade Federal de Uberlandia, Caixa Postal 593, 38400-902, Uberlandia, MG (Brazil); Souza Santos, William de; Caldas, Linda V.E. [Instituto de Pesquisas Energeticas e Nucleares, Comissao Nacional de Energia Nuclear, IPENCNEN/SP, Av. Prof. Lineu Prestes, 2242, Cidade Universitaria, 05508-000 Sao Paulo, SP (Brazil); Belinato, Walmir [Departamento de Ensino, Instituto Federal de Educacao, Ciencia e Tecnologia da Bahia, Campus Vitoria da Conquista, Zabele, Av. Amazonas 3150, 45030-220 Vitoria da Conquista, BA (Brazil)

    2015-07-01

    In this study we evaluated two radioactive sources for brachytherapy treatments. Our main goal was to quantify the absorbed doses on organs and tissues of an adult male patient, submitted to a brachytherapy treatment with two radioactive sources. We evaluated a {sup 192}Ir and a {sup 125}I radioactive sources. The {sup 192}Ir radioactive source is a cylinder with 0.09 cm in diameter and 0.415 cm long. The {sup 125}I radioactive source is also a cylinder, with 0.08 cm in diameter and 0.45 cm long. To evaluate the absorbed dose distribution on the prostate, and other organs and tissues of an adult man, a male virtual anthropomorphic phantom MASH, coupled in the radiation transport code MCNPX 2.7.0, was employed.We simulated 75, 90 and 102 radioactive sources of {sup 125}I and one of {sup 192}Ir, inside the prostate, as normally used in these treatments, and each treatment was simulated separately. As this phantom was developed in a supine position, the displacement of the internal organs of the chest, compression of the lungs and reduction of the sagittal diameter were all taken into account. For the {sup 192}Ir, the higher doses values were obtained for the prostate and surrounding organs, as the colon, gonads and bladder. Considering the {sup 125}I sources, with photons with lower energies, the doses to organs that are far from the prostate were lower. All values for the dose rates are in agreement with those recommended for brachytherapy treatments. Besides that, the new seeds evaluated in this work present usefulness as a new tool in prostate brachytherapy treatments, and the methodology employed in this work may be applied for other radiation sources, or treatments. (authors)

  1. Use of iodine-125 brachytherapy in treatment of choroidal melanomas, technic and preliminary analysis of 78 patients; Traitement conservateur des melanomes choroidiens par curietherapie par l'iode 125, technique et analyse preliminaire d'une serie de 78 patients

    Energy Technology Data Exchange (ETDEWEB)

    Quetin, P.; Schumacher, C.; Schraub, S. [Centre Paul-Strauss, Dept. de Radiotherapie, 67 - Strasbourg (France); Meyer, L.; Polto, F.; Sahel, J. [Hopitaux Universitaires de Strasbourg, Clinique Ophtalmologique, 67 (France); Magnenet, P. [Centre Paul-Strauss, Dept. de Radiophysique, 67 - Strasbourg (France); Andres, E. [Hopital de Hautepierre, Medecine Interne, 67 - Strasbourg (France)

    2001-12-01

    Purpose. - Iodine 125 curietherapy is one of the conservative treatments of uveal melanoma. The technique used to achieve these results was simplified through the physical characteristics of the radioelement and the optimized-dosimetry program employed. Patients and methods. - 78 patients with choroidal melanoma were treated with iodine 125. About 100 Gy were delivered to the superior pole of the tumour. The minimal length of follow-up was 17 months and the average, 67 months. Results. -There was 88% local control, leading to lowered visual acuity in 76 % of the cases. Radiation retinopathy, directly related to proximity to the macula, is the principle etiology. Seven patients died of hepatic metastasis, five patients were enucleated. Four patients were further treated with proton-therapy to make up for non-control locally. Conclusion. -One dose of 100 Gy to the superior pole of the tumor seemed to lead to good local control, with the exception of complications related to proximity to the macula and the optic nerve. In this attempt to optimize irradiation, the time lapse between any benefit in local control derived from irradiation and post-therapeutic complications observed remains insufficient to evaluate any relationship. (authors)

  2. Serum Testosterone Kinetics After Brachytherapy for Clinically Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Taira, Al V. [Western Radiation Oncology, Mountain View, CA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.org [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan H.; Allen, Zachariah A. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation Group Health Cooperative, University of Washington, Seattle, WA (United States)

    2012-01-01

    Purpose: To evaluate temporal changes in testosterone after prostate brachytherapy and investigate the potential impact of these changes on response to treatment. Methods and Materials: Between January 2008 and March 2009, 221 consecutive patients underwent Pd-103 brachytherapy without androgen deprivation for clinically localized prostate cancer. Prebrachytherapy prostate-specific antigen (PSA) and serum testosterone were obtained for each patient. Repeat levels were obtained 3 months after brachytherapy and at least every 6 months thereafter. Multiple clinical, treatment, and dosimetric parameters were evaluated to determine an association with temporal testosterone changes. In addition, analysis was conducted to determine if there was an association between testosterone changes and treatment outcomes or the occurrence of a PSA spike. Results: There was no significant difference in serum testosterone over time after implant (p = 0.57). 29% of men experienced an increase {>=}25%, 23% of men experienced a decrease {>=}25%, and the remaining 48% of men had no notable change in testosterone over time. There was no difference in testosterone trends between men who received external beam radiotherapy and those who did not (p = 0.12). On multivariate analysis, preimplant testosterone was the only variable that consistently predicted for changes in testosterone over time. Men with higher than average testosterone tended to experience drop in testosterone (p < 0.001), whereas men with average or below average baseline testosterone had no significant change. There was no association between men who experienced PSA spike and testosterone temporal trends (p = 0.50) nor between initial PSA response and testosterone trends (p = 0.21). Conclusion: Prostate brachytherapy does not appear to impact serum testosterone over time. Changes in serum testosterone do not appear to be associated with PSA spike phenomena nor with initial PSA response to treatment; therefore, PSA response

  3. PSA bounce after {sup 125}I-brachytherapy for prostate cancer as a favorable prognosticator

    Energy Technology Data Exchange (ETDEWEB)

    Engeler, Daniel S.; Schwab, Christoph; Schmid, Hans-Peter [Cantonal Hospital St. Gallen, Department of Urology, St. Gallen (Switzerland); Thoeni, Armin F. [Lindenhofspital Berne, Department of Radiation Oncology, Berne (Switzerland); Hochreiter, Werner [Hirslanden Klinik Aarau, Department of Urology, Aarau (Switzerland); Prikler, Ladislav [Klinik Uroviva Buelach, Department of Urology, Buelach (Switzerland); Suter, Stefan [Cantonal Hospital Zug, Department of Urology, Zug (Switzerland); Stucki, Patrick [Cantonal Hospital Lucerne, Department of Urology, Lucerne (Switzerland); Schiefer, Johann; Plasswilm, Ludwig; Putora, Paul Martin [Cantonal Hospital St. Gallen, Department of Radiation Oncology, St. Gallen (Switzerland)

    2015-10-15

    Permanent low-dose-rate brachytherapy (BT) with iodine 125 is an established curative treatment for localized prostate cancer. After treatment, prostate-specific antigen (PSA) kinetics may show a transient rise (PSA bounce). Our aim was to investigate the association of PSA bounce with biochemical control. Patients treated with BT in Switzerland were registered in a prospective database. Only patients with a follow-up of at least 2 years were included in our analysis. Clinical follow-up and PSA measurements were assessed after 1.5, 3, 6, and 12 months, and annually thereafter. If PSA increased, additional follow-up visits were scheduled. Cases of PSA bounce were defined as a rise of at least 0.2 ng/ml above the initial PSA nadir with a subsequent decline to or below the initial nadir without treatment. Biochemical failure was defined as a rise to nadir + 2 ng/ml. Between March 2001 and November 2010, 713 patients with prostate cancer undergoing BT with at least 2 years of follow-up were registered. Median follow-up time was 41 months. Biochemical failure occurred in 28 patients (3.9 %). PSA bounce occurred in 173 (24.3 %) patients; only three (1.7 %) patients with PSA bounce developed biochemical failure, in contrast to 25 (4.6 %) patients without previous bounce (p < 0.05). The median time to bounce was 12 months, the median time to biochemical failure was 30 months. The median bounce increase was 0.78 ng/ml. Twenty-eight patients with bounce (16.5 %) had a transient PSA rise of + 2 ng/ml above the nadir. In most cases, an early increase in PSA after BT indicates PSA bounce and is associated with a lower risk of biochemical failure. (orig.) [German] Die permanente Low-dose-rate-Brachytherapie (BT) mit {sup 125}I ist ein etabliertes kuratives Verfahren bei lokalisiertem Prostatakarzinom. Posttherapeutisch koennen die PSA-Konzentrationen einen voruebergehenden Anstieg zeigen (Bounce-Phaenomen). Untersucht werden sollte ein moeglicher Zusammenhang mit der

  4. Dosimetry Modeling for Focal Low-Dose-Rate Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Al-Qaisieh, Bashar [Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Mason, Josh, E-mail: joshua.mason@nhs.net [Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Bownes, Peter; Henry, Ann [Leeds Cancer Centre, Leeds Teaching Hospitals NHS Trust, Leeds (United Kingdom); Dickinson, Louise [Division of Surgery and Interventional Science, University College London, London (United Kingdom); Department of Radiology, Northwick Park Hospital, London North West NHS Trust, London (United Kingdom); Ahmed, Hashim U. [Division of Surgery and Interventional Science, University College London, London (United Kingdom); University College London Hospital, London (United Kingdom); Emberton, Mark [University College London Hospital, London (United Kingdom); Langley, Stephen [St Luke' s Cancer Centre, Guildford (United Kingdom)

    2015-07-15

    Purpose: Focal brachytherapy targeted to an individual lesion(s) within the prostate may reduce side effects experienced with whole-gland brachytherapy. The outcomes of a consensus meeting on focal prostate brachytherapy were used to investigate optimal dosimetry of focal low-dose-rate (LDR) prostate brachytherapy targeted using multiparametric magnetic resonance imaging (mp-MRI) and transperineal template prostate mapping (TPM) biopsy, including the effects of random and systematic seed displacements and interseed attenuation (ISA). Methods and Materials: Nine patients were selected according to clinical characteristics and concordance of TPM and mp-MRI. Retrospectively, 3 treatment plans were analyzed for each case: whole-gland (WG), hemi-gland (hemi), and ultra-focal (UF) plans, with 145-Gy prescription dose and identical dose constraints for each plan. Plan robustness to seed displacement and ISA were assessed using Monte Carlo simulations. Results: WG plans used a mean 28 needles and 81 seeds, hemi plans used 17 needles and 56 seeds, and UF plans used 12 needles and 25 seeds. Mean D90 (minimum dose received by 90% of the target) and V100 (percentage of the target that receives 100% dose) values were 181.3 Gy and 99.8% for the prostate in WG plans, 195.7 Gy and 97.8% for the hemi-prostate in hemi plans, and 218.3 Gy and 99.8% for the focal target in UF plans. Mean urethra D10 was 205.9 Gy, 191.4 Gy, and 92.4 Gy in WG, hemi, and UF plans, respectively. Mean rectum D2 cm{sup 3} was 107.5 Gy, 77.0 Gy, and 42.7 Gy in WG, hemi, and UF plans, respectively. Focal plans were more sensitive to seed displacement errors: random shifts with a standard deviation of 4 mm reduced mean target D90 by 14.0%, 20.5%, and 32.0% for WG, hemi, and UF plans, respectively. ISA has a similar impact on dose-volume histogram parameters for all plan types. Conclusions: Treatment planning for focal LDR brachytherapy is feasible. Dose constraints are easily met with a notable

  5. Inverse treatment planning based on MRI for HDR prostate brachytherapy

    International Nuclear Information System (INIS)

    Citrin, Deborah; Ning, Holly; Guion, Peter; Li Guang; Susil, Robert C.; Miller, Robert W.; Lessard, Etienne; Pouliot, Jean; Xie Huchen; Capala, Jacek; Coleman, C. Norman; Camphausen, Kevin; Menard, Cynthia

    2005-01-01

    Purpose: To develop and optimize a technique for inverse treatment planning based solely on magnetic resonance imaging (MRI) during high-dose-rate brachytherapy for prostate cancer. Methods and materials: Phantom studies were performed to verify the spatial integrity of treatment planning based on MRI. Data were evaluated from 10 patients with clinically localized prostate cancer who had undergone two high-dose-rate prostate brachytherapy boosts under MRI guidance before and after pelvic radiotherapy. Treatment planning MRI scans were systematically evaluated to derive a class solution for inverse planning constraints that would reproducibly result in acceptable target and normal tissue dosimetry. Results: We verified the spatial integrity of MRI for treatment planning. MRI anatomic evaluation revealed no significant displacement of the prostate in the left lateral decubitus position, a mean distance of 14.47 mm from the prostatic apex to the penile bulb, and clear demarcation of the neurovascular bundles on postcontrast imaging. Derivation of a class solution for inverse planning constraints resulted in a mean target volume receiving 100% of the prescribed dose of 95.69%, while maintaining a rectal volume receiving 75% of the prescribed dose of <5% (mean 1.36%) and urethral volume receiving 125% of the prescribed dose of <2% (mean 0.54%). Conclusion: Systematic evaluation of image spatial integrity, delineation uncertainty, and inverse planning constraints in our procedure reduced uncertainty in planning and treatment

  6. Advantages of high-dose rate (HDR) brachytherapy in treatment of prostate cancer

    Science.gov (United States)

    Molokov, A. A.; Vanina, E. A.; Tseluyko, S. S.

    2017-09-01

    One of the modern methods of preserving organs radiation treatment is brachytherapy. This article analyzes the results of prostate brachytherapy. These studies of the advantages of high dose brachytherapy lead to the conclusion that this method of radiation treatment for prostate cancer has a favorable advantage in comparison with remote sensing methods, and is competitive, preserving organs in comparison to surgical methods of treatment. The use of the method of polyfocal transperineal biopsy during the brachytherapy session provides information on the volumetric spread of prostate cancer and adjust the dosimetry plan taking into account the obtained data.

  7. Ejaculatory Function After Permanent 125I Prostate Brachytherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Huyghe, Eric; Delannes, Martine; Wagner, Fabien M.; Delaunay, Boris; Nohra, Joe; Thoulouzan, Matthieu; Shut-Yee, J. Yeung; Plante, Pierre; Soulie, Michel; Thonneau, Patrick; Bachaud, Jean Marc

    2009-01-01

    Purpose: Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent 125 I prostate brachytherapy for localized prostate cancer. Patients and Methods: Of 270 sexually active men with localized prostate cancer treated with permanent 125 I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. Results: Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). Conclusion: Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

  8. Radiotherapy and brachytherapy

    International Nuclear Information System (INIS)

    2007-02-01

    This presentation first defines the radiotherapy and brachytherapy techniques, indicates the used ionizing radiations (electromagnetic and particles), describes the mechanisms and processes of action of ionizing radiations: they can be physical by photon-matter interactions (Compton effect and photoelectric effect) or due to electron-matter interactions (excitation, ionization), physical-chemical by direct or indirect action (DNA damage), cellular (mitotic or apoptotic death), tissue (sane and tumorous tissues and differential effect). It discusses the biological efficiency of these treatments which depends on different parameters: intrinsic radio-sensitivity, time (session fractioning and organisation in time), oxygen, radiation quality, cellular cycle, dose rate, temperature. It presents the different types of radiotherapy: external radiotherapy (general sequence, delineation, dosimetry, protection of critical organs, treatment session, quality control, monitoring consultation) and briefly presents some specific techniques (total body irradiation, total cutaneous electron therapy, pre-operation radiotherapy, radio-surgery, hadron-therapy). It proposes an overview of the main indications for this treatment: brain tumours, upper aero digestive tract tumours, bronchial tumours, oesophagus, stomach and pancreas tumours, breast tumours, cervix cancer, rectum tumour, and so on, and indicates the possible associated treatments. The next part addresses brachytherapy. It presents the principles and comments the differences with radiotherapy. It indicates the used radio-elements (Caesium 137, Iridium 192, Iodine 125), describes the implementation techniques (plastic tubes, use of iodine 125, intracavitary and endo-luminal radiation therapy). It proposes an overview of the different treated tumours (skin, breast, prostates, bronchial, oesophagus, ENT) and indicates possible early and late secondary effects for different organs

  9. Treatment of localized prostate cancer with brachytherapy: six years experience

    International Nuclear Information System (INIS)

    Martinez, Pablo; Dourado, Leandro; Giudice, Carlos; Villamil, Wenceslao; Palacios, Victor; Sardi, Mabel; Damia, Oscar

    2006-01-01

    The usage of ultrasound scan to perform prostate biopsy punctures, the new radiation therapies and the more accurate selection of patients has allowed brachytherapy to play an important role in the treatment of the localized pathology. The objective of this paper is to review the results obtained when treating the localized prostate cancer by using brachytherapy with mud 125. Materials and methods: Between December 1999 and July 2006, 100 prostate cancer patients were treated at the Hospital Italiano de Buenos Aires, using brachytherapy with mud 125. One of the patients was treated with a combined therapy (brachytherapy + external radiotherapy). For that reason, the patient was not taken into consideration for this paper. The average age was 65.95 (52-79). The tumoral stages were T1c in 81% of the patients and T2a in 19% of them. The PSA was always below 15 ng/ml, with an average of 8.92 ng/ml; inferior to 10 ng/ml in 72 patients and between 10 and 15 ng/m ml in 28 of them. The average prostate volume was 34.68 c.c. (18.70 c.c.-58.00 c.c.). The combined Gleason score was below 6 (except for three patients with Gleason 7 who had a PSA below 10, stage T1c). The dose used was 16,000 cGy as recommended by the TG43. The energy charge of each seed was between 0.28 and 0.40 mci. Thirty days later, a prostate axial computer tomography was carried out every 3 mm. with a scanning set every 5 mm. to perform a dosimetric control of the implant. Results: The average age was 65.95 (52-79). The control computer tomography showed an adequate dosimetric coverage for the entire prostate volume, with a maximum urethral dose not above 400 Gy and a maximum rectal dose below 100 Gy. The PSA of all patients decreased to a normal level 6 months after the treatment started. The average follow-up of the 71 patients able to be tested from an oncological perspective lasted 31.15 months, with a minimum of 18 and a maximum of 72 months. Currently, seven patients of those tested (9.86%) manifest

  10. Assessment of corrective factors for the LNHB reference measurement in terms of Kr air for iodine 125

    International Nuclear Information System (INIS)

    Gouriou, J.; Aubineau-Laniece, I.; Cutarella, D.; Plagnard, J.

    2010-01-01

    The LNHB (Laboratoire National Henri Becquerel) is currently developing a new primary reference for low dose rate curietherapy with iodine 125 in terms of reference kerma in air. This includes an innovative sensor: an ionization chamber with a toroidal air wall. The authors present Monte Carlo calculations performed for the determination of corrective factors to be applied to come down to reference conditions or to correct possible measurement errors. Calculations have been performed for the specific geometries of BEBIG sources which are used for ophthalmic and prostatic curietherapy treatments

  11. Fully automated MRI-guided robotics for prostate brachytherapy

    International Nuclear Information System (INIS)

    Stoianovici, D.; Vigaru, B.; Petrisor, D.; Muntener, M.; Patriciu, A.; Song, D.

    2008-01-01

    The uncertainties encountered in the deployment of brachytherapy seeds are related to the commonly used ultrasound imager and the basic instrumentation used for the implant. An alternative solution is under development in which a fully automated robot is used to place the seeds according to the dosimetry plan under direct MRI-guidance. Incorporation of MRI-guidance creates potential for physiological and molecular image-guided therapies. Moreover, MRI-guided brachytherapy is also enabling for re-estimating dosimetry during the procedure, because with the MRI the seeds already implanted can be localised. An MRI compatible robot (MrBot) was developed. The robot is designed for transperineal percutaneous prostate interventions, and customised for fully automated MRI-guided brachytherapy. With different end-effectors, the robot applies to other image-guided interventions of the prostate. The robot is constructed of non-magnetic and dielectric materials and is electricity free using pneumatic actuation and optic sensing. A new motor (PneuStep) was purposely developed to set this robot in motion. The robot fits alongside the patient in closed-bore MRI scanners. It is able to stay fully operational during MR imaging without deteriorating the quality of the scan. In vitro, cadaver, and animal tests showed millimetre needle targeting accuracy, and very precise seed placement. The robot tested without any interference up to 7T. The robot is the first fully automated robot to function in MRI scanners. Its first application is MRI-guided seed brachytherapy. It is capable of automated, highly accurate needle placement. Extensive testing is in progress prior to clinical trials. Preliminary results show that the robot may become a useful image-guided intervention instrument. (author)

  12. Permanent interstitial low-dose-rate brachytherapy for patients with low risk prostate cancer. An interim analysis of 312 cases

    Energy Technology Data Exchange (ETDEWEB)

    Badakhshi, Harun; Graf, Reinhold; Budach, Volker; Wust, Peter [University Hospital Berlin, Department for Radiation Oncology of Charite School of Medicine, Berlin (Germany)

    2015-04-01

    The biochemical relapse-free survival (bRFS) rate after treatment with permanent iodine-125 seed implantation (PSI) or combined seeds and external beam radiotherapy (COMB) for clinical stage T1-T2 localized prostate cancer is a clinically relevant endpoint. The goal of this work was to evaluate the influence of relevant patient- and treatment-related factors. The study population comprised 312 consecutive patients treated with permanent seed implantation. All patients were evaluable for analysis of overall survival (OS) and disease-specific survival (DSS), 230 for bRFS, of which 192 were in the PSI group and 38 in the COMB group. The prescribed minimum peripheral dose was 145 Gy for PSI, for COMB 110 Gy implant and external beam radiotherapy of 45 Gy. The median follow-up time was 33 months (range 8-66 months). bRFS was defined as a serum prostate-specific antigen (PSA) level ≤ 0.2 ng/ml at last follow-up. Overall, the actuarial bRFS at 50 months was 88.4 %. The 50-month bRFS rate for PSI and COMB was 90.9 %, and 77.2 %, respectively. In the univariate analysis, age in the categories ≤ 63 and > 63 years (p < 0.00), PSA nadir (≤ 0.5 ng/ml and > 0.5 ng/ml) and PSA bounce (yes/no) were the significant predicting factors for bRFS. None of the other patient and treatment variables (treatment modality, stage, PSA, Gleason score, risk group, number of risk factors, D90 and various other dose parameters) were found to be a statistically significant predictor of 50-month bRFS. The biochemical failure rates were low in this study. As a proof of principle, our large monocenteric analysis shows that low-dose-rate brachytherapy is an effective and safe procedure for patients with early stage prostate cancer. (orig.) [German] Das biochemisch rezidivfreie Ueberleben (bRFS) nach der Brachytherapie mit permanenter Iod-125-Seed-Implantation (PSI) oder in Kombination mit externer Radiotherapie (COMB) ist beim Patienten mit fruehem Prostatakarzinom (T1/T2) ein relevanter

  13. Novel prostate brachytherapy technique: Improved dosimetric and clinical outcome

    International Nuclear Information System (INIS)

    Nobes, Jenny P.; Khaksar, Sara J.; Hawkins, Maria A.; Cunningham, Melanie J.; Langley, Stephen E.M.; Laing, Robert W.

    2008-01-01

    Purpose: Erectile dysfunction following prostate brachytherapy is reported to be related to dose received by the penile bulb. To minimise this, whilst preserving prostate dosimetry, we have developed a technique for I-125 seed brachytherapy using both stranded seeds and loose seeds delivered with a Mick applicator, and implanted via the sagittal plane on trans-rectal ultrasound. Materials and methods: Post-implant dosimetry and potency rates were compared in 120 potent patients. In Group 1, 60 patients were treated using a conventional technique of seeds implanted in a modified-uniform distribution. From January 2005, a novel technique was developed using stranded seeds peripherally and centrally distributed loose seeds implanted via a Mick applicator (Group 2). The latter technique allows greater flexibility when implanting the seeds at the apex. Each patient was prescribed a minimum peripheral dose of 145 Gy. No patients received external beam radiotherapy or hormone treatment. There was no significant difference in age or pre-implant potency score (mean IIEF-5 score 22.4 vs. 22.6, p = 0.074) between the two groups. Results: The new technique delivers lower penile bulb doses (D 25 as %mPD - Group 1: 61.2 ± 35.7, Group 2: 29.7 ± 16.0, p 50 as %mPD - Group 1: 45.8 ± 26.9, Group 2: 21.4 ± 11.7, p 90 - Group 1: 147 Gy ± 21.1, Group 2: 155 Gy ± 16.7, p = 0.03). At 2 years, the potency rate was also improved: Group 1: 61.7%; Group 2: 83.3% (p = 0.008). Conclusions: In this study, the novel brachytherapy technique using both peripheral stranded seeds and central loose seeds delivered via a Mick applicator results in a lower penile bulb dose whilst improving prostate dosimetry, and may achieve higher potency rates

  14. Comparison of biochemical failure definitions for permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Kuban, Deborah A.; Levy, Larry B.; Potters, Louis; Beyer, David C.; Blasko, John C.; Moran, Brian J.; Ciezki, Jay P.; Zietman, Anthony L.; Zelefsky, Michael J.; Pisansky, Thomas M.; Elshaikh, Mohamed; Horwitz, Eric M.

    2006-01-01

    Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable

  15. Intraoperative planning and evaluation of permanent prostate brachytherapy: report of the American Brachytherapy Society.

    Science.gov (United States)

    Nag, S; Ciezki, J P; Cormack, R; Doggett, S; DeWyngaert, K; Edmundson, G K; Stock, R G; Stone, N N; Yu, Y; Zelefsky, M J

    2001-12-01

    The preplanned technique used for permanent prostate brachytherapy has limitations that may be overcome by intraoperative planning. The goal of the American Brachytherapy Society (ABS) project was to assess the current intraoperative planning process and explore the potential for improvement in intraoperative treatment planning (ITP). Members of the ABS with expertise in ITP performed a literature review, reviewed their clinical experience with ITP, and explored the potential for improving the technique. The ABS proposes the following terminology in regard to prostate planning process: *Preplanning--Creation of a plan a few days or weeks before the implant procedure. *Intraoperative planning--Treatment planning in the operating room (OR): the patient and transrectal ultrasound probe are not moved between the volume study and the seed insertion procedure. * Intraoperative preplanning--Creation of a plan in the OR just before the implant procedure, with immediate execution of the plan. *Interactive planning--Stepwise refinement of the treatment plan using computerized dose calculations derived from image-based needle position feedback. *Dynamic dose calculation--Constant updating of dose distribution calculations using continuous deposited seed position feedback. Both intraoperative preplanning and interactive planning are currently feasible and commercially available and may help to overcome many of the limitations of the preplanning technique. Dosimetric feedback based on imaged needle positions can be used to modify the ITP. However, the dynamic changes in prostate size and shape and in seed position that occur during the implant are not yet quantifiable with current technology, and ITP does not obviate the need for postimplant dosimetric analysis. The major current limitation of ITP is the inability to localize the seeds in relation to the prostate. Dynamic dose calculation can become a reality once these issues are solved. Future advances can be expected in

  16. Urethral stricture following high dose rate brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Sullivan, Lisa; Williams, Scott G.; Tai, Keen Hun; Foroudi, Farshad; Cleeve, L.; Duchesne, Gillian M.

    2009-01-01

    Purpose: To evaluate the incidence, timing, nature and outcome of urethral strictures following high dose rate brachytherapy (HDRB) for prostate carcinoma. Methods and materials: Data from 474 patients with clinically localised prostate cancer treated with HDRB were analysed. Ninety percent received HDRB as a boost to external beam radiotherapy (HDRBB) and the remainder as monotherapy (HDRBM). Urethral strictures were graded according to the Common Terminology Criteria for Adverse Events v3.0. Results: At a median follow-up of 41 months, 38 patients (8%) were diagnosed with a urethral stricture (6-year actuarial risk 12%). Stricture location was bulbo-membranous (BM) urethra in 92.1%. The overall actuarial rate of grade 2 or more BM urethral stricture was estimated at 10.8% (95% CI 7.0-14.9%), with a median time to diagnosis of 22 months (range 10-68 months). All strictures were initially managed with either dilatation (n = 15) or optical urethrotomy (n = 20). Second line therapy was required in 17 cases (49%), third line in three cases (9%) and 1 patient open urethroplasty (grade 3 toxicity). Predictive factors on multivariate analysis were prior trans-urethral resection of prostate (hazard ratio (HR) 2.81, 95% CI 1.15-6.85, p = 0.023); hypertension (HR 2.83, 95% CI 1.37-5.85, p = 0.005); and dose per fraction used in HDR (HR for 1 Gy increase per fraction 1.33, 95% CI 1.08-1.64, p = 0.008). Conclusions: BM urethral strictures are the most common late grade 2 or more urinary toxicity following HDR brachytherapy for prostate cancer. Most are manageable with minimally invasive procedures. Both clinical and dosimetric factors appear to influence the risk of stricture formation.

  17. Study and methodologies for fixing epoxy resin in radioactive sources used for brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, Bruna T.; Rostelato, Maria E.C.M.; Souza, Carla D.; Tozetti, Cíntia A.; Zeituni, Carlos A.; Nogueira, Beatriz R.; Silva, José T.; Júnior, Dib K.; Fernandes, Vagner; Souza, Raquel V.; Abreu, Rodrigo T., E-mail: bteigarodrigues@gmail.com, E-mail: elisaros@ipen.br, E-mail: carladdsouza@yahoo.com.br [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil); Universidade de São Paulo (USP), SP (Brazil)

    2017-07-01

    The World Health Organization (WHO) estimates that the number of new cancer cases worldwide will reach 15 million by 2020. The disease is already the second leading cause of death worldwide, being behind only cardiovascular disease. It is unquestionable that it is a public health problem, especially among developing countries. Prostate cancer is the most common among men, approximately 28.6%. The choice of type of treatment for prostate cancer should consider several factors such as: tumor size and extent, apparent aggressiveness (pathological characteristics), age, health. Among the methods applied, brachytherapy has been used in the initial and intermediate stages of the disease. Brachytherapy is a safe and effective treatment for localized prostate cancer. Brachytherapy is a form of radiotherapy in which radioactive seeds are placed in contact with or within the organ being treated. This technique allows a large dose of radiation to be released only on the target tumor that protects healthy surrounding tissues. Sources may have different shapes and sizes, but the one used for prostate cancer is usually 4.5 mm in length and 0.8 mm in diameter. About 80 to 120 seeds can be used per patient. Iodine-125 is the radioisotope most used in brachytherapy of the prostate, it emits 35,49keV X-rays in 100% of the decays, with average energy of 29 keV. The treatment of prostate cancer with permanent implantation of iodine-125 seeds has grown dramatically in the world in recent years. Most patients can return to normal life within three days with little or no pain. (author)

  18. Study and methodologies for fixing epoxy resin in radioactive sources used for brachytherapy

    International Nuclear Information System (INIS)

    Rodrigues, Bruna T.; Rostelato, Maria E.C.M.; Souza, Carla D.; Tozetti, Cíntia A.; Zeituni, Carlos A.; Nogueira, Beatriz R.; Silva, José T.; Júnior, Dib K.; Fernandes, Vagner; Souza, Raquel V.; Abreu, Rodrigo T.

    2017-01-01

    The World Health Organization (WHO) estimates that the number of new cancer cases worldwide will reach 15 million by 2020. The disease is already the second leading cause of death worldwide, being behind only cardiovascular disease. It is unquestionable that it is a public health problem, especially among developing countries. Prostate cancer is the most common among men, approximately 28.6%. The choice of type of treatment for prostate cancer should consider several factors such as: tumor size and extent, apparent aggressiveness (pathological characteristics), age, health. Among the methods applied, brachytherapy has been used in the initial and intermediate stages of the disease. Brachytherapy is a safe and effective treatment for localized prostate cancer. Brachytherapy is a form of radiotherapy in which radioactive seeds are placed in contact with or within the organ being treated. This technique allows a large dose of radiation to be released only on the target tumor that protects healthy surrounding tissues. Sources may have different shapes and sizes, but the one used for prostate cancer is usually 4.5 mm in length and 0.8 mm in diameter. About 80 to 120 seeds can be used per patient. Iodine-125 is the radioisotope most used in brachytherapy of the prostate, it emits 35,49keV X-rays in 100% of the decays, with average energy of 29 keV. The treatment of prostate cancer with permanent implantation of iodine-125 seeds has grown dramatically in the world in recent years. Most patients can return to normal life within three days with little or no pain. (author)

  19. Prostate HDR brachytherapy catheter displacement between planning and treatment delivery

    International Nuclear Information System (INIS)

    Whitaker, May; Hruby, George; Lovett, Aimee; Patanjali, Nitya

    2011-01-01

    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 5 mm 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 7.5 mm (range −2.9–23.9 mm), 67% of implants had displacement of 5 mm or greater. Displacements were predominantly caudal. Conclusions: Catheter displacement can occur in the 1–3 h between the planning CT scan and treatment. It is recommended that departments performing HDR prostate brachytherapy verify catheter positions immediately prior to treatment delivery.

  20. [Voiding dysfunction after brachytherapy in patients with prostate cancer].

    Science.gov (United States)

    Arlandis Guzmán, Salvador; Bonillo García, Miguel Angel; Broseta Rico, Enrique

    2009-12-01

    The development of urinary symptoms after brachytherapy is very frequent, reaching a maximum between the first and third month after the implant and returning back to normal around one year. The incidence of acute urinary retention varies between 1.5 and 27% . A low percentage of patients (0-8.7% ) will need surgery to solve an extended urinary retention or severe obstructive voiding symptoms. Alphablockers may be useful to alleviate voiding symptoms after the implant, although they do not reduce the need for surgery. There are several predictive clinical factors for development of urinary complications. A patient with high IPPS score before implant, large size prostate, obstructive functional signs (Low Q max, high postvoid residual, and obstruction urodynamic parameters) has a high risk for urinary retention or extended urinary symptoms. This has repercussion on the quality of life of the patient, making them candidates to other therapies. The performance of a peripheral implant technique (guaranteeing low doses at urethra) and avoiding the urethral plane when inserting the needles may minimize urethral damage associated with development of urinary complications. Urinary incontinence after brachytherapy is a rare complication, but its frequency increases dramatically after transurethral resection of the prostate or requiring it to solve a sustained urinary retention. It is fundamental to know this circumstance to inform the patient adequately and to plan the most careful TURP.

  1. SU-F-I-19: MRI Positive Contrast Visualization of Prostate Brachytherapy Seeds Using An Integrated Laplacian-Based Phase Processing

    Energy Technology Data Exchange (ETDEWEB)

    Soliman, A; Safigholi, H [Sunnybrook Research Institute, Toronto, ON (Canada); Sunnybrook Health Sciences Center, Toronto, ON (Canada); Nosrati, R [Sunnybrook Health Sciences Center, Toronto, ON (Canada); Ryerson University, Toronto, ON (Canada); Owrangi, A; Morton, G [Sunnybrook Health Sciences Center, Toronto, ON (Canada); University of Toronto, Toronto, ON (Canada); Song, W [Sunnybrook Research Institute, Toronto, ON (Canada); Sunnybrook Health Sciences Center, Toronto, ON (Canada); Ryerson University, Toronto, ON (Canada); University of Toronto, Toronto, ON (Canada)

    2016-06-15

    Purpose: To propose a new method that provides a positive contrast visualization of the prostate brachytherapy seeds using the phase information from MR images. Additionally, the feasibility of using the processed phase information to distinguish seeds from calcifications is explored. Methods: A gel phantom was constructed using 2% agar dissolved in 1 L of distilled water. Contrast agents were added to adjust the relaxation times. Four iodine-125 (Eckert & Ziegler SML86999) dummy seeds were placed at different orientations with respect to the main magnetic field (B0). Calcifications were obtained from a sheep femur cortical bone due to its close similarity to human bone tissue composition. Five samples of calcifications were shaped into different dimensions with lengths ranging between 1.2 – 6.1 mm.MR imaging was performed on a 3T Philips Achieva using an 8-channel head coil. Eight images were acquired at eight echo-times using a multi-gradient echo sequence. Spatial resolution was 0.7 × 0.7 × 2 mm, TR/TE/dTE = 20.0/2.3/2.3 ms and BW = 541 Hz/pixel. Complex images were acquired and fed into a two-step processing pipeline: the first includes phase unwrapping and background phase removal using Laplacian operator (Wei et al. 2013). The second step applies a specific phase mask on the resulting tissue phase from the first step to provide the desired positive contrast of the seeds and to, potentially, differentiate them from the calcifications. Results: The phase-processing was performed in less than 30 seconds. The proposed method has successfully resulted in a positive contrast of the brachytherapy seeds. Additionally, the final processed phase image showed difference between the appearance of seeds and calcifications. However, the shape of the seeds was slightly distorted compared to the original dimensions. Conclusion: It is feasible to provide a positive contrast of the seeds from MR images using Laplacian operator-based phase processing.

  2. The use of nomograms in LDR-HDR prostate brachytherapy

    Directory of Open Access Journals (Sweden)

    Ma Carmen Pujades

    2011-09-01

    Full Text Available Purpose: The common use of nomograms in Low Dose Rate (LDR permanent prostate brachytherapy (BT allowsto estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for eachclinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adaptedto High Dose Rate (HDR. This work sets nomograms for LDR and HDR prostate-BT implants, which are applied tothree different institutions that use different implant techniques. Material and methods: Patients treated throughout 2010 till April 2011 were considered for this study. This examplewas chosen to be the representative of the latest implant techniques and to ensure consistency in the planning. A sufficientnumber of cases for both BT modalities, prescription dose and different work methodology (depending on theinstitution were taken into account. The specific nomograms were built using the correlation between the prostatevo lume and some characteristic parameters of each BT modality, such as the source Air Kerma Strength, numberof implanted seeds in LDR or total radiation time in HDR. Results: For each institution and BT modality, nomograms normalized to the prescribed dose were obtained andfitted to a linear function. The parameters of the adjustment show a good agreement between data and the fitting.It should be noted that for each institution these linear function parameters are different, indicating that each centreshould construct its own nomograms. Conclusions: Nomograms for LDR and HDR prostate brachytherapy are simple quality assurance tools, specific foreach institution. Nevertheless, their use should be complementary to the necessary independent verification.

  3. 10-year biochemical (prostate-specific antigen) control of prostate cancer with 125I brachytherapy

    International Nuclear Information System (INIS)

    Grimm, Peter D.; Blasko, John C.; Sylvester, John E.; Meier, Robert M.; Cavanagh, William

    2001-01-01

    Purpose: To report 10-year biochemical (prostate-specific antigen [PSA]) outcomes for patients treated with 125 I brachytherapy as monotherapy for early-stage prostate cancer. Methods and Materials: One hundred and twenty-five consecutively treated patients, with clinical Stage T1-T2b prostate cancer were treated with 125 I brachytherapy as monotherapy, and followed with PSA determinations. Kaplan-Meier estimates of PSA progression-free survival (PFS), on the basis of a two consecutive elevations of PSA, were calculated. Aggregate PSA response by time interval was assessed. Comparisons were made to an earlier-treated cohort. Results: The overall PSA PFS rate achieved at 10 years was 87% for low-risk patients (PSA 125 I achieves a high rate (87%) of biochemical and clinical control in patients with low-risk disease at 10 years. The decline of PSA following brachytherapy with low-dose-rate isotopes can be protracted. Absolute PSA and PFS curves merge, and are comparable at 10 years

  4. Incidence of Second Malignancies in Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy and Radical Prostatectomy

    Energy Technology Data Exchange (ETDEWEB)

    Hamilton, Sarah Nicole; Tyldesley, Scott [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Hamm, Jeremy [Department of Population Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Jiang, Wei Ning [Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Keyes, Mira; Pickles, Tom [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Lapointe, Vince [Department of Medical Physics, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Kahnamelli, Adam [Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); McKenzie, Michael [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada); Miller, Stacy [Department of Radiation Oncology, British Columbia Cancer Agency–Centre for the North, Prince George, British Columbia (Canada); Morris, W. James, E-mail: jmorris@bccancer.bc.ca [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Radiation Oncology, British Columbia Cancer Agency–Vancouver Centre, Vancouver, British Columbia (Canada)

    2014-11-15

    Purpose: To compare the second malignancy incidence in prostate cancer patients treated with brachytherapy (BT) relative to radical prostatectomy (RP) and to compare both groups with the cancer incidence in the general population. Methods and Materials: From 1998 to 2010, 2418 patients were treated with Iodine 125 prostate BT monotherapy at the British Columbia Cancer Agency, and 4015 referred patients were treated with RP. Cancer incidence was compared with the age-matched general population using standardized incidence ratios (SIRs). Pelvic malignancies included invasive and noninvasive bladder cancer and rectal cancer. Cox multivariable analysis was performed with adjustment for covariates to determine whether treatment (RP vs BT) was associated with second malignancy risk. Results: The median age at BT was 66 years and at RP 62 years. The SIR comparing BT patients with the general population was 1.06 (95% confidence interval [CI] 0.91-1.22) for second malignancy and was 1.53 (95% CI 1.12-2.04) for pelvic malignancy. The SIR comparing RP patients with the general population was 1.11 (95% CI 0.98-1.25) for second malignancy and was 1.11 (95% CI 0.82-1.48) for pelvic malignancy. On multivariable analysis, older age (hazard ratio [HR] 1.05) and smoking (HR 1.65) were associated with increased second malignancy risk (P<.0001). Radical prostatectomy was not associated with a decreased second malignancy risk relative to BT (HR 0.90, P=.43), even when excluding patients who received postprostatectomy external beam radiation therapy (HR 1.13, P=.25). Older age (HR 1.09, P<.0001) and smoking (HR 2.17, P=.0009) were associated with increased pelvic malignancy risk. Radical prostatectomy was not associated with a decreased pelvic malignancy risk compared with BT (HR 0.57, P=.082), even when excluding postprostatectomy external beam radiation therapy patients (HR 0.87, P=.56). Conclusions: After adjustment for covariates, BT patients did not have an increased second

  5. Radiation protection after interstitial permanent prostate brachytherapy implants

    Energy Technology Data Exchange (ETDEWEB)

    Pirraco, R.; Pereira, A.; Cavaco, A. [Instituto Portugues de Oncologia Francisco Gentil - Centro R egional de Oncologia do Porto, SA, Porto (Portugal)

    2006-07-01

    Full text of publication follows: In this study we measure patients radiation exposure dose after interstitial {sup 125}I permanent prostate Brachytherapy implants, and correlate it with dose limits for public, total activity implanted, patient preoperative weight(1), distance between prostate walls and anterior skin surface. Methods and Material: We analyse 20 patients who were implanted with {sup 125}I seeds. The instrument used to measure radiation is a calibrated Berthold Umo LB 123 aco-plated to a LB 1236-H10 detector. Three measurements were taken: at the perineal and anterior pelvic zones on contact with the skin and at 1 m from the patient. The maximum value was taken for all measurements. The dose at a distance of one meter is obtained at anterior pelvic zone, perpendicular to the skin, according to the recommendations of A.A.P.M.(1). The distance between prostate walls was determined using post -operative CT images. Results: The doses at the perineal zone have determined an average of 186 {mu}Sv/h (range: 110 340 {mu}Sv/h) and at surface pelvic zone of 41 {mu}Sv/h (range: 15 103 {mu}Sv/h). The dose at a distance of 1 meter has an average value of 0.4 {mu}Sv/h (range: 0.2 1.0 {mu}Sv/h). The average total activity implanted was 25 mCi (range: 17 38 mCi). The distance between prostate walls and skin pelvic surface of the patients has an average value of 8.9 cm (range: 6.6 -11.5 cm). At a distance of 1 meter from the pelvic zone the dose measured is very low and below dose limits imposed by the European Directive EURATOM 2 and the Portuguese law. For general public to reach annual dose limit (EURATOM - 1 mSv/year) when contacting the pelvic zone, we extrapolate that 4 days (range: 1.6 11.1 days) would be needed, assuming a daily contact period of 6 hours. Conclusion: We established a correlation between the distance of prostate walls to the skin perineal surface and the total dose, but we find no correlation between measured doses, total activity implanted

  6. Procedure for determination of the decontamination of piping in the production of iodine-125 seeds; Procedimento para determinacao da descontaminacao de tubulacoes, na producao de sementes de iodo-125

    Energy Technology Data Exchange (ETDEWEB)

    Moura, J.A.; Moura, E.S.; Sprenger, F.E.; Nagatomi, H.R.; Zeituni, C.A.; Feher, A.; Manzoli, J.E.; Souza, C.D.; Rostelato, M.E.C.M., E-mail: elisaros@ipen.b [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2009-07-01

    Iodine-125 seeds are radioactive sources used in the prostate cancer treatment. This work objective was to determine the necessary conditions and procedures for decontamination of liquid transfer tubes when a radioactive material leakage occurs during the process of seed quality control

  7. Dose to the Bladder Neck Is the Most Important Predictor for Acute and Late Toxicity After Low-Dose-Rate Prostate Brachytherapy: Implications for Establishing New Dose Constraints for Treatment Planning

    Energy Technology Data Exchange (ETDEWEB)

    Hathout, Lara; Folkert, Michael R.; Kollmeier, Marisa A.; Yamada, Yoshiya [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Cohen, Gil' ad N. [Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, New York (United States)

    2014-10-01

    Purpose: To identify an anatomic structure predictive for acute (AUT) and late (LUT) urinary toxicity in patients with prostate cancer treated with low-dose-rate brachytherapy (LDR) with or without external beam radiation therapy (EBRT). Methods and Materials: From July 2002 to January 2013, 927 patients with prostate cancer (median age, 66 years) underwent LDR brachytherapy with Iodine 125 (n=753) or Palladium 103 (n=174) as definitive treatment (n=478) and as a boost (n=449) followed by supplemental EBRT (median dose, 50.4 Gy). Structures contoured on the computed tomographic (CT) scan on day 0 after implantation included prostate, urethra, bladder, and the bladder neck, defined as 5 mm around the urethra between the catheter balloon and the prostatic urethra. AUT and LUT were assessed with the Common Terminology Criteria for Adverse Events, version4. Clinical and dosimetric factors associated with AUT and LUT were analyzed with Cox regression and receiver operating characteristic analysis to calculate area under the receiver operator curve (ROC) (AUC). Results: Grade ≥2 AUT and grade ≥2 LUT occurred in 520 patients (56%) and 154 patients (20%), respectively. No grade 4 toxicities were observed. Bladder neck D2cc retained a significant association with AUT (hazard ratio [HR], 1.03; 95% confidence interval [CI], 1.03-1.04; P<.0001) and LUT (HR, 1.01; 95% CI, 1.00-1.03; P=.014) on multivariable analysis. In a comparison of bladder neck with the standard dosimetric variables by use of ROC analysis (prostate V100 >90%, D90 >100%, V150 >60%, urethra D20 >130%), bladder neck D2cc >50% was shown to have the strongest prognostic power for AUT (AUC, 0.697; P<.0001) and LUT (AUC, 0.620; P<.001). Conclusions: Bladder neck D2cc >50% was the strongest predictor for grade ≥2 AUT and LUT in patients treated with LDR brachytherapy. These data support inclusion of bladder neck constraints into brachytherapy planning to decrease urinary toxicity.

  8. Late Urinary Side Effects 10 Years After Low-Dose-Rate Prostate Brachytherapy: Population-Based Results From a Multiphysician Practice Treating With a Standardized Protocol and Uniform Dosimetric Goals

    Energy Technology Data Exchange (ETDEWEB)

    Keyes, Mira, E-mail: mkeyes@bccancer.bc.ca; Miller, Stacy; Pickles, Tom; Halperin, Ross; Kwan, Winkle; Lapointe, Vincent; McKenzie, Michael; Spadinger, Ingrid; Pai, Howard; Chan, Elisa K.; Morris, W. James

    2014-11-01

    Purpose: To determine late urinary toxicity (>12 months) in a large cohort of uniformly treated low-dose-rate prostate brachytherapy patients. Methods and Materials: From 1998 to 2009, 2709 patients with National Comprehensive Cancer Network–defined low-risk and low-tier intermediate-risk prostate cancer were treated with Iodine 125 ({sup 125}I) low-dose-rate prostate brachytherapy; 2011 patients with a minimum of 25 months of follow-up were included in the study. Baseline patients, treatment, implant factors, and late urinary toxicity (Radiation Therapy Oncology Group [RTOG] grading system and International Prostate Symptom Score [IPSS]) were recorded prospectively. Time to IPSS resolution, late RTOG genitourinary toxicity was examined with Kaplan-Meier and log-rank tests. Cox proportional hazards regression was done for individual covariates and multivariable models. Results: Median follow-up was 54.5 months (range, 2-13 years). Actuarial toxicity rates reached 27% and 10% (RTOG ≥2 and ≥3, respectively) at 9-13 years. Symptoms resolved quickly in the majority of patients (88% in 6-12 months). The prevalence of RTOG 0, 1, 2, 3, and 4 toxicity with a minimum of 7 years' follow-up was 70%, 21%, 6.4%, 2.3%, and 0.08%, respectively. Patients with a larger prostate volume, higher baseline IPSS, higher D90, acute toxicity, and age >70 years had more late RTOG ≥2 toxicity (all P≤.02). The IPSS resolved slower in patients with lower baseline IPSS and larger ultrasound prostate volume, those not receiving androgen deprivation therapy, and those with higher D90. The crude rate of RTOG 3 toxicity was 6%. Overall the rate of transurethral resection of the prostate was 1.9%; strictures, 2%; incontinence, 1.3%; severe symptoms, 1.8%; late catheterization, 1.3%; and hematuria, 0.8%. The majority (80%) resolved their symptoms in 6-12 months. Conclusion: Long-term urinary toxicity after brachytherapy is low. Although actuarial rates increase with longer

  9. Seed displacements after permanent brachytherapy for prostate cancer in dependence on the prostate level

    International Nuclear Information System (INIS)

    Pinkawa, M.; Gagel, B.; Asadpour, B.; Piroth, M.D.; Klotz, J.; Eble, M.J.; Borchers, H.; Jakse, G.

    2008-01-01

    Purpose: to evaluate seed displacements after permanent prostate brachytherapy considering different prostate levels. Patients and methods: in 61 patients, postimplant CT scans were performed 1 day and 1 month after an implant with stranded seeds. Seed and prostate surface displacements were determined relative to pelvic bones. Four groups of seed locations were selected: seeds at the base (n = 305; B), at the apex (n = 305; A), close to the urethra (n = 306; U), and close to the rectal wall (n = 204; R). The length of two strands (always containing four seeds) per patient was measured in all CT scans and compared. Results: the largest inferior seed displacements were found at the base: mean 5.3 mm (B), 2.2 mm (A), 2.7 mm (U), 3.3 mm (R; p 3 vs. 41 cm 3 ; p < 0.001), a mean caudal prostate base displacement of 3.9 mm was found, whereas the mean inward displacement ranged from 1.2 to 1.6 mm at the remaining borders (lateral, anterior, posterior, apical). The analysis of the strand lengths revealed an implant compression between day 1 and 30 (mean 1.7 mm; p < 0.001). Conclusion: the largest prostate tissue and seed displacements were observed at the prostate base, associated with an implant compression. Predominantly inferior and posterior displacements implicate consequential smaller preplanning margins at the apex and the posterior prostate. (orig.)

  10. Local radiolytic effectiveness of Auger electrons of iodine-125 in benzene-iodine solutions

    International Nuclear Information System (INIS)

    Uenak, P.; Uenak, T.

    1987-01-01

    High radiotoxicity of iodine-125 has been mainly attributed to the local radiolytic effects of Auger electrons on biological systems. In the present study, experimental and theoretical results are compared. The agreement between the experimental and theoretical results explains that the energy absorption of iodine aggregates has an important role in the radiolytic effectiveness of Auger electrons and iodine-125 in benzene-iodine solutions. (author) 18 refs.; 3 figs

  11. Automated treatment planning engine for prostate seed implant brachytherapy

    International Nuclear Information System (INIS)

    Yu Yan; Zhang, J.B.Y.; Brasacchio, Ralph A.; Okunieff, Paul G.; Rubens, Deborah J.; Strang, John G.; Soni, Arvind; Messing, Edward M.

    1999-01-01

    Purpose: To develop a computer-intelligent planning engine for automated treatment planning and optimization of ultrasound- and template-guided prostate seed implants. Methods and Materials: The genetic algorithm was modified to reflect the 2D nature of the implantation template. A multi-objective decision scheme was used to rank competing solutions, taking into account dose uniformity and conformity to the planning target volume (PTV), dose-sparing of the urethra and the rectum, and the sensitivity of the resulting dosimetry to seed misplacement. Optimized treatment plans were evaluated using selected dosimetric quantifiers, dose-volume histogram (DVH), and sensitivity analysis based on simulated seed placement errors. These dosimetric planning components were integrated into the Prostate Implant Planning Engine for Radiotherapy (PIPER). Results: PIPER has been used to produce a variety of plans for prostate seed implants. In general, maximization of the minimum peripheral dose (mPD) for given implanted total source strength tended to produce peripherally weighted seed patterns. Minimization of the urethral dose further reduced the loading in the central region of the PTV. Isodose conformity to the PTV was achieved when the set of objectives did not reflect seed positioning uncertainties; the corresponding optimal plan generally required fewer seeds and higher source strength per seed compared to the manual planning experience. When seed placement uncertainties were introduced into the set of treatment planning objectives, the optimal plan tended to reach a compromise between the preplanned outcome and the likelihood of retaining the preferred outcome after implantation. The reduction in the volatility of such seed configurations optimized under uncertainty was verified by sensitivity studies. Conclusion: An automated treatment planning engine incorporating real-time sensitivity analysis was found to be a useful tool in dosimetric planning for prostate

  12. Automated treatment planning engine for prostate seed implant brachytherapy.

    Science.gov (United States)

    Yu, Y; Zhang, J B; Brasacchio, R A; Okunieff, P G; Rubens, D J; Strang, J G; Soni, A; Messing, E M

    1999-02-01

    To develop a computer-intelligent planning engine for automated treatment planning and optimization of ultrasound- and template-guided prostate seed implants. The genetic algorithm was modified to reflect the 2D nature of the implantation template. A multi-objective decision scheme was used to rank competing solutions, taking into account dose uniformity and conformity to the planning target volume (PTV), dose-sparing of the urethra and the rectum, and the sensitivity of the resulting dosimetry to seed misplacement. Optimized treatment plans were evaluated using selected dosimetric quantifiers, dose-volume histogram (DVH), and sensitivity analysis based on simulated seed placement errors. These dosimetric planning components were integrated into the Prostate Implant Planning Engine for Radiotherapy (PIPER). PIPER has been used to produce a variety of plans for prostate seed implants. In general, maximization of the minimum peripheral dose (mPD) for given implanted total source strength tended to produce peripherally weighted seed patterns. Minimization of the urethral dose further reduced the loading in the central region of the PTV. Isodose conformity to the PTV was achieved when the set of objectives did not reflect seed positioning uncertainties; the corresponding optimal plan generally required fewer seeds and higher source strength per seed compared to the manual planning experience. When seed placement uncertainties were introduced into the set of treatment planning objectives, the optimal plan tended to reach a compromise between the preplanned outcome and the likelihood of retaining the preferred outcome after implantation. The reduction in the volatility of such seed configurations optimized under uncertainty was verified by sensitivity studies. An automated treatment planning engine incorporating real-time sensitivity analysis was found to be a useful tool in dosimetric planning for prostate brachytherapy.

  13. Low dose rate brachytherapy (LDR-BT) as monotherapy for early stage prostate cancer in Italy: practice and outcome analysis in a series of 2237 patients from 11 institutions

    Science.gov (United States)

    Fellin, Giovanni; Mirri, Maria A; Santoro, Luigi; Divan, Claudio; Mussari, Salvatore; Ziglio, Francesco; La Face, Beniamino; Barbera, Fernando; Buglione, Michela; Bandera, Laura; Ghedi, Barbara; Di Muzio, Nadia G; Losa, Andrea; Mangili, Paola; Nava, Luciano; Chiarlone, Renato; Ciscognetti, Nunzia; Gastaldi, Emilio; Cattani, Federica; Spoto, Ruggero; Vavassori, Andrea; Giglioli, Francesca R; Guarneri, Alessia; Cerboneschi, Valentina; Mignogna, Marcello; Paoluzzi, Mauro; Ravaglia, Valentina; Chiumento, Costanza; Clemente, Stefania; Fusco, Vincenzo; Santini, Roberto; Stefanacci, Marco; Mangiacotti, Francesco P; Martini, Marco; Palloni, Tiziana; Schinaia, Giuseppe; Lazzari, Grazia; Silvano, Giovanni; Magrini, Stefano; Ricardi, Umberto; Santoni, Riccardo; Orecchia, Roberto

    2016-01-01

    Objective: Low-dose-rate brachytherapy (LDR-BT) in localized prostate cancer is available since 15 years in Italy. We realized the first national multicentre and multidisciplinary data collection to evaluate LDR-BT practice, given as monotherapy, and outcome in terms of biochemical failure. Methods: Between May 1998 and December 2011, 2237 patients with early-stage prostate cancer from 11 Italian community and academic hospitals were treated with iodine-125 (125I) or palladium-103 LDR-BT as monotherapy and followed up for at least 2 years. 125I seeds were implanted in 97.7% of the patients: the mean dose received by 90% of target volume was 145 Gy; the mean target volume receiving 100% of prescribed dose (V100) was 91.1%. Biochemical failure-free survival (BFFS), disease-specific survival (DSS) and overall survival (OS) were estimated using Kaplan–Meier method. Log-rank test and multivariable Cox regression were used to evaluate the relationship of covariates with outcomes. Results: Median follow-up time was 65 months. 5- and 7-year DSS, OS and BFFS were 99 and 98%, 94 and 89%, and 92 and 88%, respectively. At multivariate analysis, the National Comprehensive Cancer Network score (p < 0.0001) and V100 (p = 0.09) were correlated with BFFS, with V100 effect significantly different between patients at low risk and those at intermediate/high risk (p = 0.04). Short follow-up and lack of toxicity data represent the main limitations for a global evaluation of LDR-BT. Conclusion: This first multicentre Italian report confirms LDR-BT as an excellent curative modality for low-/intermediate-risk prostate cancer. Advances in knowledge: Multidisciplinary teams may help to select adequately patients to be treated with brachytherapy, with a direct impact on the implant quality and, possibly, on outcome. PMID:27384381

  14. Computed tomography-guided iodine-125 interstitial implantation as an alternative treatment option for lung cancer.

    Science.gov (United States)

    Jiang, G; Li, Z; Ding, A; Zhou, F; Jiao, W; Tang, D; Qiu, W; Yue, L; Xu, W

    2015-02-01

    The aim was to evaluate the safety, feasibility and efficacy of computed tomography (CT)-guided percutaneous interstitial brachytherapy using radioactive iodine-125 ( 125 I) seeds for the treatment of lung cancer. Included in this study were 45 male and 35 female patients aged 52-85 years (mean 72-year) who were diagnosed with lung cancer. Of the 80 cases of lung cancer, 38 were pathologically confirmed as squamous cell carcinoma, 29 as adenocarcinoma, 2 as small cell lung cancer, and 11 as metastatic lung cancer. Percutaneous interstitial implantation of radioactive 125 I seeds was performed under CT guidance. The treatment planning system was used to reconstruct three-dimensional images of the tumor to determine the quantity and distribution of 125 I seeds to be implanted. Under CT guidance, 125 I seeds were embedded into the tumor, with the matched peripheral dose set at 100-130 Gy. Follow-up CT scan was done in 2-month to explore the treatment efficacy. The procedure was successful in all patients. No major procedure-associated death occurred. The duration of follow-up was 6-month. Complete response (CR) was seen in 38 cases (47.5%), partial response (PR) in 27 cases (33.75%), stable disease (SD) in 10 cases (12.5%), and progressive disease in 5 cases (6.25%), with a local control rate (CR + PR + SD) of 93.75%. The 2-, 4- and 6-month overall response rate (CR + PR) was 78%, 83% and 81%, respectively. Implantation of CT-guided 125 I seeds is a safe and effective alternative option for the treatment of lung cancer.

  15. Computed tomographic-guided iodine-125 interstitial implants for malignant thoracic tumors

    International Nuclear Information System (INIS)

    Huang, Qiming; Chen, Jin; Chen, Qunlin; Lai, Qingquan; Cai, Siqing; Luo, Kaidong; Lin, Zhengyu

    2013-01-01

    Purpose: To evaluate the feasibility and efficacy of percutaneous interstitial brachytherapy using iodine-125 ( 125 I) radioactive seeds under computed tomographic (CT) guidance for malignant thoracic tumors. Materials and methods: Forty-one patients (34 males, 7 females; 18–90 years; mean, 63.7 years) with 77 lesions (3 in the mediastinum, 7 in the chest wall, 67 in the lung) underwent percutaneous interstitial implantation of 125 I radioactive seeds under CT guidance. A treatment planning system (TPS) was employed to calculate the number and distribution of seeds preoperatively. An 18-G needle was inserted into the lesions under CT guidance and send the seeds according to TPS. Two patients with mediastinal lesions undergoing seed implantation received an artificial pneumothorax. One patient with lung carcinoma adjacent to the anterior mediastinum underwent seed implantation through the sternum. Follow-up CT was done every 2 months postoperatively. Results: The procedure was successful in all patients. No major procedure-associated death occurred. The mean duration of follow-up was 19.4 ± 1.3 months (3–49 months). A complete response (CR) was seen in 49 lesions (63.6%), partial response (PR) in 9 lesions (11.7%), stable disease (SD) in 12 lesions (12.8%), and progressive disease (PD) in 7 lesions (7.4%). The overall response rate (CR + PR) was 75.3%; the local control rate (CR + PR + SD) was 90.9%. The 1-, 2- and 3-year progression-free rates for local tumors were 91%, 88% and 88%, respectively. The 1-, 2- and 3-year survival rates were 87%, 74% and 68%, respectively. Conclusion: Implantation of CT-guided 125 I seeds is feasible and effective for patients with malignant thoracic tumors

  16. C-arm conebeam CT guided 125I prostate brachytherapy : Dynamic dose calculation and implant dynamics

    NARCIS (Netherlands)

    Westendorp, Hendrik

    2017-01-01

    The aim of 125I prostate brachytherapy is to cover the prostate with an adequate dose to control local disease and, at the same time, limit dose to healthy structures to minimize toxicity of the treatment. The AAPM, ABS and GEC/ESTRO recommend to perform postimplant dosimetry approximately a month

  17. Body Mass Index and Prostate-Specific Antigen Failure Following Brachytherapy for Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Efstathiou, Jason A.; Skowronski, Rafi Y.; Coen, John J.; Grocela, Joseph A.; Hirsch, Ariel E.; Zietman, Anthony L.

    2008-01-01

    Purpose: Increasing body mass index (BMI) is associated with prostate-specific antigen (PSA) failure after radical prostatectomy and external beam radiation therapy (EBRT). We investigated whether BMI is associated with PSA failure in men treated with brachytherapy for clinically localized prostate cancer. Patients and Methods: Retrospective analyses were conducted on 374 patients undergoing brachytherapy for stage T1c-T2cNXM0 prostate cancer from 1996-2001. Forty-nine patients (13%) received supplemental EBRT and 131 (35%) received androgen deprivation therapy (ADT). Height and weight data were available for 353 (94%). Cox regression analyses were performed to evaluate the relationship between BMI and PSA failure (nadir + 2 ng/ml definition). Covariates included age, race, preimplantation PSA, Gleason score, T category, percent of prescription dose to 90% of the prostate, use of supplemental EBRT, and ADT. Results: Median age, PSA, and BMI were 66 years (range, 42-80 years), 5.7 ng/ml (range, 0.4-22.6 ng/ml), and 27.1 kg/m 2 (range, 18.2-53.6 kg/m 2 ), respectively. After a median follow-up of 6.0 years (range, 3.0-10.2 years), there were 76 PSA recurrences. The BMI was not associated with PSA failure. Six-year PSA failure rates were 30.2% for men with BMI less than 25 kg/m 2 , 19.5% for BMI of 25 or greater to less than 30 kg/m 2 , and 14.4% for BMI of 30 kg/m 2 or greater (p = 0.19). Results were similar when BMI was analyzed as a continuous variable, using alternative definitions of PSA failure, and excluding patients treated with EBRT and/or ADT. In multivariate analyses, only baseline PSA was significantly associated with shorter time to PSA failure (adjusted hazard ratio, 1.12; 95% confidence interval, 1.05-1.20; p 0.0006). Conclusions: Unlike after surgery or EBRT, BMI is not associated with PSA failure in men treated with brachytherapy for prostate cancer. This raises the possibility that brachytherapy may be a preferred treatment strategy in obese

  18. The PROSPER robot for prostate brachytherapy: design, development and preclinical evaluation

    International Nuclear Information System (INIS)

    Long, J.A.

    2012-01-01

    Objectives: reporting the design, development and experiments of a new robotic system for prostate brachytherapy including prostate tracking and MRI to Ultrasound registration. Material and methods: a robot for trans-perineal needle insertion has been developed. It includes the ability to track the prostate position and shape. Experiments on 90 targets inside 9 deformable phantoms have been conducted. A feasibility on 2 cadavers has also been performed. The robot had to place glass seeds simulating brachytherapy seeds as close as possible to physical targets included into the phantom or inside the prostates. A post-operative CT scan of the phantom or prostate was performed in order to measure the accuracy of the system. Results: the median accuracy was 2.73 mm with a median prostate motion of 5.46 mm. The accuracy in the base region was superior to the accuracy in the apex region (2.28 mm vs 3.83 mm, p≤0.01) and was not significantly different for horizontal or oblique needles (2.7 vs 2.82 mm, p=0.18). Cadaver experiments demonstrated that the approach was feasible and that the robot could be used in a real clinical environment. Conclusion: the robot for prostate brachytherapy is the first system enabling prostate tracking. Targets can be accurately reached despite prostate motion and deformation. It could be applied to focal therapy for prostate cancer. (author)

  19. Seed fixity in the prostate/periprostatic region following brachytherapy.

    Science.gov (United States)

    Merrick, G S; Butler, W M; Dorsey, A T; Lief, J H; Benson, M L

    2000-01-01

    Although postoperative dosimetric analyses of prostate brachytherapy are commonly reported, the long-term persistence, or fixity, of seeds implanted in the prostate gland and periprostatic region remains unclear, with only a few reports regarding the loss or migration of the seeds in the implanted region and none which correlate lung embolization to pelvic seed loss. The study population consisted of 175 consecutive patients implanted with either 125I (95 patients) or 103Pd (80 patients) using a mean of 136 seeds in a modified uniform loading approach to cover a planning volume that was 1.64 times the ultrasound prostate volume. An average of 64% of 125I seeds were embedded in braided vicryl suture, and these seeds were used on the periphery and extra prostatic regions. Following CT-based dosimetric analysis on day 0, all patients had orthogonal plain films of the pelvis obtained from day 0 to day 502, with an average of 2.3 film pairs per patient. Routine diagnostic PA and lateral chest X rays were obtained for 156 patients over the same time period. The mean pelvic seed fixity was greater than 98% throughout the time covered by this study. The seed fixity rates for 125I and 103Pd, although nearly equal, were significantly different up to 60 days post implant. The median 125I seed loss per patient was only 1 seed through 180 days while for 103Pd, the median seed loss was 2 seeds at 28 and 60 days and 3 seeds at 180 days. The fraction of patients experiencing no seed loss decreased from 40% at 28 days to 20% at 180 days for 125I and from 24% to 7% for 103Pd over the same time interval. Patient and treatment parameters closely correlated to local seed loss include the number of seeds implanted, the planning volume, and the number of loose seeds, and for 125I, the fraction of seeds in suture. The fraction of seeds placed outside the gland was not correlated with seed loss. Of the seeds lost from the pelvis, about 10% were found to embolize to the lungs. Among the 156

  20. Seed displacements after permanent brachytherapy for prostate cancer in dependence on the prostate level

    Energy Technology Data Exchange (ETDEWEB)

    Pinkawa, M.; Gagel, B.; Asadpour, B.; Piroth, M.D.; Klotz, J.; Eble, M.J. [Dept. of Radiotherapy, RWTH Aachen (Germany); Borchers, H.; Jakse, G. [Dept. of Urology, RWTH Aachen (Germany)

    2008-10-15

    Purpose: to evaluate seed displacements after permanent prostate brachytherapy considering different prostate levels. Patients and methods: in 61 patients, postimplant CT scans were performed 1 day and 1 month after an implant with stranded seeds. Seed and prostate surface displacements were determined relative to pelvic bones. Four groups of seed locations were selected: seeds at the base (n = 305; B), at the apex (n = 305; A), close to the urethra (n = 306; U), and close to the rectal wall (n = 204; R). The length of two strands (always containing four seeds) per patient was measured in all CT scans and compared. Results: the largest inferior seed displacements were found at the base: mean 5.3 mm (B), 2.2 mm (A), 2.7 mm (U), 3.3 mm (R; p < 0.001). Posterior displacements predominated both at the base and the central region: mean 2.2 mm (B), 2.0 mm (U), 0.8 mm (A), -0.6 mm (R; p < 0.001). With a decreasing edema between day 1 and 30 (mean prostate volume of 51 cm{sup 3} vs. 41 cm{sup 3}; p < 0.001), a mean caudal prostate base displacement of 3.9 mm was found, whereas the mean inward displacement ranged from 1.2 to 1.6 mm at the remaining borders (lateral, anterior, posterior, apical). The analysis of the strand lengths revealed an implant compression between day 1 and 30 (mean 1.7 mm; p < 0.001). Conclusion: the largest prostate tissue and seed displacements were observed at the prostate base, associated with an implant compression. Predominantly inferior and posterior displacements implicate consequential smaller preplanning margins at the apex and the posterior prostate. (orig.)

  1. Occupational exposure of professionals during interstitial permanent prostate brachytherapy implants

    International Nuclear Information System (INIS)

    Pirraco, R.; Pereira, A.; Viterbo, T.; Cavaco, A.

    2006-01-01

    Full text of publication follows: Introduction: In this study we present dose measurements for professionals exposed during interstitial 125 I permanent prostate brachytherapy implants. Methods and Materials: The implant technique used was intra operative real time using strand and loose seeds. The professionals inside the operating room are an oncologist, a radiologist, a physicist, a nurse and an anesthesiologist. The oncologist and the physicist contact directly the loaded needle with radioactive seeds and two types of measurements were taken: total body and extremities (finger) dose. The rest of the team operates at long distances, but measurements were made. To measure total body equivalent dose we use a Berthold Umo LB 123 coupled with a LB 1236-H10 detector, and we recorded dose, time and distance from implant location. Finger dosemeters are thermo -luminescent dosimeter (TLD) rings that were controlled over one month. Results: 50 cases (average number of applications per year) were analysed for extremities measurements and 9 cases for total body measurements (in this case, the results were extrapolated for 50 cases), with an average of 26.1 mCi total activity per implant (in a range of 17.4 - 40.3 mCi). The finger dose was 1.8 mSv for the oncologist and 1.9 mSv for the physicist. The interpolation of total body equivalent dose for the oncologist was 24 mSv, for the radiologist 6 mSv and 9 mSv for the physicist. The rest of the team did not receive anything but background radiation. The annual national limit dose for workers is 20 mSv for total body irradiation, and 500 mSv for extremities. Conclusion: In conclusion we may say that during interstitial permanent prostate brachytherapy implants, total doses received for all groups are not significant when compared to annual limits for Portuguese laws 1. Even so, our main goal is always to get the less possible dose (ALARA principle). References: 1. Decreto Lei n. 180/2002 de 8 de Agosto. (authors)

  2. Occupational exposure of professionals during interstitial permanent prostate brachytherapy implants

    Energy Technology Data Exchange (ETDEWEB)

    Pirraco, R.; Pereira, A.; Viterbo, T.; Cavaco, A. [Instituto Portugues de Oncologia Francisco Gentil, Centro R egional de Oncologia do Porto, SA, Porto (Portugal)

    2006-07-01

    Full text of publication follows: Introduction: In this study we present dose measurements for professionals exposed during interstitial 125 I permanent prostate brachytherapy implants. Methods and Materials: The implant technique used was intra operative real time using strand and loose seeds. The professionals inside the operating room are an oncologist, a radiologist, a physicist, a nurse and an anesthesiologist. The oncologist and the physicist contact directly the loaded needle with radioactive seeds and two types of measurements were taken: total body and extremities (finger) dose. The rest of the team operates at long distances, but measurements were made. To measure total body equivalent dose we use a Berthold Umo LB 123 coupled with a LB 1236-H10 detector, and we recorded dose, time and distance from implant location. Finger dosemeters are thermo -luminescent dosimeter (TLD) rings that were controlled over one month. Results: 50 cases (average number of applications per year) were analysed for extremities measurements and 9 cases for total body measurements (in this case, the results were extrapolated for 50 cases), with an average of 26.1 mCi total activity per implant (in a range of 17.4 - 40.3 mCi). The finger dose was 1.8 mSv for the oncologist and 1.9 mSv for the physicist. The interpolation of total body equivalent dose for the oncologist was 24 mSv, for the radiologist 6 mSv and 9 mSv for the physicist. The rest of the team did not receive anything but background radiation. The annual national limit dose for workers is 20 mSv for total body irradiation, and 500 mSv for extremities. Conclusion: In conclusion we may say that during interstitial permanent prostate brachytherapy implants, total doses received for all groups are not significant when compared to annual limits for Portuguese laws 1. Even so, our main goal is always to get the less possible dose (ALARA principle). References: 1. Decreto Lei n. 180/2002 de 8 de Agosto. (authors)

  3. [Ldr brachytherapy, a minimally invasive alternative in the treatment of organ-confined prostate cancer].

    Science.gov (United States)

    Siegsmund, M; Musial, A; Weiss, J; Alken, P

    2001-09-01

    LDR Brachytherapy, a Minimally Invasive Alternative in the Treatment of Organ-Confined Prostate Cancer In den letzten Jahren erlebte die Brachytherapie mit permanenten Implantaten beim organbegrenzten Prostatakarzinom besonders in den USA, wo im Jahre 1999 mehr als 40 000 Implantationen durchgeführt wurden, eine Renaissance. Mit einer gewissen Verzögerung nimmt die Popularität dieser Methode auch in Europa immer mehr zu. Dies, obwohl die Brachytherapie keine absolut neue Methode in der Behandlung des Prostatakarzinoms ist, sie hat im Gegenteil eine lange Tradition. Copyright 2001 S. Karger GmbH, Freiburg

  4. Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Gelblum, Daphna Y.; Potters, Louis

    2000-01-01

    Purpose: As transperineal interstitial permanent prostate brachytherapy (TIPPB) grows in acceptance as an option in the treatment of organ-confined prostate cancer, its associated toxicities are being defined. This clinical report documents rectal toxicity from a large cohort of men treated by a single practitioner for adenocarcinoma of the prostate. Methods and Materials: Eight hundred twenty-five men were treated from September 1992 to September 1998 with TIPPB. One hundred-forty were treated in conjunction with external beam irradiation (EBRT) and 685 with TIPPB alone. All patients were implanted under real-time ultrasound guidance. No dose-volume histogram analysis was performed for this study. All patients were followed at 5 weeks after the procedure, then every 3-6 months thereafter. Rectal morbidity was graded by a modified RTOG toxicity scale. Therapy to control symptoms was recommended on an individual basis. Results: The median follow-up for the cohort is 48 months. A total of 77 patients (9.4%) reported Grade 1 toxicity at some time following an implant whereas 54 patients (6.6%) reported Grade 2 toxicity. The peak post-TIPPB time for experiencing rectal toxicity was 8 months at which time Grade 1 and 2 rectal toxicity was reported in 9.5% of the patients. This improved over the subsequent months and resolved in all patients by 3((1)/(2)) years. Four patients (0.5%) reported Grade 3 rectal toxicity with rectal ulceration identified on colonoscopy at 1 year from implant. Two of the four patients had colonic manipulation in the radiated portion of the colon which subsequently caused it to bleed. None of the patients required blood product transfusion. In 3 of the 4 patients the Grade 3 rectal toxicity has resolved spontaneously and 1 patient continues to heal at the time of this report. No patient required hospitalization or surgical intervention. Conclusion: TIPPB is a tolerable and acceptable treatment option when used alone in early-stage, organ

  5. Prostate Brachytherapy Case Volumes by Academic and Nonacademic Practices: Implications for Future Residency Training

    International Nuclear Information System (INIS)

    Orio, Peter F.; Nguyen, Paul L.; Buzurovic, Ivan; Cail, Daniel W.; Chen, Yu-Wei

    2016-01-01

    Purpose: The use of prostate brachytherapy has continued to decline in the United States. We examined the national practice patterns of both academic and nonacademic practices performing prostate brachytherapy by case volume per year to further characterize the decline and postulate the effect this trend might have on training the next generation of residents. Methods and Materials: Men diagnosed with prostate cancer who had undergone radiation therapy in 2004 to 2012 were identified. The annual brachytherapy case volume at each facility was determined and further categorized into ≤12 cases per year (ie, an average of ≤1 cases per month), 13 to 52 cases per year, and ≥53 cases per year (ie, an average of ≥1 cases per week) in academic practices versus nonacademic practices. Results: In 2004 to 2012, academic practices performing an average of ≤1 brachytherapy cases per month increased from 56.4% to 73.7%. In nonacademic practices, this percentage increased from 60.2% to 77.4% (P<.0001 for both). Practices performing an average of ≥1 cases per week decreased among both academic practices (from 6.7% to 1.5%) and nonacademic practices (from 4.5% to 2.7%). Conclusions: Both academic and nonacademic radiation oncology practices have demonstrated a significant reduction in the use of prostate brachytherapy from 2004 to 2012. With the case volume continuing to decline, it is unclear whether we are prepared to train the next generation of residents in this critical modality.

  6. HDR brachytherapy as a solution in recurrences of locally advanced prostate cancer.

    Science.gov (United States)

    Łyczek, Jarosław; Kawczyńska, Maria M; Garmol, Darek; Kasprowicz, Anetta; Kulik, Anna; Dąbkowski, Mateusz; Czyżew, Beata; Gruszczyńska, Ewelina; Bijok, Michał; Kowalik, Łukasz

    2009-06-01

    The object of this study was to analyze the outcome of salvage HDR brachytherapy treatment after local failure, for patients with prostate specific antigen (PSA) failure without distant metastasis, after external beam radiation and HDR brachytherapy treatment, or after radical prostatectomy, with or without hormonal therapy. The group of 115 patients, without distant metastasis, after local failure and external beam radiation, followed by HDR brachytherapy treatment, or after radical prostatectomy, with hormonal therapy and without, have been enrolled to salvage HDR brachytherapy (SBR). All patients had minimum 3 months androgen deprivation therapy before salvage brachytherapy, which was continued until the next 9 months after SBR. Brachytherapy was administered in three 10 Gy fractions with 3 weeks gap between them. Each session of SBR was supported by trans-rectal USG real time pictures. The treatment planning was done on the base of Abacus system from Sauerwein ® or with SWIFT system from Nucletron ® . The following data were collected: Gleason score, clinical staging, the volume of the prostate, PSA before and after the initial treatment and periodically during the follow-up period. Also the time during which the PSA stays at the nadir level, patient's age and toxicity of treatments were taken into consideration. Doses from external radiotherapy or from HDR brachytherapy were recalculated to equivalent biological dose (EBD). The independence from biochemical progression in our group of patients after retreatment was 46% for patients with PSA ≤ 6 and 18% for patients with PSA > 6. Overall survival for patients with PSA ≤ 6 was 86% and 48% for patients with PSA > 6, respectively. Salvage prostate brachytherapy (SBR) can be safely performed with acceptable biochemical control and toxicity.

  7. Low-Dose-Rate Brachytherapy Versus Cryotherapy in Low- and Intermediate-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Gestaut, Matthew M., E-mail: Matthew.Gestaut@BSWHealth.org [Department of Radiation Oncology, Baylor Scott and White Memorial Hospital, Texas A& M University School of Medicine, Temple, Texas (United States); Cai, Wendi [Department of Biostatistics, Baylor Scott and White Health, Temple, Texas (United States); Vyas, Shilpa [Department of Radiation Oncology, Swedish Cancer Institute, Seattle, Washington (United States); Patel, Belur J. [Department of Urology, Baylor Scott and White Memorial Hospital, Texas A& M University School of Medicine, Temple, Texas (United States); Hasan, Salman A. [Department of Radiation Oncology, Baylor Scott and White Memorial Hospital, Texas A& M University School of Medicine, Temple, Texas (United States); MunozMaldonado, Yolanda [Department of Biostatistics, Baylor Scott and White Health, Temple, Texas (United States); Deb, Niloyjyoti; Swanson, Gregory [Department of Radiation Oncology, Baylor Scott and White Memorial Hospital, Texas A& M University School of Medicine, Temple, Texas (United States)

    2017-05-01

    Purpose: Cryotherapy and brachytherapy are definitive local treatment options for low- to intermediate-risk prostate cancer. There are both prospective and retrospective data for brachytherapy, but the use of cryotherapy has been limited primarily to single-institution retrospective studies. Currently, no published evidence has compared low-dose-rate brachytherapy versus cryotherapy. Methods and Materials: Institutional review board approval was obtained to conduct a retrospective chart review of consecutive patients treated at our institution from 1990 to 2012. For inclusion, patients must have received a prostate cancer diagnosis and have been considered to have low- to intermediate-risk disease according to the National Comprehensive Cancer Network criteria. All patients received brachytherapy or cryotherapy treatment. Disease specifics and failure details were collected for all patients. Failure was defined as prostate-specific antigen nadir +2 ng/mL. Results: A total of 359 patients were analyzed. The groups comprised 50 low-risk cryotherapy (LRC), 92 intermediate-risk cryotherapy (IRC), 133 low-risk brachytherapy (LRB), and 84 intermediate-risk brachytherapy (IRB) patients. The median prostate-specific antigen follow-up periods were 85.6 months (LRC), 59.2 months (IRC), 74.9 months (LRB), and 59.8 months (IRB). The 5-year biochemical progression–free survival (bPFS) rate was 57.9% in the cryotherapy group versus 89.6% in the brachytherapy group (P<.0001). The 5-year bPFS rate was 70.0% (LRC), 51.4% (IRC), 89.4% (LRB), and 89.7% (IRB). The bPFS rate was significantly different between brachytherapy and cryotherapy for low- and intermediate-risk groups (P<.05). The mean nadir temperature reached for cryotherapy patients was −35°C (range, −96°C to −6°C). Cryotherapy used a median of 2 freeze-thaw cycles (range, 2-4 freeze-thaw cycles). Conclusions: Results from this study suggest that cryotherapy is inferior to brachytherapy for patients with

  8. Low-Dose-Rate Brachytherapy Versus Cryotherapy in Low- and Intermediate-Risk Prostate Cancer

    International Nuclear Information System (INIS)

    Gestaut, Matthew M.; Cai, Wendi; Vyas, Shilpa; Patel, Belur J.; Hasan, Salman A.; MunozMaldonado, Yolanda; Deb, Niloyjyoti; Swanson, Gregory

    2017-01-01

    Purpose: Cryotherapy and brachytherapy are definitive local treatment options for low- to intermediate-risk prostate cancer. There are both prospective and retrospective data for brachytherapy, but the use of cryotherapy has been limited primarily to single-institution retrospective studies. Currently, no published evidence has compared low-dose-rate brachytherapy versus cryotherapy. Methods and Materials: Institutional review board approval was obtained to conduct a retrospective chart review of consecutive patients treated at our institution from 1990 to 2012. For inclusion, patients must have received a prostate cancer diagnosis and have been considered to have low- to intermediate-risk disease according to the National Comprehensive Cancer Network criteria. All patients received brachytherapy or cryotherapy treatment. Disease specifics and failure details were collected for all patients. Failure was defined as prostate-specific antigen nadir +2 ng/mL. Results: A total of 359 patients were analyzed. The groups comprised 50 low-risk cryotherapy (LRC), 92 intermediate-risk cryotherapy (IRC), 133 low-risk brachytherapy (LRB), and 84 intermediate-risk brachytherapy (IRB) patients. The median prostate-specific antigen follow-up periods were 85.6 months (LRC), 59.2 months (IRC), 74.9 months (LRB), and 59.8 months (IRB). The 5-year biochemical progression–free survival (bPFS) rate was 57.9% in the cryotherapy group versus 89.6% in the brachytherapy group (P<.0001). The 5-year bPFS rate was 70.0% (LRC), 51.4% (IRC), 89.4% (LRB), and 89.7% (IRB). The bPFS rate was significantly different between brachytherapy and cryotherapy for low- and intermediate-risk groups (P<.05). The mean nadir temperature reached for cryotherapy patients was −35°C (range, −96°C to −6°C). Cryotherapy used a median of 2 freeze-thaw cycles (range, 2-4 freeze-thaw cycles). Conclusions: Results from this study suggest that cryotherapy is inferior to brachytherapy for patients with

  9. Real-time photoacoustic imaging of prostate brachytherapy seeds using a clinical ultrasound system

    Science.gov (United States)

    Kuo, Nathanael; Kang, Hyun Jae; Song, Danny Y.; Kang, Jin U.; Boctor, Emad M.

    2012-06-01

    Prostate brachytherapy is a popular prostate cancer treatment option that involves the permanent implantation of radioactive seeds into the prostate. However, contemporary brachytherapy procedure is limited by the lack of an imaging system that can provide real-time seed-position feedback. While many other imaging systems have been proposed, photoacoustic imaging has emerged as a potential ideal modality to address this need, since it could easily be incorporated into the current ultrasound system used in the operating room. We present such a photoacoustic imaging system built around a clinical ultrasound system to achieve the task of visualizing and localizing seeds. We performed several experiments to analyze the effects of various parameters on the appearance of brachytherapy seeds in photoacoustic images. We also imaged multiple seeds in an ex vivo dog prostate phantom to demonstrate the possibility of using this system in a clinical setting. Although still in its infancy, these initial results of a photoacoustic imaging system for the application of prostate brachytherapy seed localization are highly promising.

  10. Low-Dose-Rate Brachytherapy Versus Cryotherapy in Low- and Intermediate-Risk Prostate Cancer.

    Science.gov (United States)

    Gestaut, Matthew M; Cai, Wendi; Vyas, Shilpa; Patel, Belur J; Hasan, Salman A; MunozMaldonado, Yolanda; Deb, Niloyjyoti; Swanson, Gregory

    2017-05-01

    Cryotherapy and brachytherapy are definitive local treatment options for low- to intermediate-risk prostate cancer. There are both prospective and retrospective data for brachytherapy, but the use of cryotherapy has been limited primarily to single-institution retrospective studies. Currently, no published evidence has compared low-dose-rate brachytherapy versus cryotherapy. Institutional review board approval was obtained to conduct a retrospective chart review of consecutive patients treated at our institution from 1990 to 2012. For inclusion, patients must have received a prostate cancer diagnosis and have been considered to have low- to intermediate-risk disease according to the National Comprehensive Cancer Network criteria. All patients received brachytherapy or cryotherapy treatment. Disease specifics and failure details were collected for all patients. Failure was defined as prostate-specific antigen nadir +2 ng/mL. A total of 359 patients were analyzed. The groups comprised 50 low-risk cryotherapy (LRC), 92 intermediate-risk cryotherapy (IRC), 133 low-risk brachytherapy (LRB), and 84 intermediate-risk brachytherapy (IRB) patients. The median prostate-specific antigen follow-up periods were 85.6 months (LRC), 59.2 months (IRC), 74.9 months (LRB), and 59.8 months (IRB). The 5-year biochemical progression-free survival (bPFS) rate was 57.9% in the cryotherapy group versus 89.6% in the brachytherapy group (Pcryotherapy for low- and intermediate-risk groups (Pcryotherapy patients was -35°C (range, -96°C to -6°C). Cryotherapy used a median of 2 freeze-thaw cycles (range, 2-4 freeze-thaw cycles). Results from this study suggest that cryotherapy is inferior to brachytherapy for patients with low- to intermediate-risk prostate cancer. Patient selection criteria for consideration of cryotherapy and brachytherapy are similar in terms of anesthesia candidacy. Therefore, cryotherapy would not be recommended as a first-line local therapy for this particular

  11. A gEUD-based inverse planning technique for HDR prostate brachytherapy: Feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Giantsoudi, D. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78229 (United States); Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Boston, Massachusetts 02114 (United States); Baltas, D. [Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach GmbH, 63069 Offenbach (Germany); Nuclear and Particle Physics Section, Physics Department, University of Athens, 15701 Athens (Greece); Karabis, A. [Pi-Medical Ltd., Athens 10676 (Greece); Mavroidis, P. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78299 and Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, 17176 (Sweden); Zamboglou, N.; Tselis, N. [Strahlenklinik, Klinikum Offenbach GmbH, 63069 Offenbach (Germany); Shi, C. [St. Vincent' s Medical Center, 2800 Main Street, Bridgeport, Connecticut 06606 (United States); Papanikolaou, N. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78299 (United States)

    2013-04-15

    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 D{sub 10} 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.

  12. Mixed integer programming improves comprehensibility and plan quality in inverse optimization of prostate HDR Brachytherapy

    NARCIS (Netherlands)

    Gorissen, B.L.; den Hertog, D.; Hoffmann, A.L.

    2013-01-01

    Current inverse treatment planning methods that optimize both catheter positions and dwell times in prostate HDR brachytherapy use surrogate linear or quadratic objective functions that have no direct interpretation in terms of dose-volume histogram (DVH) criteria, do not result in an optimum or

  13. GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer

    NARCIS (Netherlands)

    Kovács, György; Pötter, Richard; Loch, Tillmann; Hammer, Josef; Kolkman-Deurloo, Inger-Karine; de La Rosette, Jean J. M. C. H.; Bertermann, Hagen

    2005-01-01

    Background and purpose: The aim of this paper is to present the GEC/ESTRO-EAU recommendations for template and transrectal ultrasound (TRUS) guided transperineal temporary interstitial prostate brachytherapy using a high dose rate iridium-192 stepping source and a remote afterloading technique.

  14. Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy

    Directory of Open Access Journals (Sweden)

    Chunpeng Ren

    2014-01-01

    Full Text Available Chondrosarcomas are uncommon in the spinal column. En bloc excisions with wide margins are of critical importance but not always feasible in spine. We report the outcome in a case of recurrent lumbar vertebral chondrosarcoma treated with marginal resection and iodine-125 seeds placed in the resected tumor bed.

  15. Health-Related Quality of Life up to Six Years After 125I Brachytherapy for Early-Stage Prostate Cancer

    International Nuclear Information System (INIS)

    Roeloffzen, Ellen M.A.; Lips, Irene M.; Gellekom, Marion P.R. van; Roermund, Joep van; Frank, Steven J.; Battermann, Jan J.; Vulpen, Marco van

    2010-01-01

    Purpose: Health-related quality of life (HRQOL) after prostate brachytherapy has been extensively described in published reports but hardly any long-term data are available. The aim of the present study was to prospectively assess long-term HRQOL 6 years after 125 I prostate brachytherapy. Methods and Materials: A total of 127 patients treated with 125 I brachytherapy for early-stage prostate cancer between December 2000 and June 2003 completed a HRQOL questionnaire at five time-points: before treatment and 1 month, 6 months, 1 year, and 6 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer core questionnaire (EORTCQLQ-C30), and the tumor-specific EORTC prostate cancer module (EORTC-PR25). A change in a score of ≥10 points was considered clinically relevant. Results: Overall, the HRQOL at 6 years after 125 I prostate brachytherapy did not significantly differ from baseline. Although a statistically significant deterioration in HRQOL at 6 years was seen for urinary symptoms, bowel symptoms, pain, physical functioning, and sexual activity (p 125 I prostate brachytherapy. HRQOL scores returned to approximately baseline values at 1 year and remained stable up to 6 years after treatment. 125 I prostate brachytherapy did not adversely affect patients' long-term HRQOL.

  16. Brachytherapy with 125-Iodine sources: transport and radiation protection

    International Nuclear Information System (INIS)

    Souza, Carla D.; Zeituni, Carlos A.; Moura, Joao A.; Moura, Eduardo S.; Nagatomi, Helio R.; Feher, Anselmo; Hilario, Katia F.; Rostelato, Maria Elisa C.M.

    2009-01-01

    The estimates for the year 2009 show that 466,730 new cancer cases will occur in Brazil. Prostate cancer is the second most incident type. Brachytherapy, a type of radiotherapy, with Iodine-125 sources are an important form of treatment for this kind of cancer. The Instituto de Pesquisas Energeticas e Nucleares (IPEN) created a project to develop a national prototype of these sources and is implementing a facility for local production. The seeds manufacture in Brazil will allow to diminish the treatment cost and make it possible for a larger number of patients. While the laboratory is not ready, the IPEN import and it distributes seeds. This work aim is to present and evaluate the transport procedures and the radiological protection applied to imported sources in order to assist the procedures for the new laboratory implementation. Before sending to hospitals, the seeds are packed by a radioprotector supervisor, in accordance with CNEN NE 5.01 standard 'Radioactive Material Transport'. Despite Iodine-125 presents low energy photons, around 29 keV, local and personal dosimeters are used during the transport process, as described in CNEN NN 3.01 standard 'Radiological Protection Basic Guideline'. All the results show no contamination and very low exposure, proving the method to be valid. The transport procedure used is correct, according to the regulations. As an result of this work, a new dosimeter should be installed and evaluate in future study. (author)

  17. Urethral dosimetry constraints in 125I permanent prostate brachytherapy used as boost to external radiotherapy

    International Nuclear Information System (INIS)

    Lliso, F.; Perez-Calatayud, J.; Carmona, V.; Guirado, D.; Munoz, M.; Richart, J.; Ballester, F.; Granero, D.; Rodriguez, S.; Tormo, A.; Santos, M.

    2010-01-01

    With 125I monotherapy in permanent brachytherapy implants, the recommendation is to deliver to the urethra less than 150% of the prescribed dose, 145 Gy, that is a limit of 217.5 Gy. However, there are not recommendations in the case of the brachytherapy boost. At our hospitals, permanent brachytherapy implants are used as a 108 Gy boost in intermediate risk patients with prostate carcinoma, which have undergone an external beam radiotherapy course ranging between 45 and 50.4 Gy. The purpose of this work is to present a simple radiobiologically-based analysis performed in order to obtain the urethral dose limit in permanent prostate brachytherapy boost. The linear-quadratic model has been used to determine the biologically effective dose, analysing the results for different dose/fraction, t1/2 and a/b values. Assuming 46 Gy delivered by external beam radiotherapy, it is found that a limit value of 145 Gy, corresponding to the isodose level of 135% of the prescribed dose, is adequate. The results for a ten patients sample are shown in order to illustrate the values that are obtained in clinical practice. In conclusion, we present the method employed to find the urethral dose limit in the case of the combination of external beam radiotherapy and permanent 125I seeds brachytherapy boost implants (Author).

  18. Applicability and dosimetric impact of ultrasound-based preplanning in high-dose-rate brachytherapy of prostate cancer

    International Nuclear Information System (INIS)

    Aebersold, D.M.; Isaak, B.; Behrensmeier, F.; Kolotas, C.; Mini, R.; Greiner, R.H.; Thalmann, G.; Kranzbuehler, H.

    2004-01-01

    Background and purpose: analyses of permanent brachytherapy seed implants of the prostate have demonstrated that the use of a preplan may lead to a considerable decrease of dosimetric implant quality. The authors aimed to determine whether the same drawbacks of preplanning also apply to high-dose-rate (HDR) brachytherapy. Patients and methods: 15 patients who underwent two separate HDR brachytherapy implants in addition to external-beam radiation therapy for advanced prostate cancer were analyzed. A pretherapeutic transrectal ultrasound was performed in all patients to generate a preplan for the first brachytherapy implant. For the second brachytherapy, a subset of patients were treated by preplans based on the ultrasound from the first brachytherapy implant. Preplans were compared with the respective postplans assessing the following parameters: coverage index, minimum target dose, homogeneity index, and dose exposure of organs at risk. The prostate geometries (volume, width, height, length) were compared as well. Results: at the first brachytherapy, the matching between the preplan and actual implant geometry was sufficient in 47% of the patients, and the preplan could be applied. The dosimetric implant quality decreased considerably: the mean coverage differed by -0.11, the mean minimum target dose by -0.15, the mean homogeneity index by -0.09. The exposure of organs at risk was not substantially altered. At the second brachytherapy, all patients could be treated by the preplan; the differences between the implant quality parameters were less pronounced. The changes of prostate geometry between preplans and postplans were considerable, the differences in volume ranging from -8.0 to 13.8 cm 3 and in dimensions (width, height, length) from -1.1 to 1.0 cm. Conclusion: preplanning in HDR brachytherapy of the prostate is associated with a substantial decrease of dosimetric implant quality, when the preplan is based on a pretherapeutic ultrasound. The implant quality

  19. PSA Bounce and Biochemical Failure After Brachytherapy for Prostate Cancer: A Study of 820 Patients With a Minimum of 3 Years of Follow-Up

    International Nuclear Information System (INIS)

    Caloglu, Murat; Ciezki, Jay P.; Reddy, Chandana A.; Angermeier, Kenneth; Ulchaker, James; Chehade, Nabil; Altman, Andrew; Magi-Galuzzi, Christina; Klein, Eric A.

    2011-01-01

    Purpose: To determine clinical or dosimetric factors associated with a prostate-specific antigen (PSA) bounce, as well as an association between a PSA bounce and biochemical relapse-free survival (bRFS), in patients treated with iodine-125 brachytherapy. Methods and Materials: A variety of clinical and treatment factors were examined in 820 patients who had a minimum of 3 years of PSA follow-up with T1-T2cN0M0 prostate cancer. Four different PSA threshold values were used for defining a PSA bounce: a PSA rise of ≥0.2, ≥0.4, ≥0.6, and ≥0.8 ng/mL. Results: A PSA bounce of ≥0.2, ≥0.4, ≥0.6, and ≥0.8 ng/mL was noted in 247 patients (30.1%), 161 (19.6%), 105 (12.8%), and 78 (9.5%), respectively. The median time to the first PSA rise was 17.4, 16.25, 16.23, and 15.71 months, respectively, vs. 34.35 months for a biochemical failure (p < 0.0001). A PSA rise of ≥0.2 ng/mL was the only definition for which there was a significant difference in bRFS between bounce and non-bounce patients. The 5-year bRFS rate of patients having a PSA bounce of ≥0.2 was 97.7% vs. 91% for those who did not have a PSA bounce (p = 0.0011). On univariate analysis for biochemical failure, age, risk group, and PSAs per year had a statistically significant correlation with PSA bounce of ≥0.2 ng/mL. On multivariate analysis, age and PSAs per year remained statistically significant (p < 0.0001 and p = 0.0456, respectively). Conclusions: A bounce definition of a rise ≥0.2 ng/mL is a reliable definition among several other definitions. The time to first PSA rise is the most valuable factor for distinguishing between a bounce and biochemical failure.

  20. Salvage high-dose-rate brachytherapy for local prostate cancer recurrence after radical radiotherapy

    Directory of Open Access Journals (Sweden)

    V. A. Solodkiy

    2016-01-01

    Full Text Available Studies salvage interstitial radiation therapy for recurrent prostate cancer, launched at the end of the XX century. In recent years, more and more attention is paid to high-dose-rate brachytherapy (HDR-BT as a method of treating local recurrence.The purpose of research – preliminary clinical results of salvage high-dose-rate brachytherapy applied in cases of suspected local recurrence or of residual tumour after radiotherapy.Preliminary findings indicate the possibility of using HDR-BT, achieving local tumor control with low genitourinary toxicity.

  1. Prostate-specific antigen bounce after high-dose rate brachytherapy with external beam radiation therapy for prostate cancer patients

    International Nuclear Information System (INIS)

    Sakamoto, Naotaka; Kakinoki, Hiroaki; Tsutsui, Akio; Yoshikawa, Masahiro; Iguchi, Atsushi; Matsunobu, Toru; Uehara, Satoru

    2008-01-01

    Prostate-specific antigen (PSA) bounce after high-dose rate (HDR) brachytherapy with external beam radiation therapy (EBRT) for prostate cancer patients was evaluated. Sixty-one patients treated with HDR-brachytherapy followed by EBRT had a minimum follow-up of 12 months (median, 24 months) in our institute. A PSA bounce was defined as a rise of at least 0.1 ng/ml greater than a previous PSA level, with a subsequent decline equal to, or less than, the initial nadir. A PSA bounce was noted in 16 (26.2%) of 61 patients (one patient had a PSA bounce twice). Median time to develop a PSA bounce was 18 months, but 23.5% developed a PSA bounce after 24 months. Median duration of PSA bounce was 6 months and 11.8% had increased PSA within a period of 12 months. Median bounce height was 0.2 ng/ml (range, 0.1 to 3.39 ng/ml). A bounce height of gerater than 2 ng/ml was seen in 11.8%. Clinical characteristics (age, prostate volume, neoadjuvant endocrine therapy, risk classification, stage, pretreatment PSA, Gleason score) do not predict whether or not there will be a PSA bounce. In patients treated with HDR-brachytherapy followed by EBRT, the incidence and characteristics of PSA bounce were similar to those in patients treated with low-dose rate brachytherapy. Physicians should be aware of the possibility of PSA bounce following HDR-brachytherapy with EBRT. (author)

  2. HDR Brachytherapy in the Management of High-Risk Prostate Cancer

    Science.gov (United States)

    Masson, Susan; Persad, Raj; Bahl, Amit

    2012-01-01

    High-dose-rate (HDR) brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with high-risk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom. PMID:22461791

  3. HDR Brachytherapy in the Management of High-Risk Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Susan Masson

    2012-01-01

    Full Text Available High-dose-rate (HDR brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with high-risk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom.

  4. Multistation iodine-125 continuous air monitor with minicomputer alarm and data reduction

    International Nuclear Information System (INIS)

    Garfield, D.K.

    1978-01-01

    The components, operation, and calibration are described of a Multistation Continuous Air Monitor for the analysis of Iodine-125 and the functions of the Minicomputer in providing alarm functions and data reduction to units specified by regulation for permanent records. The sensitivity and accuracy, as well as the justification for purchase and comparison of costs with other types of air monitoring systems are also described

  5. [Technique of intraoperative planning in prostatic brachytherapy with permanent implants of 125I or 103Pd].

    Science.gov (United States)

    Prada Gómez, Pedro José; Juan Rijo, Germán; Hevia Suarez, Miguel; Abascal García, José María; Abascal García, Ramón

    2002-12-01

    Prostatic brachytherapy with permanent 125I or 123Pd seeds implantation is a therapeutic option for organ-confined prostate cancer. We analyze the technique based on previous planning, our current intraoperative planning procedure and the reasons that moved us to introduce this change. Changes in prostate volume and spatial localization observed between previous planning and intraoperative images, and possible difficulties for seed implantation due to pubic arch interference are some of the reasons that induce us to change technique. Before the operation, we calculate the prostatic volume by transrectal ultrasound; with this information we determine the total implant activity following Wu's nomogram, and per-seed activity; therefore, it is an individual process for each patient. We perform a peripheral implant, placing 75-80% of the seeds within the peripheral prostatic zone, generally through 12-15 needles, the rest of the seeds are placed in the central prostatic zone using a maximum of 3-4 needles in high volume prostates. The day of intervention, after positioning and catheter insertion, volumetry is re-checked. Ultrasound images (from base to apex every 5 mm) are transferred to the planner were a suitable seed distribution is determined. Implantation is then performed placing all needles unloaded, and then intraoperative post-planning to allow us to check implant precision is performed after cistoscopically check that there is no urethral or bladder penetration by any needle. We finish with the insertion of seeds into the prostate. Total time for the procedure is around 90 minutes. Intraoperative planning is an additional step for the treatment of prostate cancer with permanent seeds brachytherapy, which avoids the disadvantages of previous planning and improves tumor inclusion in the ideal irradiation dose area, which will translate into better local disease control.

  6. Isodose curve determination of prostate for the treatment of brachytherapy using MCNPX code

    International Nuclear Information System (INIS)

    Reis Junior, J.P.; Menezes, A.F.; Medeiros, J.A.C.C.; Facure, A.N.S.S.; Silva, A.X.

    2011-01-01

    Using voxel phantom MAX 06 coupled to the code MCNPX it possible to plot the isodose curves for the main levels involved in the treatment of prostate brachytherapy, V100 and V150 which are, respectively corresponding curves 144 and 216 Gy to curves are indicative of the quality of the existing implant of prostate brachytherapy. The number of 79 seeds 125 I, were placed in the voxels simulator MAX 06, in the slices x = 7.0, 7.5, 8.0, 8.5, 9.0, 9.5, 10.0 with the calculation model used in MCNPX in all voxels present in a matrix, it was possible to trace the isodose curves for MATLAB. For comparison and using own routines MCNPX it was possible to trace the same curves using mesh tallies. The results showed agreement with predicted values in the planning system prowess 3D. (author)

  7. Development of a Pneumatic Robot for MRI-guided Transperineal Prostate Biopsy and Brachytherapy: New Approaches

    Science.gov (United States)

    Song, Sang-Eun; Cho, Nathan B.; Fischer, Gregory; Hata, Nobuhito; Tempany, Clare; Fichtinger, Gabor; Iordachita, Iulian

    2011-01-01

    Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in order to enhance the cancer detection and treatment. For the accurate needle positioning, a number of robotic assistants have been developed. However, problems exist due to the strong magnetic field and limited workspace. Pneumatically actuated robots have shown the minimum distraction in the environment but the confined workspace limits optimal robot design and thus controllability is often poor. To overcome the problem, a simple external damping mechanism using timing belts was sought and a 1-DOF mechanism test result indicated sufficient positioning accuracy. Based on the damping mechanism and modular system design approach, a new workspace-optimized 4-DOF parallel robot was developed for the MRI-guided prostate biopsy and brachytherapy. A preliminary evaluation of the robot was conducted using previously developed pneumatic controller and satisfying results were obtained. PMID:21399734

  8. Radiation proctitis after the high dose rate brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Kitano, Masashi; Katsumata, Tomoe; Satoh, Takefumi

    2006-01-01

    We reviewed the medical records of 12 patients treated for rectal bleeding after high-dose rate brachytherapy for prostate cancer. All patients developed grade 2 proctitis according to the Common Terminology Criteria for Adverse Events (CTCAC) and no patients needed blood transfusion. The patients were treated with argon plasma coagulation (APC) and/or steroid suppositories. The bleeding stopped or improved in 11 patients. Although re-bleeding was noticed in 7 patients the same treatment was effective in 5 patients. (author)

  9. A Fully Actuated Robotic Assistant for MRI-Guided Prostate Biopsy and Brachytherapy

    Science.gov (United States)

    Li, Gang; Su, Hao; Shang, Weijian; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Fischer, Gregory S.

    2014-01-01

    Intra-operative medical imaging enables incorporation of human experience and intelligence in a controlled, closed-loop fashion. Magnetic resonance imaging (MRI) is an ideal modality for surgical guidance of diagnostic and therapeutic procedures, with its ability to perform high resolution, real-time, high soft tissue contrast imaging without ionizing radiation. However, for most current image-guided approaches only static pre-operative images are accessible for guidance, which are unable to provide updated information during a surgical procedure. The high magnetic field, electrical interference, and limited access of closed-bore MRI render great challenges to developing robotic systems that can perform inside a diagnostic high-field MRI while obtaining interactively updated MR images. To overcome these limitations, we are developing a piezoelectrically actuated robotic assistant for actuated percutaneous prostate interventions under real-time MRI guidance. Utilizing a modular design, the system enables coherent and straight forward workflow for various percutaneous interventions, including prostate biopsy sampling and brachytherapy seed placement, using various needle driver configurations. The unified workflow compromises: 1) system hardware and software initialization, 2) fiducial frame registration, 3) target selection and motion planning, 4) moving to the target and performing the intervention (e.g. taking a biopsy sample) under live imaging, and 5) visualization and verification. Phantom experiments of prostate biopsy and brachytherapy were executed under MRI-guidance to evaluate the feasibility of the workflow. The robot successfully performed fully actuated biopsy sampling and delivery of simulated brachytherapy seeds under live MR imaging, as well as precise delivery of a prostate brachytherapy seed distribution with an RMS accuracy of 0.98mm. PMID:25076821

  10. Development of a Pneumatic Robot for MRI-guided Transperineal Prostate Biopsy and Brachytherapy: New Approaches

    OpenAIRE

    Song, Sang-Eun; Cho, Nathan B.; Fischer, Gregory; Hata, Nobuhito; Tempany, Clare; Fichtinger, Gabor; Iordachita, Iulian

    2010-01-01

    Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in order to enhance the cancer detection and treatment. For the accurate needle positioning, a number of robotic assistants have been developed. However, problems exist due to the strong magnetic field and limited workspace. Pneumatically actuated robots have shown the minimum distraction in the environment but the confined workspace limits optimal robot design and thus controllability is often poor....

  11. Multi-atlas-based automatic 3D segmentation for prostate brachytherapy in transrectal ultrasound images

    Science.gov (United States)

    Nouranian, Saman; Mahdavi, S. Sara; Spadinger, Ingrid; Morris, William J.; Salcudean, S. E.; Abolmaesumi, P.

    2013-03-01

    One of the commonly used treatment methods for early-stage prostate cancer is brachytherapy. The standard of care for planning this procedure is segmentation of contours from transrectal ultrasound (TRUS) images, which closely follow the prostate boundary. This process is currently performed either manually or using semi-automatic techniques. This paper introduces a fully automatic segmentation algorithm which uses a priori knowledge of contours in a reference data set of TRUS volumes. A non-parametric deformable registration method is employed to transform the atlas prostate contours to a target image coordinates. All atlas images are sorted based on their registration results and the highest ranked registration results are selected for decision fusion. A Simultaneous Truth and Performance Level Estimation algorithm is utilized to fuse labels from registered atlases and produce a segmented target volume. In this experiment, 50 patient TRUS volumes are obtained and a leave-one-out study on TRUS volumes is reported. We also compare our results with a state-of-the-art semi-automatic prostate segmentation method that has been clinically used for planning prostate brachytherapy procedures and we show comparable accuracy and precision within clinically acceptable runtime.

  12. Fast prostate segmentation for brachytherapy based on joint fusion of images and labels

    Science.gov (United States)

    Nouranian, Saman; Ramezani, Mahdi; Mahdavi, S. Sara; Spadinger, Ingrid; Morris, William J.; Salcudean, Septimiu E.; Abolmaesumi, Purang

    2014-03-01

    Brachytherapy as one of the treatment methods for prostate cancer takes place by implantation of radioactive seeds inside the gland. The standard of care for this treatment procedure is to acquire transrectal ultrasound images of the prostate which are segmented in order to plan the appropriate seed placement. The segmentation process is usually performed either manually or semi-automatically and is associated with subjective errors because the prostate visibility is limited in ultrasound images. The current segmentation process also limits the possibility of intra-operative delineation of the prostate to perform real-time dosimetry. In this paper, we propose a computationally inexpensive and fully automatic segmentation approach that takes advantage of previously segmented images to form a joint space of images and their segmentations. We utilize joint Independent Component Analysis method to generate a model which is further employed to produce a probability map of the target segmentation. We evaluate this approach on the transrectal ultrasound volume images of 60 patients using a leave-one-out cross-validation approach. The results are compared with the manually segmented prostate contours that were used by clinicians to plan brachytherapy procedures. We show that the proposed approach is fast with comparable accuracy and precision to those found in previous studies on TRUS segmentation.

  13. T2*-weighted image/T2-weighted image fusion in postimplant dosimetry of prostate brachytherapy

    International Nuclear Information System (INIS)

    Katayama, Norihisa; Takemoto, Mitsuhiro; Yoshio, Kotaro

    2011-01-01

    Computed tomography (CT)/magnetic resonance imaging (MRI) fusion is considered to be the best method for postimplant dosimetry of permanent prostate brachytherapy; however, it is inconvenient and costly. In T2 * -weighted image (T2 * -WI), seeds can be easily detected without the use of an intravenous contrast material. We present a novel method for postimplant dosimetry using T2 * -WI/T2-weighted image (T2-WI) fusion. We compared the outcomes of T2 * -WI/T2-WI fusion-based and CT/T2-WI fusion-based postimplant dosimetry. Between April 2008 and July 2009, 50 consecutive prostate cancer patients underwent brachytherapy. All the patients were treated with 144 Gy of brachytherapy alone. Dose-volume histogram (DVH) parameters (prostate D90, prostate V100, prostate V150, urethral D10, and rectal D2cc) were prospectively compared between T2 * -WI/T2-WI fusion-based and CT/T2-WI fusion-based dosimetry. All the DVH parameters estimated by T2 * -WI/T2-WI fusion-based dosimetry strongly correlated to those estimated by CT/T2-WI fusion-based dosimetry (0.77≤ R ≤0.91). No significant difference was observed in these parameters between the two methods, except for prostate V150 (p=0.04). These results show that T2 * -WI/T2-WI fusion-based dosimetry is comparable or superior to MRI-based dosimetry as previously reported, because no intravenous contrast material is required. For some patients, rather large differences were observed in the value between the 2 methods. We thought these large differences were a result of seed miscounts in T2 * -WI and shifts in fusion. Improving the image quality of T2 * -WI and the image acquisition speed of T2 * -WI and T2-WI may decrease seed miscounts and fusion shifts. Therefore, in the future, T2 * -WI/T2-WI fusion may be more useful for postimplant dosimetry of prostate brachytherapy. (author)

  14. Interactive, multi-modality image registrations for combined MRI/MRSI-planned HDR prostate brachytherapy

    Directory of Open Access Journals (Sweden)

    Galen Reed

    2011-03-01

    Full Text Available Purpose: This study presents the steps and criteria involved in the series of image registrations used clinically during the planning and dose delivery of focal high dose-rate (HDR brachytherapy of the prostate. Material and methods: Three imaging modalities – Magnetic Resonance Imaging (MRI, Magnetic Resonance Spectroscopic Imaging (MRSI, and Computed Tomography (CT – were used at different steps during the process. MRSI is used for identification of dominant intraprosatic lesions (DIL. A series of rigid and nonrigid transformations were applied to the data to correct for endorectal-coil-induced deformations and for alignment with the planning CT. Mutual information was calculated as a morphing metric. An inverse planning optimization algorithm was applied to boost dose to the DIL while providing protection to the urethra, penile bulb, rectum, and bladder. Six prostate cancer patients were treated using this protocol. Results: The morphing algorithm successfully modeled the probe-induced prostatic distortion. Mutual information calculated between the morphed images and images acquired without the endorectal probe showed a significant (p = 0.0071 increase to that calculated between the unmorphed images and images acquired without the endorectal probe. Both mutual information and visual inspection serve as effective diagnostics of image morphing. The entire procedure adds less than thirty minutes to the treatment planning. Conclusion: This work demonstrates the utility of image transformations and registrations to HDR brachytherapy of prostate cancer.

  15. Embolized prostatic brachytherapy seeds mimicking acute chest pain syndromes

    Directory of Open Access Journals (Sweden)

    Nirmal Guragai

    2017-01-01

    Full Text Available A 59-year-old male with a history of nonobstructive coronary artery disease, diabetes mellitus, hypertension, and prostate cancer presented to the hospital with 1-day history of pleuritic chest pain. Initial workup for acute coronary event was unremarkable. Chest X-ray revealed multiple small radial densities which were linear and hyperdense, consistent with embolization of metallic seeds to the pulmonary circulation. The patient was noted to have had radioactive metallic seeds implanted for prostate cancer 6 months ago. Diagnosis of pulmonary embolization of prostatic seeds is challenging as they frequently present with chest pain mimicking acute coronary syndromes.

  16. Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer: long-term results

    Energy Technology Data Exchange (ETDEWEB)

    Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana Garcia; Paya, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, Maria [Department of Radiation Oncology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain); Vazquez, Andres; Pacheco, Maite; Sanchez, Jesica [Department of Radiation Physics, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria (Spain)

    2016-01-15

    Objectives: We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy. Methods and Materials: From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the 'Phoenix consensus'. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition. Results: The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function. Conclusions: The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer. (author)

  17. Coherence-based photoacoustic imaging of brachytherapy seeds implanted in a canine prostate

    Science.gov (United States)

    Lediju Bell, Muyinatu A.; Song, Danny Y.; Boctor, Emad M.

    2014-03-01

    Visualization of individual brachytherapy seed locations assists with intraoperative updates to brachytherapy treatment plans. Photoacoustic imaging is advantageous when compared to current ultrasound imaging methods, due to its superior sensitivity to metal surrounded by tissue. However, photoacoustic images suffer from poor contrast with insufficient laser fluence. A short-lag spatial coherence (SLSC) beamformer was implemented to enhance these low-contrast photoacoustic signals. Photoacoustic imaging was performed with a transrectal ultrasound probe and an optical fiber surrounded by a light-diffusing sheath, placed at a distance of approximately 4-5 mm from the location of seeds implanted in an in vivo canine prostate. The average energy density through the tip of the sheath was varied from 8 to 167 mJ/cm2. When compared to a fast Fourier transform (FFT)- based reconstruction method, the mean contrast and signal-to-noise ratios were improved by up to 22 dB and a factor of 4, respectively, with the SLSC beamformer (12% of the receive aperture elements were included in the short-lag sum). Image artifacts that were spatially coherent had spatial frequency spectra that were quadrantally symmetric about the origin, while the spatial frequency spectra of the seed signals possessed diagonal symmetry. These differences were utilized to reduce artifacts by 9-14 dB after applying a bandpass filter with diagonal symmetry. Results indicate that advanced methods, such as SLSC beamforming or frequency-based filters, hold promise for intraoperative localization of prostate brachytherapy seeds

  18. Interfraction patient motion and implant displacement in prostate high dose rate brachytherapy

    International Nuclear Information System (INIS)

    Fox, C. D.; Kron, T.; Leahy, M.; Duchesne, G.; Williams, S.; Tai, K. H.; Haworth, A.; Herschtal, A.; Foroudi, F.

    2011-01-01

    Purpose: To quantify movement of prostate cancer patients undergoing treatment, using an in-house developed motion sensor in order to determine a relationship between patient movement and high dose rate (HDR) brachytherapy implant displacement. Methods: An electronic motion sensor was developed based on a three axis accelerometer. HDR brachytherapy treatment for prostate is delivered at this institution in two fractions 24 h apart and 22 patients were monitored for movement over the interval between fractions. The motion sensors functioned as inclinometers, monitoring inclination of both thighs, and the inclination and roll of the abdomen. The implanted HDR brachytherapy catheter set was assessed for displacement relative to fiducial markers in the prostate. Angle measurements and angle differences over a 2 s time base were binned, and the standard deviations of the resulting frequency distributions used as a metric for patient motion in each monitored axis. These parameters were correlated to measured catheter displacement using regression modeling. Results: The mean implant displacement was 12.6 mm in the caudal direction. A mean of 19.95 h data was recorded for the patient cohort. Patients generally moved through a limited range of angles with a mean of the exception of two patients who spent in excess of 2 h lying on their side. When tested for a relationship between movement in any of the four monitored axes and the implant displacement, none was significant. Conclusions: It is not likely that patient movement influences HDR prostate implant displacement. There may be benefits to patient comfort if nursing protocols were relaxed to allow patients greater freedom to move while the implant is in situ.

  19. Interfraction patient motion and implant displacement in prostate high dose rate brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Fox, C. D.; Kron, T.; Leahy, M.; Duchesne, G.; Williams, S.; Tai, K. H.; Haworth, A.; Herschtal, A.; Foroudi, F. [Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Nursing Service, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria 3002 (Australia); Department of Physical Sciences, Peter MacCallum Cancer Centre and Royal Melbourne Insititute of Technology, Melbourne, Victoria 3000 (Australia); Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria 3010 (Australia)

    2011-11-15

    Purpose: To quantify movement of prostate cancer patients undergoing treatment, using an in-house developed motion sensor in order to determine a relationship between patient movement and high dose rate (HDR) brachytherapy implant displacement. Methods: An electronic motion sensor was developed based on a three axis accelerometer. HDR brachytherapy treatment for prostate is delivered at this institution in two fractions 24 h apart and 22 patients were monitored for movement over the interval between fractions. The motion sensors functioned as inclinometers, monitoring inclination of both thighs, and the inclination and roll of the abdomen. The implanted HDR brachytherapy catheter set was assessed for displacement relative to fiducial markers in the prostate. Angle measurements and angle differences over a 2 s time base were binned, and the standard deviations of the resulting frequency distributions used as a metric for patient motion in each monitored axis. These parameters were correlated to measured catheter displacement using regression modeling. Results: The mean implant displacement was 12.6 mm in the caudal direction. A mean of 19.95 h data was recorded for the patient cohort. Patients generally moved through a limited range of angles with a mean of the exception of two patients who spent in excess of 2 h lying on their side. When tested for a relationship between movement in any of the four monitored axes and the implant displacement, none was significant. Conclusions: It is not likely that patient movement influences HDR prostate implant displacement. There may be benefits to patient comfort if nursing protocols were relaxed to allow patients greater freedom to move while the implant is in situ.

  20. A new inexpensive customized plaque for choroidal melanoma iodine-125 plaque therapy

    International Nuclear Information System (INIS)

    Vine, A.K.; Tenhaken, R.K.; Diaz, R.F.; Maxson, B.B.; Lichter, A.S.

    1989-01-01

    The authors have developed a new inexpensive precious metal alloy plaque for use in customized iodine-125 plaque therapy. Each plaque is formed from two flat circular gold/palladium foils which are used in dental crown work. Using a simple manual mechanism, the two forms are stamped over a customized acrylic die shaped to the dimensions of the tumor base plus a 2-mm margin. Completed plaques consist of a back wall, a 2-mm side wall, and a 1.5-mm wide lip with holes for suture placement. Advantages include: simple construction from inexpensive components, customized shape, and iodine seeds that are readily visible on plane radiographs

  1. Analysis of monotherapy prostate brachytherapy in patients with prostate cancer. Initial PSA and Gleason are important for recurrence?

    Directory of Open Access Journals (Sweden)

    Pedro Galego

    2015-04-01

    Full Text Available Purpose To evaluate the clinical outcome of a cohort of localized prostate cancer patients treate with 125-I permanent brachytherapy at the São José Hospital – CHLC, Lisbon. Materials and Methods A retrospective analysis was carried out on 429 patients with low and intermediate-risk of prostate adenocarcinoma, according to the recommendations of the EORTC, who underwent 125I brachytherapies in intraoperative dosimetry “real-time” system between September 2003 and September 2013. Results The mean follow-up was 71.98 months. Biochemical relapse of disease by rising PSA (Phoenix criterion was observed in 18 patients (4.2%. Through the application of Kaplan-Meier survival curves in this sample, the rate of survival at 6 years without biochemical relapse was higher than 95%. By Iog rank test comparing biochemical relapse with initial PSA (15-10 and <10 and Gleason values (7 and <7, there was no statistical difference (P=0.830 of the initial PSA in the probability of developing biochemical relapse. In relation to Gleason score, it was noted a statistical difference (P<0.05, demonstrating that patients with Gleason 7 are more likely to develop biochemical relapse. Conclusions Brachytherapy as monotherapy is at present an effective choice in the treatment of localized prostate adenocarcinoma. Biochemical relapses are minimal. The initial PSA showed no statistically difference in the rate of relapses, unlike the value Gleason, where it was demonstrated that patients with Gleason 7 have a higher probability of biochemical relapse. Cases with PSA bounce should be controlled before starting a salvage treatment.

  2. A review of the recommendations governing quality assurance of ultrasound systems used for guidance in prostate brachytherapy.

    Science.gov (United States)

    Doyle, Andrea Jane; King, Deirdre M; Browne, Jacinta E

    2017-12-01

    Ultrasound guided brachytherapy for the treatment of prostate cancer has become a routine treatment option, due to many benefits including patient recovery and dose localisation [1]; however it is not clear whether the standards which govern the image quality for these systems are adequate. Upon review of the recommended standards for ultrasound systems used in prostate brachytherapy procedures, the recommended tests do not appear to be specific to the clinical application of ultrasound guided prostate brachytherapy. Rather they are generic and similar to those recommended for other clinical applications such as general abdominal scanning [2]. Furthermore, there is growing evidence that these tests should be specific to the clinical application [3,4] in order to gain meaningful data about the performance of the system for the application, and also to detect clinically relevant changes in quality control results. An additional problem is that there are no clinically relevant test phantom recommended for the quality assurance of ultrasound systems used in prostate brachytherapy. The image quality for this application of ultrasound needs to be monitored to ensure consistent levels of confidence in the procedure. This paper reviews the currently recommended test guidelines and test phantoms for ultrasound systems used in prostate brachytherapy from the different standard bodies and professional organisations. A critical analysis of those tests which are most reflective of the imaging and guidance tasks undertaken in an ultrasound guided prostate brachytherapy procedure will also be presented to inform the design of a TRUS quality assurance protocol. Copyright © 2017 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  3. The brachytherapy with low dose-rate iridium for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Momma, Tetsuo; Saito, Shiro; Ohki, Takahiro; Satoh, Hiroyuki; Toya, Kazuhito; Dokiya, Takushi [National Tokyo Medical Center (Japan); Murai, Masaru

    2000-11-01

    Brachytherapy as an option for the treatment of prostate cancer has been commonly performed in USA. As the permanent seeding of the radioactive materials is strictly restricted by the law in Japan, brachytherapy must be performed by the temporary implant. This treatment has been performed at a few facilities in Japan mostly using high dose-rate iridium. Only our facility has been using low dose-rate iridium (LDR-Ir) for prostate cancer. This study evaluates the clinical results of the treatment. Since December 1997 to December 1999, 26 patients with histologically diagnosed as prostate cancer (Stage B, 92%; Stage C, 8%) underwent brachytherapy. Twenty-two patients received brachytherapy alone, three were treated with a combination of brachytherapy and external beam radiotherapy (ERT) and one was treated with a combination of brachytherapy and neoadjuvant endocrine therapy. Patients ranged in age from 61 to 84 (median 76) years old. Treatment was initiated with perineal needle placement. From 10 to 14 needles were placed through the holes on the template which was fixed to the stabilizer of the transrectal ultrasound probe. After the needle placement, CT scan was performed to draw distribution curves for the treatment planning. LDR-Ir wires were introduced to the sheath and indwelled during the time calculated from dosimetry. Peripheral dose was 70 Gy for the monotherapy of brachytherapy. For the combination therapy, 40 Gy was given by brachytherapy and 36 Gy with ERT afterwards. LDR-Ir wires were removed after completion of the radiation and patients were followed with serum PSA level and annual biopsy. During 2 to 26 (median 12) months follow-up, 8 out of 9 patients with initial PSA level above 20 ng/ml showed PSA failure. All 13 patients with initial PSA level lower than 20 ng/ml were free from PSA failure. Eight out of 11 patients with Gleason's score 7 or higher showed PSA failure, and all 14 patients (including three patients with combined therapy) with

  4. Dose escalation using conformal high-dose-rate brachytherapy improves outcome in unfavorable prostate cancer

    International Nuclear Information System (INIS)

    Martinez, Alvaro A.; Gustafson, Gary; Gonzalez, Jose; Armour, Elwood; Mitchell, Chris; Edmundson, Gregory; Spencer, William; Stromberg, Jannifer; Huang, Raywin; Vicini, Frank

    2002-01-01

    Purpose: To overcome radioresistance for patients with unfavorable prostate cancer, a prospective trial of pelvic external beam irradiation (EBRT) interdigitated with dose-escalating conformal high-dose-rate (HDR) prostate brachytherapy was performed. Methods and Materials: Between November 1991 and August 2000, 207 patients were treated with 46 Gy pelvic EBRT and increasing HDR brachytherapy boost doses (5.50-11.5 Gy/fraction) during 5 weeks. The eligibility criteria were pretreatment prostate-specific antigen level ≥10.0 ng/mL, Gleason score ≥7, or clinical Stage T2b or higher. Patients were divided into 2 dose levels, low-dose biologically effective dose 93 Gy (149 patients). No patient received hormones. We used the American Society for Therapeutic Radiology and Oncology definition for biochemical failure. Results: The median age was 69 years. The mean follow-up for the group was 4.4 years, and for the low and high-dose levels, it was 7.0 and 3.4 years, respectively. The actuarial 5-year biochemical control rate was 74%, and the overall, cause-specific, and disease-free survival rate was 92%, 98%, and 68%, respectively. The 5-year biochemical control rate for the low-dose group was 52%; the rate for the high-dose group was 87% (p<0.001). Improvement occurred in the cause-specific survival in favor of the brachytherapy high-dose level (p=0.014). On multivariate analysis, a low-dose level, higher Gleason score, and higher nadir value were associated with increased biochemical failure. The Radiation Therapy Oncology Group Grade 3 gastrointestinal/genitourinary complications ranged from 0.5% to 9%. The actuarial 5-year impotency rate was 51%. Conclusion: Pelvic EBRT interdigitated with transrectal ultrasound-guided real-time conformal HDR prostate brachytherapy boost is both a precise dose delivery system and a very effective treatment for unfavorable prostate cancer. We demonstrated an incremental beneficial effect on biochemical control and cause

  5. Comparison between methods for fixing radioactive iodine in silver substrate for manufacturing brachytherapy sources

    International Nuclear Information System (INIS)

    Peleias Junior, Fernando S.; Zeituni, Carlos A.; Rostelato, Maria Elisa C.M.

    2013-01-01

    Cancer is a term used generically to represent a group of more than 100 illnesses, including malignant tumors from different locations. According to World Health Organization (WHO), is a leading cause of death worldwide, accounted for 7.6 million deaths. Prostate cancer is the sixth most common type in the world, representing about 10% of all cases of cancer and its treatment may be by surgery, radiotherapy or even vigilant observation. A method of radiotherapy which has been extensively used in the early and intermediate stages of the illness is brachytherapy, where radioactive seeds are placed inside or next to the area requiring treatment, which reduces the probability of unnecessary damage to surrounding healthy tissues. Currently, the radioactive isotope Iodine-125, adsorbed on silver substrate, is one of the most used in prostate brachytherapy. The present study compares several deposition methods of radioactive Iodine on silver substrate, in order to choose the most suitable one to be implemented at the laboratory of radioactive sources production of IPEN. The methodology used was chosen based on the available infrastructure and experience of the researchers of the institute. Therefore, Iodine-131 was used for testing (same chemical behavior of Iodine -125). Three methods were selected: method 1 (test based on electrodeposition method, developed by David Kubiatowicz) which presented efficiency of 65.16% ; method 2 (chemical reaction based on the method developed by David Kubiatowicz -HCl) which presented efficiency of 70.80%; method 3 (chemical reaction based on the method developed by Dr. Maria Elisa Rostelato) which presented efficiency of 55.80% . Based on the results, the second method is the suggested one to be implemented at the laboratory of radioactive sources production of IPEN. (author)

  6. Methodology study for fixation of radioactive iodine in polymeric substrate for brachytherapy sources

    International Nuclear Information System (INIS)

    Rodrigues, Bruna T.; Rostelato, Maria Elisa C.M.; Souza, Carla D.; Tiezzi, Rodrigo; Souza, Daiane B. de; Benega, Marcos A.G.; Souza, Anderson S. de; Peleias Junior, Fernando S.; Zeituni, Calos A.; Fernandes, Vagner; Melo, Emerson Ronaldo de; Camargo, Anderson Rogerio de

    2015-01-01

    Cancer is now the second leading cause of death by disease in several countries, including Brazil. Prostate cancer is the most common among men. Brachytherapy is a modality of radiotherapy in which radioactive seeds are placed inside or in contact with the organ to be treated. The most widely used radioisotope in prostate brachytherapy is Iodine-125 which is presented fixated on a silver substrate that is subsequently placed inside a titanium capsule. A large dose of radiation is released only in the targeted tumor protecting healthy surrounding tissues. The technique requires the application of 80 - 120 seeds per patient. The implants of seeds have low impact and non-surgical procedures. Most patients can return to normal life within three days with little or no pain. This work proposes an alternative to the seeds that have already been developed, in order to reduce the cost by obtaining a better efficiency on fixing the radioactive iodine onto the epoxy resin. Methods have been developed to perform the fixation of Iodine-125 onto polymeric substrates. The parameters analyzed were the immersion time, type of static or dynamic reaction, concentration of the adsorption solution, the specific activity of the radioactive source, the need for carrier and chemical form of the radioactive Iodine. These experiments defined the most effective method to fixate the Iodine onto the polymeric material (epoxy resin), the Iodine activity in the polymeric substrate, the activity of the distribution of variation in a plot of polymeric cores and the efficiency of the epoxy resin to seal the seed. (author)

  7. Methodology study for fixation of radioactive iodine in polymeric substrate for brachytherapy sources

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, Bruna T.; Rostelato, Maria Elisa C.M.; Souza, Carla D.; Tiezzi, Rodrigo; Souza, Daiane B. de; Benega, Marcos A.G.; Souza, Anderson S. de; Peleias Junior, Fernando S.; Zeituni, Calos A.; Fernandes, Vagner; Melo, Emerson Ronaldo de; Camargo, Anderson Rogerio de, E-mail: bteigarodrigues@gmail.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil)

    2015-07-01

    Cancer is now the second leading cause of death by disease in several countries, including Brazil. Prostate cancer is the most common among men. Brachytherapy is a modality of radiotherapy in which radioactive seeds are placed inside or in contact with the organ to be treated. The most widely used radioisotope in prostate brachytherapy is Iodine-125 which is presented fixated on a silver substrate that is subsequently placed inside a titanium capsule. A large dose of radiation is released only in the targeted tumor protecting healthy surrounding tissues. The technique requires the application of 80 - 120 seeds per patient. The implants of seeds have low impact and non-surgical procedures. Most patients can return to normal life within three days with little or no pain. This work proposes an alternative to the seeds that have already been developed, in order to reduce the cost by obtaining a better efficiency on fixing the radioactive iodine onto the epoxy resin. Methods have been developed to perform the fixation of Iodine-125 onto polymeric substrates. The parameters analyzed were the immersion time, type of static or dynamic reaction, concentration of the adsorption solution, the specific activity of the radioactive source, the need for carrier and chemical form of the radioactive Iodine. These experiments defined the most effective method to fixate the Iodine onto the polymeric material (epoxy resin), the Iodine activity in the polymeric substrate, the activity of the distribution of variation in a plot of polymeric cores and the efficiency of the epoxy resin to seal the seed. (author)

  8. Outcomes and toxicities in patients with intermediate-risk prostate cancer treated with brachytherapy alone or brachytherapy and supplemental external beam radiation therapy.

    Science.gov (United States)

    Schlussel Markovic, Emily; Buckstein, Michael; Stone, Nelson N; Stock, Richard G

    2018-05-01

    To evaluate the cancer control outcomes and long-term treatment-related morbidity of brachytherapy as well as combination brachytherapy and external beam radiation therapy (EBRT) in patients with intermediate-risk prostate cancer. A retrospective review was conducted in a prospectively collected database of patients with intermediate-risk prostate cancer who were treated either with brachytherapy or brachytherapy and EBRT, with or without androgen deprivation therapy (ADT), in the period 1990-2014. Urinary and erectile dysfunction symptoms were measured using the International Prostate Symptom Score (IPSS), the Mount Sinai erectile function scale and the Sexual Health Inventory for Men (SHIM). Cancer control endpoints included biochemical failure and development of distant metastases. All statistical analyses were carried out using the Statistical Package for Social Science (SPSS). Survival curves were calculated using Kaplan-Meier actuarial methods and compared using log-rank tests. Cox regression multivariate analyses were used to test the effect of multiple variables on treatment outcomes. A total of 902 patients were identified, with a median follow-up of 91 months. Of these, 390 received brachytherapy and 512 received combination therapy with EBRT. In patients with one intermediate-risk factor, the addition of EBRT did not significantly affect freedom from biochemical failure or distant metastases. Among patients with two or three intermediate-risk factors, added EBRT did not improve freedom from biochemical failure. Significant differences in late toxicity between patients treated with brachytherapy vs combination brachytherapy and EBRT were identified including urge incontinence (P actuarial methods showed that patients receiving combination therapy more frequently experienced loss of potency, as measured by the Mount Sinai erectile function scale (P = 0.040). Brachytherapy monotherapy results in equal biochemical and distant control in both patients with

  9. Conformal prostate brachytherapy: initial experience of a phase I/II dose-escalating trial

    International Nuclear Information System (INIS)

    Martinez, Alvaro; Gonzalez, Jose; Stromberg, Jannifer; Edmundson, Gregory; Plunkett, Marianne; Gustafson, Gary; Brown, Debora; Di, Yan; Vicini, Frank; Brabbins, Donald

    1995-01-01

    Purpose: To improve treatment results on prostatic adenocarcinoma, conformal radiation therapy (CRT) has been used. Two major drawbacks of external CRT are: (a) internal organ motion/daily set-up variations, and (b) exclusion of several patients for CRT based on poor geometrical relationships as identified by three dimensional (3D) treatment planning. To overcome the above problems, we began the first prospective Phase I/II dose-escalating clinical trial of conformal brachytherapy (CB) and concurrent external beam irradiation. Methods and Materials: Fifty-nine patients with T2b-T3c prostatic adenocarcinoma received 176 transperineal ultrasound-guided conformal high-dose rate (HDR) boost implants. All patients received concomitant external beam pelvic irradiation. Dose escalation of the three HDR-CB fractions proceeded as follows: 5.5 Gy (30 patients), 6 Gy (20 patients), and 6.5 Gy (9 patients). The CB dose was prescribed to the prostate contour as outlined using an online biplanar transrectal ultrasound probe. The urethra, anterior rectal wall, and prostate boundaries were identified individually and outlined at 5 mm intervals from the base to the apex of the gland. The CB using real-time ultrasound guidance with interactive online isodose distributions was performed on an outpatient basis. As needles were placed into the prostate, corrections for prostate displacement were recorded and the isodose distributions were recalculated to represent the new relationship between the needles, prostate, and normal structures. No computerized tomography (CT) planning or implant preplanning was required. Results: No patient was rejected based on poor geometrical relation of pelvic structures. In every implant performed, prostate displacement was noted. Craniocaudal motion of the gland ranged from 0.5-2.0 cm (mean = 1.0 cm), whereas lateral displacement was 0.1-0.4 cm. With the interactive online planning system, organ motion was immediately detected, accounted for, and

  10. The case for focal brachytherapy for the management of low grade prostate cancer

    International Nuclear Information System (INIS)

    Allen, B.J.; Enari, E.

    2011-01-01

    Full text: Radical therapy of low to intermediate prostate cancer patients can cause substantial adverse events relating to genitourinary and rectal toxicity. Yet there is little evidence that such treatment results in increased life expectancy. On the other hand, watchful waiting is associated with active surveillance and the patient must accept that the cancer remains untreated and has a risk of progression. Focal therapy of low grade prostate cancer provides an intermediate approach to the management of this cancer. The approach is to treat only those positive segments on biopsy and so reduce the likelihood of adverse events. However, continued surveillance is required because of the increased risk of disease progression. Focal therapy needs to be evaluated using available ablative therapies. Recent studies of focal HIFU for 20 patients showed PSA reduced from 7.3 to 1.5 ng/mL at 12 months. 1/20 patients had inadequate erections and 2120 required pads. 17/19 had no histological evidence of cancer and none had evidence of high volume or Gleason = 7 cancer in the treated lobe. Seed brachytherapy is commonly used for radical prostate treatment of low volume disease. As the same template can be used for seed therapy as is used for biopsy, the technique is ideally suited for focal brachytherapy. As any treatment involving less than the entire gland involves the risk of leaving viable cancer cells outside the treatment zone, a phase 3 randomised clinical trial between radical and focal brachytherapy is advocated to demonstrate the efficacy and safety of the latter relative to radical therapy.

  11. Use of CT or MR dosimetry in high dose rate (HDR) brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Liu, C.; Das, R.; See, A.; Duchesne, G.M.; Van Dyk, S.; Tai, K.H.

    2003-01-01

    Brachytherapy (BT) has, in recent years, become a well-utilised treatment option for prostate cancer. Tumour control probability relies on accurate dosimetry, which in turn relies on the accurate definition of the prostate gland. In external beam radiotherapy and BT, MRI has been shown to be a superior imaging modality when delineating the prostate gland especially at the apex. To date, data on MRI planning in prostate BT has focussed mainly on permanent interstitial implants. No data currently exists comparing MRI vs CT planning in HDR BT and its subsequent impact on prostate dosimetry. To determine the effects of MRI vs CT in HDR BT with respect to prostatic volumes and normal tissue doses, with the evaluations made using dose-volume histograms (DVH). Dosimetry parameters derived using CT and MRI (T2 weighted) scans of 11 patients who had received TRUS guided implants for HDR BT, were compared using the PlatoTM computer planning system. Treatment plans were generated on volumes marked by the same radiation oncologist for each patient. Comparison was made of the treatment plans (dosimetry) between: 1. CT generated plans; 2. CT generated plans assessed using MRI marked volumes and 3. MRI generated plans. We confirm the previously reported results that CT scans can overestimate prostatic volumes compared with MRI. Variations were noted in CT and MRI based plans that may allow improved sparing of the rectum and urethra when using MRI planning. The main disadvantages of using MRI scans are access to facilities as well as identifying a dummy source to adequately define the tips of our catheters. It is feasible to utilise MRI scans for HDR BT planning. The clearer definition of anatomical structures has added advantages when contouring the prostate

  12. Effects of seed migration on post-implant dosimetry of prostate brachytherapy

    International Nuclear Information System (INIS)

    Gao, M.; Wang, J. Z.; Nag, S.; Gupta, N.

    2007-01-01

    Brachytherapy using permanent seed implants has been an effective treatment for prostate cancer. However, seeds will migrate after implant, thus making the evaluation of post-implant dosimetry difficult. In this study, we developed a computer program to simulate seed migration and analyzed dosimetric changes due to seed migration at various migration amounts. The study was based on 14 patients treated with Pd-103 at the James Cancer Hospital. Modeling of seed migration, including direction, distance as well as day of migration, was based on clinical observations. Changes of commonly used dosimetric parameters as a function of migration amount (2, 4, 6 mm respectively), prostate size (from 20 to 90 cc), and prostate region (central vs peripheral) were studied. Change of biological outcome (tumor control probability) due to migration was also estimated. Migration reduced prostate D90 to 99±2% of original value in 2 mm migration, and the reduction increased to 94±6% in 6 mm migration. The reduction of prostate dose led to a 14% (40%) drop in the tumor control probability for 2 mm (6 mm) migration, assuming radiosensitive tumors. However, migration has less effect on a prostate implanted with a larger number of seeds. Prostate V100 was less sensitive to migration than D90 since its mean value was still 99% of original value even in 6 mm migration. Migration also showed a different effect in the peripheral region vs the central region of the prostate, where the peripheral mean dose tended to drop more significantly. Therefore, extra activity implanted in the peripheral region during pre-plan can be considered. The detrimental effects of migration were more severe in terms of increasing the dose to normal structures, as rectum V50 may be 70% higher and urethra V100 may be 50% higher in the case of 6 mm migration. Quantitative knowledge of these effects is helpful in treatment planning and post-implant evaluation

  13. Permanent 125I-seed prostate brachytherapy: early prostate specific antigen value as a predictor of PSA bounce occurrence

    Directory of Open Access Journals (Sweden)

    Mazeron Renaud

    2012-03-01

    Full Text Available Abstract Purpose To evaluate predictive factors for PSA bounce after 125I permanent seed prostate brachytherapy and identify criteria that distinguish between benign bounces and biochemical relapses. Materials and methods Men treated with exclusive permanent 125I seed brachytherapy from November 1999, with at least a 36 months follow-up were included. Bounce was defined as an increase ≥ 0.2 ng/ml above the nadir, followed by a spontaneous return to the nadir. Biochemical failure (BF was defined using the criteria of the Phoenix conference: nadir +2 ng/ml. Results 198 men were included. After a median follow-up of 63.9 months, 21 patients experienced a BF, and 35.9% had at least one bounce which occurred after a median period of 17 months after implantation (4-50. Bounce amplitude was 0.6 ng/ml (0.2-5.1, and duration was 13.6 months (4.0-44.9. In 12.5%, bounce magnitude exceeded the threshold defining BF. Age at the time of treatment and high PSA level assessed at 6 weeks were significantly correlated with bounce but not with BF. Bounce patients had a higher BF free survival than the others (100% versus 92%, p = 0,007. In case of PSA increase, PSA doubling time and velocity were not significantly different between bounce and BF patients. Bounces occurred significantly earlier than relapses and than nadir + 0.2 ng/ml in BF patients (17 vs 27.8 months, p Conclusion High PSA value assessed 6 weeks after brachytherapy and young age were significantly associated to a higher risk of bounces but not to BF. Long delays between brachytherapy and PSA increase are more indicative of BF.

  14. Influence of zonal dosimetry on prostate brachytherapy outcomes.

    Science.gov (United States)

    Hong, Cheng William; Reddy, Chandana A; Wilkinson, D Allan; Klein, Eric A; Ciezki, Jay P

    2015-02-01

    To examine the influence of zone-specific dosimetry on outcomes during permanent prostate implantation (PI), where the peripheral zone (PZ) and transitional zone (TZ) may receive varying radiation doses. Four hundred and sixteen patients treated with I-125 PI (target dose: 144 Gy) between 1996 and 2003 were included in this Institutional Review Board (IRB) approved, retrospective analysis. Whole prostate (WP), TZ, and PZ were contoured, and zone-specific D90 and V100 were computed. Their influence on biochemical failure (BF) was evaluated using Cox proportional hazards analysis. The median age and initial prostate-specific antigen (PSA) was 68 years and 6.1 ng/ml, respectively, and the median follow-up time was 8.8 years. There were 329 subjects with Gleason score (GS) 6 disease (79.1%), and 82 subjects had GS 7 disease (19.7%). Androgen deprivation therapy (ADT) was used in 20.4% of patients. Median D90 and V100% in the WP, PZ, and TZ were 141.2 Gy, 156.1 Gy, and 134.5 Gy; and 88.8%, 93.3%, and 84.2%, respectively. Ten-year rates for biochemical recurrence-free survival, distant metastasis-free survival, and prostate cancer-specific mortality were 82.4%, 92.4%, and 0.97% respectively. Only initial PSA, GS7+ disease, ADT, and PSA frequency were significant on multivariate analysis. Ten-year rates of grade 3 or higher GU and GI toxicity was 10.9% and 1.8%, respectively. TZ V200 and TZ V300 were significantly associated with late genitourinary toxicity. The TZ received significantly lower doses of radiation compared to the PZ. On multivariate analysis, no dosimetric parameter was associated with efficacy. Higher TZ doses may be associated with higher late GU toxicity without improving efficacy.

  15. 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Martin, T.; Baltas, D.; Kurek, R.; Roeddiger, S.; Kontova, M.; Anagnostopoulos, G.; Skazikis, G.; Zamboglou, N. [Dept. of Radiation Oncology, Klinikum Offenbach, Offenbach/Main (Germany); Dannenberg, T.; Buhleier, T.; Tunn, U. [Dept. of Urology, Klinikum Offenbach, Offenbach/Main (Germany)

    2004-04-01

    Purpose: pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose-rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning. Patients and methods: between 05/2002 and 05/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) {<=} 10 ng/ml, Gleason score {<=} 7 and clinical stage {<=} T2a were treated. Median PSA was 6.4 ng/ml and median Gleason score 5. 24/52 patients had stage T1c and 28/52 stage T2a. For transrectal ultrasound-(TRUS-)guided transperineal implantation of flexible plastic needles into the prostate, the real-time HDR planning system SWIFT trademark was used. After implantation, CT-based 3-D postplanning was performed. All patients received one implant for four fractions of HDR brachytherapy in 48 h using a reference dose (D{sub ref}) of 9.5 Gy to a total dose of 38.0 Gy. Dose-volume histograms (DVHs) were analyzed to evaluate the conformal quality of each implant using D{sub 90}, D{sub 10} urethra, and D{sub 10} rectum. Acute toxicity was evaluated using the CTC (common toxicity criteria) scales. Results: median D{sub 90} was 106% of D{sub ref} (range: 93-115%), median D{sub 10} urethra 159% of D{sub ref} (range: 127-192%), and median D{sub 10} rectum 55% of D{sub ref} (range: 35-68%). Median follow-up is currently 8 months. In 2/52 patients acute grade 3 genitourinary toxicity was observed. No gastrointestinal toxicity > grade 1 occurred. Conclusion: 3-D conformal HDR brachytherapy as monotherapy using intraoperative real-time planning is a feasible and highly conformal treatment for localized prostate cancer associated with minimal acute toxicity. Longer follow-up is needed to evaluate late toxicity and biochemical control. (orig.)

  16. Adaptive cone-beam CT planning improves long-term biochemical disease-free survival for 125I prostate brachytherapy

    NARCIS (Netherlands)

    Peters, M.; Smit Duijzentkunst, D. A.; Westendorp, H.; van de Pol, S. M G; Kattevilder, R.; Schellekens, A.; van der Voort van Zyp, J. R N|info:eu-repo/dai/nl/326982728; Moerland, M. A.|info:eu-repo/dai/nl/153488174; van Vulpen, M.|info:eu-repo/dai/nl/250581035; Hoekstra, C. J.

    2017-01-01

    Purpose: Determining the independent effect of additional intraoperative adaptive C-arm cone-beam CT (CBCT) planning vs. transrectal ultrasound (TRUS)-guided interactive planning alone in 125I brachytherapy for prostate cancer (PCa) on biochemical disease-free survival (BDFS). Methods and materials:

  17. A prospective analysis of long-term quality of life after permanent I-125 brachytherapy for localised prostate cancer

    International Nuclear Information System (INIS)

    Ash, Dan; Bottomley, David; Al-Qaisieh, Bashar; Carey, Brendan; Gould, Kath; Henry, Ann

    2007-01-01

    Background and purpose: To prospectively evaluate long-term urinary, bowel and sexual function after I-125 brachytherapy for localised prostate cancer using patient administered validated Quality of Life (QoL) instruments. Materials and methods: Between March 1995 and March 2004, 673 men underwent brachytherapy and recorded urinary symptoms prospectively using the International Prostate Symptom Score (IPSS). In addition, in a subgroup of 116 patients, the Expanded Prostate Cancer Index Composite (EPIC) was used to record QoL information on urinary, bowel and sexual function before treatment and at regular time intervals for at least two years. Results: Initially, there was a sharp rise in urinary symptoms which was most marked within the first three months. Scores then resolved slowly and returned to within one or two units of pre-treatment level at one year. Subsequently, there was no significant deterioration in urinary symptoms up to nine years following brachytherapy. Few had significant bowel symptoms. Sexual function deteriorated initially and then improved but failed to return to pre-treatment levels by two years. Patients requiring neo-adjuvant hormones experienced significantly more dysfunction. Conclusions: After an initial period of mild to moderate urinary symptoms prostate brachytherapy is well tolerated with relatively little deterioration in long-term quality of life. Long-term reduction in sexual function may be seen particularly in those requiring hormones

  18. Surgical Management of a Locally Advanced Symptomatic Recurrence of Penile Sarcoma Secondary to Prostate Brachytherapy

    Directory of Open Access Journals (Sweden)

    Tariq S. Hakky

    2013-04-01

    Full Text Available Background The surgical management of patients with symptomatic metastatic or locally advanced recurrences involving the penis remains poorly characterized. The aim of the present abstract and video is to detail our experience in the surgical management of a specific patient with a locally advanced symptomatic recurrence of penile sarcoma secondary to prostate cancer treated with primary brachytherapy. Materials and Methods A 70 year old male patient initially treated for localized prostate cancer with interstitial brachytherapy at an outside facility developed an unfortunate secondary malignancy consisting of a locally advanced penile sarcoma involving as well the prostate and base of the bladder. Despite our best efforts to control his pain, he developed a very symptomatic local recurrence with a secondary penile abscess and purulent periurethral drainage. At this time, it was felt a surgical resection consisting of a total penectomy, urethrectomy, cystoprostatectomy, and ileal conduit urinary diversion would be the best option for local cancer control in this particular patient. Results The patient underwent the surgical resection without any complications as illustrated in this surgical video, with a jejunal intestinal mass identified at the time of surgery which was resected with a primary bowel anastomosis performed. The patient was discharged from hospital uneventfully with his symptomatic local recurrence being successfully managed and the patient no longer requiring oral narcotics for pain control. The pathological report confirmed a locally advanced sarcoma involving the penile, prostate, and bladder which was resected with negative surgical margins and the jejunal mass was confirmed to represent a small bowel sarcoma metastatic site. Conclusion As highlighted in the present video, the treatment of a symptomatic sarcoma local recurrence contiguously involving the penis can be successfully managed provided the patient is informed of the

  19. Adjoint current-based approaches to prostate brachytherapy optimization

    International Nuclear Information System (INIS)

    Roberts, J. A.; Henderson, D. L.

    2009-01-01

    This paper builds on previous work done at the Univ. of Wisconsin - Madison to employ the adjoint concept of nuclear reactor physics in the so-called greedy heuristic of brachytherapy optimization. Whereas that previous work focused on the adjoint flux, i.e. the importance, this work has included use of the adjoint current to increase the amount of information available in optimizing. Two current-based approaches were developed for 2-D problems, and each was compared to the most recent form of the flux-based methodology. The first method aimed to take a treatment plan from the flux-based greedy heuristic and adjust via application of the current-displacement, or a vector displacement based on a combination of tissue (adjoint) and seed (forward) currents acting as forces on a seed. This method showed promise in improving key urethral and rectal dosimetric quantities. The second method uses the normed current-displacement as the greedy criterion such that seeds are placed in regions of least force. This method, coupled with the dose-update scheme, generated treatment plans with better target irradiation and sparing of the urethra and normal tissues than the flux-based approach. Tables of these parameters are given for both approaches. In summary, these preliminary results indicate adjoint current methods are useful in optimization and further work in 3-D should be performed. (authors)

  20. Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity

    International Nuclear Information System (INIS)

    Allen, Zachariah A.; Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian; Anderson, Richard L.; Murray, Brian C.; Galbreath, Robert W.

    2005-01-01

    Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha

  1. Radiation exposure to general public after permanent brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Kono, Y.; Miyamoto, Y.; Oohashi, S.; Fukushi, M.

    2011-01-01

    Permanent prostate brachytherapy patients are generally told to limit their time around children and pregnant women. However, there is little data available to validate the instruction. For the skin effective dose rate, ion chamber survey meter model 451B-DE-SI was used. The meter was scanned at the point of 4.5, 20, 50 and 100 cm from the skin surface in each plane. Life time exposure was calculated from the average anterior data. At the point of 4.5 cm from the anterior skin surface, the lifetime equivalent dose was 46.5 mSv, at 20 cm it was 13.2 mSv, at 50 cm it was 3.5 mSv and at 100 cm it was 0.9 mSv. The risk from the prostate brachytherapy patients to general public is quite low. Only the case of close and long-time contact with the pregnant and the infant should be paid attention to. (authors)

  2. CT-guided brachytherapy of prostate cancer: reduction of effective dose from X-ray examination

    Science.gov (United States)

    Sanin, Dmitriy B.; Biryukov, Vitaliy A.; Rusetskiy, Sergey S.; Sviridov, Pavel V.; Volodina, Tatiana V.

    2014-03-01

    Computed tomography (CT) is one of the most effective and informative diagnostic method. Though the number of CT scans among all radiographic procedures in the USA and European countries is 11% and 4% respectively, CT makes the highest contribution to the collective effective dose from all radiographic procedures, it is 67% in the USA and 40% in European countries [1-5]. Therefore it is necessary to understand the significance of dose value from CT imaging to a patient . Though CT dose from multiple scans and potential risk is of great concern in pediatric patients, this applies to adults as well. In this connection it is very important to develop optimal approaches to dose reduction and optimization of CT examination. International Commission on Radiological Protection (ICRP) in its publications recommends radiologists to be aware that often CT image quality is higher than it is necessary for diagnostic confidence[6], and there is a potential to reduce the dose which patient gets from CT examination [7]. In recent years many procedures, such as minimally invasive surgery, biopsy, brachytherapy and different types of ablation are carried out under guidance of computed tomography [6;7], and during a procedures multiple CT scans focusing on a specific anatomic region are performed. At the Clinics of MRRC different types of treatment for patients with prostate cancer are used, incuding conformal CT-guided brachytherapy, implantation of microsources of I into the gland under guidance of spiral CT [8]. So, the purpose of the study is to choose optimal method to reduce radiation dose from CT during CT-guided prostate brachytherapy and to obtain the image of desired quality.

  3. An open-source genetic algorithm for determining optimal seed distributions for low-dose-rate prostate brachytherapy.

    Science.gov (United States)

    McGeachy, P; Madamesila, J; Beauchamp, A; Khan, R

    2015-01-01

    An open source optimizer that generates seed distributions for low-dose-rate prostate brachytherapy was designed, tested, and validated. The optimizer was a simple genetic algorithm (SGA) that, given a set of prostate and urethra contours, determines the optimal seed distribution in terms of coverage of the prostate with the prescribed dose while avoiding hotspots within the urethra. The algorithm was validated in a retrospective study on 45 previously contoured low-dose-rate prostate brachytherapy patients. Dosimetric indices were evaluated to ensure solutions adhered to clinical standards. The SGA performance was further benchmarked by comparing solutions obtained from a commercial optimizer (inverse planning simulated annealing [IPSA]) with the same cohort of 45 patients. Clinically acceptable target coverage by the prescribed dose (V100) was obtained for both SGA and IPSA, with a mean ± standard deviation of 98 ± 2% and 99.5 ± 0.5%, respectively. For the prostate D90, SGA and IPSA yielded 177 ± 8 Gy and 186 ± 7 Gy, respectively, which were both clinically acceptable. Both algorithms yielded reasonable dose to the rectum, with V100 < 0.3 cc. A reduction in dose to the urethra was seen using SGA. SGA solutions showed a slight prostate volume dependence, with smaller prostates (<25 cc) yielding less desirable, although still clinically viable, dosimetric outcomes. SGA plans used, on average, fewer needles than IPSA (21 vs. 24, respectively), which may lead to a reduction in urinary toxicity and edema that alters post-implant dosimetry. An open source SGA was validated that provides a research tool for the brachytherapy community. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  4. Study of CT-guided iodine-125 implantation in the treatment of rabbit VX2 tumor

    International Nuclear Information System (INIS)

    He Kewu; Gao Bin; Li Jiajia

    2008-01-01

    Objective: To evaluate the effect of CT-guided iodine-125 seed( 125 I) implantation to rabbit model VX2 tumor cell apoptosis. Methods: VX2 tumor cells were implanted into muscle of 40 rabbits legs, 3 weeks later, as the diameter of tumor reached 2 cm available for test. Randomly selected the sampling tumor on one leg of rabbit as for the test team and tumor on the contralateral leg as for control team. Under CT guidance, 125 I seeds were implanted into 20 tumor lesions of the test team, and hollow seeds were implanted into 20 tumor lesions of the control team. Instantly, 72 h, 1, 2, 3 w after operation, percutaneous tumor tissue sampling was done 0.5-1.0 cm and 1.0-1.5 cm away from seed implanted site under CT guidance; and apoptosis was investigated by FCM. Results: Instantly, 72 h, 1, 2, 3 w after treatment with iodine-125 ( 125 I) implantation, the tissue sampling away from seed 0.5-1.0 cm showed the apoptosis rates of control team and test team were respectively as follows: (5.43±0.67)% and (5.48±0.66)%, (P>0.05), (5.45±0.58)% and (11.60±0.87)%, (P O.05)of the control team and test team. Conclusions: 125 I seeds implantation can induce tumor cell apoptosis, beginning at 72 h and reached peak at 2 w and kept the high level here afterword. The apoptosis rate descended rapidly along with the increase of distance away from the 125 I seedling. (authors)

  5. Dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with high-dose-rate brachytherapy for large prostate volumes

    Energy Technology Data Exchange (ETDEWEB)

    Yang, George; Strom, Tobin J.; Shrinath, Kushagra; Mellon, Eric A.; Fernandez, Daniel C.; Biagioli, Matthew C. [Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, FL (United States); Wilder, Richard B., E-mail: mcbiagioli@yahoo.com [Cancer Treatment Centers of America, Newnan, GA (United States)

    2015-05-15

    Purpose: to evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes. Materials and methods: one hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL) were treated with high-dose-rate (HDR) brachytherapy ± intensity modulated radiation therapy (IMRT) to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38%) unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE) version 4. Results: median follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3%) patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17%) patients developed Grade 2 acute urinary retention. American Urological Association (AUA) symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p-0.04). There was no ≥ Grade 3 acute toxicity. Conclusions: dosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes. (author)

  6. Dosimetric Coverage of the Prostate, Normal Tissue Sparing, and Acute Toxicity with High-Dose-Rate Brachytherapy for Large Prostate Volumes

    Directory of Open Access Journals (Sweden)

    George Yang

    2015-06-01

    Full Text Available ABSTRACTPurposeTo evaluate dosimetric coverage of the prostate, normal tissue sparing, and acute toxicity with HDR brachytherapy for large prostate volumes.Materials and MethodsOne hundred and two prostate cancer patients with prostate volumes >50 mL (range: 5-29 mL were treated with high-dose-rate (HDR brachytherapy ± intensity modulated radiation therapy (IMRT to 4,500 cGy in 25 daily fractions between 2009 and 2013. HDR brachytherapy monotherapy doses consisted of two 1,350-1,400 cGy fractions separated by 2-3 weeks, and HDR brachytherapy boost doses consisted of two 950-1,150 cGy fractions separated by 4 weeks. Twelve of 32 (38% unfavorable intermediate risk, high risk, and very high risk patients received androgen deprivation therapy. Acute toxicity was graded according to the Common Terminology Criteria for Adverse Events (CTCAE version 4.ResultsMedian follow-up was 14 months. Dosimetric goals were achieved in over 90% of cases. Three of 102 (3% patients developed Grade 2 acute proctitis. No variables were significantly associated with Grade 2 acute proctitis. Seventeen of 102 (17% patients developed Grade 2 acute urinary retention. American Urological Association (AUA symptom score was the only variable significantly associated with Grade 2 acute urinary retention (p=0.04. There was no ≥ Grade 3 acute toxicity.ConclusionsDosimetric coverage of the prostate and normal tissue sparing were adequate in patients with prostate volumes >50 mL. Higher pre-treatment AUA symptom scores increased the relative risk of Grade 2 acute urinary retention. However, the overall incidence of acute toxicity was acceptable in patients with large prostate volumes.

  7. High-dose rate brachytherapy in the treatment of prostate cancer: acute toxicity and biochemical behavior analysis

    International Nuclear Information System (INIS)

    Esteves, Sergio Carlos Barros; Oliveira, Antonio Carlos Zuliani de; Cardoso, Herbeni; Tagawa, Eduardo Komai; Castelo, Roberto; D'Imperio, Marcio

    2006-01-01

    Objective: this study focuses on the biochemical response of the following variables: prostate volume, prostate-specific antigen (PSA) value, Gleason scores, staging, the risk of the disease, and hormone therapy. Objective: in the period between February of 1998 and July of 2001, 46 patients with prostate cancer were treated with radiotherapy, in a combination of teletherapy and high-dose rate (HDR) brachytherapy. The age ranged from 51 to 79 years (averaging 66.4 years). T1c stage was the most frequent one: 30 (65%). The Gleason score was below 7 in 78% of the patients. PSA ranged from 3.4 to 33.3, being below 10 in 39% of the cases. The average prostatic volume was 32.3 cc. Twenty-eight percent of the patients received hormone therapy. Teletherapy dose ranged from 45 to 50.4 Gy, associated to four fractions of 4 Gy of HDR brachytherapy. Results: the follow-up period varied from 6 to 43 months. Four patients missed the follow-up and four died (one due to the disease). Out of the 39 patients that were analyzed, 76% presented a less than 1.5 PSA. None of the analyzed variables were found to be of statistical significance (p > 0.05) regarding biochemical control. Conclusion: the use of HDR brachytherapy was found to be effective in the treatment of prostate cancer and, in this study, the variables considered as prognostic factors did not interfere in the biochemical control. (author)

  8. High-Dose-Rate Monotherapy: Safe and Effective Brachytherapy for Patients With Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Demanes, D. Jeffrey; Martinez, Alvaro A.; Ghilezan, Michel; Hill, Dennis R.; Schour, Lionel; Brandt, David; Gustafson, Gary

    2011-01-01

    Purpose: High-dose-rate (HDR) brachytherapy used as the only treatment (monotherapy) for early prostate cancer is consistent with current concepts in prostate radiobiology, and the dose is reliably delivered in a prospectively defined anatomic distribution that meets all the requirements for safe and effective therapy. We report the disease control and toxicity of HDR monotherapy from California Endocurietherapy (CET) and William Beaumont Hospital (WBH) in low- and intermediate-risk prostate cancer patients. Methods and Materials: There were 298 patients with localized prostate cancer treated with HDR monotherapy between 1996 and 2005. Two biologically equivalent hypofractionation protocols were used. At CET the dose was 42 Gy in six fractions (two implantations 1 week apart) delivered to a computed tomography–defined planning treatment volume. At WBH the dose was 38 Gy in four fractions (one implantation) based on intraoperative transrectal ultrasound real-time treatment planning. The bladder, urethral, and rectal dose constraints were similar. Toxicity was scored with the National Cancer Institute Common Toxicity Criteria for Adverse Events version 3. Results: The median follow-up time was 5.2 years. The median age of the patients was 63 years, and the median value of the pretreatment prostate-specific antigen was 6.0 ng/mL. The 8-year results were 99% local control, 97% biochemical control (nadir +2), 99% distant metastasis–free survival, 99% cause-specific survival, and 95% overall survival. Toxicity was scored per event, meaning that an individual patient with more than one symptom was represented repeatedly in the morbidity data table. Genitourinary toxicity consisted of 10% transient Grade 2 urinary frequency or urgency and 3% Grade 3 episode of urinary retention. Gastrointestinal toxicity was <1%. Conclusions: High disease control rates and low morbidity demonstrate that HDR monotherapy is safe and effective for patients with localized prostate cancer.

  9. Oncological and functional results of robotic salvage radical prostatectomy after permanent brachytherapy implants.

    Science.gov (United States)

    Orré, M; Piéchaud, T; Sargos, P; Richaud, P; Roubaud, G; Thomas, L

    2017-04-01

    To evaluate the feasibility of robotic salvage prostatectomy for local recurrence after permanent brachytherapy implants for prostate cancer. Seven patients were operated by robotic salvage prostatectomy with or without pelvic lymph node dissection between October 2007 and March 2012, for a local recurrence after iodine 125 permanent brachytherapy implants. Local recurrence was proved by prostate biopsies, once biochemical relapse was diagnosed and imaging assessment performed. The average age of a patient at the time of diagnosis was 66 years (62-71 years). The median nadir prostate specific antigen (PSA) serum concentration after brachytherapy was 1.29ng/mL (0.6-2.1ng/mL), obtained after a median of 12 months (7-21 months). The average [PSA] before robotic salvage prostatectomy was 6.60ng/mL (4.17-13.80ng/mL). [PSA] at 1 and 3 months after prostatectomy was less than 0.05ng/mL in five patients. [PSA] remained below 0.05ng/mL for six patients at 12 and 24 months. One month after robotic salvage prostatectomy, all patients had at least partial urinary incontinence. At 12 and 24 months after robotic salvage prostatectomy four patients have regained full urinary continence. In terms of erectile function at 24 months, three patients retained erectile function with possible sexual intercourse. Robotic salvage prostatectomy appears to be a reliable treatment in terms of oncological outcome with convincing results both for urinary continence and erectile function for selected patients with local recurrence after permanent brachytherapy implants. Copyright © 2017 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  10. High dose rate interstitial brachytherapy with external beam irradiation for localized prostate cancer. Preliminary results

    Energy Technology Data Exchange (ETDEWEB)

    Hiratsuka, Junichi; Jo, Yoshimasa; Yoden, Eisaku; Tanaka, Hiroyoshi; Imajo, Yoshinari [Kawasaki Medical School, Kurashiki, Okayama (Japan); Nagase, Naomi; Narihiro, Naomasa; Kubota, Juichi

    2000-12-01

    This study was undertaken to assess the biochemical and pathological results of combined external beam radiotherapy and high dose rate Ir-192 brachytherapy (HDR-Ir192) for clinically localized prostate cancer. Between October 1997 and August 1999, 39 evaluable patients with adenocarcinoma of prostate diagnosed by biopsy were treated with interstitial and external beam irradiation. Patients ranged in age from 58-82 years, with a mean of 69.7 years. T1c, T2 and T3 tumors, according to the UICC classification system (1997), were found in 7, 21 and 11 cases respectively. The mean initial pre-treatment PSA was 35.9 ng/ml (median 13.2), with 77% of the patients having had a pre-treatment PSA greater than 10 ng/ml. Of all patients, 17 had received pre-treatment hormonal therapy. Hormonal pretreatment was stopped at the beginning of radiotherapy in all cases. External beam four-field box irradiation was given to the small pelvis to a dose of 45 Gy/25 fractions. Three HDR-Ir192 treatments were given over a 30-h period, with 5.5 Gy per fraction at the circumference of the prostate gland over the course of this study. Biochemical failure was defined as a PSA level >1.5 ng/ml and rising on three consecutive values. If serial post-treatment PSA levels showed a continuous downward trend, failure was not scored. The patient with clinical evidence of progression was classified as a clinical failure. The median follow-up at the time of evaluation was 19.6 months. A post-treatment PSA level {<=}1.0 ng/ml was seen in 26 (67%) patients, and values from >1.0 to {<=}2.0 ng/ml were seen in 10 (26%) patients. Biochemical failure was not seen in 38 patients except for one patient who developed a distant bone metastasis with negative prostatic biopsy 15 months after treatment. Biochemical control rate was 100% (38/38) except for the patient with bone metastasis classified as clinical failure. Negative biopsies 18 months after treatment were found in 93% (14/15) of patients. Only one patient

  11. Modelling second malignancy risks from low dose rate and high dose rate brachytherapy as monotherapy for localised prostate cancer.

    Science.gov (United States)

    Murray, Louise; Mason, Joshua; Henry, Ann M; Hoskin, Peter; Siebert, Frank-Andre; Venselaar, Jack; Bownes, Peter

    2016-08-01

    To estimate the risks of radiation-induced rectal and bladder cancers following low dose rate (LDR) and high dose rate (HDR) brachytherapy as monotherapy for localised prostate cancer and compare to external beam radiotherapy techniques. LDR and HDR brachytherapy monotherapy plans were generated for three prostate CT datasets. Second cancer risks were assessed using Schneider's concept of organ equivalent dose. LDR risks were assessed according to a mechanistic model and a bell-shaped model. HDR risks were assessed according to a bell-shaped model. Relative risks and excess absolute risks were estimated and compared to external beam techniques. Excess absolute risks of second rectal or bladder cancer were low for both LDR (irrespective of the model used for calculation) and HDR techniques. Average excess absolute risks of rectal cancer for LDR brachytherapy according to the mechanistic model were 0.71 per 10,000 person-years (PY) and 0.84 per 10,000 PY respectively, and according to the bell-shaped model, were 0.47 and 0.78 per 10,000 PY respectively. For HDR, the average excess absolute risks for second rectal and bladder cancers were 0.74 and 1.62 per 10,000 PY respectively. The absolute differences between techniques were very low and clinically irrelevant. Compared to external beam prostate radiotherapy techniques, LDR and HDR brachytherapy resulted in the lowest risks of second rectal and bladder cancer. This study shows both LDR and HDR brachytherapy monotherapy result in low estimated risks of radiation-induced rectal and bladder cancer. LDR resulted in lower bladder cancer risks than HDR, and lower or similar risks of rectal cancer. In absolute terms these differences between techniques were very small. Compared to external beam techniques, second rectal and bladder cancer risks were lowest for brachytherapy. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  12. Impact of Insurance Status on Radiation Treatment Modality Selection Among Potential Candidates for Prostate, Breast, or Gynecologic Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Grant, Stephen R. [Baylor College of Medicine, Houston, Texas (United States); Walker, Gary V. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Koshy, Matthew [Department of Radiation Oncology, The University of Chicago, Chicago, Illinois (United States); Shaitelman, Simona F.; Klopp, Ann H.; Frank, Steven J.; Pugh, Thomas J.; Allen, Pamela K. [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States); Mahmood, Usama, E-mail: UMahmood@mdanderson.org [Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston, Texas (United States)

    2015-12-01

    Purpose: The Patient Protection and Affordable Care Act looks to expand both private and Medicaid insurance. To evaluate how these changes may affect the field of radiation oncology, we evaluated the association of insurance status with the use of brachytherapy in cancers for which this treatment technique is used. Methods and Materials: A total of 190,467 patients met the inclusion criteria, of whom 95,292 (50.0%) had breast cancer, 61,096 (32.1%) had prostate cancer, 28,194 (14.8%) had endometrial cancer, and 5885 (3.1%) had cervical cancer. A multivariate logistic regression model was used to determine the association between insurance status and receipt of brachytherapy among patients treated definitively for prostate and cervical cancer or postoperatively for breast and endometrial cancer. Results: The rates of non-Medicaid insurance were 49.9% (cervical), 85.3% (endometrial), 87.4% (breast), and 90.9% (prostate) (P<.001). In a logistic regression, patients who received radiation therapy were less likely to receive brachytherapy if they had Medicaid coverage (odds ratio [OR] 0.57, 95% confidence interval [CI] 0.53-0.61, P<.001) or did not have insurance coverage (OR 0.50, 95% CI 0.45-0.56, P<.001) compared with those with non-Medicaid insurance. On subset analysis, patients with Medicaid coverage or without insurance coverage were significantly less likely to receive brachytherapy than were those with non-Medicaid insurance for all 4 sites, except for patients with endometrial cancer. Conclusions: Despite being a cost-effective treatment modality, brachytherapy is less often used in the definitive or postoperative management of cancer in patients with Medicaid coverage or without insurance. Upcoming health policy changes resulting in the expansion of private insurance and Medicaid will likely increase access to and demand for brachytherapy.

  13. Brachytherapy guideline in prostate cancer (high and low dose rate)

    Energy Technology Data Exchange (ETDEWEB)

    Hanna, Samir Abdallah; Pimentel, Leonardo [Sociedade Brasileira de Radioterapia (SBR), Rio de Janeiro, RJ (Brazil)

    2017-04-15

    Through the elaboration of seven relevant clinical questions related to the proposed theme, we sought to present the main evidences regarding safety, toxicity and effectiveness of the presented radiotherapy (RT) techniques. The study population consisted of male patients of all ages with early primary prostate cancer and candidates for treatment with curative intent. For this, a systematic review of the literature was carried out in primary scientific databases (MEDLINE - PubMed; Embase - Elsevier; LILACS - BIREME; Cochrane Library -Record of Controlled Trials). All articles available through February 22, 2015 were considered. The search strategy used in MEDLINE searches is described in Appendix 1. The articles were selected based on critical evaluation, seeking the best evidence available. The recommendations were elaborated from discussions held with a drafting group composed of four members of the Brazilian Society of Radiotherapy. The guideline was reviewed by an independent group, which specializes in evidence-based clinical guidelines. After completion, the guideline was released for public consultation for 15 days; the suggestions obtained were forwarded to the authors for evaluation and possible insertion in the final text. (author)

  14. Validation of MRI to TRUS registration for high-dose-rate prostate brachytherapy.

    Science.gov (United States)

    Poulin, Eric; Boudam, Karim; Pinter, Csaba; Kadoury, Samuel; Lasso, Andras; Fichtinger, Gabor; Ménard, Cynthia

    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. 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. 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. An open-source MRI to TRUS registration platform was validated for integration in the brachytherapy workflow. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  15. Long-term tumor control after brachytherapy for base-of-prostate cancer

    Directory of Open Access Journals (Sweden)

    Seungtaek Choi

    2011-12-01

    Full Text Available Purpose: To evaluate the outcomes of patients presenting with cancer at the base of the prostate after brachytherapyas monotherapy. Material and methods: We retrospectively reviewed the medical records of all patients who had undergone transpe -ri neal ultrasound-guided implantation with 125I or 103Pd seeds as monotherapy between March 1998 and December2006, at our institution. A minimum follow-up interval of 2 years was required for inclusion in our analysis. Dosimetrywas assessed using computed tomography 30 days after the implant. Treatment failure was defined as the appearanceof biopsy-proved tumor after seed implantation, radiographic evidence of metastases, receipt of salvage therapy,or elevation of the prostate-specific antigen level beyond the nadir value plus 2 ng/mL. Results: With a median follow-up interval of 89 months (range 25-128 months, all 52 of the identified patients hadno evidence of disease progression or biochemical failure. The mean number of cores sampled at the prostate base was2.84 (median 2; Gleason scores assigned at central review were 6-8 in all patients. Of the 30 patients (58% for whomdosimetric data were available at day 30, the median V100 values of the right and left base were 92.0% and 93.5%, respectively,and the median D90 values of the right and left base were 148 Gy and 151 Gy, respectively. Conclusion: Permanent prostate brachytherapy as monotherapy results in a high probability of disease-free survivalfor men with cancer at the base of the prostate.

  16. Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results

    Energy Technology Data Exchange (ETDEWEB)

    Genebes, Caroline, E-mail: genebes.caroline@claudiusregaud.fr [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Filleron, Thomas; Graff, Pierre [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Jonca, Frédéric [Department of Urology, Clinique Ambroise Paré, Toulouse (France); Huyghe, Eric; Thoulouzan, Matthieu; Soulie, Michel; Malavaud, Bernard [Department of Urology and Andrology, CHU Rangueil, Toulouse (France); Aziza, Richard; Brun, Thomas; Delannes, Martine; Bachaud, Jean-Marc [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France)

    2013-11-15

    Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

  17. Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results

    International Nuclear Information System (INIS)

    Genebes, Caroline; Filleron, Thomas; Graff, Pierre; Jonca, Frédéric; Huyghe, Eric; Thoulouzan, Matthieu; Soulie, Michel; Malavaud, Bernard; Aziza, Richard; Brun, Thomas; Delannes, Martine; Bachaud, Jean-Marc

    2013-01-01

    Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes

  18. Comparison of dose length, area, and volume histograms as quantifiers of urethral dose in prostate brachytherapy

    International Nuclear Information System (INIS)

    Butler, Wayne M.; Merrick, Gregory S.; Dorsey, Anthony T.; Hagedorn, Brenda M.

    2000-01-01

    Purpose: To determine the magnitude of the differences between urethral dose-volume, dose-area, and dose-length histograms (DVH, DAH, and DLH, respectively, or DgH generically). Methods and Materials: Six consecutive iodine-125 ( 125 I) patients and 6 consecutive palladium-103 ( 103 Pd) patients implanted via a modified uniform planning approach were evaluated with day 0 computed tomography (CT)-based dosimetry. The urethra was identified by the presence of a urinary catheter and was hand drawn on the CT images with a mean radius of 3.3 ± 0.7 mm. A 0.1-mm calculation matrix was employed for the urethral volume and surface analysis, and urethral dose points were placed at the centroid of the urethra on each 5-mm CT slice. Results: Although individual patient DLHs were step-like, due to the sparseness of the data points, the composite urethral DLH, DAH, and DVHs were qualitatively similar. The DAH curve delivered more radiation than the other two curves at all doses greater than 90% of the prescribed minimum peripheral dose (mPD) to the prostate. In addition, the DVH curve was consistently higher than the DLH curve at most points throughout that range. Differences between the DgH curves were analyzed by integrating the difference curves between 0 and 200% of the mPD. The area-length, area-volume, and volume-length difference curves integrated in the ratio of 3:2:1. The differences were most pronounced near the inflection point of the DgH curves with mean A 125 , V 125 , and L 125 values of 36.6%, 31.4%, and 23.0%, respectively, of the urethra. Quantifiers of urethral hot spots such as D 10 , defined as the minimal dose delivered to the hottest 10% of the urethra, followed the same ranking: area analysis indicated the highest dose and length analysis, the lowest dose. D 10 was 148% and 136% of mPD for area and length evaluations, respectively. Comparing the two isotopes in terms of the amount of urethra receiving a given dose, 103 Pd implants were significantly

  19. WE-DE-201-08: Multi-Source Rotating Shield Brachytherapy Apparatus for Prostate Cancer

    International Nuclear Information System (INIS)

    Dadkhah, H; Wu, X; Kim, Y; Flynn, R

    2016-01-01

    Purpose: To introduce a novel multi-source rotating shield brachytherapy (RSBT) apparatus for the precise simultaneous angular and linear positioning of all partially-shielded 153Gd radiation sources in interstitial needles for treating prostate cancer. The mechanism is designed to lower the detrimental dose to healthy tissues, the urethra in particular, relative to conventional high-dose-rate brachytherapy (HDR-BT) techniques. Methods: Following needle implantation, the delivery system is docked to the patient template. Each needle is coupled to a multi-source afterloader catheter by a connector passing through a shaft. The shafts are rotated by translating a moving template between two stationary templates. Shaft walls as well as moving template holes are threaded such that the resistive friction produced between the two parts exerts enough force on the shafts to bring about the rotation. Rotation of the shaft is then transmitted to the shielded source via several keys. Thus, shaft angular position is fully correlated with the position of the moving template. The catheter angles are simultaneously incremented throughout treatment as needed, and only a single 360° rotation of all catheters is needed for a full treatment. For each rotation angle, source depth in each needle is controlled by a multi-source afterloader, which is proposed as an array of belt-driven linear actuators, each of which drives a source wire. Results: Optimized treatment plans based on Monte Carlo dose calculations demonstrated RSBT with the proposed apparatus reduced urethral D 1cc below that of conventional HDR-BT by 35% for urethral dose gradient volume within 3 mm of the urethra surface. Treatment time to deliver 20 Gy with multi-source RSBT apparatus using nineteen 62.4 GBq 153 Gd sources is 117 min. Conclusions: The proposed RSBT delivery apparatus in conjunction with multiple nitinol catheter-mounted platinum-shielded 153 Gd sources enables a mechanically feasible urethra

  20. Predicting pubic arch interference in prostate brachytherapy on transrectal ultrasonography-computed tomography fusion images

    International Nuclear Information System (INIS)

    Fukada, Junichi; Shigematsu, Naoyuki; Nakashima, Jun; Ohashi, Toshio; Kawaguchi, Osamu; Oya, Mototsugu

    2012-01-01

    We investigated the usefulness of the fusion image created by transrectal ultrasonography (TRUS) and large-bore computed tomography (CT) for predicting pubic arch interference (PAI) during prostate seed brachytherapy. The TRUS volume study was performed in 21 patients, followed by large-bore computed tomography of patients in the lithotomy position. Then, we created TRUS-CT fusion images using a radiation planning treatment system. TRUS images in which the prostate outline was the largest were overlaid on CT images with the narrowest pubic arch. PAI was estimated in the right and left arch separately and classified to three grades: no PAI, PAI positive within 5 mm and PAI of >5 mm. If the estimated PAI was more than 5 mm on at least one side of the arch, we judged there to be a significant PAI. Brachytherapy was performed in 18 patients who were evaluated as not having significant PAI on TRUS. Intra-operative PAI was observed in one case, which was also detected with a fusion image. On the other hand, intra-operative PAI was not observed in one case that had been evaluated as having significant PAI with a fusion image. In the remaining three patients, TRUS suggested the presence of significant PAI, which was also confirmed by a fusion image. Intra-operative PAI could be predicted by TRUS-CT fusion imaging, even when it was undetectable by TRUS. Although improvement of the reproducibility of the patients' position to avoid false-positive cases is warranted, TRUS-CT fusion imaging has the possibility that the uncertainty of TRUS can be supplemented. (author)

  1. An image-guidance system for dynamic dose calculation in prostate brachytherapy using ultrasound and fluoroscopy

    Science.gov (United States)

    Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Mian, Omar Y.; Le, Yi; Burdette, E. Clif; Fichtinger, Gabor; Prince, Jerry L.; Song, Danny Y.; Lee, Junghoon

    2014-01-01

    Purpose: Brachytherapy is a standard option of care for prostate cancer patients but may be improved by dynamic dose calculation based on localized seed positions. The American Brachytherapy Society states that the major current limitation of intraoperative treatment planning is the inability to localize the seeds in relation to the prostate. An image-guidance system was therefore developed to localize seeds for dynamic dose calculation. Methods: The proposed system is based on transrectal ultrasound (TRUS) and mobile C-arm fluoroscopy, while using a simple fiducial with seed-like markers to compute pose from the nonencoded C-arm. Three or more fluoroscopic images and an ultrasound volume are acquired and processed by a pipeline of algorithms: (1) seed segmentation, (2) fiducial detection with pose estimation, (3) seed matching with reconstruction, and (4) fluoroscopy-to-TRUS registration. Results: The system was evaluated on ten phantom cases, resulting in an overall mean error of 1.3 mm. The system was also tested on 37 patients and each algorithm was evaluated. Seed segmentation resulted in a 1% false negative rate and 2% false positive rate. Fiducial detection with pose estimation resulted in a 98% detection rate. Seed matching with reconstruction had a mean error of 0.4 mm. Fluoroscopy-to-TRUS registration had a mean error of 1.3 mm. Moreover, a comparison of dose calculations between the authors’ intraoperative method and an independent postoperative method shows a small difference of 7% and 2% forD90 and V100, respectively. Finally, the system demonstrated the ability to detect cold spots and required a total processing time of approximately 1 min. Conclusions: The proposed image-guidance system is the first practical approach to dynamic dose calculation, outperforming earlier solutions in terms of robustness, ease of use, and functional completeness. PMID:25186387

  2. Implementation of High-Dose-Rate Brachytherapy and Androgen Deprivation in Patients With Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lilleby, Wolfgang, E-mail: wolfgang.lilleby@ous-hf.no [Cancer Clinic, Oslo University Hospital, Norwegian Radiumhospital, Department of Radiotherapy and Oncology, Oslo (Norway); Tafjord, Gunnar; Raabe, Nils K. [Cancer Clinic, Oslo University Hospital, Norwegian Radiumhospital, Department of Radiotherapy and Oncology, Oslo (Norway)

    2012-07-01

    Purpose: To evaluate outcome (overall survival [OS], the actuarial 5-year cancer-specific survival [CSS], disease-free survival [DFS], biochemical failure-free survival [BFS]), complications and morbidity in patients treated with high-dose-rate brachytherapy (HDR-BT) boost and hormonal treatment with curative aims. Methods: Between 2004 and 2009, 275 prospectively followed pN0/N0M0 patients were included: 19 patients (7%) with T2, Gleason score 7 and prostate-specific antigen (PSA) <10 and 256 patients (93%) with T3 or Gleason score 8-10 or PSA >20 received multimodal treatment with conformal four-field radiotherapy (prostate/vesiculae 2 Gy Multiplication-Sign 25) combined with HDR-BT (iridium 192; prostate 10 Gy Multiplication-Sign 2) with long-term androgen deprivation therapy (ADT). Results: After a median observation time of 44.2 months (range, 10.4-90.5 months) 12 patients had relapsed clinically and/or biochemically and 10 patients were dead, of which 2 patients died from prostate cancer. Five-year estimates of BFS, CSS, DFS, and OS rates were 98.5%, 99.3%, 95.6%, and 96.3%, respectively. None of the patients with either Gleason score <8 or with intermediate risk profile had relapsed. The number of HDR-BT treatments was not related to outcome. Despite of age (median, 65.7 years; range, 45.7-77 years) and considerable pretreatment comorbidity in 39 of 275 patients, Genitourinary treatment-related morbidity was moderate with long-lasting Radiation Therapy Oncology Group Grade 2 voiding problems in 26 patients (9.5%) and occasionally mucous discharge in 20 patients (7%), none with Grade >2 for gastrointestinal at follow-up. Complications during implantations were related to pubic arch interference (4 patients) and lithotomy time, causing 2 patients to develop compartment syndrome. Conclusion: Despite still preliminary observations, our 5-year outcome estimates favor the implementation of high-dose-rate brachytherapy in high-risk patients combined with conformal

  3. Time to PSA rise differentiates the PSA bounce after HDR and LDR brachytherapy of prostate cancer.

    Science.gov (United States)

    Burchardt, Wojciech; Skowronek, Janusz

    2018-02-01

    To investigate the differences in prostate-specific antigen (PSA) bounce (PB) after high-dose-rate (HDR-BT) or low-dose-rate (LDR-BT) brachytherapy alone in prostate cancer patients. Ninety-four patients with localized prostate cancer (T1-T2cN0), age ranged 50-81 years, were treated with brachytherapy alone between 2008 and 2010. Patients were diagnosed with adenocarcinoma, Gleason score ≤ 7. The LDR-BT total dose was 144-145 Gy, in HDR-BT - 3 fractions of 10.5 or 15 Gy. The initial PSA level (iPSA) was assessed before treatment, then PSA was rated every 3 months over the first 2 years, and every 6 months during the next 3 years. Median follow-up was 3.0 years. Mean iPSA was 7.8 ng/ml. In 58 cases, PSA decreased gradually without PB or biochemical failure (BF). In 24% of patients, PB was observed. In 23 cases (24%), PB was observed using 0.2 ng/ml definition; in 10 cases (11%), BF was diagnosed using nadir + 2 ng/ml definition. The HDR-BT and LDR-BT techniques were not associated with higher level of PB (26 vs. 22%, p = 0.497). Time to the first PSA rise finished with PB was significantly shorter after HDR-BT then after LDR-BT (median, 10.5 vs. 18.0 months) during follow-up. Predictors for PB were observed only after HDR-BT. Androgen deprivation therapy (ADT) and higher Gleason score decreased the risk of PB (HR = 0.11, p = 0.03; HR = 0.51, p = 0.01). The higher PSA nadir and longer time to PSA nadir increased the risk of PB (HR 3.46, p = 0.02; HR 1.04, p = 0.04). There was no predictors for PB after LDR-BT. HDR-BT and LDR-BT for low and intermediate risk prostate cancer had similar PB rate. The PB occurred earlier after HDR-BT than after LDR-BT. ADT and higher Gleason score decreased, and higher PSA nadir and longer time to PSA nadir increased the risk of PB after HDR-BT.

  4. Iodine-125 Chitosan-Vitamin C complex. Preparation, characterization and application

    Energy Technology Data Exchange (ETDEWEB)

    Elbarbary, Ahmed M. [National Center for Radiation Research and Technology, Cairo (Egypt). Polymer Chemistry Dept.; Shafik, H.M.; Ebeid, N.H.; Ayoub, S.M. [Atomic Energy Authority, Cairo (Egypt). Hot Lab. Center; Othman, Sameh H. [Atomic Energy Authority, Cairo (Egypt). Nuclear Research Center

    2015-07-01

    In heterogeneous conditions, water soluble Chitosan-Vitamin C Complex (CSVC) is successfully synthesized via the ionic interaction between γ-degraded CS and VC. Chitosan (CS) of low molecular weight (MW) is prepared using γ-irradiation method. The coupling of CS and vitamin C (VC) is carried out by the chemical treatment of VC with the γ-degraded CS. The formation of CSVC complex instead of physical mixture is confirmed by FT-IR and UV spectrometry. Characterization by transmission electron microscope (TEM) and dynamic light scattering (DLS) shows the formation of a nanostructure in 40 nm range. The preparation of labeled CSVC was performed using chloramines-T oxidation method. The labeling feasibility of CSVC nanostructure by Iodine-125 ({sup 125}I) is investigated. The optimized conditions of labeling are thought to be 50 μg of oxidizing agent, pH 3, and one minute reaction time. The Biodistribution activity of {sup 125}I radiolabeled CSVC nanostructure ({sup 125}I-CSVC) is examined on a group of different ascites tumor bearing mice. Calculation of the biodistribution percentages shows that the tumor, liver, and kidney are the targeting organs of {sup 125}I-CSVC nanostructure.

  5. Towards in vivo nuclear microscopy: iodine-125 imaging in mice using micro-pinholes

    International Nuclear Information System (INIS)

    Beekman, Freek J.; McElroy, David P.; Hoffman, Edward J.; Berger, Frank; Gambhir, Sanjiv S.; Cherry, Simon R.

    2002-01-01

    Position-sensitive gamma-radiation detectors equipped with collimators have been used for in vivo imaging of the distribution of radiolabelled molecules in laboratory animals and humans for several decades. To date, the best image resolution achieved in a rodent is on the order of 1 mm. Here we demonstrate how a basic and compact gamma camera can be constructed for in vivo radionuclide imaging in small animals, at much higher spatial resolution. Resolution improvements were obtained by combining dense, shaped, micro-pinhole apertures with iodine-125, an isotope with low energy emissions, ease of incorporation into a wide range of molecules, and straightforward translation into the clinic via other isotopes of iodine that are suitable for nuclear medicine imaging. 125 I images of test distributions and a mouse thyroid have been obtained at a resolution of as high as 200 μm using this simple bench-top camera. Possible future applications and extension to ultra-high-resolution emission tomography are discussed. (orig.)

  6. The effect of catheter displacement and anatomical variations on the dose distribution in MRI-guided focal HDR brachytherapy for prostate cancer

    NARCIS (Netherlands)

    Maenhout, Metha; van der Voort van Zyp, Jochem R N; Borot, Maxence; Peters, Max; van Vulpen, Marco; van den Bosch, Maurice; Moerland, Rien

    PURPOSE: The aim of this study was to analyze the effect of catheter displacement and anatomical variations of prostate and organs at risk on dose distribution in MRI-guided 19 Gy single fraction focal high-dose-rate brachytherapy (HDR-BT) of the prostate. METHODS AND MATERIALS: Seventeen patients

  7. Biomaterial characteristics and application of silicone rubber and PVA hydrogels mimicked in organ groups for prostate brachytherapy.

    Science.gov (United States)

    Li, Pan; Jiang, Shan; Yu, Yan; Yang, Jun; Yang, Zhiyong

    2015-09-01

    It is definite that transparent material with similar structural characteristics and mechanical properties to human tissue is favorable for experimental study of prostate brachytherapy. In this paper, a kind of transparent polyvinyl alcohol (PVA) hydrogel and silicone rubber are developed as suitable substitutions for human soft tissue. Segmentation and 3D reconstruction of medical image are performed to manufacture the mould of organ groups through rapid prototyping technology. Micro-structure observation, force test and CCD deformation test have been conducted to investigate the structure and mechanical properties of PVA hydrogel used in organ group mockup. Scanning electron microscope (SEM) image comparison results show that PVA hydrogel consisting of 3 g PVA, 17 g de-ionized water, 80 g dimethyl-sulfoxide (DMSO), 4 g NaCl, 1.5 g NaOH, 3 g epichlorohydrin (ECH) and 7 freeze/thaw cycles reveals similar micro-structure to human prostate tissue. Through the insertion force comparison between organ group mockup and clinical prostate brachytherapy, PVA hydrogel and silicone rubber are found to have the same mechanical properties as prostate tissue and muscle. CCD deformation test results show that insertion force suffers a sharp decrease and a relaxation of tissue deformation appears when needle punctures the capsule of prostate model. The results exhibit that organ group mockup consisting of PVA hydrogel, silicone rubber, membrane and agarose satisfies the needs of prostate brachytherapy simulation in general and can be used to mimic the soft tissues in pelvic structure. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Race and Survival Following Brachytherapy-Based Treatment for Men With Localized or Locally Advanced Adenocarcinoma of the Prostate

    International Nuclear Information System (INIS)

    Winkfield, Karen M.; Chen Minghui; Dosoretz, Daniel E.; Salenius, Sharon A.; Katin, Michael; Ross, Rudi; D’Amico, Anthony V.

    2011-01-01

    Purpose: We investigated whether race was associated with risk of death following brachytherapy-based treatment for localized prostate cancer, adjusting for age, cardiovascular comorbidity, treatment, and established prostate cancer prognostic factors. Methods: The study cohort was composed of 5,360 men with clinical stage T1-3N0M0 prostate cancer who underwent brachytherapy-based treatment at 20 centers within the 21st Century Oncology consortium. Cox regression multivariable analysis was used to evaluate the risk of death in African-American and Hispanic men compared to that in Caucasian men, adjusting for age, pretreatment prostate-specific antigen (PSA) level, Gleason score, clinical T stage, year and type of treatment, median income, and cardiovascular comorbidities. Results: After a median follow-up of 3 years, there were 673 deaths. African-American and Hispanic races were significantly associated with an increased risk of all-cause mortality (ACM) (adjusted hazard ratio, 1.77 and 1.79; 95% confidence intervals, 1.3–2.5 and 1.2–2.7; p < 0.001 and p = 0.005, respectively). Other factors significantly associated with an increased risk of death included age (p < 0.001), Gleason score of 8 to 10 (p = 0.04), year of brachytherapy (p < 0.001), and history of myocardial infarction treated with stent or coronary artery bypass graft (p < 0.001). Conclusions: After adjustment for prostate cancer prognostic factors, age, income level, and revascularized cardiovascular comorbidities, African-American and Hispanic races were associated with higher ACM in men with prostate cancer. Additional causative factors need to be identified.

  9. DNA Ploidy Measured on Archived Pretreatment Biopsy Material May Correlate With Prostate-Specific Antigen Recurrence After Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Keyes, Mira, E-mail: mkeyes@bccancer.bc.ca [Radiation Oncology, Provincial Prostate Brachytherapy Program, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); MacAulay, Calum [Department of Integrative Oncology, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Hayes, Malcolm [Department of Pathology, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Korbelik, Jagoda [Department of Integrative Oncology, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Morris, W. James [Radiation Oncology, Provincial Prostate Brachytherapy Program, Vancouver Cancer Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada); Palcic, Branko [Department of Integrative Oncology, British Columbia Cancer Research Centre, British Columbia Cancer Agency, Vancouver, British Columbia (Canada)

    2013-08-01

    Purpose: To explore whether DNA ploidy of prostate cancer cells determined from archived transrectal ultrasound-guided biopsy specimens correlates with disease-free survival. Methods and Materials: Forty-seven failures and 47 controls were selected from 1006 consecutive low- and intermediate-risk patients treated with prostate {sup 125}I brachytherapy (July 1998-October 2003). Median follow-up was 7.5 years. Ten-year actuarial disease-free survival was 94.1%. Controls were matched using age, initial prostate-specific antigen level, clinical stage, Gleason score, use of hormone therapy, and follow-up (all P nonsignificant). Seventy-eight specimens were successfully processed; 27 control and 20 failure specimens contained more than 100 tumor cells were used for the final analysis. The Feulgen-Thionin stained cytology samples from archived paraffin blocks were used to determine the DNA ploidy of each tumor by measuring integrated optical densities. Results: The samples were divided into diploid and aneuploid tumors. Aneuploid tumors were found in 16 of 20 of the failures (80%) and 8 of 27 controls (30%). Diploid DNA patients had a significantly lower rate of disease recurrence (P=.0086) (hazard ratio [HR] 0.256). On multivariable analysis, patients with aneuploid tumors had a higher prostate-specific antigen failure rate (HR 5.13). Additionally, those with “excellent” dosimetry (V100 >90%; D90 >144 Gy) had a significantly lower recurrence rate (HR 0.25). All patients with aneuploid tumors and dosimetry classified as “nonexcellent” (V100 <90%; D90 <144 Gy) (5 of 5) had disease recurrence, compared with 40% of patients with aneuploid tumors and “excellent” dosimetry (8 of 15). In contrast, dosimetry did not affect the outcome for diploid patients. Conclusions: Using core biopsy material from archived paraffin blocks, DNA ploidy correctly classified the majority of failures and nonfailures in this study. The results suggest that DNA ploidy can be used as a

  10. Evolution of dosimetry constraints to reduce the acute urinary toxicity after prostate brachytherapy with iodine 125 of 395 localised cancers; Evolution des contraintes dosimetriques pour reduire la toxicite urinaire aigue apres curietherapie de prostate a l'iode 125 de 395 cancers localises

    Energy Technology Data Exchange (ETDEWEB)

    Guerif, S.; Bonvalet, L.; Goudona, J.B.; Glandier, C. [Centre Hospitalier Universitaire, 86 - Poitiers (France)

    2007-11-15

    The incidence reduction of urethritis and its length are correlated with a reduction of the urethral D90 and D30 on our selection. The future progress will pass through a targeted therapy on a macroscopic tumoral volume by keeping the V100 to reduce the urethral D90 and the D30. We study now, the possibility to boost the macroscopic tumoral volume seen on MRI with a coverage one V100 between 145 and 150 Gy, a D90 inferior to 160 Gy and an minimal urethral D30. (N.C.)

  11. Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Ferrer, Montserrat; Suarez, Jose Francisco; Guedea, Ferran; Fernandez, Pablo; Macias, Victor; Marino, Alfonso; Hervas, Asuncion; Herruzo, Ismael; Ortiz, Maria Jose; Villavicencio, Humberto; Craven-Bratle, Jordi; Garin, Olatz; Aguilo, Ferran

    2008-01-01

    Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel

  12. Comparative dosimetry of prostate brachytherapy with I-125 and Pd-103 seeds via SISCODES/MCNP

    Energy Technology Data Exchange (ETDEWEB)

    Trindade, Bruno Machado; Falcao, Patricia Lima, E-mail: bmtrindade@yahoo.com [Nucleo de Radiacoes Ionizantes - Universidade Federal de Minas Gerais (NRI/UFMG), Belo Horizonte, MG (Brazil); Christovao, Marilia Tavares [Centro de Desenvolvimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil); Trindade, Daniela de Fatima Maia [Centro Universitario Una, Belo Horizonte, MG (Brazil); Campos, Tarcisio Passos Ribeiro de [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil)

    2012-09-15

    Objective: The present paper is aimed at presenting a comparative dosimetric study of prostate brachytherapy with I-125 and Pd-103 seeds. Materials and Methods: A protocol for both implants with 148 seeds was simulated on a heterogeneous three-dimensional pelvic phantom by means of the SISCODES/MCNP5 codes. Dose-volume histograms on prostate, rectum and bladder, dose indexes D10, D30, D90, D0.5cc, D2cc and D7cc, and representations of the spatial dose distribution were evaluated. Results: For a D90 index equivalent to the prescription dose, the initial activity of each I-125 seed was calculated as 0.42 mCi and of Pd-103 as 0.94 mCi. The maximum dose on the urethra was 90% and 108% of the prescription dose for I-125 and Pd-103, respectively. The D2cc for I-125 was 30 Gy on the rectum and 127 Gy on the bladder; for Pd-103 was 29 Gy on the rectum and 189 Gy on the bladder. The D10 on the pubic bone was 144 Gy for I-125 and 66 Gy for Pd-103. Conclusion: The results indicate that Pd-103 and I-125 implants could deposit the prescribed dose on the target volume. Among the findings of the present study, there is an excessive radiation exposure of the pelvic bones, particularly with the I-125 protocol. (author)

  13. Iodine-125 irradiation of choroidal melanoma: clinical experience from the Prince of Wales and Sydney Eye Hospitals

    International Nuclear Information System (INIS)

    Mameghan, H.; Karolis, Ch.; Fisher, R.; Mameghan, J.; Billson, F.A.; Donaldson, E.J.; Giblin, M.E.; Hunyor, A.B.L.

    1992-01-01

    The records of 53 patients treated for choroidal melanoma between 1985 and 1989 were examined. The aim of this study was to assess the safety and short-term results of iodine-125 episcleral plaque therapy. There were 28 males and 25 females aged 20 to 77 years, treated for single tumours with a median diameter of 9 mm (range 5 to 16 mm) and with a median thickness of 4 mm (range 2 to 10 mm). The plaques containing iodine-125 seeds were chosen according to tumour size: 10 mm (16 patients); 15 mm (36 patients); 20 mm (one patient). All patients were alive at last follow-up (median 1.3 years, range 4 months to 3.3 years). Four patients underwent enucleation for melanoma progression. Thirty patients have developed some type of complication (more than one complication occurred in the same eye in 12 patients); retinitis (19), optic neuropathy (7); cataract (4), rubeosis iridis (2). Overall, visual acuity deteriorated in 32 patients, remained stable in 12 patients and improved in 9 patients. It was therefore concluded that iodine-125 plaque therapy appears to offer patients good prospects of tumour control and preservation of useful vision. 16 refs., 4 tabs

  14. Customized Dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes

    International Nuclear Information System (INIS)

    Stone, Nelson N.; Potters, Louis; Davis, Brian J.; Ciezki, Jay P.; Zelefsky, Michael J.; Roach, Mack; Fearn, Paul A. B.A.; Kattan, Michael W.; Stock, Richard G.

    2007-01-01

    Purpose: To investigate the biochemical control rate in patients undergoing permanent prostate brachytherapy as a function of the biologically effective dose (BED) and risk group. Methods and Materials: Six centers provided data on 3,928 permanent brachytherapy patients with postimplant dosimetry results. The mean prostate-specific antigen level was 8.9 ng/mL. 125 I was used in 2,293 (58%), 103 Pd in 1,635, and supplemental external beam radiotherapy in 882 (22.5%) patients. The patients were stratified into low- (n = 2,188), intermediate- (n = 1,188), and high- (n = 552) risk groups and into three BED groups of 200 Gy (n = 1,115). Freedom from biochemical disease progression (biochemical freedom from failure [bFFF]) was determined using the American Society for Therapeutic Radiology Oncology and Phoenix definitions and calculated using the Kaplan-Meier method, with factors compared using the log-rank test. Results: The 10-year prostate-specific antigen bFFF rate for the American Society for Therapeutic Radiology Oncology and Phoenix definitions was 79.2% and 70%, respectively. The corresponding bFFF rates for the low-, intermediate-, and high-risk groups was 84.1% and 78.1%, 76.8% and 63.6%, and 64.4% and 58.2%, respectively (p < 0.0001). The corresponding bFFF rate for the three BED groups was 56.1% and 41.4%, 80% and 77.9%, and 91.1% and 82.9% (p < 0.0001). The corresponding bFFF rate for the low-risk patients by dose group was 69.8% and 49.8%, 86% and 85.2%, and 88.1% and 88.3% for the low-, intermediate, and high-dose group, respectively (p <0.0001). The corresponding bFFF rate for the intermediate-risk patients by dose group was 52.9% and 23.1%, 74.1% and 77.7%, and 94.3% and 88.8% for the low-, intermediate-, and high-dose group, respectively (p < 0.0001). The corresponding bFFF rate for high-risk patients by dose group was 19.2% and 41.7%, 61.8% and 53.2%, and 90% and 69.6% for the low-, intermediate-, and high-dose group, respectively (p < 0

  15. Influence of external beam technique and brachytherapy quality assurance on the side effects in the combined external beam- and brachytherapy treatment of local advanced prostate cancer

    International Nuclear Information System (INIS)

    Kovacs, G.; Galalae, R.; Wirth, B.; Bertermann, H.; Wilhelm, R.; Kohr, P.; Kimmig, B.

    1996-01-01

    Transrectal ultrasound(TRUS) guided HDR implantation of the prostate has been established at the Kiel University by Bertermann and Brix in 1986 and there are to date 179 (T1b-T3 No Mo) patients treated in a combined modality. The dose for the implant was 2x 15 Gy on the capsule of the prostate in 14-20 days. For local and regional lymph nodes 20 Gy external beam therapy (AP-PA pelvic portals), 20 Gy with an individual transmission block (100% for subclinical disease, 70% and 50% according to the implant dosimetry for the prostate) and 10 Gy small volume irradiation for the prostate was applied, conventional fractioned. Total dose after the therapy 70 Gy for the prostate and 50 Gy for the subclinical disease in 6-7 weeks. As a quality control method we use since 1991 in vivo dosimetry on the medial rectum wall as well as in the prostatic part of the urethra. Regular follow-up 3-118 months after therapy (median 55) with PSA, digital rectal examination, control TRUS with volumetry (after one year with biopsy) and bone scan. There were no major early side effects within the first three months. Proctitis till 1991 with a duration up to 12 months 49%, prolonging more than one year in 23 %, (total proctitis 72.6%). Dysuria in up to 12 months 30 %, long lasting 30% (total number of dysuria 60 %). Erectile dysfunction in 56 %. Because of the number of the side effects 1991 we changed the external beam technique: instead of the biaxial arch therapy the AP-PA portals, and reduced irradiated volume (from 6480 cm 3 to 5040 cm 3 ). We introduced instead of the small volume arch therapy for 10 Gy external boost the box-technique with shielding the back part of the rectum and the upper part of the bladder resulting additional volume reduction. Through the 15 Gy HDR brachytherapy dose on the prostate capsule there are up to 8 Gy on the medial rectal wall, measured by in vivo dosimetry. This dose could not be responsible for the high number of side effects (see gynecological

  16. Comparison of MRI-based and CT/MRI fusion-based postimplant dosimetric analysis of prostate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Osamu; Hayashi, Shinya; Matsuo, Masayuki; Sakurai, Kota; Nakano, Masahiro; Maeda, Sunaho; Kajita, Kimihiro R.T.; Deguchi, Takashi; Hoshi, Hiroaki

    2006-01-01

    Purpose: The aim of this study was to compare the outcomes between magnetic resonance imaging (MRI)-based and computed tomography (CT)/MRI fusion-based postimplant dosimetry methods in permanent prostate brachytherapy. Methods and Materials: Between October 2004 and March 2006, a total of 52 consecutive patients with prostate cancer were treated by brachytherapy, and postimplant dosimetry was performed using CT/MRI fusion. The accuracy and reproducibility were prospectively compared between MRI-based dosimetry and CT/MRI fusion-based dosimetry based on the dose-volume histogram (DVH) related parameters as recommended by the American Brachytherapy Society. Results: The prostate volume was 15.97 ± 6.17 cc (mean ± SD) in MRI-based dosimetry, and 15.97 ± 6.02 cc in CT/MRI fusion-based dosimetry without statistical difference. The prostate V100 was 94.5% and 93.0% in MRI-based and CT/MRI fusion-based dosimetry, respectively, and the difference was statistically significant (p = 0.002). The prostate D90 was 119.4% and 114.4% in MRI-based and CT/MRI fusion-based dosimetry, respectively, and the difference was statistically significant (p = 0.004). Conclusion: Our current results suggested that, as with fusion images, MR images allowed accurate contouring of the organs, but they tended to overestimate the analysis of postimplant dosimetry in comparison to CT/MRI fusion images. Although this MRI-based dosimetric discrepancy was negligible, MRI-based dosimetry was acceptable and reproducible in comparison to CT-based dosimetry, because the difference between MRI-based and CT/MRI fusion-based results was smaller than that between CT-based and CT/MRI fusion-based results as previously reported

  17. Urethral and periurethral dosimetry in prostate brachytherapy: is there a convenient surrogate?

    International Nuclear Information System (INIS)

    Bucci, Joseph; Spadinger, Ingrid; Hilts, Michelle; Sidhu, Sabeena; Smith, Clarke; Keyes, Mira; Morris, W. James

    2002-01-01

    Purpose: To assess and compare two models for a surrogate urethra to be used for postimplant dosimetry in prostate brachytherapy. Methods and Materials: Twenty men with a urinary catheter present at the time of postimplant computed tomographic imaging were studied. Urethral and periurethral volumes were defined as 5-mm and 10-mm diameter volumes, respectively. Three contours of each were used: one contour of the true urethra (and periurethra), and two surrogate models. The true volumes were centered on the catheter center. One surrogate model used volumes centered on the geometrical center of each prostate contour (centered surrogate). The other surrogate model was based on the average deviation of the true urethra from a reference line through the geometrical center of the axial midplane of the prostate (deviated surrogate). Maximum point doses and the D 10 , D 25 , D 50 , D 90 , V 100 , V 120 , and V 150 of the true and surrogate volumes were measured and compared (D n is the minimum dose [Gy] received by n% of the structure, and V m is the volume [%] of the structure that received m% of the prescribed dose) as well as the distances between the surrogate urethras and the true urethra. Results: Doses determined from both surrogate urethral and periurethral volumes were in good agreement with the true urethral and periurethral doses except in the superior third of the gland. The deviated surrogate provided a physically superior likeness to the true urethra. Certain dose-volume histogram (DVH)-based parameters could also be predicted reasonably well on the basis of the surrogates. Correlation coefficients ≥0.85 were seen for D 25 , D 50 , V 100 , V 120 , and V 150 for both models. All the other parameters had correlation coefficients in the range of 0.73 - 0.85. Conclusions: Both surrogate models predicted true urethral dosimetry reasonably well. It is recommended that the simpler deviated surrogate would be a more suitable surrogate for routine clinical practice

  18. Second salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer

    Directory of Open Access Journals (Sweden)

    Metha Maenhout

    2017-04-01

    Full Text Available Purpose : Salvage treatments for localized radiorecurrent prostate cancer can be performed safely when a focal and image guided approach is used. Due to the low toxicity, the opportunity exists to investigate a second salvage treatment when a second locally recurrent prostate cancer occurs. Here, we describe a second salvage treatment procedure of 4 patients. Material and methods : Four patients with a pathologically proven second local recurrence were treated in an outpatient magnetic resonance imaging (MRI-guided setting with a single fraction of 19 Gy focal high-dose-rate brachytherapy (HDR-BT. Delineation was performed using choline-PET-CT or a 68Ga-PSMA PET in combination with multiparametric 3 Tesla MRI in all four patients. Toxicity was measured using common toxicity criteria for adverse events (CTCAE version 4.0. Results : With a median follow-up of 12 months (range, 6-15, there were 2 patients with biochemical recurrence as defined by the Phoenix-definition. There were no patients with grade 3 or more toxicity. In all second salvage HDR-BT treatments, the constraints for rectum, bladder, and urethra were met. Median treatment volume (GTV was 4.8 cc (range, 1.9-6.6 cc. A median of 8 catheters (range, 6-9 were used, and the median dose to the treatment volume (GTV was a D95: 19.3 Gy (SD 15.5-19.4 Gy. Conclusions : Second focal salvage MRI-guided HDR-BT for a select group of patients with a second locally recurrent prostate cancer is feasible. There was no grade 3 or more acute toxicity for these four patients.

  19. Evaluation of clinical benefits achievable by using different optimization algorithms during real-time prostate brachytherapy.

    Science.gov (United States)

    Adamczyk, Marta; Zwierzchowski, Grzegorz; Malicki, Julian; Skowronek, Janusz

    2013-01-01

    High dose rate (HDR) brachytherapy is a clinically used procedure in prostate cancer treatment. The purpose of this study was to present the influence of using different optimization algorithms in 3D-CBRT planning on the treatment plan quality. Treatment plans were calculated for 15 patients--three plans for each patient using: geometrical optimization (GO), inverse optimization (IO) and blind inverse optimization (BIO). For each patient, PTV and OAR volumes, number of needles and geometry of the implant were set equal. Differences between dose distributions were tracked using: D90, V100, V200, Dmax (for prostate); D10, Dmax (for urethra); D10, V100, Dmax (for rectum). The analysis of mean values of D90 and V100 in the prostate showed that inverse algorithms gave the best results (mean D90 was 12.1% for BIO and 9.3% for IO better than for GO, mean V100 was 8.2% for BIO and 6.3% for IO better than for GO). From a clinical point of view, GO diminished the doses in the PTV and urethra in all analyzed parameters. The lowest mean doses in the rectum were achieved for plans optimized with IO and BIO (mean D10: 61.2% for GO, 58.1% for IO, 58.0% for BIO; mean Dmax: 92.8% for GO, 85.1% for IO, 83.6% for BIO). Application of the blind inverse optimization (BIO) algorithm led to clinically best dose parameters for PTV and the rectum. Use of geometrical optimization (GO) led to smaller doses in the urethra, which was however associated with a certain dose decrease also in PTV. Copyright © 2011 Associazione Italiana di Fisica Medica. Published by Elsevier Ltd. All rights reserved.

  20. Dosimetric comparison of interactive planned and dynamic dose calculated prostate seed brachytherapy.

    Science.gov (United States)

    Meijer, Gert J; van den Berg, Hetty A; Hurkmans, Coen W; Stijns, Pascal E; Weterings, Jan H

    2006-09-01

    To compare the dosimetrical results of an interactive planning procedure and a procedure based on dynamic dose calculation for permanent prostate brachytherapy. Between 6/2000 and 11/2005, 510 patients underwent (125)I implants for T1-T2 prostate cancer. Before 4/2003, 187 patients were treated using an interactive technique that included needle updating. After that period, 323 patients were treated with a more refined dynamic technique that included constant updating of the deposited seed position. The comparison is based on postimplant dose - volume parameters such as the V(100) and d(90) for the target, V(100)(r) for the rectum and d(10)(u) for the urethra. Furthermore, the target volume ratios (TVR identical with V(100)(body)/V(100)), and the homogeneity indices (HI identical with [V(100)-V(150)]/V(100)) were calculated as additional quality parameters. The dose outside the target volume was significantly reduced, the V(100)(r) decreased from 1.4 cm(3) for the interactive technique to 0.6 cm(3) for the dynamic technique. Similarly the mean TVR reduced from 1.66 to 1.44. In addition, the mean V(100) increased from 92% for the interactive procedure to 95% for the dynamic procedure. More importantly, the percentage of patients with a V(100) < 80% reduced from 5% to 1%. A slight decline was observed with regard to the d(10)(u) (136% vs. 140%) and the HI (0.58 vs. 0.51). The dynamic implant procedure resulted in improved implants. Almost ideal dose coverage was achieved, while minimizing the dose outside the prostate.

  1. Dosimetric comparison of interactive planned and dynamic dose calculated prostate seed brachytherapy

    International Nuclear Information System (INIS)

    Meijer, Gert J.; Berg, Hetty A. van den; Hurkmans, Coen W.; Stijns, Pascal E.; Weterings, Jan H.

    2006-01-01

    Purpose: To compare the dosimetrical results of an interactive planning procedure and a procedure based on dynamic dose calculation for permanent prostate brachytherapy. Materials and methods: Between 6/2000 and 11/2005, 510 patients underwent 125 I implants for T1-T2 prostate cancer. Before 4/2003, 187 patients were treated using an interactive technique that included needle updating. After that period, 323 patients were treated with a more refined dynamic technique that included constant updating of the deposited seed position. The comparison is based on postimplant dose-volume parameters such as the V 100 and d 90 for the target, V 100 r for the rectum and d 10 u for the urethra. Furthermore, the target volume ratios (TVR=V 100 body /V 100 ), and the homogeneity indices (HI=[V 100 -V 150 ]/V 100 ) were calculated as additional quality parameters. Results: The dose outside the target volume was significantly reduced, the V 100 r decreased from 1.4cm 3 for the interactive technique to 0.6cm 3 for the dynamic technique. Similarly the mean TVR reduced from 1.66 to 1.44. In addition, the mean V 100 increased from 92% for the interactive procedure to 95% for the dynamic procedure. More importantly, the percentage of patients with a V 100 10 u (136% vs. 140%) and the HI (0.58 vs. 0.51). Conclusion: The dynamic implant procedure resulted in improved implants. Almost ideal dose coverage was achieved, while minimizing the dose outside the prostate

  2. Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Mingsheng; Wang, Haofan; Chen, Junwei; Bai, Mingjun; Wang, Long; Zhu, Kangshun; Jiang, Zaibo; Guan, Shouhai; Li, Zhengran; Qian, Jiesheng; Li, Mingan; Pang, Pengfei; Shan, Hong [Sun Yat-sen University, Department of Radiology, the Third Affiliated Hospital, Guangzhou (China); Sun Yat-Sen University, Department of Interventional Radiology, Ling-nan Hospital, Guangzhou (China); Sun Yat-sen University, Interventional Radiology Institute, Guangzhou (China); Lin, Qu [Sun Yat-sen University, Department of Oncology, the Third Affiliated Hospital, Guangzhou (China)

    2016-10-15

    To investigate the survival benefit of transarterial chemoembolization (TACE) plus Iodine125 seed implantation (TACE-Iodine125) in hepatitis B-related HCC patients with portal vein tumour thrombus (PVTT) and the underlying prognostic factors. A retrospective matched cohort study was performed on consecutive HCC patients with PVTT from January 2011 to June 2014. Seventy patients (TACE-Iodine125 group) who underwent TACE-Iodine125 were compared with a historical case-matched control group of 140 patients (TACE group) who received TACE alone. The survival of patients and the underlying prognostic factors were analysed. The median survival times of the TACE-Iodine125 and TACE groups were 11.0 and 7.5 months, respectively (p < 0.001). The survival probability at 12, 24, and 36 months was 50 %, 14.5 %, and 14.5 % vs. 25 %, 9 %, and 5 % in the TACE-Iodine125 and TACE groups, respectively (p < 0.001). The PVTT responders had better survival than the PVTT non-responders (p < 0.001). For the PVTT non-responders, there were no differences in the survival curves between the groups (p = 0.353). Multivariate analysis showed that type III PVTT (p < 0.001) and APS (p < 0.001) were independent predictors of poor prognosis. In contrast, the treatment modality of TACE-Iodine125 (p < 0.001) and PVTT response (p = 0.001) were favourable prognostic features. TACE combined with Iodine125 seed implantation may be a good choice for selected HB-HCC patients with PVTT. (orig.)

  3. The influence of the dwell time deviation constraint (DTDC) parameter on dosimetry with IPSA optimisation for HDR prostate brachytherapy

    International Nuclear Information System (INIS)

    Smith, Ryan L.; Millar, Jeremy L.; Panettieri, Vanessa; Mason, Natasha; Lancaster, Craig; Francih, Rick D.

    2015-01-01

    To investigate how the dwell time deviation constraint (DTDC) parameter, applied to inverse planning by simulated annealing (IPSA) optimisation limits large dwell times from occurring in each catheter and to characterise the effect on the resulting dosimetry for prostate high dose rate (HDR) brachytherapy treatment plans. An unconstrained IPSA optimised treatment plan, using the Oncentra Brachytherapy treatment planning system (version 4.3, Nucletron an Elekta company, Elekta AB, Stockholm, Sweden), was generated for 20 consecutive HDR prostate brachytherapy patients, with the DTDC set to zero. Successive constrained optimisation plans were also created for each patient by increasing the DTDC parameter by 0.2, up to a maximum value of 1.0. We defined a “plan modulation index”, to characterise the change of dwell time modulation as the DTDC parameter was increased. We calculated the dose volume histogram indices for the PTV (D90, V100, V150, V200%) and urethra (D10%) to characterise the effect on the resulting dosimetry. The average PTV D90% decreases as the DTDC is applied, on average by only 1.5 %, for a DTDC = 0.4. The measures of high dose regions in the PTV, V150 and V200%, increase on average by less than 5 and 2 % respectively. The net effect of DTDC on the modulation of dwell times has been characterised by the introduction of the plan modulation index. DTDC applied during IPSA optimisation of HDR prostate brachytherapy plans reduce the occurrence of large isolated dwell times within individual catheters. The mechanism by which DTDC works has been described and its effect on the modulation of dwell times has been characterised. The authors recommend using a DTDC parameter no greater than 0.4 to obtain a plan with dwell time modulation comparable to a geometric optimised plan. This yielded on average a 1.5 % decrease in PTV coverage and an acceptable increase in V150%, without compromising the urethral dose.

  4. Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy

    International Nuclear Information System (INIS)

    Balvert, Marleen; Gorissen, Bram L; Den Hertog, Dick; Hoffmann, Aswin L

    2015-01-01

    Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this problem. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that inevitably result from catheter reconstruction errors and afterloader source positioning inaccuracies. This study quantifies the reduction of high-dose subvolumes and the robustness against these uncertainties by applying a DTMR to template-based prostate HDR brachytherapy implants. Three different DTMRs were consecutively applied to a linear dose-based penalty model (LD) and a dose-volume based model (LDV), both obtained from literature. The models were solved with DTMR levels ranging from no restriction to uniform dwell times within catheters in discrete steps. Uncertainties were simulated on clinical cases using in-house developed software, and dose-volume metrics were calculated in each simulation. For the assessment of high-dose subvolumes, the dose homogeneity index (DHI) and the contiguous dose volume histogram were analysed. Robustness was measured by the improvement of the lowest D 90% of the planning target volume (PTV) observed in the simulations. For (LD), a DTMR yields an increase in DHI of approximately 30% and reduces the size of the largest high-dose volume by 2–5 cc. However, this comes at a cost of a reduction in D 90% of the PTV of 10%, which often implies that it drops below the desired minimum of 100%. For (LDV), none of the DTMRs were able to improve high-dose volume measures. DTMRs were not capable of improving robustness of PTV D 90% against uncertainty in dwell positions for both models. (paper)

  5. Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy

    Science.gov (United States)

    Balvert, Marleen; Gorissen, Bram L.; den Hertog, Dick; Hoffmann, Aswin L.

    2015-01-01

    Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this problem. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that inevitably result from catheter reconstruction errors and afterloader source positioning inaccuracies. This study quantifies the reduction of high-dose subvolumes and the robustness against these uncertainties by applying a DTMR to template-based prostate HDR brachytherapy implants. Three different DTMRs were consecutively applied to a linear dose-based penalty model (LD) and a dose-volume based model (LDV), both obtained from literature. The models were solved with DTMR levels ranging from no restriction to uniform dwell times within catheters in discrete steps. Uncertainties were simulated on clinical cases using in-house developed software, and dose-volume metrics were calculated in each simulation. For the assessment of high-dose subvolumes, the dose homogeneity index (DHI) and the contiguous dose volume histogram were analysed. Robustness was measured by the improvement of the lowest D90% of the planning target volume (PTV) observed in the simulations. For (LD), a DTMR yields an increase in DHI of approximately 30% and reduces the size of the largest high-dose volume by 2-5 cc. However, this comes at a cost of a reduction in D90% of the PTV of 10%, which often implies that it drops below the desired minimum of 100%. For (LDV), none of the DTMRs were able to improve high-dose volume measures. DTMRs were not capable of improving robustness of PTV D90% against uncertainty in dwell positions for both models.

  6. WE-A-17A-11: Implanted Brachytherapy Seed Movement Due to Transrectal Ultrasound Probe-Induced Prostate Deformation

    Energy Technology Data Exchange (ETDEWEB)

    Liu, D; Usmani, N; Sloboda, R [Cross Cancer Institute, Edmonton, Alberta (Canada); University of Alberta, Edmonton, Alberta (Canada); Meyer, T; Husain, S; Angyalfi, S [Tom Baker Cancer Centre, Calgary, Alberta (Canada); University of Calgary, Calgary, Alberta (Canada); Kay, I [Canterbury District Health Board, Christchurch (New Zealand)

    2014-06-15

    Purpose: To characterize the movement of implanted brachytherapy seeds due to transrectal ultrasound probe-induced prostate deformation and to estimate the effects on prostate dosimetry. Methods: Implanted probe-in and probe-removed seed distributions were reconstructed for 10 patients using C-arm fluoroscopy imaging. The prostate was delineated on ultrasound and registered to the fluoroscopy seeds using a visible subset of seeds and residual needle tracks. A linear tensor and shearing model correlated the seed movement with position. The seed movement model was used to infer the underlying prostate deformation and to simulate the prostate contour without probe compression. Changes in prostate and surrogate urethra dosimetry were calculated. Results: Seed movement patterns reflecting elastic decompression, lateral shearing, and rectal bending were observed. Elastic decompression was characterized by anterior-posterior expansion and superior-inferior and lateral contractions. For lateral shearing, anterior movement up to 6 mm was observed for extraprostatic seeds in the lateral peripheral region. The average intra-prostatic seed movement was 1.3 mm, and the residual after linear modeling was 0.6 mm. Prostate D90 increased by 4 Gy on average (8 Gy max) and was correlated with elastic decompression. For selected patients, lateral shearing resulted in differential change in D90 of 7 Gy between anterior and posterior quadrants, and increase in whole prostate D90 of 4 Gy. Urethra D10 increased by 4 Gy. Conclusion: Seed movement upon probe removal was characterized. The proposed model captured the linear correlation between seed movement and position. Whole prostate dose coverage increased slightly, due to the small but systematic seed movement associated with elastic decompression. Lateral shearing movement increased dose coverage in the anterior-lateral region, at the expense of the posterior-lateral region. The effect on whole prostate D90 was smaller due to the subset

  7. Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma

    International Nuclear Information System (INIS)

    Chargari, Cyrus; Haie-Meder, Christine; Guérin, Florent; Minard-Colin, Véronique; Lambert, Guénolée de; Mazeron, Renaud; Escande, Alexandre; Marsolat, Fanny; Dumas, Isabelle; Deutsch, Eric; Valteau-Couanet, Dominique

    2017-01-01

    Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder–prostate rhabdomyosarcoma (BP RMS). Methods and Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

  8. Brachytherapy Combined With Surgery for Conservative Treatment of Children With Bladder Neck and/or Prostate Rhabdomyosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Chargari, Cyrus, E-mail: cyrus.chargari@gustaveroussy.fr [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Institut de Recherche Biomédicale des Armées, Bretigny-sur-Orge (France); French Military Health Service Academy, Ecole du Val-de-Grâce, Paris (France); Haie-Meder, Christine [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Guérin, Florent [Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France); Minard-Colin, Véronique [Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France); Lambert, Guénolée de [Department of Pediatric Surgery, Bicêtre Hospital, Hôpitaux Universitaires Paris Sud, Assistance Publique des Hôpitaux de Paris, Le Kremlin-Bicêtre (France); Mazeron, Renaud; Escande, Alexandre; Marsolat, Fanny; Dumas, Isabelle [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Deutsch, Eric [Brachytherapy Unit, Department of Radiotherapy, Gustave Roussy, Villejuif (France); Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris Saclay, Paris (France); Valteau-Couanet, Dominique [Department of Pediatric and Adolescent Oncology, Gustave Roussy, Villejuif (France); and others

    2017-06-01

    Purpose: To report the results of a conservative strategy based on partial surgery combined with brachytherapy in a prospective cohort of children with bladder–prostate rhabdomyosarcoma (BP RMS). Methods and Materials: We prospectively documented the outcome of children treated in our department between 1991 and 2015 for BP RMS and undergoing a multimodal approach combining conservative surgery (partial cystectomy and/or partial prostatectomy) and perioperative interstitial low-dose-rate or pulse-dose-rate brachytherapy. Before brachytherapy, children had received chemotherapy with modalities depending on their risk group of treatment. Results: A total of 100 patients were identified, with a median age of 28 months (range, 5.6 months-14 years). According to the Intergroup Rhabdomyosarcoma Study (IRS) group, 84 were IRS-III, and 12 were IRS-IV tumors. Four patients were treated at relapse. The median number of chemotherapy cycles before local therapy was 6 (range, 4-13). After surgery, 63 patients had a macroscopic tumor residuum. Five patients underwent a brachytherapy boost before pelvic external beam radiation therapy because of nodal involvement, and 95 had exclusive brachytherapy. Median follow-up was 64 months (range, 6 months-24.5 years). Five-year disease-free and overall survival rates were 84% (95% confidence interval 80%-88%) and 91% (95% confidence interval 87%-95%), respectively. At last follow-up most survivors presented with only mild to moderate genitourinary sequelae and a normal diurnal urinary continence. Five patients required a secondary total cystectomy: 3 for a nonfunctional bladder and 2 for relapse. Conclusion: Brachytherapy is effective as part of a conservative strategy for BP RMS, with a relatively low delayed toxicity as compared with previously published studies using external beam radiation therapy. Longer follow-up is required to ensure that the functional results are maintained over time.

  9. Matched-pair analysis and dosimetric variations of two types of software for interstitial permanent brachytherapy for prostate cancer.

    Science.gov (United States)

    Ishiyama, Hiromichi; Nakamura, Ryuji; Satoh, Takefumi; Tanji, Susumu; Teh, Bin S; Uemae, Mineko; Baba, Shiro; Hayakawa, Kazushige

    2012-01-01

    The purpose of this study was to determine whether identical dosimetric results could be achieved using different planning software for permanent interstitial brachytherapy for prostate cancer. Data from 492 patients treated with brachytherapy were used for matched-pair analysis. Interplant and Variseed were used as software for ultrasound-based treatment planning. Institution, neoadjuvant hormonal therapy, prostate volume, and source strength were used for factors to match the 2 groups. The study population comprised of 126 patients with treatment planning using Interplant software and 127 matched patients using Variseed software. Dosimetric results were compared between the 2 groups. The Variseed group showed significantly higher values for dose covering 90% of prostate volume (pD90), prostate volume covered by 150% of prescription dose (pV150), and dose covering 30% of the urethra (uD30) compared with the Interplant group. Our results showed that use of different software could lead to different dosimetric results, which might affect the clinical outcomes. Copyright © 2012 American Association of Medical Dosimetrists. Published by Elsevier Inc. All rights reserved.

  10. Seed migration after transperineal interstitial prostate brachytherapy with I-125 free seeds: analysis of its incidence and risk factors.

    Science.gov (United States)

    Miyazawa, Katsuhito; Matoba, Munetaka; Minato, Hiroshi; Morita, Nobuyo; Chikazawa, Ippei; Ota, Kiyotaka; Tokunaga, Kosuke; Tonami, Hisao; Nojima, Takayuki; Suzuki, Koji

    2012-10-01

    The purpose of this study was to evaluate the incidence and predictors of seed migration after transperineal interstitial prostate brachytherapy. From March 2007 to March 2011, 121 patients with stage T1-T2 prostate cancer underwent transperineal interstitial prostate brachytherapy. Pre-planning was performed 3 weeks prior to implantation, and the implants were inserted using the standard parallel needle insertion technique. All patients underwent a series of radiographs [chest radiography, kidney-ureter-bladder (KUB) radiography, and a CT scan] to assess whether seed migration had occurred on postoperative days 1 and 30, and 12 months. Seed migration occurred in 31 (25.6 %) of 121 patients. A total of 51 of 7,883 (0.65 %) implanted seeds migrated. Migration was detected on postoperative day 1 in 16 patients, day 30 in 13 patients and at 12 months in 4 patients (migration occurred at different times in 2 patients). The migrated seeds were found in the lungs, pelvis, heart, mediastinum, kidney, inguinal canal, liver and sacrum. The number of needles was a statistically significant factor in seed migration. The seeds migrated to many organs. No decrease in the dose administered to the prostate or adverse effects associated with seed migration were noted.

  11. Genitourinary Toxicity After High-Dose-Rate (HDR) Brachytherapy Combined With Hypofractionated External Beam Radiotherapy for Localized Prostate Cancer: An Analysis to Determine the Correlation Between Dose-Volume Histogram Parameters in HDR Brachytherapy and Severity of Toxicity

    International Nuclear Information System (INIS)

    Ishiyama, Hiromichi; Kitano, Masashi; Satoh, Takefumi; Kotani, Shouko; Uemae, Mineko; Matsumoto, Kazumasa; Okusa, Hiroshi; Tabata, Ken-ichi; Baba, Shiro; Hayakawa, Kazushige

    2009-01-01

    Purpose: To evaluate the severity of genitourinary (GU) toxicity in high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiotherapy (EBRT) for prostate cancer and to explore factors that might affect the severity of GU toxicity. Methods and Materials: A total of 100 Japanese men with prostate cancer underwent 192 Ir HDR brachytherapy combined with hypofractionated EBRT. Mean (SD) dose to 90% of the planning target volume was 6.3 (0.7) Gy per fraction of HDR. After 5 fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administrated. The urethral volume receiving 1-15 Gy per fraction in HDR brachytherapy (V1-V15) and the dose to at least 5-100% of urethral volume in HDR brachytherapy (D5-D100) were compared between patients with Grade 3 toxicity and those with Grade 0-2 toxicity. Prostate volume, patient age, and International Prostate Symptom Score were also compared between the two groups. Results: Of the 100 patients, 6 displayed Grade 3 acute GU toxicity, and 12 displayed Grade 3 late GU toxicity. Regarding acute GU toxicity, values of V1, V2, V3, and V4 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Regarding late GU toxicity, values of D70, D80, V12, and V13 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Conclusions: The severity of GU toxicity in HDR brachytherapy combined with hypofractionated EBRT for prostate cancer was relatively high. The volume of prostatic urethra was associated with grade of acute GU toxicity, and urethral dose was associated with grade of late GU toxicity.

  12. Comparison between methods for fixing radioactive iodine in silver substrate for manufacturing brachytherapy sources

    International Nuclear Information System (INIS)

    Souza, Carla Daruich

    2012-01-01

    Among the different ways to treat prostate cancer, brachytherapy with iodine- 125 seeds is an option that provides good results and fewer side effects. In the present study several deposition methods of radioactive iodine in a silver substrate were compared in order to choose the most suitable alternative for the routine production to be implemented at IPEN's laboratory. The methodology used was chosen based on the available infrastructure and experience of the researchers present. Therefore, the 131 I was used for testing (same chemical behavior as 131 I). Four methods were selected: Method 1 (test based on electrodeposition method developed by D.Kubiatowicz) presented 65.16% efficiency; Method 2 (chemical reaction based on the method developed by D. Kubiatowicz - HCl) with the result of 70.80% efficiency; method 3 (chemical reaction based on the method developed by Dr. Maria Elisa Rostelato) with 55.80% efficiency; Method 4 (IQ-IPEN) resulted in 99% efficiency. Since this method has more radioactive material fixation (which represents virtually the entire cost of the seed), the final price is the cheapest. This method is the suggested one to be implemented in the IPEN's laboratory for brachytherapy sources production. Besides, the method is the fasted one. (author)

  13. Urethra-Sparing, Intraoperative, Real-Time Planned, Permanent-Seed Prostate Brachytherapy: Toxicity Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Zilli, Thomas [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada); Taussky, Daniel, E-mail: daniel.taussky.chum@ssss.gouv.qc.ca [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada); Donath, David; Le, Hoa Phong; Larouche, Renee-Xaviere; Beliveau-Nadeau, Dominique; Hervieux, Yannick; Delouya, Guila [Department of Radiation Oncology, Centre hospitalier de l' Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada)

    2011-11-15

    Purpose: To report the toxicity outcome in patients with localized prostate cancer undergoing {sup 125}I permanent-seed brachytherapy (BT) according to a urethra-sparing, intraoperative (IO), real-time planned conformal technique. Methods and Materials: Data were analyzed on 250 patients treated consecutively for low- or intermediate-risk prostate cancer between 2005 and 2009. The planned goal was urethral V{sub 150} = 0. Acute and late genitourinary (GU), gastrointestinal (GI), and erectile toxicities were scored with the International Prostate Symptom Score (IPSS) questionnaire and Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time for patients with at least 2 years of follow-up (n = 130) was 34.4 months (range, 24-56.9 months). Results: Mean IO urethra V{sub 150} was 0.018% {+-} 0.08%. Mean prostate D{sub 90} and V{sub 100} on day-30 computed tomography scan were 158.0 {+-} 27.0 Gy and 92.1% {+-} 7.2%, respectively. Mean IPSS peak was 9.5 {+-} 6.3 1 month after BT (mean difference from baseline IPSS, 5.3). No acute GI toxicity was observed in 86.8% of patients. The 3-year probability of Grade {>=}2 late GU toxicity-free survival was 77.4% {+-} 4.0%, with Grade 3 late GU toxicity encountered in only 3 patients. Three-year Grade 1 late GI toxicity-free survival was 86.1% {+-} 3.2%. No patient presented Grade {>=}2 late GI toxicity. Of patients with normal sexual status at baseline, 20.7% manifested Grade {>=}2 erectile dysfunction after BT. On multivariate analysis, elevated baseline IPSS (p = 0.016) and high-activity sources (median 0.61 mCi) (p = 0.033) predicted increased Grade {>=}2 late GU toxicity. Conclusions: Urethra-sparing IO BT results in low acute and late GU toxicity compared with the literature. High seed activity and elevated IPSS at baseline increased long-term GU toxicity.

  14. Immunospecific red cell binding of iodine 125-labeled immunoglobulin G erythrocyte autoantibodies

    International Nuclear Information System (INIS)

    Masouredis, S.P.; Branks, M.J.; Garratty, G.; Victoria, E.J.

    1987-01-01

    The primary interaction of autoantibodies with red cells has been studied by using labeled autoantibodies. Immunoglobulin G red cell autoantibodies obtained from IgG antiglobulin-positive normal blood donors were labeled with radioactive iodine and compared with alloanti-D with respect to their properties and binding behavior. Iodine 125 -labeled IgG autoantibody migrated as a single homogeneous peak with the same relative mobility as human IgG on sodium dodecyl sulfate-polyacrylamide gel electrophoresis. The isoelectric focusing pattern of labeled autoantibodies varied from donor to donor but was similar to that of alloanti-D, consisting of multiple IgG populations with isoelectric points in the neutral to alkaline range. 125 I-autoantibody bound to all human red cells of common Rh phenotypes. Evidence for immunospecific antibody binding of the labeled autoantibody was based on variation in equilibrium binding to nonhuman and human red cells of common and rare phenotypes, enhanced binding after red cell protease modification, antiglobulin reactivity of cell-bound IgG comparable to that of cell-bound anti-D, and saturation binding in autoantibody excess. Scatchard analysis of two 125 I-autoantibody preparations yielded site numbers of 41,500 and 53,300 with equilibrium constants of 3.7 and 2.1 X 10(8) L X mol-1. Dog, rabbit, rhesus monkey, and baboon red cells were antigen(s) negative by quantitative adsorption studies adsorbing less than 3% of the labeled autoantibody. Reduced ability of rare human D--red blood cells to adsorb the autoantibody and identification of donor autoantibodies that bind to Rh null red blood cells indicated that eluates contained multiple antibody populations of complex specificities in contrast to anti-D, which consists of a monospecific antibody population. Another difference is that less than 70% of the autoantibody IgG was adsorbed by maximum binding red blood cells as compared with greater than 85% for alloanti-D

  15. An Eight-Year Experience of HDR Brachytherapy Boost for Localized Prostate Cancer: Biopsy and PSA Outcome

    International Nuclear Information System (INIS)

    Bachand, Francois; Martin, Andre-Guy; Beaulieu, Luc; Harel, Francois M.Sc.; Vigneault, Eric

    2009-01-01

    Purpose: To evaluate the biochemical recurrence-free survival (bRFS), the 2-year biopsy outcome and the prostate-specific antigen (PSA) bounce in patients with localized prostate cancer treated with an inversely planned high-dose-rate (HDR) brachytherapy boost. Materials and methods: Data were collected from 153 patients treated between 1999 and 2006 with external beam pelvic radiation followed by an HDR Ir-192 prostate boost. These patients were given a boost of 18 to 20 Gy using inverse-planning with simulated annealing (IPSA).We reviewed and analyzed all prostate-specific antigen levels and control biopsies. Results: The median follow-up was 44 months (18-95 months). When categorized by risk of progression, 74.5% of patients presented an intermediate risk and 14.4% a high one. Prostate biopsies at 2 years posttreatment were negative in 86 of 94 patients (91.5%), whereas two biopsies were inconclusive. Biochemical control at 60 months was at 96% according to the American Society for Therapeutic Radiology and Oncology and the Phoenix consensus definitions. A PSA bounce (PSA values of 2 ng/mL or more above nadir) was observed in 15 patients of 123 (9.8%). The median time to bounce was 15.2 months (interquartile range, 11.0-17.7) and the median bounce duration 18.7 months (interquartile range, 12.1-29). The estimate of overall survival at 60 months was 97.1% (95% CI, 91.6-103%). Conclusions: Considering that inverse planned HDR brachytherapy prostate boosts led to an excellent biochemical response, with a 2-year negative biopsy rate, we recommend a conservative approach in face of a PSA bounce even though it was observed in 10% of patients

  16. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer.

    Science.gov (United States)

    Rosenthal, Seth A; Bittner, Nathan H J; Beyer, David C; Demanes, D Jeffrey; Goldsmith, Brian J; Horwitz, Eric M; Ibbott, Geoffrey S; Lee, W Robert; Nag, Subir; Suh, W Warren; Potters, Louis

    2011-02-01

    Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachytherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program. Copyright © 2011 American Society for Radiation Oncology and American College of Radiology. Published by Elsevier Inc. All rights reserved.

  17. Obstructive urination problems after high-dose-rate brachytherapy boost treatment for prostate cancer are avoidable

    International Nuclear Information System (INIS)

    Kragelj, Borut

    2016-01-01

    Aiming at improving treatment individualization in patients with prostate cancer treated with combination of external beam radiotherapy and high-dose-rate brachytherapy to boost the dose to prostate (HDRB-B), the objective was to evaluate factors that have potential impact on obstructive urination problems (OUP) after HDRB-B. In the follow-up study 88 patients consecutively treated with HDRB-B at the Institute of Oncology Ljubljana in the period 2006-2011 were included. The observed outcome was deterioration of OUP (DOUP) during the follow-up period longer than 1 year. Univariate and multivariate relationship analysis between DOUP and potential risk factors (treatment factors, patients’ characteristics) was carried out by using binary logistic regression. ROC curve was constructed on predicted values and the area under the curve (AUC) calculated to assess the performance of the multivariate model. Analysis was carried out on 71 patients who completed 3 years of follow-up. DOUP was noted in 13/71 (18.3%) of them. The results of multivariate analysis showed statistically significant relationship between DOUP and anti-coagulation treatment (OR 4.86, 95% C.I. limits: 1.21-19.61, p = 0.026). Also minimal dose received by 90% of the urethra volume was close to statistical significance (OR = 1.23; 95% C.I. limits: 0.98-1.07, p = 0.099). The value of AUC was 0.755. The study emphasized the relationship between DOUP and anticoagulation treatment, and suggested the multivariate model with fair predictive performance. This model potentially enables a reduction of DOUP after HDRB-B. It supports the belief that further research should be focused on urethral sphincter as a critical structure for OUP

  18. Is intraoperative real-time dosimetry in prostate seed brachytherapy predictive of biochemical outcome?

    Directory of Open Access Journals (Sweden)

    Daniel Taussky

    2017-06-01

    Full Text Available Purpose : To analyze intraoperative (IO dosimetry using transrectal ultrasound (TRUS, performed before and after prostate low-dose-rate brachytherapy (LDR-BT, and compare it to dosimetry performed 30 days following the LDR-BT implant (Day 30. Material and methods : A total of 236 patients underwent prostate LDR-BT using 125 I that was performed with a three-dimensional TRUS-guided interactive inverse preplanning system (preimplant dosimetry. After the implant procedure, the TRUS was repeated in the operating room, and the dosimetry was recalculated (postimplant dosimetry and compared to dosimetry on Day 30 computed tomography (CT scans. Area under curve (AUC statistics was used for models predictive of dosimetric parameters at Day 30. Results : The median follow-up for patients without BF was 96 months, the 5-year and 8-year biochemical recurrence (BR-free rate was 96% and 90%, respectively. The postimplant median D 90 was 3.8 Gy lower (interquartile range [IQR], 12.4-0.9, and the V 100 only 1% less (IQR, 2.9-0.2% than the preimplant dosimetry. When comparing the postimplant and the Day 30 dosimetries, the postimplant median D 90 was 9.6 Gy higher (IQR [–] 9.5-30.3 Gy, and the V 100 was 3.2% greater (0.2-8.9% than Day 30 postimplant dosimetry. The variables that best predicted the D 90 of Day 30 was the postimplant D 90 (AUC = 0.62, p = 0.038. None of the analyzed values for IO or Day 30 dosimetry showed any predictive value for BR. Conclusions : Although improving the IO preimplant and postimplant dosimetry improved dosimetry on Day 30, the BR-free rate was not dependent on any dosimetric parameter. Unpredictable factors such as intraprostatic seed migration and IO factors, prevented the accurate prediction of Day 30 dosimetry.

  19. Mixed integer programming improves comprehensibility and plan quality in inverse optimization of prostate HDR brachytherapy.

    Science.gov (United States)

    Gorissen, Bram L; den Hertog, Dick; Hoffmann, Aswin L

    2013-02-21

    Current inverse treatment planning methods that optimize both catheter positions and dwell times in prostate HDR brachytherapy use surrogate linear or quadratic objective functions that have no direct interpretation in terms of dose-volume histogram (DVH) criteria, do not result in an optimum or have long solution times. We decrease the solution time of the existing linear and quadratic dose-based programming models (LP and QP, respectively) to allow optimizing over potential catheter positions using mixed integer programming. An additional average speed-up of 75% can be obtained by stopping the solver at an early stage, without deterioration of the plan quality. For a fixed catheter configuration, the dwell time optimization model LP solves to optimality in less than 15 s, which confirms earlier results. We propose an iterative procedure for QP that allows us to prescribe the target dose as an interval, while retaining independence between the solution time and the number of dose calculation points. This iterative procedure is comparable in speed to the LP model and produces better plans than the non-iterative QP. We formulate a new dose-volume-based model that maximizes V(100%) while satisfying pre-set DVH criteria. This model optimizes both catheter positions and dwell times within a few minutes depending on prostate volume and number of catheters, optimizes dwell times within 35 s and gives better DVH statistics than dose-based models. The solutions suggest that the correlation between the objective value and the clinical plan quality is weak in the existing dose-based models.

  20. BrachyView, A novel inbody imaging system for HDR prostate brachytherapy: Design and Monte Carlo feasibility study

    Energy Technology Data Exchange (ETDEWEB)

    Safavi-Naeini, M.; Han, Z.; Cutajar, D.; Guatelli, S.; Petasecca, M.; Lerch, M. L. F. [Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Franklin, D. R. [Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007 (Australia); Jakubek, J.; Pospisil, S. [Institute of Experimental and Applied Physics (IEAP), Czech Technical University in Prague (CTU) (Czech Republic); Bucci, J.; Zaider, M.; Rosenfeld, A. B. [St. George Hospital Cancer Care Centre, Gray Street, Kogarah, NSW 2217 (Australia); Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)

    2013-07-15

    Purpose: High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper, HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 Multiplication-Sign 60 mm{sup 2} silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project.Methods: Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a {sup 192}Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location.Results: Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in

  1. BrachyView, a novel inbody imaging system for HDR prostate brachytherapy: design and Monte Carlo feasibility study.

    Science.gov (United States)

    Safavi-Naeini, M; Han, Z; Cutajar, D; Guatelli, S; Petasecca, M; Lerch, M L F; Franklin, D R; Jakubek, J; Pospisil, S; Bucci, J; Zaider, M; Rosenfeld, A B

    2013-07-01

    High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper, HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 × 60 mm(2) silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project. Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a (192)Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location. Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in the estimated projection position was found to be

  2. An in vivo investigative protocol for HDR prostate brachytherapy using urethral and rectal thermoluminescence dosimetry

    International Nuclear Information System (INIS)

    Toye, Warren; Das, Ram; Kron, Tomas; Franich, Rick; Johnston, Peter; Duchesne, Gillian

    2009-01-01

    Purpose: To develop an in vivo dosimetry based investigative action level relevant for a corrective protocol for HDR brachytherapy boost treatment. Methods and materials: The dose delivered to points within the urethra and rectum was measured using TLD in vivo dosimetry in 56 patients. Comparisons between the urethral and rectal measurements and TPS calculations showed differences, which are related to the relative position of the implant and TLD trains, and allowed shifts of implant position relative to the prostate to be estimated. Results and conclusions: Analysis of rectal dose measurements is consistent with implant movement, which was previously only identified with the urethral data. Shift corrected doses were compared with results from the TPS. Comparison of peak doses to the urethra and rectum has been assessed against the proposed corrective protocol to limit overdosing these critical structures. An initial investigative level of 20% difference between measured and TPS peak dose was established, which corresponds to 1/3 of patients which was practical for the caseload. These patients were assessed resulting in corrective action being applied for one patient. Multiple triggering for selective investigative action is outlined. The use of a single in vivo measurement in the first fraction optimizes patient benefit at acceptable cost.

  3. Comparison of urethral diameters for calculating the urethral dose after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Osamu; Hayashi, Shinya; Matsuo, Masayuki; Nakano, Masahiro; Kubota, Yasuaki; Maeda, Sunaho; Ohtakara, Kazuhiro; Deguchi, Takashi; Hoshi, Hiroaki

    2007-01-01

    No studies have yet evaluated the effects of a dosimetric analysis for different urethral volumes. We therefore evaluated the effects of a dosimetric analysis to determine the different urethral volumes. This study was based on computed tomography/magnetic resonance imaging (CT/MRI) combined findings in 30 patients who had undergone prostate brachytherapy. Postimplant CT/MRI scans were performed 30 days after the implant. The urethra was contoured based on its diameter (8, 6, 4, 2, and 0 mm). The total urethral volume-in cubic centimeters [UrV150/200 (cc)] and percent (UrV150%/200%), of the urethra receiving 150% or 200% of the prescribed dose-and the doses (UrD90/30/5) in Grays to 90%, 30%, and 5% of the urethral volume were measured based on the urethral diameters. The UrV150 (cc) and UrD30 were statistically different between the of 8-, 6-, 4-, 2-, and 0-mm diameters, whereas the UrD5 was statistically different only between the 8-, 6-, and 4-mm diameters. Especially for UrD5, there was an approximately 40-Gy difference between the mean values for the 8- and 0-mm diameters. We recommend that the urethra should be contoured as a 4- to 6-mm diameter circle or one side of a triangle of 5-7 mm. By standardizing the urethral diameter, the urethral dose will be less affected by the total urethral volume. (author)

  4. Optimization of interstitial brachytherapy for local advanced prostate cancer by a new implantation technique

    International Nuclear Information System (INIS)

    Kovacs, G.; Galalae, R.; Wirth, B.; Kimmig, B.N.

    1995-01-01

    In cooperation with the companies BIP GmbH and Isotopen-Technik Dr. Sauerwein GmbH we developed a high-speed implantation machine, which was tested by 22 interstitial prostate applications. We compared the manual needle positioning method to the high-speed machine and observed the sequence of needle deviation as well as the acute postoperative side effects (hematoma, macroscopic hematuria, pain and urin stop). Using the manual implantation method (n=12) 43.8% of all implanted needles (42 out of 96, mean 3.5) showed a deviation vs. 3.6% (3 out of 83, mean 0.3) by the use of the high-speed device (n=10). Acute postoperative side effects according to the implantation were: Urin stop (3 vs. 0), macroscopic hematuria (3 vs.1), and pain (4 vs. 1), respectively. The use of a modified high-speed biopsy device for the interstitial brachytherapy results in a higher accuracy in the needle positioning and in reproducing pretreatment implantation plans. Because of the good clinical experience we introduced the high-speed implantation device into our clinical routine. (orig./MG) [de

  5. Feasibility of salvage interstitial microwave thermal therapy for prostate carcinoma following failed brachytherapy: studies in a tissue equivalent phantom

    International Nuclear Information System (INIS)

    McCann, Claire; Kumaradas, J Carl; Gertner, Mark R; Davidson, Sean R H; Dolan, Alfred M; Sherar, Michael D

    2003-01-01

    Thermal therapy is an experimental treatment to destroy solid tumours by heating them to temperatures ranging from 55 deg C to 90 deg C, inducing thermal coagulation and necrosis of the tumour. We are investigating the feasibility of interstitial microwave thermal therapy as a salvage treatment for prostate cancer patients with local recurrence following failed brachytherapy. Due to the electrical and thermal conductivity of the brachytherapy seeds, we hypothesized that the seeds could scatter the microwave energy and cause unpredictable heating. To investigate this, a 915 MHz helical antenna was inserted into a muscle-equivalent phantom with and without brachytherapy seeds. Following a 10 W, 5 s input to the antenna, the temperature rise was used to calculate absorbed power, also referred to as specific absorption rate (SAR). Plane wave models based on Maxwell's equations were also used to characterize the electromagnetic scattering effect of the seeds. In addition, the phantom was heated with 8 W for 5 min to quantify the effect of the seeds on the temperature distribution during extended heating. SAR measurements indicated that the seeds had no significant effect on the shape and size of the SAR pattern of the antenna. However, the plane wave simulations indicated that the seeds could scatter the microwave energy resulting in hot spots at the seed edges. Lack of experimental evidence of these hot spots was probably due to the complex polarization of the microwaves emitted by the helical antenna. Extended heating experiments also demonstrated that the seeds had no significant effect on the temperature distributions and rates of temperature rise measured in the phantom. The results indicate that brachytherapy seeds are not a technical impediment to interstitial microwave thermal therapy as a salvage treatment following failed brachytherapy

  6. Measurement of the increase in the capillary permeability in skin with Evans blue labelled with iodine-125 or 131

    International Nuclear Information System (INIS)

    Sugarava, S.; Goncalves, J.M.

    1976-01-01

    The quantitative evaluation of bradykinin and histamine with Evans blue labelled with iodine -125 or 131 is described. The activity upon vascular permeability was performed in the abdominal wall of rats injecting intravenously solution of labelled Evans blue and 0,1 ml of vasoactive drugs solution intradermally. Skin discs were cut with circular punch for external counting, quantitative results being compared with control discs. By using this method, satisfactory log dose-reponse curves were obtained for bradykinin and histamine that followed the general trend of S - shaped curves [pt

  7. Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Stock, Richard G.; Stone, Nelson N.; Iannuzzi, Christopher

    1996-01-01

    brachytherapy for the treatment of localized prostate cancer is associated with preservation of erectile function in the vast majority of patients, although a minor decrease in potency is not uncommon

  8. Reliability of EUCLIDIAN: An autonomous robotic system for image-guided prostate brachytherapy

    International Nuclear Information System (INIS)

    Podder, Tarun K.; Buzurovic, Ivan; Huang Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan

    2011-01-01

    Purpose: Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. Methods: The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane's model and the Army Material Systems Analysis Activity, i.e., Crow's model, were applied. The MTBF was used as an important measure for assessing the system's reliability. Results: During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane's postulation as well as Crow's postulation of reliability growth. The Laplace test index was -3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward improved reliability. The MTBF

  9. Nationwide, Multicenter, Retrospective Study on High-Dose-Rate Brachytherapy as Monotherapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yoshioka, Yasuo, E-mail: yoshioka@radonc.med.osaka-u.ac.jp [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Kotsuma, Tadayuki [Department of Radiation Oncology, Osaka National Hospital, Osaka (Japan); Komiya, Akira [Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama (Japan); Department of Urology, Chiba University Hospital, Chiba (Japan); Kariya, Shinji [Department of Radiology, Kochi Medical School, Kochi (Japan); Konishi, Koji [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Nonomura, Norio [Department of Urology, Osaka University Graduate School of Medicine, Osaka (Japan); Ogawa, Kazuhiko [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Tanaka, Eiichi [Department of Radiation Oncology, Osaka National Hospital, Osaka (Japan); Nishimura, Kensaku [Department of Urology, Osaka National Hospital, Osaka (Japan); Fujiuchi, Yasuyoshi; Kitamura, Hiroshi [Department of Urology, Graduate School of Medicine and Pharmaceutical Sciences for Research, University of Toyama, Toyama (Japan); Yamagami, Takuji [Department of Radiology, Kochi Medical School, Kochi (Japan); Yamasaki, Ichiro [Department of Urology, Kochi Medical School, Kochi (Japan); Nishimura, Kazuo [Department of Urology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Teshima, Teruki [Department of Radiation Oncology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka (Japan); Nakamura, Katsumasa [Department of Radiation Oncology, Hamamatsu University School of Medicine, Shizuoka (Japan); Itami, Jun [Department of Radiation Oncology, National Cancer Center Hospital, Tokyo (Japan)

    2017-04-01

    Purpose: To present, analyze, and discuss results of a nationwide, multicenter, retrospective study on high-dose-rate brachytherapy (HDR-BT) as monotherapy for low-, intermediate-, and high-risk prostate cancer. Methods and Materials: From 1995 through 2013, 524 patients, 73 (14%) with low-risk, 207 (40%) with intermediate-risk, and 244 (47%) with high-risk prostate cancer, were treated with HDR-BT as monotherapy at 5 institutions in Japan. Dose fractionations were 27 Gy/2 fractions for 69 patients (13%), 45.5 Gy/7 fractions for 168 (32%), 49 Gy/7 fractions for 149 (28%), 54 Gy/9 fractions for 130 (25%), and others for 8 (2%). Of these patients, 156 (30%) did not receive androgen deprivation therapy, and 202 patients (39%) did receive androgen deprivation therapy <1 year, 112 (21%) for 1-3 years, and 54 (10%) for >3 years. Median follow-up time was 5.9 years (range, 0.4-18.1 years), with a minimum of 2 years for surviving patients. Results: After 5 years, respective actuarial rates of no biochemical evidence of disease, overall survival, cause-specific survival, and metastasis-free survival for all patients were 92%, 97%, 99%, and 94%. For low/intermediate/high-risk patients, the 5-year no biochemical evidence of disease rates were 95%/94%/89%, the 5-year overall survival rates were 98%/98%/94%, the 5-year cause-specific survival rates were 98%/100%/98%, and the 5-year metastasis-free survival rates were 98%/95%/90%, respectively. The cumulative incidence of late grade 2 to 3 genitourinary toxicity at 5 years was 19%, and that of late grade 3 was 1%. The corresponding incidences of gastrointestinal toxicity were 3% and 0% (0.2%). No grade 4 or 5 of either type of toxicity was detected. Conclusions: The findings of this nationwide, multicenter, retrospective study demonstrate that HDR-BT as monotherapy was safe and effective for all patients with low-, intermediate-, and high-risk prostate cancer.

  10. High-dose-rate brachytherapy as salvage modality for locally recurrent prostate cancer after definitive radiotherapy. A systematic review

    Energy Technology Data Exchange (ETDEWEB)

    Chatzikonstantinou, Georgios; Zamboglou, Nikolaos; Roedel, Claus; Tselis, Nikolaos [J.W. Goethe University of Frankfurt, Department of Radiotherapy and Oncology, Frankfurt am Main (Germany); Zoga, Eleni [Sana Klinikum Offenbach, Department of Radiotherapy and Oncology, Offenbach am Main (Germany); Strouthos, Iosif [Medical Center - University of Freiburg, Department of Radiotherapy and Oncology, University of Freiburg, Freiburg (Germany); Butt, Saeed Ahmed [Sana Klinikum Offenbach, Department of Medical Physics and Engineering, Offenbach am Main (Germany)

    2017-09-15

    To review the current status of interstitial high-dose-rate brachytherapy as a salvage modality (sHDR BRT) for locally recurrent prostate cancer after definitive radiotherapy (RT). A literature search was performed in PubMed using ''high-dose-rate, brachytherapy, prostate cancer, salvage'' as search terms. In all, 51 search results published between 2000 and 2016 were identified. Data tables were generated and summary descriptions created. The main outcome parameters used were biochemical control (BC) and toxicity scores. Eleven publications reported clinical outcome and toxicity with follow-up ranging from 4-191 months. A variety of dose and fractionation schedules were described, including 19.0 Gy in 2 fractions up to 42.0 Gy in 6 fractions. The 5-year BC ranged from 18-77%. Late grade 3 genitourinary and gastrointestinal toxicity was 0-32% and 0-5.1%, respectively. sHDR BRT appears as safe and effective salvage modality for the reirradiation of locally recurrent prostate cancer after definitive RT. (orig.) [German] Zusammenfassende Darstellung relevanter Literatur zur interstitiellen High-Dose-Rate-Brachytherapie als Salvage-Modalitaet (sHDR-BRT) bei der Behandlung des lokal rezidivierten Prostatakarzinoms nach vorausgegangener definitiver Radiotherapie (RT). In der PubMed-Datenbank wurde eine Literaturrecherche mit den Suchbegriffen ''high-dose-rate, brachytherapy, prostate cancer, salvage'' durchgefuehrt. Zwischen den Jahren 2000 und 2016 wurden 51 Publikationen identifiziert. Die biochemische Kontrolle (BC) sowie das assoziierte Toxizitaetsprofil waren onkologische Hauptpunkte in der Analyse der beruecksichtigten Literatur. Von onkologischen Ergebnissen und Toxizitaeten berichteten 11 Publikationen bei einer medianen Nachbeobachtungszeit von 4-191 Monaten. Eine Variabilitaet von Dosis- und Fraktionierungsregimen wurde beschrieben mit totalen physikalischen Dosen von 19,0 Gy in 2 Fraktionen bis zu 42,0 Gy in 6 Fraktionen

  11. Three-dimensional computed tomography-guided monotherapeutic pararectal brachytherapy of prostate cancer with seminal vesicle invasion

    International Nuclear Information System (INIS)

    Koutrouvelis, Panos; Lailas, Niko; Hendricks, Fred; Gil-Montero, Guillermo; Sehn, James; Katz, Stuart

    2001-01-01

    Purpose: To treat patients with prostate cancer and seminal vesicle invasion with monotherapeutic three dimensional computed tomography (3-DCT)-guided posterior pararectal brachytherapy. Methods and materials: Three hundred and sixty two patients with clinical stage T1 a,b or T2 a,b of prostate cancer were referred for 3-DCT-guided brachytherapy. Each underwent further staging with 3-D CT-guided pararectal biopsy of the seminal vesicles under local anesthesia during the pre-treatment CT-planning. Forty-three patients (12%) were upstaged to T3 cNoMo disease. In the set of 43 patients, Eight had Gleason's score≤6, 24 Gleason's score=7, and 11 patients ≥8. Initial PSA was 20 in 18 patients. Of the 43 patients, 37 patients were treated monotherapeutically with 3-D CT-guided brachytherapy. No patients received hormone therapy after the implant. The prescribed dosage to the seminal vesicles and prostate is 120 Gy with Pd-103 seeds and 144 Gy with 1-125 seeds. Results: The prescribed dosage was achieved in all 37 patient's throughout the seminal vesicles whose range of target radiation extended 5-10 mm outside the target in the adjacent fat as calculated with post-implant CT-dosimetry with Varian Brachy Vision or MMS software. Prostate Specific Antigen (PSA) outcome data were available in 34 patients treated with monotherapy and follow up ranged from 12-56 months (median, 24 months). Decreased PSA levels were stratified into six groups based on the presenting Gleason's score and initial PSA. In the first group (with Gleason's score≤6 and initial PSA 20 ng/ml), PSA decreased to less than 0.5 ng/ml in four out of eight patients (50%). All of the patients in the fourth group (with Gleason's score≥8 and initial PSA 20 ng/ml). There were no patients with Gleason's score of 1-6 and greater than 20 ng/ml initial PSA. Patients, irrespective of the Gleason's score and PSA, had an overall response of decreased PSA (less than 1 ng/ml) of 79%. Conclusion: 3-D CT

  12. Dosimetric study of prostate brachytherapy using techniques of Monte-Carlo simulation, experimental measurements and comparison with a treatment plan

    International Nuclear Information System (INIS)

    Teles, Pedro; Barros, Silvia; Vaz, Pedro; Goncalves, Isabel; Facure, Alessandro; Rosa, Luiz da; Santos, Maira; Pereira Junior, Pedro Paulo; Zankl, Maria

    2013-01-01

    Prostate Brachytherapy is a radiotherapy technique, which consists in inserting a number of radioactive seeds (containing, usually, the following radionuclides 125 l, 241 Am or 103 Pd ) surrounding or in the vicinity of, prostate tumor tissue . The main objective of this technique is to maximize the radiation dose to the tumor and minimize it in other tissues and organs healthy, in order to reduce its morbidity. The absorbed dose distribution in the prostate, using this technique is usually non-homogeneous and time dependent. Various parameters such as the type of seed, the attenuation interactions between them, their geometrical arrangement within the prostate, the actual geometry of the seeds,and further swelling of the prostate gland after implantation greatly influence the course of absorbed dose in the prostate and surrounding areas. Quantification of these parameters is therefore extremely important for dose optimization and improvement of their plans conventional treatment, which in many cases not fully take into account. The Monte Carlo techniques allow to study these parameters quickly and effectively. In this work, we use the program MCNPX and generic voxel phantom (GOLEM) where simulated different geometric arrangements of seeds containing 125 I, Amersham Health model of type 6711 in prostates of different sizes, in order to try to quantify some of the parameters. The computational model was validated using a phantom prostate cubic RW3 type , consisting of tissue equivalent, and thermoluminescent dosimeters. Finally, to have a term of comparison with a treatment real plan it was simulate a treatment plan used in a hospital of Rio de Janeiro, with exactly the same parameters, and our computational model. The results obtained in our study seem to indicate that the parameters described above may be a source of uncertainty in the correct evaluation of the dose required for actual treatment plans. The use of Monte Carlo techniques can serve as a complementary

  13. Prostate brachytherapy postimplant dosimetry: Seed orientation and the impact of dosimetric anisotropy in stranded implants

    International Nuclear Information System (INIS)

    Chng, Nicholas; Spadinger, Ingrid; Rasoda, Rosey; Morris, W. James; Salcudean, Septimiu

    2012-01-01

    Purpose: In postimplant dosimetry for prostate brachytherapy, dose is commonly calculated using the TG-43 1D formalism, because seed orientations are difficult to determine from CT images, the current standard for the procedure. However, the orientation of stranded seeds soon after implantation is predictable, as these seeds tend to maintain their relative spacing, and orient themselves along the implant trajectory. The aim of this study was to develop a method for determining seed orientations from reconstructed strand trajectories, and to use this information to investigate the dosimetric impact of applying the TG-43 2D formalism to clinical postimplant analysis. Methods: Using in-house software, the preplan to postimplant seed correspondence was determined for a cohort of 30 patients during routine day-0 CT-based postimplant dosimetry. All patients were implanted with stranded-seed trains. Spline curves were fit to each set of seeds composing a strand, with the requirement that the distance along the spline between seeds be equal to the seed spacing within the strand. The orientations of the seeds were estimated by the tangents to the spline at each seed centroid. Dose distributions were then determined using the 1D and 2D TG-43 formalisms. These were compared using the TG-137 recommended dose metrics for the prostate, prostatic urethra, and rectum. Results: Seven hundred and sixty one strands were analyzed in total. Defining the z-axis to be cranial-positive and the x-axis to be left-lateral positive in the CT coordinate system, the average seed had an inclination of 21 deg. ± 10 deg. and an azimuth of -81 deg. ± 57 deg. These values correspond to the average strand rising anteriorly from apex to base, approximately parallel to the midsagittal plane. Clinically minor but statistically significant differences in dose metrics were noted. Compared to the 2D calculation, the 1D calculation underestimated prostate V100 by 1.1% and D90 by 2.3 Gy, while

  14. Evaluation of interobserver differences in postimplant dosimetry following prostate brachytherapy and the efficacy of CT/MRI fusion imaging

    International Nuclear Information System (INIS)

    Aoki, Manabu; Yorozu, Atsunori; Dokiya, Takushi

    2009-01-01

    Interobserver differences in postimplant dosimetry based on computed tomography (CT) and CT/magnetic resonance imaging (MRI) fusion images were assessed to evaluate the efficacy of the fusion image. In addition, the part of the prostate contour responsible for the interobserver differences in CT was identified. In June 2008, 1-month postimplant CT data from two patients who underwent 125 I prostate brachytherapy were sent to 90 institutions for postimplant dosimetry. Subsequently, MRI data from the same patients were sent for fusion-based postimplant dosimetry. The variance of the difference between MRI-based D90 and CT-based or fusion-based D90 was compared. Prostate volume on CT was plotted on the y-axis against the position of the most cranial and caudal slices in the prostate contour delineated at each institution to analyze interobserver differences. The prostate volume from CT was significantly greater than from the CT/MRI fusion image (P=0.0014). Fusion-based variance was significantly greater than CT-based variance (P<0.01). CT-based postimplant dosimetry showed that 88%-96% of the institutions had an apical and basal position within a range of 5 mm. There were marked interobserver differences in CT/MRI fusion-based postimplant dosimetry. (author)

  15. Chemisorption of iodine-125 to gold nanoparticles allows for real-time quantitation and potential use in nanomedicine

    Energy Technology Data Exchange (ETDEWEB)

    Walsh, Adrian A, E-mail: a.walsh@nanobiosols.com [Liverpool Science Park, Nano Biosols Ltd (United Kingdom)

    2017-04-15

    Gold nanoparticles have been available for many years as a research tool in the life sciences due to their electron density and optical properties. New applications are continually being developed, particularly in nanomedicine. One drawback is the need for an easy, real-time quantitation method for gold nanoparticles so that the effects observed in in vitro cell toxicity assays and cell uptake studies can be interpreted quantitatively in terms of nanoparticle loading. One potential method of quantifying gold nanoparticles in real time is by chemisorption of iodine-125, a gamma emitter, to the nanoparticles. This paper revisits the labelling of gold nanoparticles with iodine-125, first described 30 years ago and never fully exploited since. We explore the chemical properties and usefulness in quantifying bio-functionalised gold nanoparticle binding in a quick and simple manner. The gold particles were labelled specifically and quantitatively simply by mixing the two items. The nature of the labelling is chemisorption and is robust, remaining bound over several weeks in a variety of cell culture media. Chemisorption was confirmed as potassium iodide can remove the label whereas sodium chloride and many other buffers had no effect. Particles precoated in polymers or proteins can be labelled just as efficiently allowing for post-labelling experiments in situ rather than using radioactive gold atoms in the production process. We also demonstrate that interparticle exchange of I-125 between different size particles does not appear to take place confirming the affinity of the binding.

  16. Red cell autoantibodies characterized by competitive inhibition of iodine 125 Rh alloantibody binding and by immunoprecipitation of membrane proteins

    International Nuclear Information System (INIS)

    Pierce, S.W.; Victoria, E.J.; Masouredis, S.P.

    1990-01-01

    The relationship between determinants recognized by warm-type immunoglobulin G red cell autoantibodies and the Rh antigens was characterized by autoantibody competitive inhibition of iodine 125 Rh alloantibody binding and autoantibody immunoprecipitation of iodine 125 red blood cell membrane proteins. The majority of blood donor autoantibody recognized epitopes that are closely related to Rh antigens as determined by competitive inhibition studies. Eighteen of 20 (90%) autoantibodies inhibited anti-Rh(c) binding, 15 inhibited anti-Rh(E), 5 inhibited anti-Rh(D), and only 2 failed to inhibit any of the three Rh alloantibodies tested. Autoantibodies that inhibited anti-Rh(D) also inhibited anti-Rh(c) and anti-Rh(E) and all those that inhibited anti-Rh(E) also inhibited anti-Rh(c). Autoantibodies that inhibited all three Rh alloantibodies immunoprecipitated 30 kd membrane polypeptides, as did two of the three autoantibodies that inhibited only anti-Rh(c) and anti-Rh(E). One autoantibody in this group and two autoantibodies that inhibited only anti-Rh(c), as well as an autoantibody that did not inhibit any of the Rh alloantibodies, immunoprecipitated only a single membrane polypeptide identified as band 3. The majority of normal donor red blood cell autoantibodies inhibited the binding of Rh alloantibodies, which indicates that they either bound to the Rh polypeptides or to epitopes on band 3 that were closely associated with the Rh complex

  17. Chemisorption of iodine-125 to gold nanoparticles allows for real-time quantitation and potential use in nanomedicine

    Science.gov (United States)

    Walsh, Adrian A.

    2017-04-01

    Gold nanoparticles have been available for many years as a research tool in the life sciences due to their electron density and optical properties. New applications are continually being developed, particularly in nanomedicine. One drawback is the need for an easy, real-time quantitation method for gold nanoparticles so that the effects observed in in vitro cell toxicity assays and cell uptake studies can be interpreted quantitatively in terms of nanoparticle loading. One potential method of quantifying gold nanoparticles in real time is by chemisorption of iodine-125, a gamma emitter, to the nanoparticles. This paper revisits the labelling of gold nanoparticles with iodine-125, first described 30 years ago and never fully exploited since. We explore the chemical properties and usefulness in quantifying bio-functionalised gold nanoparticle binding in a quick and simple manner. The gold particles were labelled specifically and quantitatively simply by mixing the two items. The nature of the labelling is chemisorption and is robust, remaining bound over several weeks in a variety of cell culture media. Chemisorption was confirmed as potassium iodide can remove the label whereas sodium chloride and many other buffers had no effect. Particles precoated in polymers or proteins can be labelled just as efficiently allowing for post-labelling experiments in situ rather than using radioactive gold atoms in the production process. We also demonstrate that interparticle exchange of I-125 between different size particles does not appear to take place confirming the affinity of the binding.

  18. Chemisorption of iodine-125 to gold nanoparticles allows for real-time quantitation and potential use in nanomedicine

    International Nuclear Information System (INIS)

    Walsh, Adrian A

    2017-01-01

    Gold nanoparticles have been available for many years as a research tool in the life sciences due to their electron density and optical properties. New applications are continually being developed, particularly in nanomedicine. One drawback is the need for an easy, real-time quantitation method for gold nanoparticles so that the effects observed in in vitro cell toxicity assays and cell uptake studies can be interpreted quantitatively in terms of nanoparticle loading. One potential method of quantifying gold nanoparticles in real time is by chemisorption of iodine-125, a gamma emitter, to the nanoparticles. This paper revisits the labelling of gold nanoparticles with iodine-125, first described 30 years ago and never fully exploited since. We explore the chemical properties and usefulness in quantifying bio-functionalised gold nanoparticle binding in a quick and simple manner. The gold particles were labelled specifically and quantitatively simply by mixing the two items. The nature of the labelling is chemisorption and is robust, remaining bound over several weeks in a variety of cell culture media. Chemisorption was confirmed as potassium iodide can remove the label whereas sodium chloride and many other buffers had no effect. Particles precoated in polymers or proteins can be labelled just as efficiently allowing for post-labelling experiments in situ rather than using radioactive gold atoms in the production process. We also demonstrate that interparticle exchange of I-125 between different size particles does not appear to take place confirming the affinity of the binding.

  19. Reduced dose to urethra and rectum with the use of variable needle spacing in prostate brachytherapy: a potential role for robotic technology.

    Science.gov (United States)

    Vyas, Shilpa; Le, Yi; Zhang, Zhe; Armour, Woody; Song, Daniel Y

    2015-08-01

    Several robotic delivery systems for prostate brachytherapy are under development or in pre-clinical testing. One of the features of robotic brachytherapy is the ability to vary spacing of needles at non-fixed intervals. This feature may play an important role in prostate brachytherapy, which is traditionally template-based with fixed needle spacing of 0.5 cm. We sought to quantify potential reductions in the dose to urethra and rectum by utilizing variable needle spacing, as compared to fixed needle spacing. Transrectal ultrasound images from 10 patients were used by 3 experienced planners to create 120 treatment plans. Each planner created 4 plan variations per patient with respect to needle positions: (125)I fixed spacing, (125)I variable spacing, (103)Pd fixed spacing, and (103)Pd variable spacing. The primary planning objective was to achieve a prostate V100 of 100% while minimizing dose to urethra and rectum. All plans met the objective of achieving prostate V100 of 100%. Combined results for all plans show statistically significant improvements in all assessed dosimetric variables for urethra (Umax, Umean, D30, D5) and rectum (Rmax, Rmean, RV100) when using variable spacing. The dose reductions for mean and maximum urethra dose using variable spacing had p values of 0.011 and 0.024 with (103)Pd, and 0.007 and 0.029 with (125)I plans. Similarly dose reductions for mean and maximum rectal dose using variable spacing had p values of 0.007 and 0.052 with (103)Pd, and 0.012 and 0.037 with (125)I plans. The variable needle spacing achievable by the use of robotics in prostate brachytherapy allows for reductions in both urethral and rectal planned doses while maintaining prostate dose coverage. Such dosimetric advantages have the potential in translating to significant clinical benefits with the use of robotic brachytherapy.

  20. Prospective evaluation of quality of life after permanent prostate brachytherapy with I-125: Importance of baseline symptoms and of prostate-V150

    International Nuclear Information System (INIS)

    Vordermark, Dirk; Noe, Michael; Markert, Klaus; Wulf, Joern; Mueller, Gerd; Bratengeier, Klaus; Beckmann, Gabriele; Baier, Fabian; Guckenberger, Matthias; Schiefelbein, Frank; Schoen, Georg; Flentje, Michael; Baier, Kurt

    2009-01-01

    Background and purpose: Detailed knowledge of quality of life (QoL) after permanent I-125 brachytherapy may aid in counselling patients with early-stage prostate cancer. Materials and methods: Seventy-four consecutive patients with low-risk prostate cancer were asked to complete the EORTC QLQ-C30 questionnaire with the prostate-specific PR25 module before implant, four weeks and one year after implant (response rates 97%, 88% and 89%, respectively). Implant characteristics were correlated with QoL scores. Results: Global QoL was stable from pre-treatment to one year after implant and similar to age-adjusted scores of healthy controls. Significant changes versus baseline in QLQ-C30 domains were worsened social function at four weeks, increased constipation at four weeks and at one year and improved emotional function at one year. PR25 urinary symptoms were significantly increased at four weeks and, despite some improvement, at one year; bowel symptoms were slightly increased. Both types of symptoms were most strongly related with pre-treatment symptom scores. Prostate-V150 was the only implant parameter significantly associated with both urinary and bowel symptoms at four weeks and one year. Conclusions: Limiting the high-dose subvolume in the prostate may be beneficial to reduce urinary and bowel symptoms but the major determinant of symptoms after I-125 implant is the baseline symptom level.

  1. Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma

    International Nuclear Information System (INIS)

    Candela-Juan, Cristian; Perez-Calatayud, Jose; Ballester, Facundo; Rivard, Mark J.

    2013-01-01

    Purpose: The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using 60 Co or 192 Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference man defined in ICRP Publication 89. Point sources of 60 Co or 192 Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate, and equivalent doses per clinical absorbed dose in this target organ were obtained in several radiosensitive organs. Values were corrected to account for clinical circumstances with the source located at various positions with differing dwell times throughout the prostate. This was repeated for a homogeneous water phantom. Results: For the nearest organs considered (bladder, rectum, testes, small intestine, and colon), equivalent doses given by 60 Co source were smaller (8%–19%) than from 192 Ir. However, as the distance increases, the more penetrating gamma rays produced by 60 Co deliver higher organ equivalent doses. The overall result is that effective dose per clinical absorbed dose from a 60 Co source (11.1 mSv/Gy) is lower than from a 192 Ir source (13.2 mSv/Gy). On the other hand, equivalent doses were the same in the tissue and the homogeneous water phantom for those soft tissues closer to the prostate than about 30 cm. As the distance increased, the differences of photoelectric effect in water and soft tissue, and appearance of other materials such as air, bone, or lungs, produced

  2. Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Candela-Juan, Cristian [Radioprotection Department, La Fe University and Polytechnic Hospital, Valencia 46026 (Spain); Perez-Calatayud, Jose [Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia 46026 (Spain); Ballester, Facundo [Department of Atomic, Molecular and Nuclear Physics, University of Valencia, Burjassot 46100 (Spain); Rivard, Mark J. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States)

    2013-03-15

    Purpose: The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using {sup 60}Co or {sup 192}Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference man defined in ICRP Publication 89. Point sources of {sup 60}Co or {sup 192}Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate, and equivalent doses per clinical absorbed dose in this target organ were obtained in several radiosensitive organs. Values were corrected to account for clinical circumstances with the source located at various positions with differing dwell times throughout the prostate. This was repeated for a homogeneous water phantom. Results: For the nearest organs considered (bladder, rectum, testes, small intestine, and colon), equivalent doses given by {sup 60}Co source were smaller (8%-19%) than from {sup 192}Ir. However, as the distance increases, the more penetrating gamma rays produced by {sup 60}Co deliver higher organ equivalent doses. The overall result is that effective dose per clinical absorbed dose from a {sup 60}Co source (11.1 mSv/Gy) is lower than from a {sup 192}Ir source (13.2 mSv/Gy). On the other hand, equivalent doses were the same in the tissue and the homogeneous water phantom for those soft tissues closer to the prostate than about 30 cm. As the distance increased, the differences of photoelectric effect in water and soft tissue, and appearance of other materials

  3. A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

    Science.gov (United States)

    Borot de Battisti, M.; de Senneville, B. Denis; Hautvast, G.; Binnekamp, D.; Lagendijk, J. J. W.; Maenhout, M.; Moerland, M. A.

    2017-05-01

    MR-guided high-dose-rate (HDR) brachytherapy has gained increasing interest as a treatment for patients with localized prostate cancer because of the superior value of MRI for tumor and surrounding tissues localization. To enable needle insertion into the prostate with the patient in the MR bore, a single needle MR-compatible robotic system involving needle-by-needle dose delivery has been developed at our institution. Throughout the intervention, dose delivery may be impaired by: (1) sub-optimal needle positioning caused by e.g. needle bending, (2) intra-operative internal organ motion such as prostate rotations or swelling, or intra-procedural rectum or bladder filling. This may result in failure to reach clinical constraints. To assess the first aforementioned challenge, a recent study from our research group demonstrated that the deposited dose may be greatly improved by real-time adaptive planning with feedback on the actual needle positioning. However, the needle insertion sequence is left to the doctor and therefore, this may result in sub-optimal dose delivery. In this manuscript, a new method is proposed to determine and update automatically the needle insertion sequence. This strategy is based on the determination of the most sensitive needle track. The sensitivity of a needle track is defined as its impact on the dose distribution in case of sub-optimal positioning. A stochastic criterion is thus presented to determine each needle track sensitivity based on needle insertion simulations. To assess the proposed sequencing strategy, HDR prostate brachytherapy was simulated on 11 patients with varying number of needle insertions. Sub-optimal needle positioning was simulated at each insertion (modeled by typical random angulation errors). In 91% of the scenarios, the dose distribution improved when the needle was inserted into the most compared to the least sensitive needle track. The computation time for sequencing was less than 6 s per needle track. The

  4. Seed loss in prostate brachytherapy : Operator dependency and impact on dosimetry.

    Science.gov (United States)

    El-Bared, Nancy; Sebbag, Natanel; Béliveau-Nadeau, Dominic; Hervieux, Yannick; Larouche, Renée; Taussky, Daniel; Delouya, Guila

    2016-05-01

    The aim of our study was to review seed loss and its impact on dosimetry as well as the influence of the treating physician on seed loss and dosimetry in patients treated with prostate brachytherapy using permanent loose (125)I implant. We analyzed 1087 consecutive patients treated by two physicians between July 2005 and April 2015 at a single institution. Pelvic fluoroscopic imaging was done 30 days post implant and a chest X-ray when seed loss was observed. Seed loss occurred in 19.4 % of patients: in 20.0 % of implants done by the most experienced physician and in 17.2 % by the less experienced physician (p = 0.4) and migration to the thorax occurred in 5.9 % (6.9 vs. 2.2 %, p = 0.004). The mean seed loss rate was 0.57 % [standard deviation (SD) 1.39] and the mean rate of seeds in the thorax was 0.14 % (SD 0.65). The most experienced physician had a higher mean number of seeds lost: 0.36 versus 0.25 (p = 0.055), and a higher mean number of seed migration to the thorax: 0.1 versus 0.02 (p < 0.001). When at least one seed was lost, a decrease of 4.2 Gy (p < 0.001) in the D90 and a decrease of 3.5 % (p = 0.002) in the V150 was observed. We found a significant decrease in V150 and D90 with the occurrence of seed loss. Furthermore, we found a difference in seed migration among the physicians demonstrating that seed loss is operator dependant.

  5. Incidence of seed migration to the chest, abdomen, and pelvis after transperineal interstitial prostate brachytherapy with loose 125I seeds

    International Nuclear Information System (INIS)

    Sugawara, Akitomo; Shigematsu, Naoyuki; Nakashima, Jun; Kunieda, Etsuo; Nagata, Hirohiko; Mizuno, Ryuichi; Seki, Satoshi; Shiraishi, Yutaka; Kouta, Ryuichi; Oya, Mototsugu

    2011-01-01

    The aim was to determine the incidence of seed migration not only to the chest, but also to the abdomen and pelvis after transperineal interstitial prostate brachytherapy with loose 125 I seeds. We reviewed the records of 267 patients who underwent prostate brachytherapy with loose 125 I seeds. After seed implantation, orthogonal chest radiographs, an abdominal radiograph, and a pelvic radiograph were undertaken routinely to document the occurrence and sites of seed migration. The incidence of seed migration to the chest, abdomen, and pelvis was calculated. All patients who had seed migration to the abdomen and pelvis subsequently underwent a computed tomography scan to identify the exact location of the migrated seeds. Postimplant dosimetric analysis was undertaken, and dosimetric results were compared between patients with and without seed migration. A total of 19,236 seeds were implanted in 267 patients. Overall, 91 of 19,236 (0.47%) seeds migrated in 66 of 267 (24.7%) patients. Sixty-nine (0.36%) seeds migrated to the chest in 54 (20.2%) patients. Seven (0.036%) seeds migrated to the abdomen in six (2.2%) patients. Fifteen (0.078%) seeds migrated to the pelvis in 15 (5.6%) patients. Seed migration occurred predominantly within two weeks after seed implantation. None of the 66 patients had symptoms related to the migrated seeds. Postimplant prostate D90 was not significantly different between patients with and without seed migration. We showed the incidence of seed migration to the chest, abdomen and pelvis. Seed migration did not have a significant effect on postimplant prostate D90

  6. Study and development of methodology for radioactive iodine fixation in polymeric substrate for manufacturing sources used in brachytherapy

    International Nuclear Information System (INIS)

    Rodrigues, Bruna T.; Souza, Carla D.; Benega, Marcos A.G. and others

    2014-01-01

    According global estimates of Globocan 2012 project of the International Agency for Research of Cancer, of the World Health Organization, there were 14,1 million new cases of cancer and a total of 8,2 million deaths from cancer. Also show that in 2030, the overall load will be 21,4 million new cases and 13,2 million cancer deaths. One of the prostate cancer therapy is brachytherapy, used in early and middle stages of the disease. It is made with the introduction of seeds with radioactive material within the tumor or in nearby regions, affecting the minimum surrounding tissues. The aim of this work is the study and developing the deposition of radioactive iodine on the polymeric substrate method, and an analysis relating the efficiency of the method to implementation in the laboratory of brachytherapy from IPEN. Iodine-125 is adsorbed on an epoxy resin solution. The objective of this study is to offer a new proposal for seeds. The results will give the data for the radiation protection and the procedures for radioactive waste management

  7. Predictors of Prostate Cancer-Specific Mortality in Elderly Men With Intermediate-Risk Prostate Cancer Treated With Brachytherapy With or Without External Beam Radiation Therapy

    International Nuclear Information System (INIS)

    Nanda, Akash; Chen, M.-H.; Moran, Brian J.; Braccioforte, Michelle H.; Dosoretz, Daniel; Salenius, Sharon; Katin, Michael; Ross, Rudi; D'Amico, Anthony V.

    2010-01-01

    Purpose: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for comorbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy. Methods and Materials: The study cohort comprised 1,978 men of median age 71 (interquartile range, 66-75) years with intermediate-risk disease (Gleason score 7, prostate-specific antigen (PSA) 20 ng/mL or less, tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether prevalent cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category was associated with the risk of PCSM. Results: After a median follow-up of 3.2 (interquartile range, 1.7-5.4) years, the presence of CVD was significantly associated with a decreased risk of PCSM (adjusted hazard ratio, 0.20; 95% CI 0.04-0.99; p = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (adjusted hazard ratio 1.14; 95% CI 1.02-1.27; p = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (p = 0.03) in men with PSA levels above as compared with the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (p = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: In elderly men with intermediate-risk prostate cancer, CVD status is a negative predictor of PCSM and affects the prognostic capacity of pretreatment PSA level. These observations support the potential utility of prerandomization stratification by comorbidity to more accurately assess prognostic factors and treatment effects within this population.

  8. Association of early PSA failure time with increased distant metastasis and decreased survival in prostate brachytherapy patients

    International Nuclear Information System (INIS)

    Ko, Eric C.; Liu, Jerry T.; Stone, Nelson N.; Stock, Richard G.

    2014-01-01

    Background and purpose: We investigated whether earlier PSA failure following prostate brachytherapy is associated with increased rates of distant metastases (DM), prostate cancer-specific mortality (PCSM), and overall mortality. Materials and methods: We retrospectively analyzed 2818 patients who underwent brachytherapy ± external beam radiation therapy (EBRT) ± androgen deprivation therapy (ADT). With median follow-up of 5.52 years, 264 patients experienced PSA failure at a median time of 3.25 years. Patients were stratified to early vs. late PSA failures at cutoffs of 1.5 years, 3 years, or 5 years, and tested in univariate/multivariate analyses for freedom from DM, cause-specific survival (CSS), and overall survival (OS). Results: Among patients with PSA failures, 69 (26%) patients experienced DM, 47 (18%) PCSM, and 56 (21%) deaths from other causes. Patients with rapid PSA failures demonstrated increased rates of DM, PCSM, and overall mortality, despite higher total BED and longer ADT. In multivariate analysis with a PSA failure interval <3 years, the hazard ratio (HR) for DM was 3.92 (95% CI: 2.34–6.55; p = 0.000); HR for PCSM was 2.79 (95% CI: 1.45–5.38; p = 0.002); and HR for overall mortality was 2.28 (95% CI: 1.50–3.48; p = 0.000). Conclusion: Early PSA failure following radiation is a poor prognostic factor, as it is associated with increased DM, PCSM, and overall mortality

  9. [Prostate cancer boost using high-dose-rate brachytherapy: impact of the learning curve on the dosimetry].

    Science.gov (United States)

    Benhaïm, C; Chand, M-È; Gal, J; Hijazi, H; Gautier, M; Hannoun-Lévi, J-M

    2014-11-01

    To analyse the influence of the learning curve on dosimetric data for high-dose-rate brachytherapy prostate cancer boost. From February 2009 to May 2012, after a first course of external beam radiation therapy (46Gy/23 fractions), 124 patients underwent high-dose-rate brachytherapy boost using Plato™ (Nucletron, an Elekta company, Elekta AB, Stockholm, Sweden). The impact of the learning curve on the dosimetric quality of the prostate implant was assessed. The dosimetric data have been analysed: clinical target volume (CTV), D90 (dose to 90 % of CTV), D100, V100 (part on the CTV receiving 100 % of the dose), V150, V200 and DHI (dose non-homogeneity index). The doses delivered to 0.1, 1 and 2 cm(3) of the rectum and urethra were calculated. During the study period (39 months), a significant reduction of V150 (Plearning curve period. Copyright © 2014 Société française de radiothérapie oncologique (SFRO). Published by Elsevier SAS. All rights reserved.

  10. SU-F-19A-08: Optimal Time Release Schedule of In-Situ Drug Release During Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Cormack, R; Ngwa, W; Makrigiorgos, G; Tangutoori, S; Rajiv, K; Sridhar, S

    2014-01-01

    Purpose: Permanent prostate brachytherapy spacers can be used to deliver sustained doses of radiosentitizing drug directly to the target, in order to enhance the radiation effect. Implantable nanoplatforms for chemo-radiation therapy (INCeRTs) have a maximum drug capacity and can be engineered to control the drug release schedule. The optimal schedule for sensitization during continuous low dose rate irradiation is unknown. This work studies the optimal release schedule of drug for both traditional sensitizers, and those that work by suppressing DNA repair processes. Methods: Six brachytherapy treatment plans were used to model the anatomy, implant geometry and calculate the spatial distribution of radiation dose and drug concentrations for a range of drug diffusion parameters. Three state partial differential equations (cells healthy, damaged or dead) modeled the effect of continuous radiation (radiosensitivities α,β) and cellular repair (time tr) on a cell population. Radiosensitization was modeled as concentration dependent change in α,β or tr which with variable duration under the constraint of fixed total drug release. Average cell kill was used to measure effectiveness. Sensitization by means of both enhanced damage and reduced repair were studied. Results: Optimal release duration is dependent on the concentration of radiosensitizer compared to the saturation concentration (csat) above which additional sensitization does not occur. Long duration drug release when enhancing α or β maximizes cell death when drug concentrations are generally over csat. Short term release is optimal for concentrations below saturation. Sensitization by suppressing repair has a similar though less distinct trend that is more affected by the radiation dose distribution. Conclusion: Models of sustained local radiosensitization show potential to increase the effectiveness of radiation in permanent prostate brachytherapy. INCeRTs with high drug capacity produce the greatest

  11. SU-F-19A-08: Optimal Time Release Schedule of In-Situ Drug Release During Permanent Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Cormack, R; Ngwa, W; Makrigiorgos, G [Dana-Farber Cancer Institute, Brigham and Women' s Hospital and Harvard Medical School, Boston, MA (United States); Tangutoori, S; Rajiv, K; Sridhar, S [Northeastern University, Boston, MA (United States)

    2014-06-15

    Purpose: Permanent prostate brachytherapy spacers can be used to deliver sustained doses of radiosentitizing drug directly to the target, in order to enhance the radiation effect. Implantable nanoplatforms for chemo-radiation therapy (INCeRTs) have a maximum drug capacity and can be engineered to control the drug release schedule. The optimal schedule for sensitization during continuous low dose rate irradiation is unknown. This work studies the optimal release schedule of drug for both traditional sensitizers, and those that work by suppressing DNA repair processes. Methods: Six brachytherapy treatment plans were used to model the anatomy, implant geometry and calculate the spatial distribution of radiation dose and drug concentrations for a range of drug diffusion parameters. Three state partial differential equations (cells healthy, damaged or dead) modeled the effect of continuous radiation (radiosensitivities α,β) and cellular repair (time tr) on a cell population. Radiosensitization was modeled as concentration dependent change in α,β or tr which with variable duration under the constraint of fixed total drug release. Average cell kill was used to measure effectiveness. Sensitization by means of both enhanced damage and reduced repair were studied. Results: Optimal release duration is dependent on the concentration of radiosensitizer compared to the saturation concentration (csat) above which additional sensitization does not occur. Long duration drug release when enhancing α or β maximizes cell death when drug concentrations are generally over csat. Short term release is optimal for concentrations below saturation. Sensitization by suppressing repair has a similar though less distinct trend that is more affected by the radiation dose distribution. Conclusion: Models of sustained local radiosensitization show potential to increase the effectiveness of radiation in permanent prostate brachytherapy. INCeRTs with high drug capacity produce the greatest

  12. Comparison of Dosimetric and Biologic Effective Dose Parameters for Prostate and Urethra Using 131Cs and 125I for Prostate Permanent Implant Brachytherapy

    International Nuclear Information System (INIS)

    Sahgal, Arjun; Jabbari, Siavash; Chen, Josephine; Pickett, Barbie; Roach, Mack; Weinberg, Vivian; Hsu, I-C.; Pouliot, Jean

    2008-01-01

    Purpose: To compare the urethral and prostate absolute and biologic effective doses (BEDs) for 131 Cs and 125 I prostate permanent implant brachytherapy (PPI). Methods and Materials: Eight previously implanted manually planned 125 I PPI patients were replanned manually with 131 Cs, and re-planned using Inverse Planning Simulated Annealing. 131 Cs activity and the prescribed dose (115 Gy) were determined from that recommended by IsoRay. The BED was calculated for the prostate and urethra using an α/β ratio of 2 and was also calculated for the prostate using an α/β ratio of 6 and a urethral α/β ratio of 2. The primary endpoints of this study were the prostate D 90 BED (pD 90 BED) and urethral D 30 BED normalized to the maximal potential prostate D 90 BED (nuD 30 BED). Results: The manual plan comparison (α/β = 2) yielded no significant difference in the prostate D 90 BED (median, 192 Gy 2 for both isotopes). No significant difference was observed for the nuD 30 BED (median, 199 Gy 2 and 202 Gy 2 for 125 I and 131 Cs, respectively). For the inverse planning simulated annealing plan comparisons (α/β 2), the prostate D 90 BED was significantly lower with 131 Cs than with 125 I (median, 177 Gy 2 vs. 187 Gy 2 , respectively; p = 0.01). However, the nuD 30 BED was significantly greater with 131 Cs than with 125 I (median, 192 Gy 2 vs. 189 Gy 2 , respectively; p = 0.01). Both the manual and the inverse planning simulated annealing plans resulted in a significantly lower prostate D 90 BED (p = 0.01) and significantly greater nuD 30 BED for 131 Cs (p = 0.01), compared with 125 I, when the prostate α/β ratio was 6 and the urethral α/β ratio was 2. Conclusion: This report highlights the controversy in comparing the dose to both the prostate and the organs at risk with different radionuclides

  13. Needle migration and dosimetric impact in high-dose-rate brachytherapy for prostate cancer evaluated by repeated MRI.

    Science.gov (United States)

    Buus, Simon; Lizondo, Maria; Hokland, Steffen; Rylander, Susanne; Pedersen, Erik M; Tanderup, Kari; Bentzen, Lise

    To quantify needle migration and dosimetric impact in high-dose-rate brachytherapy for prostate cancer and propose a threshold for needle migration. Twenty-four high-risk prostate cancer patients treated with an HDR boost of 2 × 8.5 Gy were included. Patients received an MRI for planning (MRI1), before (MRI2), and after treatment (MRI3). Time from needle insertion to MRI3 was ∼3 hours. Needle migration was evaluated from coregistered images: MRI1-MRI2 and MRI1-MRI3. Dose volume histogram parameters from the treatment plan based on MRI1 were related to parameters based on needle positions in MRI2 or MRI3. Regression was used to model the average needle migration per implant and change in D90 clinical target volume, CTV prostate+3mm . The model fit was used for estimating the dosimetric impact in equivalent dose in 2 Gy fractions for dose levels of 6, 8.5, 10, 15, and 19 Gy. Needle migration was on average 2.2 ± 1.8 mm SD from MRI1-MRI2 and 5.0 ± 3.0 mm SD from MRI1-MRI3. D90 CTV prostate+3mm was robust toward average needle migration ≤3 mm, whereas for migration >3 mm D90 decreased by 4.5% per mm. A 3 mm of needle migration resulted in a decrease of 0.9, 1.7, 2.3, 4.8, and 7.6 equivalent dose in 2 Gy fractions for dose levels of 6, 8.5, 10, 15, and 19 Gy, respectively. Substantial needle migration in high-dose-rate brachytherapy occurs frequently in 1-3 hours following needle insertion. A 3-mm threshold of needle migration is proposed, but 2 mm may be considered for dose levels ≥15 Gy. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  14. PSA kinetics after prostate brachytherapy: PSA bounce phenomenon and its implications for PSA doubling time.

    Science.gov (United States)

    Ciezki, Jay P; Reddy, Chandana A; Garcia, Jorge; Angermeier, Kenneth; Ulchaker, James; Mahadevan, Arul; Chehade, Nabil; Altman, Andrew; Klein, Eric A

    2006-02-01

    To analyze prostate-specific antigen (PSA) kinetics in patients treated with prostate brachytherapy (PI) with a minimum of 5 years of PSA follow-up. The records of 162 patients treated with PI for localized prostate cancer with a minimum of 5 years of PSA follow-up were reviewed. A variety of pretreatment and posttreatment variables were examined. Patients were coded as having a PSA bounce if their PSA achieved a nadir, elevated at least 0.2 ng/mL greater than that nadir, and decreased to, or below, the initial nadir. Two definitions of biochemical failure (bF) or biochemical relapse-free survival (bRFS) were used: the classic American Society for Therapeutic Radiology and Oncology consensus definition of three consecutive rises (bF3) and the nadir plus 2 ng/mL definition (bFn+2). Associations between a PSA bounce and the various pre- and posttreatment factors were assessed with logistic regression analysis, and the association between a PSA bounce and bF was examined with the log-rank test. The Mann-Whitney U test was applied to test for differences in the PSA doubling time (PSADT) and the time to a PSA rise between the PSA bounce patients and the bF patients. PSADT was calculated from the nadir to the time of the first PSA rise, because this point is known first in the clinical setting. The 5-year overall bRFS rate was 87% for the bF3 definition and 96% for the bFn+2 definition. A PSA bounce was experienced by 75 patients (46.3%). Patients who experienced a PSA bounce were less likely to have a bF, regardless of the bRFS definition used (bF3: p=0.0015; bFn+2: p=0.0040). Among the pre- and posttreatment factors, only younger age predicted for a PSA bounce on multivariate analysis (p=0.0018). The use of androgen deprivation had no effect on PSA bounce. No difference was found in the PSADT between patients who had a PSA bounce and those with bF. The median PSADT for those with a PSA bounce was 8.3 months vs. 10.3 months using the bF3 definition and 8.8 months using

  15. PSA kinetics after prostate brachytherapy: PSA bounce phenomenon and its implications for PSA doubling time

    International Nuclear Information System (INIS)

    Ciezki, Jay P.; Reddy, Chandana A.; Garcia, Jorge; Angermeier, Kenneth; Ulchaker, James; Mahadevan, Arul; Chehade, Nabil; Altman, Andrew; Klein, Eric A.

    2006-01-01

    Purpose: To analyze prostate-specific antigen (PSA) kinetics in patients treated with prostate brachytherapy (PI) with a minimum of 5 years of PSA follow-up. Methods and Materials: The records of 162 patients treated with PI for localized prostate cancer with a minimum of 5 years of PSA follow-up were reviewed. A variety of pretreatment and posttreatment variables were examined. Patients were coded as having a PSA bounce if their PSA achieved a nadir, elevated at least 0.2 ng/mL greater than that nadir, and decreased to, or below, the initial nadir. Two definitions of biochemical failure (bF) or biochemical relapse-free survival (bRFS) were used: the classic American Society for Therapeutic Radiology and Oncology consensus definition of three consecutive rises (bF3) and the nadir plus 2 ng/mL definition (bFn+2). Associations between a PSA bounce and the various pre- and posttreatment factors were assessed with logistic regression analysis, and the association between a PSA bounce and bF was examined with the log-rank test. The Mann-Whitney U test was applied to test for differences in the PSA doubling time (PSADT) and the time to a PSA rise between the PSA bounce patients and the bF patients. PSADT was calculated from the nadir to the time of the first PSA rise, because this point is known first in the clinical setting. Results: The 5-year overall bRFS rate was 87% for the bF3 definition and 96% for the bFn+2 definition. A PSA bounce was experienced by 75 patients (46.3%). Patients who experienced a PSA bounce were less likely to have a bF, regardless of the bRFS definition used (bF3: p = 0.0015; bFn+2: p = 0.0040). Among the pre- and posttreatment factors, only younger age predicted for a PSA bounce on multivariate analysis (p = 0.0018). The use of androgen deprivation had no effect on PSA bounce. No difference was found in the PSADT between patients who had a PSA bounce and those with bF. The median PSADT for those with a PSA bounce was 8.3 months vs. 10.3 months

  16. SU-E-J-232: Feasibility of MRI-Based Preplan On Low Dose Rate Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Huang, Y; Tward, J; Rassiah-Szegedi, P; Zhao, H; Sarkar, V; Huang, L; Szegedi, M; Kokeny, K; Salter, B [University of Utah Huntsman Cancer Institute, Salt Lake City, UT (United States)

    2015-06-15

    Purpose: To investigate the feasibility of using MRI-based preplan for low dose rate prostate brachytherapy. Methods: 12 patients who received transrectal ultrasound (TRUS) guided prostate brachytherapy with Pd-103 were retrospectively studied. Our care-standard of the TRUS-based preplan served as the control. One or more prostate T2-weighted wide and/or narrow-field of view MRIs obtained within the 3 months prior to the implant were imported into the MIM Symphony software v6.3 (MIM Software Inc., Cleveland, OH) for each patient. In total, 37 MRI preplans (10 different image sequences with average thickness of 4.8mm) were generated. The contoured prostate volume and the seed counts required to achieve adequate dosimetric coverage from TRUS and MRI preplans were compared for each patient. The effects of different MRI sequences and image thicknesses were also investigated statistically using Student’s t-test. Lastly, the nomogram from the MRI preplan and TRUS preplan from our historical treatment data were compared. Results: The average prostate volume contoured on the TRUS and MRI were 26.6cc (range: 12.6∼41.3cc), and 27.4 cc (range: 14.3∼50.0cc), respectively. Axial MRI thicknesses (range: 3.5∼8.1mm) did not significantly affect the contoured volume or the number of seeds required on the preplan (R2 = 0.0002 and 0.0012, respectively). Four of the MRI sequences (AX-T2, AX-T2-Whole-Pelvis, AX-T2-FSE, and AXIALT2- Hi-Res) showed statistically significant better prostate volume agreement with TRUS than the other seven sequences (P <0.01). Nomogram overlay between the MRI and TRUS preplans showed good agreement; indicating volumes contoured on MRI preplan scan reliably predict how many seeds are needed for implant. Conclusion: Although MRI does not allow for determination of the actual implant geometry, it can give reliable volumes for seed ordering purposes. Our future work will investigate if MRI is sufficient to reliably replace TRUS preplanning in patients

  17. Prostate-specific antigen nadir after high-dose-rate brachytherapy predicts long-term survival outcomes in high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Hideyasu Tsumura

    2016-04-01

    Full Text Available Purpose : To evaluate the prognostic value of prostate-specific antigen nadir (nPSA after high-dose-rate (HDR brachytherapy in clinically non-metastatic high-risk prostate cancer patients. Material and methods : Data from 216 patients with high-risk or locally advanced prostate cancer who underwent HDR brachytherapy and external beam radiation therapy with long-term androgen deprivation therapy (ADT between 2003 and 2008 were analyzed. The median prostate-specific antigen (PSA level at diagnosis was 24 ng/ml (range: 3-338 ng/ml. The clinical stage was T1c-2a in 55 cases (26%, T2b-2c in 48 (22%, T3a in 75 (35%, and T3b-4 in 38 (17%. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After 5 fractions, external beam radiation therapy with 10 fractions of 3 Gy was administered. All patients initially underwent neoadjuvant ADT for at least 6 months, and adjuvant ADT was continued for 36 months. The median follow-up was 7 years from the start of radiotherapy. Results : The 7-year PSA relapse-free rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 94%, compared with 23% for patients with higher nPSA values (HR = 28.57; 95% CI: 12.04-66.66; p < 0.001. Multivariate analysis revealed that the nPSA value after radiotherapy was a significant independent predictor of biochemical failure, whereas pretreatment predictive values for worse biochemical control including higher level of initial PSA, Gleason score ≥ 8, positive biopsy core rate ≥ 67%, and T3b-T4, failed to reach independent predictor status. The 7-year cancer-specific survival rate among patients with a post-radiotherapy nPSA level of ≤ 0.02 ng/ml was 99%, compared with 82% for patients with higher nPSA values (HR = 32.25; 95% CI: 3.401-333.3; p = 0.002. Conclusions : A post-radiotherapy nPSA value of ≤ 0.02 ng/ml was associated with better long-term biochemical tumor control even if patients had pretreatment predictive

  18. Seed loss in prostate brachytherapy. Operator dependency and impact on dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    El-Bared, Nancy; Sebbag, Natanel; Beliveau-Nadeau, Dominic; Hervieux, Yannick; Larouche, Renee; Taussky, Daniel; Delouya, Guila [Centre hospitalier de l' Universite de Montreal - Hopital Notre-Dame, Departement de Radio-Oncologie, Montreal, QC (Canada)

    2016-05-15

    The aim of our study was to review seed loss and its impact on dosimetry as well as the influence of the treating physician on seed loss and dosimetry in patients treated with prostate brachytherapy using permanent loose {sup 125}I implant. We analyzed 1087 consecutive patients treated by two physicians between July 2005 and April 2015 at a single institution. Pelvic fluoroscopic imaging was done 30 days post implant and a chest X-ray when seed loss was observed. Seed loss occurred in 19.4 % of patients: in 20.0 % of implants done by the most experienced physician and in 17.2 % by the less experienced physician (p = 0.4) and migration to the thorax occurred in 5.9 % (6.9 vs. 2.2 %, p = 0.004). The mean seed loss rate was 0.57 % [standard deviation (SD) 1.39] and the mean rate of seeds in the thorax was 0.14 % (SD 0.65). The most experienced physician had a higher mean number of seeds lost: 0.36 versus 0.25 (p = 0.055), and a higher mean number of seed migration to the thorax: 0.1 versus 0.02 (p < 0.001). When at least one seed was lost, a decrease of 4.2 Gy (p < 0.001) in the D90 and a decrease of 3.5 % (p = 0.002) in the V150 was observed. We found a significant decrease in V150 and D90 with the occurrence of seed loss. Furthermore, we found a difference in seed migration among the physicians demonstrating that seed loss is operator dependant. (orig.) [German] Wir analysierten den Prozentsatz des Seed-Verlusts sowie den Einfluss von Arzterfahrung und Seed-Abgang auf die Dosimetrie bei Patienten, die mit einer Prostata-Brachytherapie mit permanent beweglichen {sup 125}I-Implantaten behandelt wurden. Eingeschlossen in diese Studie wurden alle zwischen Juli 2005 und April 2015 an unserem Krankenhaus von zwei Aerzten konsekutiv behandelten 1087 Patienten. Anhand fluoroskopischer Bilder wurden noch vorhandene Seeds 30 Tage nach dem Eingriff gezaehlt. Bei unvollstaendiger Seed-Anzahl wurde ein Thorax-Roentgenbild angefertigt. In 19% der Patienten ging mindestens ein

  19. Favorable Preliminary Outcomes for Men With Low- and Intermediate-risk Prostate Cancer Treated With 19-Gy Single-fraction High-dose-rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Krauss, Daniel J., E-mail: dkrauss@beaumont.edu [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Ye, Hong [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Martinez, Alvaro A. [21st Century Oncology, Farmington Hills, Michigan (United States); Mitchell, Beth; Sebastian, Evelyn; Limbacher, Amy; Gustafson, Gary S. [Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2017-01-01

    Purpose: To report the toxicity and preliminary clinical outcomes of a prospective trial evaluating 19-Gy, single-fraction high-dose-rate (HDR) brachytherapy for men with low- and intermediate-risk prostate cancer. Methods and Materials: A total of 63 patients were treated according to an institutional review board-approved prospective study of single-fraction HDR brachytherapy. Eligible patients had tumor stage ≤T2a, prostate-specific antigen level ≤15 ng/mL, and Gleason score ≤7. Patients with a prostate gland volume >50 cm{sup 3} and baseline American Urologic Association symptom score >12 were ineligible. Patients underwent transrectal ultrasound-guided transperineal implantation of the prostate, followed by single-fraction HDR brachytherapy. Treatment was delivered using {sup 192}Ir to a dose of 19 Gy prescribed to the prostate, with no additional margin applied. Results: Of the 63 patients, 58 had data available for analysis. Five patients had withdrawn consent during the follow-up period. The median follow-up period was 2.9 years (range 0.3-5.2). The median age was 61.4 years. The median gland volume at treatment was 34.8 cm{sup 3}. Of the 58 patients, 91% had T1 disease, 71% had Gleason score ≤6 (29% with Gleason score 7), and the median pretreatment prostate-specific antigen level was 5.1 ng/mL. The acute and chronic grade 2 genitourinary toxicity incidence was 12.1% and 10.3%, respectively. No grade 3 urinary toxicity occurred. No patients experienced acute rectal toxicity grade ≥2, and 2 experienced grade ≥2 chronic gastrointestinal toxicity. Three patients experienced biochemical failure, yielding a 3-year cumulative incidence estimate of 6.8%. Conclusions: Single-fraction HDR brachytherapy is well-tolerated, with favorable preliminary biochemical and clinical disease control rates.

  20. Use of 5-alpha-reductase inhibitors as alternatives to luteinizing-hormone releasing hormone (LHRH) analogs or anti-androgens for prostate downsizing before brachytherapy.

    Science.gov (United States)

    Bae, Hee Joon; Mian, Omar; Vaidya, Dhananjay; DeWeese, Theodore L; Song, Daniel Y

    2017-10-10

    Prostate hypertrophy, median lobe hypertrophy, and pubic arch interference (PAI) are relative contraindications to brachytherapy because of potential morbidity and technical considerations. GnRH analogs or non-steroidal anti-androgens are currently utilized to achieve prostatic downsizing prior to brachytherapy. However, such agents have been associated with effects on body habitus, metabolism, and quality of life. In contrast, 5-alpha reductase inhibitors (5-ARI) are far less frequently associated with these morbidities. Patients with large gland size, median lobe hypertrophy, or PAI were offered 5-ARI therapy. Repeat transrectal ultrasound was performed at 3 or 4 months, followed by brachytherapy if resolution was achieved. If downsizing was inadequate, patients were offered continuation of 5-ARI for additional 3 months, gonadotropin-releasing hormone analog (GnRH) agonist or antiandrogen therapy, or other curative treatment. Of 59 patients with follow-up available, 42 (71%) were deemed to have adequate downsizing; 37 (63%) after 3 to 4 months of 5-ARI and 5 (8%) after 7 to 8 months. Seventeen patients (29%) received other treatments because of inadequate effect. Median volume reduction was 20%. Of 41 patients undergoing brachytherapy, 4 (9.7%) required temporary catheterization because of obstruction. Median follow-up after implantation was 25 months (range, 1-64). Median time for return to International Prostate Symptom Score ≤5 of baseline score was 7 months (interquartile ratio, 6-13). All but 1 patient who received brachytherapy remain biochemically controlled. 5-ARI monotherapy is an alternative for downsizing in patients with hypertrophy or PAI, with more than 70% achieving adequate downsizing without use of GnRH analogs or antiandrogens. Patients who received brachytherapy experienced typical rates of postimplant urinary morbidity. Copyright © 2017. Published by Elsevier Inc.

  1. Iris melanoma management with iodine-125 plaque radiotherapy in 144 patients: impact of melanoma-related glaucoma on outcomes.

    Science.gov (United States)

    Shields, Carol L; Shah, Sanket U; Bianciotto, Carlos G; Emrich, Jacqueline; Komarnicky, Lydia; Shields, Jerry A

    2013-01-01

    To evaluate the outcomes of iris melanoma managed with plaque radiotherapy on the basis of the initial presence or absence of glaucoma. Retrospective, comparative case series. A total of 144 patients. Custom-designed iodine-125 plaque radiotherapy delivering planned 8000 cGy to melanoma apex using transcorneal application. Tumor control and treatment-related complications. Of 144 patients with iris melanoma, glaucoma was present at the initial visit in 58 (40%). Causes of elevated intraocular pressure included angle infiltration by melanoma in 50 patients (86%), angle neovascularization in 4 patients (7%), and hyphema in 4 patients (7%). At presentation, the eyes displaying iris melanoma with glaucoma (vs. without glaucoma) were statistically more likely to display angle tumor (66% vs. 43%), with minimal thickness (1.9 vs. 2.9 mm), and melanoma seeding in iris stroma (7 vs. 3 clock hours) and angle (5 vs. 2 clock hours). Plaque radiotherapy was performed in all cases. Kaplan-Meier estimates at 7 years post-treatment revealed no statistical differences in outcomes of local recurrence (14% vs. 15%), enucleation (14% vs. 11%), or metastasis (2% vs. 0%) comparing eyes with and without glaucoma. Of the entire group, multivariate analysis for factors predictive of recurrence included partial (vs. complete) anterior segment irradiation and postradiotherapy glaucoma. Factors related to enucleation included diabetes mellitus, poor initial visual acuity, higher radiation dose to tumor apex, and tumor recurrence. There were no factors predictive of metastasis. Iodine-125 plaque radiotherapy provides adequate tumor control for iris melanoma with a low metastatic potential of 1% at 7 years. Iris melanoma with secondary glaucoma showed a statistically significant greater likelihood of flat tumor with iris and angle seeding and no difference in outcomes compared with eyes without glaucoma. The author(s) have no proprietary or commercial interest in any materials discussed in this

  2. The Effect of Scattering from Leg Region on Organ Doses in Prostate Brachytherapy for 103Pd, 125I and 131Cs Seeds

    Directory of Open Access Journals (Sweden)

    Seyed Milad Vahabi

    2016-09-01

    Full Text Available Introduction Dose calculation of tumor and surrounding tissues is essential during prostate brachytherapy. Three radioisotopes, namely, 125I, 103Pd, and 131Cs, are extensively used in this method. In this study, we aimed to calculate the received doses by the prostate and critical organs using the aforementioned radioactive seeds and to investigate the effect of scattering contribution for the legs on dose calculations. Materials and Methods The doses to organs of interest were calculated using MCNPX code and ORNL (Oak Ridge National Laboratory phantom. Results Doses to the prostate as a source of radiation for 125I, 103Pd, and 131Cs were approximately 108.9, 97.7, and 81.5 Gy, respectively. Bladder, sigmoid colon, and testes received higher doses than other organs due to proximity to the prostate. Differences between the doses when tallying with the legs intact and with the legs voided were significant for testes, sigmoid colon contents, and sigmoid colon wall because of their proximity to the prostate. There was also a good consistency between our results and the data published by Montefiore Medical Center and Albert Einstein College of Medicine for the prostate. Conclusion Scattering from leg region had a significant effect on doses to testes, sigmoid colon contents, and sigmoid colon wall in the pelvic region, and prostate and the other organs were unaffected. Brachytherapy treatment plans using 131Cs seeds allow for better sparing of critical tissues, with a comparable number of, or fewer, seeds required, compared to 125I seeds.

  3. Long-Term Outcome and Toxicity of Salvage Brachytherapy for Local Failure After Initial Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Burri, Ryan J.; Stone, Nelson N.; Unger, Pam; Stock, Richard G.

    2010-01-01

    Purpose: To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer. Methods and Materials: Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with 103 Pd or 125 I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0. Results: Median follow-up was 86 months (range, 2-156). The median dose to 90% of the prostate volume was 122 Gy (range, 67-166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA) >10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age <70 years (p = 0.08) and PSA <6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA <6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Grade ≥2 toxicity (p = 0.03). Conclusion: With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA <6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.

  4. Correlation between prostate brachytherapy-related urethral stricture and peri-apical urethral dosimetry: A matched case–control study

    International Nuclear Information System (INIS)

    Earley, James J.; Abdelbaky, Ather M.; Cunningham, Melanie J.; Chadwick, Eliot; Langley, Stephen E.M.; Laing, Robert W.

    2012-01-01

    Background and purpose: Radiation dose to the bulbomembranous urethra has been shown to correlate with urethral stricture formation. This retrospective case–control study was designed to explore the relationship between dose to the apical/peri-apical regions of the urethra and development of brachytherapy (BXT)-related urethral stricture. Materials and methods: Cases were patients who developed urethral stricture after treatment with BXT as monotherapy and who had urethral dosimetry post-implant. Each case was matched with a control that had not developed urethral stricture. Dosimetry was compared between cases and controls. Results: Twenty-three cases were pair matched with 23 controls. There were no significant differences between the two groups in terms of age, presenting Prostate Specific Antigen (PSA), International Prostate Symptom Score (IPSS) or Gleason score. The dose delivered to the peri-apical and apical urethra was significantly higher for cases when compared with controls (peri-apical urethra: mean V 150 1.1 Vs 0.8 cc [p = 0.02]; apical urethra: mean dose 200 Vs 174 Gy [p = 0.01]). The distance from the prostate apex to isodose lines was also found to be significant in predicting stricture formation. Conclusion: There was evidence to suggest that the development of BXT-related stricture was associated with radiation dose at the apical and peri-apical urethra. Attention to the dose delivered to those areas may minimise the risk of developing such morbidity.

  5. Dosimetric analysis of urethral strictures following HDR 192Ir brachytherapy as monotherapy for intermediate- and high-risk prostate cancer

    International Nuclear Information System (INIS)

    Díez, Patricia; Mullassery, Vinod; Dankulchai, Pittaya; Ostler, Peter; Hughes, Robert; Alonzi, Roberto; Lowe, Gerry; Hoskin, Peter J.

    2014-01-01

    Background and purpose: To evaluate dosimetric parameters related to urethral strictures following high dose-rate brachytherapy (HDRBT) alone for prostate cancer. Material and methods: Ten strictures were identified in 213 patients treated with HDRBT alone receiving 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in 3 fractions or 26 Gy in 2 fractions. A matched-pair analysis used 2 controls for each case matched for dose fractionation schedule, pre-treatment IPSS score, number of needles used and clinical target volume. The urethra was divided into membranous urethra and inferior, mid and superior thirds of the prostatic urethra. Results: Stricture rates were 3% in the 34 Gy group, 4% in the 36 Gy group, 6% in the 31.5 Gy group and 4% in the 26 Gy group. The median time to stricture formation was 26 months (range 8–40). The dosimetric parameters investigated were not statistically different between cases and controls. No correlation was seen between stricture rate and fractionation schedule. Conclusions: Urethral stricture is an infrequent complication of prostate HDRBT when used to deliver high doses as sole treatment, with an overall incidence in this cohort of 10/213 (4.7%). In a matched pair analysis no association with dose schedule or urethral dosimetry was identified, but the small number of events limits definitive conclusions

  6. Three-dimensional (3D) real-time conformal brachytherapy - a novel solution for prostate cancer treatment Part I. Rationale and method

    International Nuclear Information System (INIS)

    Fijalkowski, M.; Bialas, B.; Maciejewski, B.; Bystrzycka, J.; Slosarek, K.

    2005-01-01

    Recently, the system for conformal real-time high-dose-rate brachytherapy has been developed and dedicated in general for the treatment of prostate cancer. The aim of this paper is to present the 3D-conformal real-time brachytherapy technique introduced to clinical practice at the Institute of Oncology in Gliwice. Equipment and technique of 3D-conformal real time brachytherapy (3D-CBRT) is presented in detail and compared with conventional high-dose-rate brachytherapy. Step-by-step procedures of treatment planning are described, including own modifications. The 3D-CBRT offers the following advantages: (1) on-line continuous visualization of the prostate and acquisition of the series of NS images during the entire procedure of planning and treatment; (2) high precision of definition and contouring the target volume and the healthy organs at risk (urethra, rectum, bladder) based on 3D transrectal continuous ultrasound images; (3) interactive on-line dose optimization with real-time corrections of the dose-volume histograms (DVHs) till optimal dose distribution is achieved; (4) possibility to overcome internal prostate motion and set-up inaccuracies by stable positioning of the prostate with needles fixed to the template; (5) significant shortening of overall treatment time; (6) cost reduction - the treatment can be provided as an outpatient procedure. The 3D- real time CBRT can be advertised as an ideal conformal boost dose technique integrated or interdigitated with pelvic conformal external beam radiotherapy or as a monotherapy for prostate cancer. (author)

  7. Defining the value of magnetic resonance imaging in prostate brachytherapy using time-driven activity-based costing.

    Science.gov (United States)

    Thaker, Nikhil G; Orio, Peter F; Potters, Louis

    Magnetic resonance imaging (MRI) simulation and planning for prostate brachytherapy (PBT) may deliver potential clinical benefits but at an unknown cost to the provider and healthcare system. Time-driven activity-based costing (TDABC) is an innovative bottom-up costing tool in healthcare that can be used to measure the actual consumption of resources required over the full cycle of care. TDABC analysis was conducted to compare patient-level costs for an MRI-based versus traditional PBT workflow. TDABC cost was only 1% higher for the MRI-based workflow, and utilization of MRI allowed for cost shifting from other imaging modalities, such as CT and ultrasound, to MRI during the PBT process. Future initiatives will be required to follow the costs of care over longer periods of time to determine if improvements in outcomes and toxicities with an MRI-based approach lead to lower resource utilization and spending over the long-term. Understanding provider costs will become important as healthcare reform transitions to value-based purchasing and other alternative payment models. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  8. Incidence of Secondary Cancer Development After High-Dose Intensity-Modulated Radiotherapy and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Zelefsky, Michael J.; Housman, Douglas M.; Pei Xin; Alicikus, Zumre; Magsanoc, Juan Martin; Dauer, Lawrence T.; St Germain, Jean; Yamada, Yoshiya; Kollmeier, Marisa; Cox, Brett; Zhang Zhigang

    2012-01-01

    Purpose: To report the incidence and excess risk of second malignancy (SM) development compared with the general population after external beam radiotherapy (EBRT) and brachytherapy to treat prostate cancer. Methods and Materials: Between 1998 and 2001, 1,310 patients with localized prostate cancer were treated with EBRT (n = 897) or brachytherapy (n = 413). We compared the incidence of SMs in our patients with that of the general population extracted from the National Cancer Institute’s Surveillance, Epidemiology, and End Results data set combined with the 2000 census data. Results: The 10-year likelihood of SM development was 25% after EBRT and 15% after brachytherapy (p = .02). The corresponding 10-year likelihood for in-field SM development in these groups was 4.9% and 1.6% (p = .24). Multivariate analysis showed that EBRT vs. brachytherapy and older age were the only significant predictors for the development of all SMs (p = .037 and p = .030), with a trend for older patients to develop a SM. The increased incidence of SM for EBRT patients was explained by the greater incidence of skin cancer outside the radiation field compared with that after brachytherapy (10.6% and 3.3%, respectively, p = .004). For the EBRT group, the 5- and 10-year mortality rate was 1.96% and 5.1% from out-of field cancer, respectively; for in-field SM, the corresponding mortality rates were 0.1% and 0.7%. Among the brachytherapy group, the 5- and 10-year mortality rate related to out-of field SM was 0.8% and 2.7%, respectively. Our observed SM rates after prostate RT were not significantly different from the cancer incidence rates in the general population. Conclusions: Using modern sophisticated treatment techniques, we report low rates of in-field bladder and rectal SM risks after prostate cancer RT. Furthermore, the likelihood of mortality secondary to a SM was unusual. The greater rate of SM observed with EBRT vs. brachytherapy was related to a small, but significantly increased

  9. Dosimetric impact of dual-energy CT tissue segmentation for low-energy prostate brachytherapy: a Monte Carlo study

    Science.gov (United States)

    Remy, Charlotte; Lalonde, Arthur; Béliveau-Nadeau, Dominic; Carrier, Jean-François; Bouchard, Hugo

    2018-01-01

    The purpose of this study is to evaluate the impact of a novel tissue characterization method using dual-energy over single-energy computed tomography (DECT and SECT) on Monte Carlo (MC) dose calculations for low-dose rate (LDR) prostate brachytherapy performed in a patient like geometry. A virtual patient geometry is created using contours from a real patient pelvis CT scan, where known elemental compositions and varying densities are overwritten in each voxel. A second phantom is made with additional calcifications. Both phantoms are the ground truth with which all results are compared. Simulated CT images are generated from them using attenuation coefficients taken from the XCOM database with a 100 kVp spectrum for SECT and 80 and 140Sn kVp for DECT. Tissue segmentation for Monte Carlo dose calculation is made using a stoichiometric calibration method for the simulated SECT images. For the DECT images, Bayesian eigentissue decomposition is used. A LDR prostate brachytherapy plan is defined with 125I sources and then calculated using the EGSnrc user-code Brachydose for each case. Dose distributions and dose-volume histograms (DVH) are compared to ground truth to assess the accuracy of tissue segmentation. For noiseless images, DECT-based tissue segmentation outperforms the SECT procedure with a root mean square error (RMS) on relative errors on dose distributions respectively of 2.39% versus 7.77%, and provides DVHs closest to the reference DVHs for all tissues. For a medium level of CT noise, Bayesian eigentissue decomposition still performs better on the overall dose calculation as the RMS error is found to be of 7.83% compared to 9.15% for SECT. Both methods give a similar DVH for the prostate while the DECT segmentation remains more accurate for organs at risk and in presence of calcifications, with less than 5% of RMS errors within the calcifications versus up to 154% for SECT. In a patient-like geometry, DECT-based tissue segmentation provides dose

  10. Brachytherapy of choroidal melanomas

    International Nuclear Information System (INIS)

    Brady, L.W.; Hernandez, J.C.

    1992-01-01

    In a compilation of nine reported series consisting of 2,024 enucleations, the five- and ten-year survivals following surgery were 63% and 43%, respectively. The 25-year survival has been reported to be 40%. In 1974 at Wills Eye Hospital and Hahnemann University, the cobalt-60 plaques technique was introduced. During the following years, other radioactive isotopes were introduced including irridium-192, iodine-125, ruthenium-106/rhodium-106 and more recently palladium-103. At the present time, iodine-125 is the most widely used radionuclide. Until now, 302 patients treated with plaque brachytherapy showed an actuarial survival of 77% and 67.8% at five and eight years, respectively. There was no significant survival difference when compared with a similar group of patients undergoing enucleation. Other retrospective studies show similar excellent results. In spite of these convincing results, the decision making process in management melanoma remains unsettled primarily due to the absence of prospective randomized trials. Because of this, the Collaborative Ocular Melanoma Study was initiated. From the standpoint of toxicity, the data are available on ocular radiation toxicity. In an analysis of 77 patients from the Wills Eye Hospital with pretreatment visual acuities of 20/25 or better, it was noted that 90% of patients who had received less than 500 Gy to the fovea retained visual acuity of 20/200 or better while only 52% of patients receiving more than 5,000 Gy to the fovea had vision of 20/200 or better. A serious late effect of radioactivity plaque treatment is scleral necrosis which may require repair or enucleation even in the absence of tumor progression. Enucleation may be necessary in approximately 10% of patients. We conclude that malignant melanoma of the uvea can be safely treated with radioactive plaques. (orig./MG) [de

  11. Lack of Apparent Survival Benefit With Use of Androgen Deprivation Therapy in Patients With High-risk Prostate Cancer Receiving Combined External Beam Radiation Therapy and Brachytherapy.

    Science.gov (United States)

    Yang, David D; Muralidhar, Vinayak; Mahal, Brandon A; Nguyen, Paul L; Devlin, Phillip M; King, Martin T; Orio, Peter F

    2018-01-01

    Although level 1 evidence has demonstrated a survival benefit from the addition of androgen deprivation therapy (ADT) to external beam radiation therapy (EBRT) for patients with high-risk prostate cancer, the benefits of ADT with combined EBRT and brachytherapy for high-risk patients are unclear. We examined the association between ADT and overall survival in a national cohort of high-risk patients treated with EBRT with or without brachytherapy. We identified 46,325 men in the National Cancer Database with a diagnosis of high-risk prostate cancer (Gleason score 8-10, clinical stage T3-T4, or prostate-specific antigen >20 ng/mL) who were treated with EBRT with or without brachytherapy and ADT from 2004 through 2011. Multivariable Cox regression analysis adjusting for sociodemographic and clinicopathologic factors was used to identify the association between ADT and overall survival. The median follow-up period was 48.6 and 59.2 months for patients treated with EBRT only and combined modality RT, respectively. ADT was associated with an improvement in overall survival for the 85.0% (39,361) of the study cohort who underwent EBRT alone (adjusted hazard ratio 0.91, P=.001) but not for patients treated with combined modality RT (adjusted hazard ratio 1.05, P=.496), with a significant interaction (P interaction =.036). In contrast to the known survival benefit when ADT is given with EBRT, our results suggest that ADT might not improve survival for high-risk patients who undergo combined EBRT and brachytherapy. Given the significant adverse effects of ADT, in particular, with long-term therapy, a randomized controlled trial of combined EBRT and brachytherapy with or without ADT for select high-risk patients using a noninferiority design should be undertaken. Copyright © 2017 Elsevier Inc. All rights reserved.

  12. Biodistribution and dosimetric study in medullary thyroid cancer xenograft using bispecific antibody and iodine-125-labeled bivalent hapten.

    Science.gov (United States)

    Hosono, M; Hosono, M N; Kraeber-Bodéré, F; Devys, A; Thédrez, P; Fiche, M; Gautherot, E; Barbet, J; Chatal, J F

    1998-09-01

    The purpose of this study was to evaluate biodistributions and absorbed doses of anti-carcinoembryonic antigen (CEA)/anti-diethylenetriamine pentaacetic acid (DTPA)-indium (anti-DTPA-In) bispecific monoclonal antibody (BsMAb) F6-734 and 125I-labeled DTPA-indium dimer hapten (125I-di-DTPA-In hapten) in athymic mice xenografted with human medullary thyroid cancer. Bispecific monoclonal antibodies F6-679 (anti-CEA/antihistamine) and G7A5-734 (antimelanoma/anti-di-DTPA-In) were used as irrelevant BsMAbs. Athymic mice inoculated with TT medullary thyroid cancer cells expressing CEA were administered BsMAbs F6-734, F6-679 or G7A5-734 and then, 48 hr later, 125I-di-DTPA-In hapten. Iodine-125-labeled F6 F(ab')2 fragment was injected into other groups of mice. Biodistributions were examined at 30 min and 5, 24, 48 and 96 hr after injection of 125I-di-DTPA-In hapten or 125I-labeled F6 F(ab')2. In mice injected with BsMAb F6-734 and 125I-di-DTPA-In hapten, tumor uptake was 9.1%+/-2.1%, 8.7%+/-3.5%, 8.0%+/-2.3%, 5.1%+/-0.9% and 3.5%+/-1.5% of the injected dose/g at 30 min and 5, 24, 48 and 96 hr, and tumor-to-blood, tumor-to-liver and tumor-to-kidney ratios were 37.0+/-12.5, 32.3+/-10.9 and 10.4+/-2.7 at 24 hr. Iodine-125-F6 F(ab')2 fragment showed a tumor uptake of 7.39% injected dose/g and tumor-to-blood, tumor-to-liver and tumor-to-kidney ratios of 1.8+/-0.6, 7.3+/-2.9 and 3.6+/-1.6 at 24 hr. In mice injected with F6-679 or G7A5-734, tumor uptake and tumor-to-normal tissue ratios were much lower than in the mice injected with F6-734. These results were confirmed by autoradiographic studies that demonstrated clear tumor-to-normal tissue contrast. This two-step targeting method seems very potent for the diagnosis and therapy of human medullary thyroid cancer and other CEA-producing tumors because it combines high tumor uptake and low normal tissue background.

  13. A comparative study of seed localization and dose calculation on pre- and post-implantation ultrasound and CT images for low-dose-rate prostate brachytherapy

    International Nuclear Information System (INIS)

    Ali, Imad; Algan, Ozer; Thompson, Spencer; Sindhwani, Puneet; Herman, Terence; Cheng, C.-Y.; Ahmad, Salahuddin

    2009-01-01

    This work investigates variation in the volume of the prostate measured at different stages through the prostate brachytherapy procedure for 30 patients treated with I-125 radioactive seeds. The implanted seeds were localized on post-implantation ultrasound (US) images and the effect of prostate enlargement due to edema on dose coverage for 15 patients was studied. The volume of the prostate was measured at four stages as follows: (a) 2-3 weeks prior to implantation using US imaging, (b) then at the start of the intra-operative prostate brachytherapy procedure on the day of the implant, (c) immediately post-implantation using US imaging in the operating room and (d) finally by CT imaging at nearly 4 weeks post-implantation. Comparative prostate volume studies were performed using US imaging stepper and twister modes. For the purpose of this study, the implanted seeds were localized successfully on post-implant ultrasound twister images, retrospectively. The plans using post-implant US imaging were compared with intra-operative plans on US and plans created on CT images. The prostate volume increases about 10 cm 3 on average due to edema induced by needle insertion and seed loading during implantation. The visibility of the implanted seeds on US twister images acquired post-implantation is as good as those on CT images and can be localized and used for dose calculation. The dose coverage represented by parameters such as D90 (dose covering 90% of the volume) and V100 (volume covered by 100% dose) is poorer on plans performed on post-implantation twister US studies than on the intra-operative live plan or the CT scan performed 4 weeks post-operatively. For example, the mean D90 difference on post-implantation US is lower by more than 15% than that on pre-implantation US. The volume enlargement of the prostate due to edema induced by needle insertion and seed placement has a significant effect on the quality of dosimetric coverage in brachytherapy prostate seed

  14. A comparative study of seed localization and dose calculation on pre- and post-implantation ultrasound and CT images for low-dose-rate prostate brachytherapy

    Science.gov (United States)

    Ali, Imad; Algan, Ozer; Thompson, Spencer; Sindhwani, Puneet; Herman, Terence; Cheng, Chih-Yao; Ahmad, Salahuddin

    2009-09-01

    This work investigates variation in the volume of the prostate measured at different stages through the prostate brachytherapy procedure for 30 patients treated with I-125 radioactive seeds. The implanted seeds were localized on post-implantation ultrasound (US) images and the effect of prostate enlargement due to edema on dose coverage for 15 patients was studied. The volume of the prostate was measured at four stages as follows: (a) 2-3 weeks prior to implantation using US imaging, (b) then at the start of the intra-operative prostate brachytherapy procedure on the day of the implant, (c) immediately post-implantation using US imaging in the operating room and (d) finally by CT imaging at nearly 4 weeks post-implantation. Comparative prostate volume studies were performed using US imaging stepper and twister modes. For the purpose of this study, the implanted seeds were localized successfully on post-implant ultrasound twister images, retrospectively. The plans using post-implant US imaging were compared with intra-operative plans on US and plans created on CT images. The prostate volume increases about 10 cm3 on average due to edema induced by needle insertion and seed loading during implantation. The visibility of the implanted seeds on US twister images acquired post-implantation is as good as those on CT images and can be localized and used for dose calculation. The dose coverage represented by parameters such as D90 (dose covering 90% of the volume) and V100 (volume covered by 100% dose) is poorer on plans performed on post-implantation twister US studies than on the intra-operative live plan or the CT scan performed 4 weeks post-operatively. For example, the mean D90 difference on post-implantation US is lower by more than 15% than that on pre-implantation US. The volume enlargement of the prostate due to edema induced by needle insertion and seed placement has a significant effect on the quality of dosimetric coverage in brachytherapy prostate seed

  15. Prophylactic tamsulosin (Flomax) in patients undergoing prostate 125I brachytherapy for prostate carcinoma: Final report of a double-blind placebo-controlled randomized study

    International Nuclear Information System (INIS)

    Elshaikh, Mohamed A.; Ulchaker, James C.; Reddy, Chandana A.; Angermeier, Kenneth W.; Klein, Eric A.; Chehade, Nabil; Altman, Andrew; Ciezki, Jay P.

    2005-01-01

    Purpose: To evaluate the effectiveness of prophylactic tamsulosin (Flomax) in reducing the urinary symptoms in patients undergoing 125 I prostate implantation (PI) for prostate adenocarcinoma. Methods and materials: This is a single-institution, double-blind, placebo-controlled, randomized trial for patients undergoing PI for prostate adenocarcinoma comparing prophylactic tamsulosin versus placebo. Eligibility criteria included patients not taking tamsulosin or other α-blockers treated with PI. The patients were randomly assigned to either tamsulosin (0.8 mg, orally once a day) or matched placebo. All patients started the medication 4 days before PI and continued for 60 days. The American Urologic Association (AUA) symptom index questionnaire was used to assess urinary symptoms. The AUA questionnaire was administered before PI for a baseline score and weekly for 8 weeks after PI. Patients were taken off the study if they developed urinary retention, had intolerable urinary symptoms, or wished to discontinue with the trial. Results: One hundred twenty-six patients were enrolled in this study from November 2001 to January 2003 (118 were evaluable: 58 in the tamsulosin arm and 60 in the placebo group). Pretreatment and treatment characteristics were comparably matched between the two groups. The urinary retention rate was 17% (10 patients) in the placebo group compared with 10% (6 patients) in the tamsulosin group (p = 0.3161). Eighty-eight percent (14 patients) of those who developed urinary retention experienced it within 2 weeks after the PI. Intolerable urinary symptoms were reported equally (10 patients in each group) with 70% occurring in the first 2 weeks after PI. There was a significant difference in mean AUA score in favor of tamsulosin at Week 5 after PI (p = 0.03). Conclusions: Prophylactic tamsulosin (0.8 mg/day) before prostate brachytherapy did not significantly affect urinary retention rates, but had a positive effect on urinary morbidity at Week 5

  16. Impact of age on quality of life in patients with localized prostate cancer treated with high-dose rate brachytherapy combined with external beam radiotherapy.

    Science.gov (United States)

    Kikkawa, Kazuro; Iba, Akinori; Kohjimoto, Yasuo; Noda, Yasutaka; Sonomura, Tetsuo; Hara, Isao

    2018-02-04

    To evaluate age-related quality of life changes in patients with localized prostate cancer treated by high-dose rate brachytherapy combined with external beam radiation therapy. A total of 172 patients with clinically localized prostate cancer were categorized to age groups <75 years and ≥75 years. Changes in their quality of life were evaluated using the Japanese version of Medical Outcome Study 8-Items Short Form Health Survey, Expanded Prostate Cancer Index Composite and International Index of Erectile Function-5 at baseline, and followed up to 24 months after treatment. There were no significant differences in Medical Outcome Study 8-Items Short Form Health Survey scores, and urinary and bowel scores of the Expanded Prostate Cancer Index Composite for older men after treatment. International Index of Erectile Function-5 summary scores were significantly decreased in both groups. Although sexual function and sexual bother scores were decreased in patients aged <75 years, these scores were maintained in patients aged ≥75 years. Quality of life of prostate cancer patients undergoing high-dose rate brachytherapy combined with external beam radiation therapy does not seem to be significantly affected by age. © 2018 The Japanese Urological Association.

  17. High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer in Patients at Moderate or High Risk of Biochemical Recurrence

    Energy Technology Data Exchange (ETDEWEB)

    Hoskin, Peter [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Rojas, Ana, E-mail: arc03@btconnect.com [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Lowe, Gerry; Bryant, Linda; Ostler, Peter; Hughes, Rob; Milner, Jessica; Cladd, Helen [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom)

    2012-03-15

    Purpose: To evaluate genitourinary (GU) and gastrointestinal (GI) morbidity and biochemical control of disease in patients with localized prostate adenocarcinoma treated with escalating doses per fraction of high-dose rate brachytherapy alone. Methods and Materials: A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median follow-up times were 60, 54, 36, and 6 months, respectively. Results: Incidence of early Grade {>=} 3 GU morbidity was 3% to 7%, and Grade 4 was 0% to 4%. During the first 12 weeks, the highest mean International Prostate Symptom Score (IPSS) value was 14, and between 6 months and 5 years it was 8. Grade 3 or 4 early GI morbidity was not observed. The 3-year actuarial rate of Grade 3 GU was 3% to 16%, and was 3% to 7% for strictures requiring surgery (4-year rate). An incidence of 1% Grade 3 GI events was seen at 3 years. Late Grade 4 GU or GI events were not observed. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (log-rank p = 0.02). Conclusions: There was no significant difference in urinary and rectal morbidity between schedules. Biochemical control of disease in patients with intermediate and high risk of relapse was good.

  18. Seed loss through the urinary tract after prostate brachytherapy: examining the role of cystoscopy and urine straining post implant

    International Nuclear Information System (INIS)

    Stutz, Michael; Petrikas, James; Raslowsky, Michael; Lee, Plato; Gurel, Michelle; Moran, Brian

    2003-01-01

    This study describes one institution's experience with seed retrieval through the urinary tract and makes recommendations for cystoscopy and urine straining post prostate brachytherapy (PB). 1794 patients from two separate cohorts covering different time periods (early versus late) were analyzed. All patients were preplanned with a modified peripheral loading technique and implanted with preloaded needles ( 125 I or 103 Pd) under ultrasound guidance. A catheter was used to delineate the urethra during the volume study but was not used during the implant. All patients underwent post implant cystoscopy. All patients were instructed to strain their urine for seven days post implant and return any seeds to our center. In our experience, seed loss through the urinary tract is a common event after PB, occurring in 29.7% of patients and was more common in patients from the early cohort, those implanted with 125 I seeds or those patients with prior transurethral resection of the prostate. Average seed loss per case, however, represents only 0.58% of total activity. We continue to recommend routine post implant cystoscopy for seed retrieval and periprocedural management. We no longer recommend that patients strain their urine at home after documenting a low rate of seed loss after discharge

  19. Relation of immediate and delayed thallium-201 distribution to localization of iodine-125 antimyosin antibody in acute experimental myocardial infarction

    International Nuclear Information System (INIS)

    Khaw, B.A.; Strauss, H.W.; Pohost, G.M.; Fallon, J.T.; Katus, H.A.; Haber, E.

    1983-01-01

    Thallium-201 (TI-201) distribution in acute experimental myocardial infarction (MI) (n . 18) was compared with cardiac-specific antimyosin Fab (AM-Fab) uptake, a specific marker for myocardial necrosis. When antimyosin was injected 4 hours after ligation with TI-201 administered 23 hours 55 minutes later and measurement of myocardial distribution determined 5 minutes after intravenous administration of TI-201, (1) TI-201 distribution closely correlated with microsphere regional blood flow, and (2) an inverse exponential relation to iodine-125 (I-125) AM-Fab uptake was apparent. In another group of 4 animals, TI-201 and AM-Fab were administered intravenously 4 hours after MI, and 36 hours later myocardial distribution was measured. This delayed TI-201 distribution had a close inverse linear correlation with I-125 AM-Fab uptake. This inverse linear relation also was apparent in 28-hour-old MIs in dogs (n . 4) where collateral circulation had been established. TI-201 was administered intravenously at 27 hours after MI, and TI-201 distribution was determined 1 hour later. The present study demonstrated that whereas immediate TI-201 distribution is flow-limited, delayed TI-201 distribution is a marker of cell viability which, due to prolonged circulation time and redistribution, is not flow-limited

  20. Quantification of the simple and double strand breaks following the disintegration of iodine-125 in situ in chromosomal fiber

    International Nuclear Information System (INIS)

    Oudira, H.; Saifi, A.

    2010-01-01

    The principal objective of this study is to compare the radiochemical yields of the simple and double strand breaks (C.S.B. and C.D.B.) generated in the propellers of the molecule of DNA, following the taking in consideration of two electronic spectra of disintegration of iodine-125. Indeed, the combined use of the Monte Carlo method of the type step by step and the equation of diffusion (∂ C i / ∂ t = D i Δ 2 C i + S) makes it possible to simulate the transport of the electrons, and the chemical reactions due to the diffusion of the entities created throughout the physico-chemical and chemical process considered (e-aq, H, OH, H 2 , H 2 O 2 , and H 3 O + ). In this study, we take in consideration a complex model of DNA (nucleosome) and its envelope of hydration like we also take in consideration of the radio-protector effect of the inhibitors such as the Formiat (Formiat the sodium, HCOO - ). Moreover, the comparison of our results to those obtained by other models, highlights on one hand an unquestionable agreement and on the other hand the power and the capacity of adaptation of the codes worked out to various models of DNA. (authors)

  1. Increasing Fractional Doses Increases the Probability of Benign PSA Bounce in Patients Undergoing Definitive HDR Brachytherapy for Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Hauck, Carlin R.; Ye, Hong; Chen, Peter Y.; Gustafson, Gary S.; Limbacher, Amy; Krauss, Daniel J., E-mail: Daniel.krauss@beaumont.edu

    2017-05-01

    Purpose: Prostate-specific antigen (PSA) bounce is a temporary elevation of the PSA level above a prior nadir. The purpose of this study was to determine whether the frequency of a PSA bounce following high-dose-rate (HDR) interstitial brachytherapy for the treatment of prostate cancer is associated with individual treatment fraction size. Methods and Materials: Between 1999 and 2014, 554 patients underwent treatment of low- or intermediate-risk prostate cancer with definitive HDR brachytherapy as monotherapy and had ≥3 subsequent PSA measurements. Four different fraction sizes were used: 950 cGy × 4 fractions, 1200 cGy × 2 fractions, 1350 cGy × 2 fractions, 1900 cGy × 1 fraction. Four definitions of PSA bounce were applied: ≥0.2, ≥0.5, ≥1.0, and ≥2.0 ng/mL above the prior nadir with a subsequent return to the nadir. Results: The median follow-up period was 3.7 years. The actuarial 3-year rate of PSA bounce for the entire cohort was 41.3%, 28.4%, 17.4%, and 6.8% for nadir +0.2, +0.5, +1.0, and +2.0 ng/mL, respectively. The 3-year rate of PSA bounce >0.2 ng/mL was 42.2%, 32.1%, 41.0%, and 59.1% for the 950-, 1200-, 1350-, and 1900-cGy/fraction levels, respectively (P=.002). The hazard ratio for bounce >0.2 ng/mL for patients receiving a single fraction of 1900 cGy compared with those receiving treatment in multiple fractions was 1.786 (P=.024). For patients treated with a single 1900-cGy fraction, the 1-, 2-, and 3-year rates of PSA bounce exceeding the Phoenix biochemical failure definition (nadir +2 ng/mL) were 4.5%, 18.7%, and 18.7%, respectively, higher than the rates for all other administered dose levels (P=.025). Conclusions: The incidence of PSA bounce increases with single-fraction HDR treatment. Knowledge of posttreatment PSA kinetics may aid in decision making regarding management of potential biochemical failures.

  2. Evaluation of a Machine-Learning Algorithm for Treatment Planning in Prostate Low-Dose-Rate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Nicolae, Alexandru [Department of Physics, Ryerson University, Toronto, Ontario (Canada); Department of Medical Physics, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Morton, Gerard; Chung, Hans; Loblaw, Andrew [Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Jain, Suneil; Mitchell, Darren [Department of Clinical Oncology, The Northern Ireland Cancer Centre, Belfast City Hospital, Antrim, Northern Ireland (United Kingdom); Lu, Lin [Department of Radiation Therapy, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Helou, Joelle; Al-Hanaqta, Motasem [Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada); Heath, Emily [Department of Physics, Carleton University, Ottawa, Ontario (Canada); Ravi, Ananth, E-mail: ananth.ravi@sunnybrook.ca [Department of Medical Physics, Odette Cancer Center, Sunnybrook Health Sciences Centre, Toronto, Ontario (Canada)

    2017-03-15

    Purpose: This work presents the application of a machine learning (ML) algorithm to automatically generate high-quality, prostate low-dose-rate (LDR) brachytherapy treatment plans. The ML algorithm can mimic characteristics of preoperative treatment plans deemed clinically acceptable by brachytherapists. The planning efficiency, dosimetry, and quality (as assessed by experts) of preoperative plans generated with an ML planning approach was retrospectively evaluated in this study. Methods and Materials: Preimplantation and postimplantation treatment plans were extracted from 100 high-quality LDR treatments and stored within a training database. The ML training algorithm matches similar features from a new LDR case to those within the training database to rapidly obtain an initial seed distribution; plans were then further fine-tuned using stochastic optimization. Preimplantation treatment plans generated by the ML algorithm were compared with brachytherapist (BT) treatment plans in terms of planning time (Wilcoxon rank sum, α = 0.05) and dosimetry (1-way analysis of variance, α = 0.05). Qualitative preimplantation plan quality was evaluated by expert LDR radiation oncologists using a Likert scale questionnaire. Results: The average planning time for the ML approach was 0.84 ± 0.57 minutes, compared with 17.88 ± 8.76 minutes for the expert planner (P=.020). Preimplantation plans were dosimetrically equivalent to the BT plans; the average prostate V150% was 4% lower for ML plans (P=.002), although the difference was not clinically significant. Respondents ranked the ML-generated plans as equivalent to expert BT treatment plans in terms of target coverage, normal tissue avoidance, implant confidence, and the need for plan modifications. Respondents had difficulty differentiating between plans generated by a human or those generated by the ML algorithm. Conclusions: Prostate LDR preimplantation treatment plans that have equivalent quality to plans created

  3. Increasing Fractional Doses Increases the Probability of Benign PSA Bounce in Patients Undergoing Definitive HDR Brachytherapy for Prostate Cancer.

    Science.gov (United States)

    Hauck, Carlin R; Ye, Hong; Chen, Peter Y; Gustafson, Gary S; Limbacher, Amy; Krauss, Daniel J

    2017-05-01

    Prostate-specific antigen (PSA) bounce is a temporary elevation of the PSA level above a prior nadir. The purpose of this study was to determine whether the frequency of a PSA bounce following high-dose-rate (HDR) interstitial brachytherapy for the treatment of prostate cancer is associated with individual treatment fraction size. Between 1999 and 2014, 554 patients underwent treatment of low- or intermediate-risk prostate cancer with definitive HDR brachytherapy as monotherapy and had ≥3 subsequent PSA measurements. Four different fraction sizes were used: 950 cGy × 4 fractions, 1200 cGy × 2 fractions, 1350 cGy × 2 fractions, 1900 cGy × 1 fraction. Four definitions of PSA bounce were applied: ≥0.2, ≥0.5, ≥1.0, and ≥2.0 ng/mL above the prior nadir with a subsequent return to the nadir. The median follow-up period was 3.7 years. The actuarial 3-year rate of PSA bounce for the entire cohort was 41.3%, 28.4%, 17.4%, and 6.8% for nadir +0.2, +0.5, +1.0, and +2.0 ng/mL, respectively. The 3-year rate of PSA bounce >0.2 ng/mL was 42.2%, 32.1%, 41.0%, and 59.1% for the 950-, 1200-, 1350-, and 1900-cGy/fraction levels, respectively (P=.002). The hazard ratio for bounce >0.2 ng/mL for patients receiving a single fraction of 1900 cGy compared with those receiving treatment in multiple fractions was 1.786 (P=.024). For patients treated with a single 1900-cGy fraction, the 1-, 2-, and 3-year rates of PSA bounce exceeding the Phoenix biochemical failure definition (nadir +2 ng/mL) were 4.5%, 18.7%, and 18.7%, respectively, higher than the rates for all other administered dose levels (P=.025). The incidence of PSA bounce increases with single-fraction HDR treatment. Knowledge of posttreatment PSA kinetics may aid in decision making regarding management of potential biochemical failures. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Outcomes Associated With 3 Treatment Schedules of High-Dose-Rate Brachytherapy Monotherapy for Favorable-Risk Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Jawad, Maha Saada; Dilworth, Joshua T.; Gustafson, Gary S.; Ye, Hong; Wallace, Michelle [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Martinez, Alvaro [Michigan HealthCare Professionals/21" s" t Century Oncology, Farmington Hills, Michigan (United States); Chen, Peter Y. [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States); Krauss, Daniel J., E-mail: DKrauss@beaumont.edu [Department of Radiation Oncology, Oakland University William Beaumont School of Medicine, Royal Oak, Michigan (United States)

    2016-03-15

    Purpose: We report the outcomes associated with 3 high-dose-rate (HDR) brachytherapy regimens used as monotherapy for favorable-risk prostate cancer. Methods and Materials: Four hundred ninety-four patients with stage ≤T2b prostate cancer, Gleason score ≤7, and prostate-specific antigen levels ≤15 ng/mL underwent HDR brachytherapy as monotherapy. Of those, 319 received 38 Gy in 4 fractions, 79 received 24 Gy in 2 fractions, and 96 received 27 Gy in 2 fractions. Acute and chronic genitourinary (GU) and gastrointestinal (GI) toxicities were defined as side effects occurring ≤6 and >6 months, respectively, after radiation therapy (RT) and were graded according to the Common Terminology Criteria for Adverse Events version 3.0. The time to toxicity was calculated from the date of RT completion. Variables were analyzed with χ{sup 2} test. P values <.05 were considered significant. Results: The median overall follow-up time was 4 years (range, 5.5, 3.5, and 2.5 years for 38 Gy, 24 Gy, and 27 Gy, respectively, P<.001). Acute and chronic grade ≥2 GU and GI toxicity profiles were similar among groups. Acceptable rates of grade 2 GU toxicities were seen with overall acute/chronic frequency/urgency, dysuria, retention, incontinence, and hematuria rates of 14%/20%, 6%/7%, 7%/4%, 1.5%/2%, and 1.5%/7%, respectively. Minimal grade 3 and no grade 4 or 5 toxicities were seen. Grade 1, 2, and 3 chronic urethral stricture rates were 0.3%, 2%, and 1%, respectively. All GI toxicities were similar between groups, with overall rates of acute/chronic grade 2 diarrhea, rectal pain/tenesmus, rectal bleeding, and proctitis of 1%/1%, <1%/0.5%, 0%/2%, and <1%/1%, respectively. No grade 3, 4, or 5 toxicities were seen. All comparisons were similar for hormone-naïve patients. The median time to maximal GU/GI toxicity was similar between groups, ranging from 1 to 1.6 to 0.9 to 1.2 years, respectively. There were no differences in clinical outcomes between the 3 groups at 5

  5. TU-F-BRF-02: MR-US Prostate Registration Using Patient-Specific Tissue Elasticity Property Prior for MR-Targeted, TRUS-Guided HDR Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, X; Rossi, P; Ogunleye, T; Jani, A; Curran, W; Liu, T [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, GA (United States)

    2014-06-15

    Purpose: High-dose-rate (HDR) brachytherapy has become a popular treatment modality for prostate cancer. Conventional transrectal ultrasound (TRUS)-guided prostate HDR brachytherapy could benefit significantly from MR-targeted, TRUS-guided procedure where the tumor locations, acquired from the multiparametric MRI, are incorporated into the treatment planning. In order to enable this integration, we have developed a MR-TRUS registration with a patient-specific biomechanical elasticity prior. Methods: The proposed method used a biomechanical elasticity prior to guide the prostate volumetric B-spline deformation in the MRI and TRUS registration. The patient-specific biomechanical elasticity prior was generated using ultrasound elastography, where two 3D TRUS prostate images were acquired under different probe-induced pressures during the HDR procedure, which takes 2-4 minutes. These two 3D TRUS images were used to calculate the local displacement (elasticity map) of two prostate volumes. The B-spline transformation was calculated by minimizing the Euclidean distance between the normalized attribute vectors of the prostate surface landmarks on the MR and TRUS. This technique was evaluated through two studies: a prostate-phantom study and a pilot study with 5 patients undergoing prostate HDR treatment. The accuracy of our approach was assessed through the locations of several landmarks in the post-registration and TRUS images; our registration results were compared with the surface-based method. Results: For the phantom study, the mean landmark displacement of the proposed method was 1.29±0.11 mm. For the 5 patients, the mean landmark displacement of the surface-based method was 3.25±0.51 mm; our method, 1.71±0.25 mm. Therefore, our proposed method of prostate registration outperformed the surfaced-based registration significantly. Conclusion: We have developed a novel MR-TRUS prostate registration approach based on patient-specific biomechanical elasticity prior

  6. Evaluation of time, attendance of medical staff, and resources during interstitial brachytherapy for prostate cancer. DEGRO-QUIRO trial

    International Nuclear Information System (INIS)

    Tselis, N.; Zamboglou, N.; Maurer, U.; Popp, W.; Sack, H.

    2014-01-01

    The German Society of Radiation Oncology initiated a multicenter trial to evaluate core processes and subprocesses of radiotherapy by prospective evaluation of all important procedures in the most frequent malignancies treated by radiation therapy. The aim of this analysis was to assess the required resources for interstitial high-dose-rate (HDR) and low-dose-rate (LDR) prostate brachytherapy (BRT) based on actual time measurements regarding allocation of personnel and room occupation needed for specific procedures. Two radiotherapy centers (community hospital of Offenbach am Main and community hospital of Eschweiler) participated in this prospective study. Working time of the different occupational groups and room occupancies for the workflow of prostate BRT were recorded and methodically assessed during a 3-month period. For HDR and LDR BRT, a total of 560 and 92 measurements, respectively, were documented. The time needed for treatment preplanning was median 24 min for HDR (n=112 measurements) and 6 min for LDR BRT (n=21). Catheter implantation with intraoperative HDR real-time planning (n=112), postimplantation HDR treatment planning (n=112), and remotely controlled HDR afterloading irradiation (n=112) required median 25, 39, and 50 min, respectively. For LDR real-time planning (n=39) and LDR treatment postplanning (n=32), the assessed median duration was 91 and 11 min, respectively. Room occupancy and overall mean medical staff times were 194 and 910 min respectively, for HDR, and 113 and 371 min, respectively, for LDR BRT. In this prospective analysis, the resource requirements for the application of HDR and LDR BRT of prostate cancer were assessed methodically and are presented for first time. (orig.)

  7. Evaluation of time, attendance of medical staff, and resources during interstitial brachytherapy for prostate cancer. DEGRO-QUIRO trial

    Energy Technology Data Exchange (ETDEWEB)

    Tselis, N.; Zamboglou, N. [Sana Klinikum Offenbach, Department of Radiation Oncology, Offenbach am Main (Germany); Maurer, U. [St.-Antonius-Hospital, Strahlentherapie, Eschweiler (Germany); Popp, W. [Prime Networks AG, Basel (Switzerland); Sack, H. [University of Essen, Department of Radiation Oncology, Essen (Germany)

    2014-04-15

    The German Society of Radiation Oncology initiated a multicenter trial to evaluate core processes and subprocesses of radiotherapy by prospective evaluation of all important procedures in the most frequent malignancies treated by radiation therapy. The aim of this analysis was to assess the required resources for interstitial high-dose-rate (HDR) and low-dose-rate (LDR) prostate brachytherapy (BRT) based on actual time measurements regarding allocation of personnel and room occupation needed for specific procedures. Two radiotherapy centers (community hospital of Offenbach am Main and community hospital of Eschweiler) participated in this prospective study. Working time of the different occupational groups and room occupancies for the workflow of prostate BRT were recorded and methodically assessed during a 3-month period. For HDR and LDR BRT, a total of 560 and 92 measurements, respectively, were documented. The time needed for treatment preplanning was median 24 min for HDR (n=112 measurements) and 6 min for LDR BRT (n=21). Catheter implantation with intraoperative HDR real-time planning (n=112), postimplantation HDR treatment planning (n=112), and remotely controlled HDR afterloading irradiation (n=112) required median 25, 39, and 50 min, respectively. For LDR real-time planning (n=39) and LDR treatment postplanning (n=32), the assessed median duration was 91 and 11 min, respectively. Room occupancy and overall mean medical staff times were 194 and 910 min respectively, for HDR, and 113 and 371 min, respectively, for LDR BRT. In this prospective analysis, the resource requirements for the application of HDR and LDR BRT of prostate cancer were assessed methodically and are presented for first time. (orig.)

  8. Aspects of an automatic system of implants of radioactive seeds and anatomic object simulator for tests in prostate brachytherapy

    International Nuclear Information System (INIS)

    Silva, Leonardo S.M.; Braga, Viviane V.B.; Campos, Tarcísio P. R. de

    2017-01-01

    This work presents the state of the art of the research and development of an automatic radioactive seed implantation system (PSIS). PSIS may assist in the procedure of testing permanent implants in the prostate. These tests will be important in measurements of absorbed doses in the pelvic structures, involving the organs and tissues at risk to improve planning, seed positioning and dosimetry. The automated Prostate Seed Implant System (PSIS) has been designed to meet operational needs, which offers the freedom of positioning of the brachytherapy needle within the treatment area and ensures repeatability and fidelity to the planned treatment. Both the ultrasound probe and the seed implant needle are driven by step motors, Atmega microcontroller, bearings, aluminum shafts and a GUI (Graphical User Interface). Movement of both the probe and the needle holder was performed by fixed spindle on a threaded rod rushing to the step motors by a coupling. The step motors used to move the system consist of step motors used in CNC (Computer Numeric Control) machine. The choice of these engines occurred due to the precision in the movements that can be obtained with these types of motors. The ultrasound probe serves to help, through the images acquired during the longitudinal movement, to monitor the application of the seeds. The parts that make up the system infrastructure were made of aluminum and translucent acrylic and cylindrical aluminum bars of different diameters. All these pieces were fixed and adjusted trough screws, washers, nuts and adhesive to metal, composing the final prototype of the PSIS. The project was developed and the PSIS prototype was assembled. The prototype presented acceptable operating characteristics for prostate implants. The advantage of this system is the automation of the application that provides an accurate positioning and movement of both probe and seed application. In addition to this study, seeds implantation tests will be performed, and

  9. Aspects of an automatic system of implants of radioactive seeds and anatomic object simulator for tests in prostate brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Silva, Leonardo S.M.; Braga, Viviane V.B.; Campos, Tarcísio P. R. de, E-mail: leonardosantiago.lsms@gmail.com, E-mail: vitoriabraga06@gmail.com, E-mail: tprcampos@yahoo.com.br [Universidade Federal de Minas Gerais (PCTN/UFMG), Belo Horizonte (Brazil). Pós-Graduação em Ciências e Técnicas Nucleares. Departamento de Engenharia Nuclear

    2017-07-01

    This work presents the state of the art of the research and development of an automatic radioactive seed implantation system (PSIS). PSIS may assist in the procedure of testing permanent implants in the prostate. These tests will be important in measurements of absorbed doses in the pelvic structures, involving the organs and tissues at risk to improve planning, seed positioning and dosimetry. The automated Prostate Seed Implant System (PSIS) has been designed to meet operational needs, which offers the freedom of positioning of the brachytherapy needle within the treatment area and ensures repeatability and fidelity to the planned treatment. Both the ultrasound probe and the seed implant needle are driven by step motors, Atmega microcontroller, bearings, aluminum shafts and a GUI (Graphical User Interface). Movement of both the probe and the needle holder was performed by fixed spindle on a threaded rod rushing to the step motors by a coupling. The step motors used to move the system consist of step motors used in CNC (Computer Numeric Control) machine. The choice of these engines occurred due to the precision in the movements that can be obtained with these types of motors. The ultrasound probe serves to help, through the images acquired during the longitudinal movement, to monitor the application of the seeds. The parts that make up the system infrastructure were made of aluminum and translucent acrylic and cylindrical aluminum bars of different diameters. All these pieces were fixed and adjusted trough screws, washers, nuts and adhesive to metal, composing the final prototype of the PSIS. The project was developed and the PSIS prototype was assembled. The prototype presented acceptable operating characteristics for prostate implants. The advantage of this system is the automation of the application that provides an accurate positioning and movement of both probe and seed application. In addition to this study, seeds implantation tests will be performed, and

  10. Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes

    International Nuclear Information System (INIS)

    Stone, Nelson N.; Stock, Richard G.; Cesaretti, Jamie A.; Unger, Pam

    2010-01-01

    Purpose: To determine factors that influence local control and systemic relapse in patients undergoing permanent prostate brachytherapy (PPB). Methods and Materials: A total of 584 patients receiving PPB alone or PPB with external beam radiation therapy (19.5%) agreed to undergo prostate biopsy (PB) at 2 years postimplantion and yearly if results were positive or if the prostate-specific antigen (PSA) level increased. Short-term hormone therapy was used with 280 (47.9%) patients. Radiation doses were converted to biologically effective doses (BED) (using α/β = 2). Comparisons were made by chi-square analysis and linear regression. Survival was determined by the Kaplan-Meier method. Results: The median PSA concentration was 7.1 ng/ml, and the median follow-up period was 7.1 years. PB results were positive for 48/584 (8.2%) patients. Positive biopsy results by BED group were as follows: 22/121 (18.2%) patients received a BED of ≤150 Gy; 15/244 (6.1%) patients received >150 to 200 Gy; and 6/193 (3.1%; p 200 Gy. Significant associations of positive PB results by risk group were low-risk group BED (p = 0.019), intermediate-risk group hormone therapy (p = 0.011) and BED (p = 0.040), and high-risk group BED (p = 0.004). Biochemical freedom from failure rate at 7 years was 82.7%. Biochemical freedom from failure rate by PB result was 84.7% for negative results vs. 59.2% for positive results (p 200 Gy with an α/β ratio of 2 yields 96.9% local control rate. Failure to establish local control impacts survival.

  11. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer.

    Science.gov (United States)

    Le Fur, E; Malhaire, J P; Baverez, D; Delage, F; Perrouin-Verbe, M A; Schlurmann, F; Guerif, S; Fournier, G; Pradier, O; Valeri, A

    2012-12-01

    To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB). From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I(125) PPB as monotherapy with intraoperative planning. Patients were divided into three groups-P1 (n = 64), P2 (n = 45), P3 (n = 41)-according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation). We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10(-5)) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008). We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters.

  12. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Le Fur, E. [CHU Brest (France). Radiation Therapy Dept.; Universite de Bretagne Occidentale, Brest (France). Faculte de Medecine et des Sciences de la Sante; Malhaire, J.P.; Baverez, D.; Schlurmann, F. [CHU Brest (France). Radiation Therapy Dept.; Delage, F.; Perrouin-Verbe, M.A. [CHU Brest (France). Urology Dept.; Guerif, S. [University Hospital La Miletrie, Poitiers (France). Radiation Therapy Dept.; Poitiers Univ. (France); Fournier, G.; Valeri, A. [CHU Brest (France). Urology Dept.; Universite de Bretagne Occidentale, Brest (France). Faculte de Medecine et des Sciences de la Sante; Universite Europeenne de Bretagne, Rennes (France); APHP, Hopital Tenon, Paris (France). CeRe.PP; Pradier, O. [CHU Brest (France). Radiation Therapy Dept.; Universite de Bretagne Occidentale, Brest (France). Faculte de Medecine et des Sciences de la Sante; Universite Europeenne de Bretagne, Rennes (France); CHU Brest (France). LaTIM, INSERM U650

    2012-12-15

    Purpose: To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB). Patients and methods: From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I{sup 125} PPB as monotherapy with intraoperative planning. Patients were divided into three groups - P1 (n = 64), P2 (n = 45), P3 (n = 41) - according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation). Results: We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10- 5) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008). Conclusion: We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters. (orig.)

  13. Second salvage high-dose-rate brachytherapy for radiorecurrent prostate cancer

    NARCIS (Netherlands)

    Maenhout, Metha; Van Vulpen, Marco; Moerland, Marinus; Peters, Max; Meijer, Richard; Van Den Bosch, Maurice; Nguyen, Paul; Frank, Steven; Van Der Voort Van Zyp, Jochem

    2017-01-01

    Purpose: Salvage treatments for localized radiorecurrent prostate cancer can be performed safely when a focal and image guided approach is used. Due to the low toxicity, the opportunity exists to investigate a second salvage treatment when a second locally recurrent prostate cancer occurs. Here, we

  14. Standards, options and recommendations for brachytherapy of prostate cancer: efficacy and toxicity; Standards, options et recommandations pour la curietherapie des patients atteints de cancer de la prostate: efficacite et toxicite

    Energy Technology Data Exchange (ETDEWEB)

    Pommier, P. [Centre de Lutte Contre le Cancer Leon-Berard, 69 - Lyon (France); Villers, A. [Centre Hospitalier Universitaire, Hopital Huriez, 59 - Lille (France); Bataillard, A. [Federation Nationale des Centres de Lutte Contre le Cancer, FNCLCC, 75 - Paris (France)] [and others

    2001-12-01

    Context. - The 'Standards, Options and Recommendations' (SOR) collaborative project was initiated in 1993 by the Federation of the French Cancer Centres (FNCLCC), with the 20 French Regional Cancer Centres, several French public university and general hospitals, as well as private clinics and medical specialty societies. Its main objective is the development of serviceable clinical practice guidelines in order to improve the quality of health care and the outcome of cancer patients. The methodology is based on a literature review, followed by a critical appraisal by a multidisciplinary group of experts. Draft guidelines are produced, then validated by specialists in cancer care delivery. Objectives. - Produce technical practice guidelines for the brachytherapy of prostate cancer using the methodology developed by the Standards, Options and Recommendations project. Methods. - The FNCLCC and the French Urology Association (AFU) first designated the multidisciplinary group of experts. Available data were collected by a search of Medline and lists selected by experts in the group. A first draft of the guidelines was written, they validated by independent reviewers. Results. - The main recommendations are: 1/ Brachytherapy with permanent seeds alone is a possible curative treatment for prostate cancer patients with the following prognosis factors: tumour stage T1 or T2a (TNM 1992), Gleason score {<=} 6 and PSA < 10 {mu}g/L. 2/ Combined treatment with brachytherapy and hormonal therapy could be more efficient than brachytherapy alone for prostate cancer patients with Gleason score > 7 and/or PSA > 10. 3/ Combination of brachytherapy and external beam radiation therapy can be proposed to prostate cancer patients with intermediate prognosis. 4/ Before and after seed implantation, risks of infection must be prevented by appropriate antibiotic therapy (recommendation). 5/ Brachytherapy must not be performed within 2 months of trans-urethral prostate resection. 6

  15. SU-F-J-157: Effect of Contouring Uncertainty in Post Implant Dosimetry of Low-Dose-Rate Prostate Permanent Seed Brachytherapy

    International Nuclear Information System (INIS)

    Mashouf, S; Merino, T; Ravi, A; Morton, G; Song, W; Safigholi, H; Soliman, A

    2016-01-01

    Purpose: There is strong evidence relating post-implant dosimetry for low-dose-rate (LDR) prostate seed brachytherapy to local control rates. The delineation of the prostate on CT images, however, represents a challenge due to the lack of soft tissue contrast in order to identify the prostate borders. This study aims at quantifying the sensitivity of clinically relevant dosimetric parameters to uncertainty in the contouring of prostate. Methods: CT images, post-op plans and contours of a cohort of patients (n=43) (low risk=55.8%, intermediate risk=39.5%, high risk=4.7%), who had received prostate seed brachytherapy, were imported into MIM Symphony treatment planning system. The prostate contours in post-implant CT images were expanded/contracted uniformly for margins of ±1.00 mm, ±2.00 mm, ±3.00 mm, ±4.00 mm and ±5.00 mm. The values for V100 and D90 were extracted from Dose Volume Histograms for each contour and compared. Results: Significant changes were observed in the values of D90 and V100 as well as the number of suboptimal plans for expansion or contraction margins of only few millimeters. Evaluation of coverage based on D90 was found to be less sensitive to expansion errors compared to V100. D90 led to a lower number of implants incorrectly identified with insufficient coverage for expanded contours which increases the accuracy of post-implant QA using CT images compared to V100. Conclusion: In order to establish a successful post implant QA for LDR prostate seed brachytherapy, it is necessary to identify the low and high thresholds of important dose metrics of the target volume such as D90 and V100. Since these parameters are sensitive to target volume definition, accurate identification of prostate borders would help to improve accuracy and predictive value of the post-implant QA process. In this respect, use of imaging modalities such as MRI where prostate is well delineated should prove useful.

  16. Study and development of methodology for radioactive iodine fixation in polymeric substrate for manufacturing sources used in brachytherapy; Estudo e desenvolvimento de metodologia para fixacao de iodo radioativo em substrato polimerico para confeccao de fontes utilizadas em braquiterapia

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigues, Bruna T.; Souza, Carla D.; Benega, Marcos A.G. and others, E-mail: bteigarodrigues@gmail.com, E-mail: carladdsouza@yahoo.com.br, E-mail: marcosagbenega@gmail.com [Instituto de Pesquisas Energeticas e Nucleares (IPEN/CNEN-SP), Sao Paulo, SP (Brazil). Centro de Tecnologia das Radiacoes

    2014-07-01

    According global estimates of Globocan 2012 project of the International Agency for Research of Cancer, of the World Health Organization, there were 14,1 million new cases of cancer and a total of 8,2 million deaths from cancer. Also show that in 2030, the overall load will be 21,4 million new cases and 13,2 million cancer deaths. One of the prostate cancer therapy is brachytherapy, used in early and middle stages of the disease. It is made with the introduction of seeds with radioactive material within the tumor or in nearby regions, affecting the minimum surrounding tissues. The aim of this work is the study and developing the deposition of radioactive iodine on the polymeric substrate method, and an analysis relating the efficiency of the method to implementation in the laboratory of brachytherapy from IPEN. Iodine-125 is adsorbed on an epoxy resin solution. The objective of this study is to offer a new proposal for seeds. The results will give the data for the radiation protection and the procedures for radioactive waste management.

  17. Comparison between methods for fixing radioactive iodine in silver substrate for manufacturing brachytherapy sources; Comparacao entre metodos de fixacao do iodo radioativo em substrato de prata para confeccao de fontes utilizadas em braquiterapia

    Energy Technology Data Exchange (ETDEWEB)

    Souza, Carla Daruich

    2012-07-01

    Among the different ways to treat prostate cancer, brachytherapy with iodine- 125 seeds is an option that provides good results and fewer side effects. In the present study several deposition methods of radioactive iodine in a silver substrate were compared in order to choose the most suitable alternative for the routine production to be implemented at IPEN's laboratory. The methodology used was chosen based on the available infrastructure and experience of the researchers present. Therefore, the {sup 131}I was used for testing (same chemical behavior as {sup 131}I). Four methods were selected: Method 1 (test based on electrodeposition method developed by D.Kubiatowicz) presented 65.16% efficiency; Method 2 (chemical reaction based on the method developed by D. Kubiatowicz - HCl) with the result of 70.80% efficiency; method 3 (chemical reaction based on the method developed by Dr. Maria Elisa Rostelato) with 55.80% efficiency; Method 4 (IQ-IPEN) resulted in 99% efficiency. Since this method has more radioactive material fixation (which represents virtually the entire cost of the seed), the final price is the cheapest. This method is the suggested one to be implemented in the IPEN's laboratory for brachytherapy sources production. Besides, the method is the fasted one. (author)

  18. In vivo dosimetry HDR brachytherapy prostate with source CO-60: Results of measures in a point urethra; Dosimetria in vivo en braquiterapia HDR de prostate con fuente de CO-60: Resultados de medidas en un punto de uretra

    Energy Technology Data Exchange (ETDEWEB)

    Latorre, D.; Fernandez, J.; Rivero, G.; Crelgo, D.; Gonzalez, J. M.; Sanchez, P.; Villace, A.; Sanchez, E.; Arroyo, M. A.; Garcia, E.; Trabanco, E.

    2015-07-01

    In this study we present and analyze the results of the in vivo dosimetry made a point of urethra with a group of 30 patients treated with brachytherapy prostate high rate with Co-60 source. Taking into account the uncertainties, the results and integration, globally evaluate this system DIV. This DIV system, due to its ease of calibration and use, and provides a relatively simple integration way to avoid serious errors in administering treatment. (Author)

  19. Acute genitourinary toxicity after high-dose-rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: Correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity

    International Nuclear Information System (INIS)

    Akimoto, Tetsuo; Ito, Kazuto; Saitoh, Jun-ichi; Noda, Shin-ei; Harashima, Koichi; Sakurai, Hideyuki; Nakayama, Yuko; Yamamoto, Takumi; Suzuki, Kazuhiro; Nakano, Takashi; Niibe, Hideo

    2005-01-01

    Purpose: Several investigations have revealed that the α/β ratio for prostate cancer is atypically low, and that hypofractionation or high-dose-rate (HDR) brachytherapy regimens using appropriate radiation doses may be expected to yield tumor control and late sequelae rates that are better or at least as favorable as those achieved with conventional radiation therapy. In this setting, we attempted treating localized prostate cancer patients with HDR brachytherapy combined with hypofractionated external beam radiation therapy (EBRT). The purpose of this study was to evaluate the feasibility of using this approach, with special emphasis on the relationship between the severity of acute genitourinary (GU) toxicity and the urethral dose calculated from the dose-volume histogram (DVH) of HDR brachytherapy. Methods and Materials: Between September 2000 and December 2003, 70 patients with localized prostate cancer were treated by iridium-192 HDR brachytherapy combined with hypofractionated EBRT at the Gunma University Hospital. Hypofractionated EBRT was administered in fraction doses of 3 Gy, three times per week; a total dose of 51 Gy was delivered to the prostate gland and the seminal vesicles using the four-field technique. No elective pelvic irradiation was performed. After the completion of EBRT, all the patients additionally received transrectal ultrasonography (TRUS)-guided HDR brachytherapy. The fraction size and the number of fractions in HDR brachytherapy were prospectively changed, whereas the total radiation dose for EBRT was fixed at 51 Gy. The fractionation in HDR brachytherapy was as follows: 5 Gy x 5, 7 Gy x 3, 9 Gy x 2, administered twice per day, although the biologic effective dose (BED) for HDR brachytherapy combined with EBRT, assuming that the α/β ratio is 3, was almost equal to 138 in each fractionation group. The planning target volume was defined as the prostate gland with 5-mm margin all around, and the planning was conducted based on

  20. In vivo imaging of insulin receptors by PET: preclinical evaluation of iodine-125 and iodine-124 labelled human insulin

    International Nuclear Information System (INIS)

    Iozzo, P.; Osman, S.; Glaser, M.; Knickmeier, M.; Ferrannini, E.; Pike, V.W.; Camici, P.G.; Law, M.P.

    2002-01-01

    [A 14 -*I]iodoinsulin was prepared for studies to assess the suitability of labeled iodoinsulin for positron emission tomography (PET). Iodine-125 was used to establish the methods and for preliminary studies in rats. Further studies and PET scanning in rats were carried out using iodine-124. Tissue and plasma radioactivity was measured as the uptake index (UI={cpm·(g tissue) -1 }/{cpm injected·(g body weight) -1 }) at 1 to 40 min after intravenous injection of either [A 14 - 125 I]iodoinsulin or [A 14 - 124 I]iodoinsulin. For both radiotracers, initial clearance of radioactivity from plasma was rapid (T 1/2 ∼ 1 min), reaching a plateau (UI = 2.8) at ∼ 5 min which was maintained for 35 min. Tissue biodistributions of the two radiotracers were comparable; at 10 min after injection, UI for myocardium was 2.4, liver, 4.0, pancreas, 5.4, brain, 0.17, kidney, 22, lung, 2.3, muscle, 0.54 and fat, 0.28. Predosing rats with unlabelled insulin reduced the UI for myocardium (0.95), liver (1.8), pancreas (1.2) and brain (0.08), increased that for kidney (61) but had no effect on that for lung (2.5), muscle (0.50) or fat (0.34). Analysis of radioactivity in plasma demonstrated a decrease of [ 125 I]iodoinsulin associated with the appearance of labeled metabolites; the percentage of plasma radioactivity due to [ 125 I]iodoinsulin was 40% at 5 min and 10% at 10 min. The heart, liver and kidneys were visualized using [ 124 I]iodoinsulin with PET

  1. Robustness to source displacement in dual air kerma strength planning for focal low-dose-rate brachytherapy of prostate cancer.

    Science.gov (United States)

    Mahdavi, S Sara; Spadinger, Ingrid T; Chng, Nicholas T; Morris, W James

    2016-01-01

    To describe the use of dual source strength implants for focal low-dose-rate brachytherapy. An interneedle dual source strength planning strategy is described for focal low-dose-rate brachytherapy of the prostate. The implanted treatment plans were designed using peripheral (except near the rectum) needles loaded with high strength (0.9 U) sources and central needles loaded with low strength (0.4 U) sources ("interneedle" dual strength planning). This approach has been applied for focally treating 3 patients. In this article, we compare the characteristics and robustness to source motion of interneedle dual strength planning with four alternative planning strategies (single strength high, low, and intermediate, and intraneedle dual strength) on 50 simulated cases. Interneedle dual source strength planning results in greater robustness to source motion and overall lower seed and needle density compared to the standard low source strength planning currently used in our centre. This planning approach is also significantly superior to single strength high, single strength intermediate and intraneedle dual strength planning strategies in terms of high dose to the urethral avoidance structure. The use of interneedle dual source strength treatment plans for focal low-dose-rate brachytherapy is possibly the practical solution for limiting the density of sources required to deliver the prescribed dose while limiting proximity of high strength sources to organs at risk. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  2. A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Wallner, Kent; Butler, Wayne M.; Galbreath, Robert W.; Lief, Jonathan H.; Benson, Mark L.

    2001-01-01

    Purpose: To retrospectively evaluate the relationship between the radiation dose to the bulb of the penis and the development of erectile dysfunction (ED) in patients undergoing permanent prostate brachytherapy without external beam radiation therapy. Methods and Materials: Twenty-three men who developed ED after transperineal ultrasound-guided permanent prostate brachytherapy for clinical T1/T2 adenocarcinoma of the prostate gland were paired with 23 similar men who maintained potency after implantation. Potency was defined as an erection sufficient for vaginal penetration. The mean and median follow-up for the entire group was 34.6 ± 13.7 months and 32.8 months, respectively. Patients were implanted with either 125 I (145 Gy TG-43) or 103 Pd (115 Gy, pre-NIST-99). No patient received external beam radiation therapy either before or after brachytherapy. The bulb of the penis was outlined at 0.5-cm intervals on the Day 0 postimplant CT scan. The radiation dose distribution to the bulb of the penis was defined in terms of the minimal dose delivered to 25%, 50%, 70%, 75%, 90%, and 95% of the bulb (D 25 , D 50 , D 70 , D 75 , D 90 , and D 95 ). Results: The radiation dose delivered to the bulb of the penis in men with postbrachytherapy-induced ED was statistically greater for all evaluated dosimetric parameters (D 25 , D 50 , D 70 , D 75 , D 90 , and D 95 ). Multivariate analysis indicated that dose to the bulb of the penis and patient age at the time of implant were predictive of postimplant ED, whereas choice of isotope had no effect. Among potent patients, 19/23 had D 50 ≤ 40% of prescribed minimal peripheral dose, whereas for the impotent patients, 19/23 had D 50 >40% of the minimal peripheral dose. Of the impotent patients, 17 utilized sildenafil, with 15 experiencing a favorable response (88%). Conclusion: Our data suggest that prostate brachytherapy-induced impotence is highly correlated with the radiation dose delivered to the bulb of the penis. With Day 0

  3. Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Riaz, Nadeem [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Afaq, Asim; Akin, Oguz [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Pei Xin; Kollmeier, Marisa A.; Cox, Brett [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hricak, Hedvig [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2012-11-01

    Purpose: To investigate the utility of endorectal coil magenetic resonance imaging (eMRI) in predicting biochemical relapse in prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Methods and Materials: Between 2000 and 2008, 279 men with intermediate- or high-risk prostate cancer underwent eMRI of their prostate before receiving brachytherapy and supplemental intensity-modulated radiotherapy. Endorectal coil MRI was performed before treatment and retrospectively reviewed by two radiologists experienced in genitourinary MRI. Image-based variables, including tumor diameter, location, number of sextants involved, and the presence of extracapsular extension (ECE), were incorporated with other established clinical variables to predict biochemical control outcomes. The median follow-up was 49 months (range, 1-13 years). Results: The 5-year biochemical relapse-free survival for the cohort was 92%. Clinical findings predicting recurrence on univariate analysis included Gleason score (hazard ratio [HR] 3.6, p = 0.001), PSA (HR 1.04, p = 0.005), and National Comprehensive Cancer Network risk group (HR 4.1, p = 0.002). Clinical T stage and the use of androgen deprivation therapy were not correlated with biochemical failure. Imaging findings on univariate analysis associated with relapse included ECE on MRI (HR 3.79, p = 0.003), tumor size (HR 2.58, p = 0.04), and T stage (HR 1.71, p = 0.004). On multivariate analysis incorporating both clinical and imaging findings, only ECE on MRI and Gleason score were independent predictors of recurrence. Conclusions: Pretreatment eMRI findings predict for biochemical recurrence in intermediate- and high-risk prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Gleason score and the presence of ECE on MRI were the only significant predictors of biochemical relapse in this group of patients.

  4. Justification for inter-fraction correction of catheter movement in fractionated high dose-rate brachytherapy treatment of prostate cancer

    International Nuclear Information System (INIS)

    Simnor, Tania; Li, Sonia; Lowe, Gerry; Ostler, Peter; Bryant, Linda; Chapman, Caroline; Inchley, Dave; Hoskin, Peter J.

    2009-01-01

    Background and purpose: Fractionated high dose-rate (HDR) brachytherapy in the treatment of prostate cancer relies on reproducible catheter positions for each fraction to ensure adequate tumour coverage while minimising dose to normal tissues. Peri-prostatic oedema may cause caudal displacement of the catheters relative to the prostate gland between fractions. This can be corrected for by changing source dwell positions or by physical re-advancement of catheters before treatment. Materials and methods: Data for 20 consecutive monotherapy patients receiving three HDR fractions of 10.5 Gy per fraction over 2 days were analysed retrospectively. Pre-treatment CT scans were used to assess the effect of catheter movement between fractions on implant quality, with and without movement correction. Implant quality was evaluated using dosimetric parameters. Results: Compared to the first fraction (f1) the mean inter-fraction caudal movement relative to the prostate base was 7.9 mm (f2) (range 0-21 mm) and 3.9 mm (f3) (range 0-25.5 mm). PTV D90% was reduced without movement correction by a mean of 27.8% (f2) and 32.3% (f3), compared with 5.3% and 5.1%, respectively, with catheter movement correction. Dose to 2 cc of the rectum increased by a mean of 0.69 (f2) and 0.76 Gy (f3) compared with an increase of 0.03 and 0.04 Gy, respectively, with correction. The urethra V12 also increased by a mean of 0.36 (f2) and 0.39 Gy (f3) compared with 0.06 and 0.16 Gy, respectively, with correction. Conclusions: Inter-fraction correction for catheter movement using pre-treatment imaging is critical to maintain the quality of an implant. Without movement correction there is significant risk of tumour under-dosage and normal tissue over-dosage. The findings of this study justify additional imaging between fractions in order to carry out correction.

  5. Justification for inter-fraction correction of catheter movement in fractionated high dose-rate brachytherapy treatment of prostate cancer.

    Science.gov (United States)

    Simnor, Tania; Li, Sonia; Lowe, Gerry; Ostler, Peter; Bryant, Linda; Chapman, Caroline; Inchley, Dave; Hoskin, Peter J

    2009-11-01

    Fractionated high dose-rate (HDR) brachytherapy in the treatment of prostate cancer relies on reproducible catheter positions for each fraction to ensure adequate tumour coverage while minimising dose to normal tissues. Peri-prostatic oedema may cause caudal displacement of the catheters relative to the prostate gland between fractions. This can be corrected for by changing source dwell positions or by physical re-advancement of catheters before treatment. Data for 20 consecutive monotherapy patients receiving three HDR fractions of 10.5 Gy per fraction over 2 days were analysed retrospectively. Pre-treatment CT scans were used to assess the effect of catheter movement between fractions on implant quality, with and without movement correction. Implant quality was evaluated using dosimetric parameters. Compared to the first fraction (f1) the mean inter-fraction caudal movement relative to the prostate base was 7.9 mm (f2) (range 0-21 mm) and 3.9 mm (f3) (range 0-25.5 mm). PTV D90% was reduced without movement correction by a mean of 27.8% (f2) and 32.3% (f3), compared with 5.3% and 5.1%, respectively, with catheter movement correction. Dose to 2 cc of the rectum increased by a mean of 0.69 (f2) and 0.76 Gy (f3) compared with an increase of 0.03 and 0.04 Gy, respectively, with correction. The urethra V12 also increased by a mean of 0.36 (f2) and 0.39 Gy (f3) compared with 0.06 and 0.16 Gy, respectively, with correction. Inter-fraction correction for catheter movement using pre-treatment imaging is critical to maintain the quality of an implant. Without movement correction there is significant risk of tumour under-dosage and normal tissue over-dosage. The findings of this study justify additional imaging between fractions in order to carry out correction.

  6. 3D MR-Spectroscopic Imaging Assessment of Metabolic Activity in the Prostate During the PSA 'Bounce' Following 125Iodine Brachytherapy

    International Nuclear Information System (INIS)

    Kirilova, Anna; Damyanovich, Andrei; Crook, Juanita; Jezioranski, John; Wallace, Kris; Pintilie, Melania

    2011-01-01

    Purpose: A temporary increase in prostate-specific antigen (PSA) values is observed in 30%-40% of men following 125 I brachytherapy (BT) for prostate cancer. We present the results of a study to characterize prostate metabolic activity during the PSA 'bounce' and to correlate metabolic changes with PSA levels using three-dimensional magnetic resonance spectroscopic imaging (3D-MRSI). Methods and Materials: 3D-MRSI was performed in 24 patients during the PSA bounce. Eight of these had also had a baseline 3D-MRSI scan before BT for the purpose of tumor mapping. The 3D-MRSI was repeated at 6- and 12-month intervals, and PSA levels were monitored every 3 months. Twenty-one of the patients had favorable-risk prostate cancer, and 3 had intermediate risk. Results: The choline+creatine signal intensity, although markedly reduced, was observable following BT. Diffuse activity not corresponding to original biopsy-positive sites was observed in 22 cases, and 2 cases were documented to have local recurrence. No statistically significant correlation between metabolic activity and PSA levels at each interval was found. Conclusion: Post-BT prostate 3D-MRSI shows evidence of diffuse metabolic activity unrelated to residual malignancy. This supports the benign nature of the PSA bounce and suggests an inflammatory etiology. In the situation of a rising PSA, observation of focal activity on MRI/3D-MRSI could be a useful adjunct to suggest local recurrence at an earlier interval after brachytherapy when prostate biopsies would still be unhelpful. Longer follow-up is necessary to confirm the complex relationship between metabolic activity and PSA levels.

  7. Prostate-Specific Antigen at 4 to 5 Years After Low-Dose-Rate Prostate Brachytherapy Is a Strong Predictor of Disease-Free Survival

    Energy Technology Data Exchange (ETDEWEB)

    Lo, Andrea C. [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Morris, W. James, E-mail: JMorris@bccancer.bc.ca [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Lapointe, Vincent [Department of Medical Physics, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Hamm, Jeremy [Department of Population Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Keyes, Mira; Pickles, Tom; McKenzie, Michael [Department of Radiation Oncology, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada); Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Spadinger, Ingrid [Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia (Canada); Department of Medical Physics, British Columbia Cancer Agency Vancouver Centre, Vancouver, British Columbia (Canada)

    2014-01-01

    Purpose: To determine (1) the prognostic utility of prostate-specific antigen (PSA) concentration at 45 to 60 months (48mPSA) after low-dose-rate prostate brachytherapy (LDR-PB); (2) the predictors of 48mPSA; and (3) the prognostic utility of directional trends between PSA levels at 24, 36, and 48 months after LDR-PB. Methods and Materials: Between 1998 and 2008, 2223 patients with low- and intermediate-risk prostate cancer received LDR-PB monotherapy. A cohort of 1434 of these patients was identified with a documented 48mPSA and no evidence of disease relapse prior to the 48mPSA. In addition, a subset of this cohort (n=585) was identified with ≥72 months of follow-up and documented PSA values at both 24 and 36 months after implantation. Results: Median follow-up time was 76 months. Eight-year Kaplan-Meier disease-free survival (DFS) rates were 100% vs 73.4% for patients with 48mPSA ≤0.2 vs those with >0.2 ng/mL; 99.1% versus 53.8% for a 48mPSA threshold of ≤0.4 versus >0.4 ng/mL, respectively; and 97.3% versus 0% for a threshold of ≤1.0 versus >1.0 ng/mL, respectively. On multivariate analysis, the only factor predictive of DFS was 48mPSA (P<.0001). On subset analysis (n=585), 29 patients had a PSA rise (defined as >0.2 ng/mL) between 24 and 36 months, 24 patients had a rise between 36 and 48 months, and 11 patients had rises over both intervals. Failure rates in these patients were 52%, 79%, and 100%, respectively. On multivariate analysis, initial PSA, androgen deprivation therapy, and dose to 90% of the prostate significantly correlated with 48mPSA but together accounted for only ∼5% of its total variance. Conclusions: The 48mPSA after LDR-PB is highly predictive of long-term DFS. Patients with 48mPSA ≤0.4 ng/mL had a <1% risk of disease relapse at 8 years, whereas all patients with 48mPSA >1.0 ng/mL relapsed. Consecutive PSA rises of >0.2 ng/mL from 24 to 36 months and from 36 to 48 months were also highly predictive of subsequent failure.

  8. Periodical assessment of genitourinary and gastrointestinal toxicity in patients who underwent prostate low-dose-rate brachytherapy

    International Nuclear Information System (INIS)

    Tanaka, Nobumichi; Asakawa, Isao; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Fujimoto, Kiyohide

    2013-01-01

    To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)). A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out. Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity. The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity

  9. CT and MR image fusion using two different methods after prostate brachytherapy: impact on post-implant dosimetric assessment

    International Nuclear Information System (INIS)

    Servois, V.; El Khoury, C.; Lantoine, A.; Ollivier, L.; Neuenschwander, S.; Chauveinc, L.; Cosset, J.M.; Flam, T.; Rosenwald, J.C.

    2003-01-01

    To study different methods of CT and MR images fusion in patient treated by brachytherapy for localized prostate cancer. To compare the results of the dosimetric study realized on CT slices and images fusion. Fourteen cases of patients treated by 1125 were retrospectively studied. The CT examinations were realized with continuous section of 5 mm thickness, and MR images were obtained with a surface coil with contiguous section of 3 mm thickness. For the images fusion process, only the T2 weighted MR sequence was used. Two processes of images fusion were realized for each patient, using as reference marks the bones of the pelvis and the implanted seeds. A quantitative and qualitative appreciation was made by the operators, for each patient and both methods of images fusion. The dosimetric study obtained by a dedicated software was realized on CT images and all types of images fusion. The usual dosimetric indexes (D90, V 100 and V 150) were compared for each type of image. The quantitative results given by the software of images fusion showed a superior accuracy to the one obtained by the pelvic bony reference marks. Conversely, qualitative and quantitative results obtained by the operators showed a better accuracy of the images fusion based on iodine seeds. For two patients out of three presenting a D90 inferior to 145 Gy on CT examination, the D90 was superior to this norm when the dosimetry was based on images fusion, whatever the method used. The images fusion method based on implanted seed matching seems to be more precise than the one using bony reference marks. The dosimetric study realized on images fusion could allow to rectify possible errors, mainly due to difficulties in surrounding prostate contour delimitation on CT images. (authors)

  10. Clinical efficacy of computed tomography-guided iodine-125 seed implantation therapy in patients with advanced spinal metastatic tumors

    Directory of Open Access Journals (Sweden)

    Zhang LY

    2015-12-01

    Full Text Available Liyun Zhang,1,2,* Jian Lu,2,* Zhongmin Wang,3 Yingsheng Cheng,4 Gaojun Teng,5 Kemin Chen4 1Medical College of Soochow University, Suzhou, 2Department of Radiology, Shanghai Ruijin Hospital Luwan Branch, 3Department of Radiology, Shanghai Ruijin Hospital, 4Department of Radiology, Shanghai the Sixth People Hospital, Shanghai, 5Department of Radiology, Jiangsu Key Laboratory of Molecular and Functional Imaging, Zhongda Hospital, Medical School, Southeast University, Nanjing, People’s Republic of China *These authors contributed equally to this work Objective: The purpose of this study was to examine the safety and clinical efficacy of computed tomography (CT-guided radioactive iodine-125 (125I seed implantation treatment in patients with spinal metastatic tumors.Methods: We retrospectively analyzed 20 cases of spinal metastatic tumors, including nine men and eleven women aged 50–79 years (mean age: 61.1 years. We used treatment planning system (TPS to construct three-dimensional images of the spinal metastatic tumors and to determine what number and dose rate distribution to use for the 125I seeds. The matched peripheral dose of the 125I seed implantation was 90–130 Gy. Twenty-four spinal metastatic tumors were treated by CT-guided radioactive 125I seed implantation. A median of 19 (range: 4–43 125I seeds were implanted.Results: Twenty cases were followed for a median of 15.3 months (range: 7–32 months. The rate of pain relief was 95%. The median control time for all of the patients was 12.5 months. The 3-, 6-, and 12-month cumulative local control rates were 100%, 95%, and 60%, respectively. The median survival time for all of the patients was 16 months. The cumulative 6- and 12-month survival rates were 100% and 78.81%, respectively. No major complications were observed. No 125I seeds were lost or migrated to other tissues or organs.Conclusion: CT-guided radioactive 125I seed implantation is a safe, effective, and minimally

  11. Quality of life following 3D conformal radiation therapy or permanent interstitial brachytherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Michalski, J.M.; Kong, F.M.; Mansur, D.B.; Ahmed, N.; Perez, C.A.

    2001-01-01

    Purpose: Both 3D Conformal Radiation Therapy (3DCRT) and Transperineal Interstitial Permanent Brachytherapy (TIPPB) are offered as suitable non-surgical alternatives to radical prostatectomy. Despite equivalent cancer control, very little data has been published that compares Quality of Life (QOL) in contemporary cohorts of patients choosing these treatments. Materials and Methods: Since 1998, patients selecting either 3DCRT alone or TIPPB (monotherapy or boost after external beam) for primary management of localized prostate cancer were asked to participate in a prospective assessment of QOL measures. In this preliminary report, 41 3DCRT and 40 TIPPB (34 monotherapy, 6 boost) patients completed validated QOL instruments at each followup visit. QOL instruments included the International Prostate Symptom Score (IPSS), FACT-P, and Sexual Adjustment Questionnaire (SAQ). Results: The average age of men in each group was 69 years. Choice of treatment was left to the patient unless there were significant medical or technical contraindications to either modality. 3DCRT total doses ranged from 61-78 Gy (mean 73.5Gy) and TIPPB doses were 145Gy (TG43) in 34 I-125 implants and 115 Gy in 1 Pd-103 (monotherapy) or 90 Gy in 5 Pd-103 (boost) implants. Patients undergoing TIPPB reported significantly worse urinary and sexual function than their counterparts receiving 3DCRT. The mean cumulative IPSS was 12.5 with TIPPB compared to 8.3 with 3DCRT (p=0.036). Differences were most pronounced in the first 12 months after treatment, particularly with respect to the strength of stream and the need to strain. TIPPB patients were more likely to report a need to urinate frequently (p=0.02), require a pad (p=0.001), be bothered (p=0.02), or have activity limited by urinary side effects (p=0.01). TIPPB patients were less likely to resume sexual activity within 6 months after treatment (p=0.0003) and engaged in sexual activity less often (p= 0.016) than 3DCRT patients. They were also more

  12. After low and high dose-rate interstitial brachytherapy followed by IMRT radiotherapy for intermediate and high risk prostate cancer

    International Nuclear Information System (INIS)

    Nakamura, Satoshi; Murakami, Naoya; Inaba, Koji; Wakita, Akihisa; Kobayashi, Kazuma; Takahashi, Kana; Okamoto, Hiroyuki; Umezawa, Rei; Morota, Madoka; Sumi, Minako; Igaki, Hiroshi; Ito, Yoshinori; Itami, Jun

    2016-01-01

    The study aimed to compare urinary symptoms in patients with clinically localized prostate cancer after a combination of either low-dose-rate or high-dose-rate interstitial brachytherapy along with intensity-modulated radiation therapy (LDR-ISBT + IMRT or HDR-ISBT + IMRT). From June 2009 to April 2014, 16 and 22 patients were treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT, respectively. No patient from these groups was excluded from this study. The prescribed dose of LDR-ISBT, HDR-ISBT, and IMRT was 115 Gy, 20 Gy in 2 fractions, and 46 Gy in 23 fractions, respectively. Obstructive and irritative urinary symptoms were assessed by the International Prostate Symptom Score (IPSS) examined before and after treatments. After ISBT, IPSS was evaluated in the 1st and 4th weeks, then every 2–3 months for the 1st year, and every 6 months thereafter. The median follow-up of the patients treated with LDR-ISBT + IMRT and HDR-ISBT + IMRT was 1070.5 days and 1048.5 days, respectively (p = 0.321). The IPSS-increment in the LDR-ISBT + IMRT group was greater than that in the HDR-ISBT + IMRT between 91 and 180 days after ISBT (p = 0.015). In the LDR-ISBT + IMRT group, the IPSS took longer time to return to the initial level than in the HDR-ISBT + IMRT group (in LDR-ISBT + IMRT group, the recovery time was 90 days later). The dose to urethra showed a statistically significant association with the IPSS-increment in the irritative urinary symptoms (p = 0.011). Clinical outcomes were comparable between both the groups. Both therapeutic modalities are safe and well suited for patients with clinically localized prostate cancer; however, it took patients longer to recover from LDR-ISBT + IMRT than from HDR-ISBT + IMRT. It is possible that fast dose delivery induced early symptoms and early recovery, while gradual dose delivery induced late symptoms and late recovery. Urethral dose reductions were associated with small increments in IPSS

  13. WE-AB-BRA-12: Post-Implant Dosimetry in Prostate Brachytherapy by X-Ray and MRI Fusion

    Energy Technology Data Exchange (ETDEWEB)

    Park, S; Song, D; Lee, J [Johns Hopkins University, Baltimore, MD (United States); Le, Y [Indiana University, Indianapolis, IN (United States)

    2016-06-15

    Purpose: For post-implant dosimetric assessment after prostate brachytherapy, CT-MR fusion approach has been advocated due to the superior accuracy on both seeds localization and soft tissue delineation. However, CT deposits additional radiation to the patient, and seed identification in CT requires manual review and correction. In this study, we propose an accurate, low-dose, and cost-effective post-implant dosimetry approach based on X-ray and MRI. Methods: Implanted seeds are reconstructed using only three X-ray fluoroscopy images by solving a combinatorial optimization problem. The reconstructed seeds are then registered to MR images using an intensity-based points-to-volume registration. MR images are first pre-processed by geometric and Gaussian filtering, yielding smooth candidate seed-only images. To accommodate potential soft tissue deformation, our registration is performed in two steps, an initial affine followed by local deformable registrations. An evolutionary optimizer in conjunction with a points-to-volume similarity metric is used for the affine registration. Local prostate deformation and seed migration are then adjusted by the deformable registration step with external and internal force constraints. Results: We tested our algorithm on twenty patient data sets. For quantitative evaluation, we obtained ground truth seed positions by fusing the post-implant CT-MR images. Seeds were semi-automatically extracted from CT and manually corrected and then registered to the MR images. Target registration error (TRE) was computed by measuring the Euclidean distances from the ground truth to the closest registered X-ray seeds. The overall TREs (mean±standard deviation in mm) are 1.6±1.1 (affine) and 1.3±0.8 (affine+deformable). The overall computation takes less than 1 minute. Conclusion: It has been reported that the CT-based seed localization error is ∼1.6mm and the seed localization uncertainty of 2mm results in less than 5% deviation of prostate D

  14. WE-AB-BRA-12: Post-Implant Dosimetry in Prostate Brachytherapy by X-Ray and MRI Fusion

    International Nuclear Information System (INIS)

    Park, S; Song, D; Lee, J; Le, Y

    2016-01-01

    Purpose: For post-implant dosimetric assessment after prostate brachytherapy, CT-MR fusion approach has been advocated due to the superior accuracy on both seeds localization and soft tissue delineation. However, CT deposits additional radiation to the patient, and seed identification in CT requires manual review and correction. In this study, we propose an accurate, low-dose, and cost-effective post-implant dosimetry approach based on X-ray and MRI. Methods: Implanted seeds are reconstructed using only three X-ray fluoroscopy images by solving a combinatorial optimization problem. The reconstructed seeds are then registered to MR images using an intensity-based points-to-volume registration. MR images are first pre-processed by geometric and Gaussian filtering, yielding smooth candidate seed-only images. To accommodate potential soft tissue deformation, our registration is performed in two steps, an initial affine followed by local deformable registrations. An evolutionary optimizer in conjunction with a points-to-volume similarity metric is used for the affine registration. Local prostate deformation and seed migration are then adjusted by the deformable registration step with external and internal force constraints. Results: We tested our algorithm on twenty patient data sets. For quantitative evaluation, we obtained ground truth seed positions by fusing the post-implant CT-MR images. Seeds were semi-automatically extracted from CT and manually corrected and then registered to the MR images. Target registration error (TRE) was computed by measuring the Euclidean distances from the ground truth to the closest registered X-ray seeds. The overall TREs (mean±standard deviation in mm) are 1.6±1.1 (affine) and 1.3±0.8 (affine+deformable). The overall computation takes less than 1 minute. Conclusion: It has been reported that the CT-based seed localization error is ∼1.6mm and the seed localization uncertainty of 2mm results in less than 5% deviation of prostate D

  15. Results of 14 years of brachytherapy for localized prostate cancer in Denmark

    DEFF Research Database (Denmark)

    Jacobsen, Mikael G; Thomsen, Frederik B; Fode, Mikkel

    2018-01-01

    , respectively. The 10 year cumulative incidence of PCa mortality was 1% (95% CI 0-3), 5% (95% CI 0-12) and 11% (95% CI 0-25) for men with low-, intermediate- and high-risk PCa, respectively. CONCLUSIONS: Low-dose brachytherapy offers good short- to intermediate-term cancer control in selected men with localized...... interval (CI) 6.2-7.0]. The 10 year BRFS was 90% (95% CI 83-97), 75% (95% CI 65-87) and 75% (95% CI 59-92) in men with low-, intermediate- and high-risk PCa, respectively. The 10 year MFS was 95% (95% CI 89-100), 93% (95% CI 88-98) and 78% (95% CI 57-99) in men with low-, intermediate- and high-risk PCa...

  16. WE-AB-BRA-11: Improved Imaging of Permanent Prostate Brachytherapy Seed Implants by Combining an Endorectal X-Ray Sensor with a CT Scanner

    Energy Technology Data Exchange (ETDEWEB)

    Steiner, J; Matthews, K; Jia, G [Louisiana State University, Baton Rouge, LA (United States)

    2016-06-15

    Purpose: To test feasibility of the use of a digital endorectal x-ray sensor for improved image resolution of permanent brachytherapy seed implants compared to conventional CT. Methods: Two phantoms simulating the male pelvic region were used to test the capabilities of a digital endorectal x-ray sensor for imaging permanent brachytherapy seed implants. Phantom 1 was constructed from acrylic plastic with cavities milled in the locations of the prostate and the rectum. The prostate cavity was filled a Styrofoam plug implanted with 10 training seeds. Phantom 2 was constructed from tissue-equivalent gelatins and contained a prostate phantom implanted with 18 strands of training seeds. For both phantoms, an intraoral digital dental x-ray sensor was placed in the rectum within 2 cm of the seed implants. Scout scans were taken of the phantoms over a limited arc angle using a CT scanner (80 kV, 120–200 mA). The dental sensor was removed from the phantoms and normal helical CT and scout (0 degree) scans using typical parameters for pelvic CT (120 kV, auto-mA) were collected. A shift-and add tomosynthesis algorithm was developed to localize seed plane location normal to detector face. Results: The endorectal sensor produced images with improved resolution compared to CT scans. Seed clusters and individual seed geometry were more discernable using the endorectal sensor. Seed 3D locations, including seeds that were not located in every projection image, were discernable using the shift and add algorithm. Conclusion: This work shows that digital endorectal x-ray sensors are a feasible method for improving imaging of permanent brachytherapy seed implants. Future work will consist of optimizing the tomosynthesis technique to produce higher resolution, lower dose images of 1) permanent brachytherapy seed implants for post-implant dosimetry and 2) fine anatomic details for imaging and managing prostatic disease compared to CT images. Funding: LSU Faculty Start-up Funding

  17. The impact of postimplant edema on the urethral dose in prostate brachytherapy

    International Nuclear Information System (INIS)

    Waterman, Frank M.; Dicker, Adam P.

    2000-01-01

    Purpose: The objective of this work is to determine the effect of timing of the postimplant CT scan on the assessment of the urethral dose. Methods and Materials: A preimplant CT scan and two postimplant CT scans were obtained on 50 patients who received I-125 prostate seed implants. The first postimplant CT scan was obtained on the day of the implant; the second usually 4 to 9 weeks later (mean: 46 no. +-no. 23 days; range: 27-135 days). The urethra was localized in each postimplant CT scan and a dose-volume histogram (DVH) of the urethral dose was compiled from each CT study. The relative decrease in the prostate volume between the first and second postimplant CT scans was determined by contouring the prostate in each CT scan. Results: The prostate volume decreased by 27 no. +-no. 9% (mean no. +-no. SD) between the first and second postimplant CT scans. As a result, the averaged urethral dose derived from the second CT scan was about 30% higher. In terms of dose, the D 10 , D 25 , D 50 , D 75 , and D 90 urethral doses derived from the second CT scan were 90 no. +-no. 56 Gy, 81 no. +-no. 49 Gy, 67 no. +-no. 42 Gy, 49 no. +-no. 44 Gy, and 40 no. +-no. 46 Gy higher, respectively. The increase in the urethral dose is correlated with the decrease in the prostate volume (R = 0.57, no. rhono. 10 dose derived from the CT scans obtained at 46 no. +-no. 23 days postimplant was 90 no. +-no. 56 Gy higher than that derived from the CT scans obtained on the day of the implant. Because of this large difference, the timing of the postimplant CT scan needs to be specified when specifying dose thresholds for urethral morbidity

  18. Iodine-125 in the fresh water environment in England; measurements along the pathway from sewage discharge to thyroid glands and determinations of absorbed dose to humans

    International Nuclear Information System (INIS)

    Howe, J.R.; Bowlt, C.

    1992-01-01

    Iodine-125 has been measured in the fresh water supply in England, particularly in the Thames Valley. 125 I discarded into the sewage drainage system, travels in the liquid effluent into rivers. When mains water is abstracted downstream from such discharges low levels of 125 I ( 125 I. However it was never possible to establish more than a semi-quantitative relationship between their activity levels and those of their surroundings. In general, levels of 125 I have shown a 3-4 fold increase in the fresh water environment during the 1980's. (Author)

  19. Real-time magnetic resonance image-guided interstitial brachytherapy in the treatment of select patients with clinically localized prostate cancer

    International Nuclear Information System (INIS)

    D'Amico, Anthony V.; Cormack, Robert; Tempany, Clare M.; Kumar, Sanjaya; Topulos, George; Kooy, Hanne M.; Coleman, C. Norman

    1998-01-01

    Purpose: This study was performed to establish the dose-localization capability and acute toxicity of a real-time intraoperative magnetic resonance (MR) image-guided approach to prostate brachytherapy in select patients with clinically localized prostate cancer. Methods and Materials: Nine patients with 1997 American Joint Commission on Cancer (AJCC) clinical stage T1cNxM0 prostate cancer, prostate-specific antigen (PSA) 125 Iodine sources was placed under real-time MR guidance to ensure that its position in the coronal, sagittal, and axial planes was in agreement with the planned trajectory. Real-time dose- volume histogram analyses were used intraoperatively to optimize the dosimetry. Results: For the 9 study patients, 89-99% (median 94%) of the CTV received a minimum peripheral dose of 160 Gy and ≥ 95% of the volume of the prostatic urethra and 42-89% (median 70%) of the volume of the anterior rectal wall received doses that were below the reported tolerance. All patients voided spontaneously within 3 h after discontinuation of the Foley catheter and no patient required more than a limited course (≤ 3 weeks) of oral α-1 blockers for postimplant urethritis. Conclusions: Real-time MR-guided interstitial radiation therapy provided the ability to achieve the planned optimized dose-volume histogram profiles to the CTV and healthy juxtaposed structures intraoperatively, with minimal acute morbidity

  20. Calculation Monte Carlo equivalent dose to organs in a treatment of prostate with Brachytherapy of high rate; Calculo Monte Carlo de dosis equivalente a organos en un tratamiento de prostata con braquiterapia de alta tasa

    Energy Technology Data Exchange (ETDEWEB)

    Candela-Juan, C.; Vijande, J.; Granero, D.; Ballester, F.; Perez-Calatayud, J.; Rivard, M. J.

    2013-07-01

    The objective of this study was to obtain equivalent dose to radiosensitive organs when applies brachytherapy high dose (HDR) with sources of 60 Co or 192 Go to a localized carcinoma of the prostate. The results are compared with those reported in the literature on treatment with protons and intensity modulated (IMRT) radiation therapy. (Author)

  1. Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Ghadjar, Pirus; Oesch, Sebastian L; Rentsch, Cyrill A; Isaak, Bernhard; Cihoric, Nikola; Manser, Peter; Thalmann, George N; Aebersold, Daniel M

    2014-01-01

    To determine the 5-year outcome after high-dose-rate brachytherapy (HDR-BT) as a monotherapy. Between 10/2003 and 06/2006, 36 patients with low (28) and intermediate (8) risk prostate cancer were treated by HDR-BT monotherapy. All patients received one implant and 4 fractions of 9.5 Gy within 48 hours for a total prescribed dose (PD) of 38 Gy. Five patients received concomitant androgen deprivation therapy (ADT). Toxicity was scored according to the common terminology criteria for adverse events from the National Cancer Institute (CTCAE) version 3.0. Biochemical recurrence was defined according to the Phoenix criteria and analyzed using the Kaplan Meier method. Predictors for late grade 3 GU toxicity were analyzed using univariate and multivariate Cox regression analyses. The median follow-up was 6.9 years (range, 1.5-8.0 years). Late grade 2 and 3 genitourinary (GU) toxicity was observed in 10 (28%) and 7 (19%) patients, respectively. The actuarial proportion of patients with late grade 3 GU toxicity at 5 years was 17.7%. Late grade 2 and 3 gastrointestinal (GI) toxicities were not observed. The crude erectile function preservation rate in patients without ADT was 75%. The 5 year biochemical recurrence-free survival (bRFS) rate was 97%. Late grade 3 GU toxicity was associated with the urethral volume (p = 0.001) and the urethral V 120 (urethral volume receiving ≥120% of the PD; p = 0.0005) after multivariate Cox regression. After HDR-BT monotherapy late grade 3 GU was observed relatively frequently and was associated with the urethral V 120 . GI toxicity was negligible, the erectile function preservation rate and the bRFS rate was excellent

  2. Decline in acute urinary toxicities with increased institutional experience: 15-year experience of permanent seed prostate brachytherapy in a single Australasian institution.

    Science.gov (United States)

    Ong, Wee Loon; Matheson, Bronwyn; Millar, Jeremy

    To evaluate the incidence of acute urinary toxicity after permanent seed prostate brachytherapy (BT) over a 15-year period. The study consisted of 782 prostate cancer patients treated with BT. All patients completed self-administered International Prostate Symptoms Score (IPSS) at baseline and during regular follow-up. We evaluated the risk of acute urinary retention (AUR) up to 3 months post-BT and lower urinary tract symptom (LUTS) resolution (defined as return to within two points of baseline IPSS score) at regular intervals, up to 24 months post-BT. Univariate and multivariate logistic regressions were used to evaluate the effect of various patient, tumor, and treatment factors on the risk of AUR and the likelihood of LUTS resolution. Ninety-six patients (12%) developed AUR at a median of 1 day post-BT. Increased peak urinary flow is independently associated with lower risk of AUR (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.91-0.97). Decline in incidence of AUR was observed over time with increased institutional experience (p = 0.03). Of the 646 patients with a minimum of 24-month follow-up, 29%, 49%, and 72% had LUTS resolution at 6, 12, and 24 months, respectively. Patients who had pre-BT transurethral resection of prostate (OR = 2.4; 95% CI = 1.5-4.0), cytoreductive neo-adjuvant androgen deprivation (OR = 2.0; 95% CI = 1.0-4.0), and higher baseline IPSS (OR = 1.1; 95% CI = 1.07-1.19) are more likely to report LUTS resolution at 24 months. We reported decline in AUR over time with increased institutional experience in one of the largest Australasian BT series. Approximately three-quarters of patients achieved LUTS resolution at 24-month follow-up. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  3. Real-time intraoperative evaluation of implant quality and dose correction during prostate brachytherapy consistently improves target coverage using a novel image fusion and optimization program.

    Science.gov (United States)

    Zelefsky, Michael J; Cohen, Gilad N; Taggar, Amandeep S; Kollmeier, Marisa; McBride, Sean; Mageras, Gig; Zaider, Marco

    Our purpose was to describe the process and outcome of performing postimplantation dosimetric assessment and intraoperative dose correction during prostate brachytherapy using a novel image fusion-based treatment-planning program. Twenty-six consecutive patients underwent intraoperative real-time corrections of their dose distributions at the end of their permanent seed interstitial procedures. After intraoperatively planned seeds were implanted and while the patient remained in the lithotomy position, a cone beam computed tomography scan was obtained to assess adequacy of the prescription dose coverage. The implanted seed positions were automatically segmented from the cone-beam images, fused onto a new set of acquired ultrasound images, reimported into the planning system, and recontoured. Dose distributions were recalculated based upon actual implanted seed coordinates and recontoured ultrasound images and were reviewed. If any dose deficiencies within the prostate target were identified, additional needles and seeds were added. Once an implant was deemed acceptable, the procedure was completed, and anesthesia was reversed. When the intraoperative ultrasound-based quality assurance assessment was performed after seed placement, the median volume receiving 100% of the dose (V100) was 93% (range, 74% to 98%). Before seed correction, 23% (6/26) of cases were noted to have V100 90%. In these patients, postimplantation evaluation during the actual prostate seed implant procedure was successfully applied to determine the need for additional seeds to correct dose deficiencies before anesthesia reversal. When applied, this approach should significantly reduce intraoperative errors and chances for suboptimal dose delivery during prostate brachytherapy. Copyright © 2017 American Society for Radiation Oncology. Published by Elsevier Inc. All rights reserved.

  4. Using the magnitude of PSA bounce after MRI-guided prostate brachytherapy to distinguish recurrence, benign precipitating factors, and idiopathic bounce

    International Nuclear Information System (INIS)

    Das, Prajnan; Chen, M.-H.; Valentine, Kristin; Lopes, Lynn; Cormack, Robert A.; Renshaw, Andrew A.; Tempany, Clare M.; Kumar, Sanjaya; D'Amico, Anthony V.

    2002-01-01

    Purpose: To identify events that precipitated a prostate-specific antigen (PSA) bounce and characterize the magnitude, duration, and time to PSA bounce after MRI-guided prostate brachytherapy. Methods and Materials: Between 1997 and 2001, 186 patients with low-risk prostate cancer underwent MRI-guided permanent 125 I source implantation, with or without external beam radiotherapy. A PSA bounce was defined as a ≥15% elevation in PSA compared with the most recent value, followed by a decline to a level at or less than the prebounce value. At the time of PSA measurement, data were prospectively collected on whether the patient had recent ejaculation, ongoing radiation proctitis, or recent instrumentation. Results: A total of 115 patients (61.8%) had a total of 156 PSA bounces. Of these, 36 patients had PSA bounces associated with ejaculation, proctitis, or instrumentation, and 79 experienced idiopathic PSA bounces (not associated with a precipitating event). The magnitude of the PSA bounce was significantly lower for the idiopathic PSA bounce (0.6 ng/mL) compared with that associated with ejaculation (p=0.003), proctitis (p<0.0001), or instrumentation (p=0.007). Patients with biopsy-proven local recurrence had a median PSA elevation of 1.2 ng/mL, significantly higher (p=0.006) than the magnitude of the idiopathic PSA bounce, but not significantly different from the magnitude of the PSA bounce due to ejaculation, proctitis, or instrumentation. Conclusion: