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Sample records for prostate brachytherapy guided

  1. A comparison of complications between ultrasound-guided prostate brachytherapy and open prostate brachytherapy

    International Nuclear Information System (INIS)

    Benoit, Ronald M.; Naslund, Michael J.; Cohen, Jeffrey K.

    2000-01-01

    Purpose: Prostate brachytherapy has reemerged during the 1990s as a treatment for clinically localized prostate cancer. The renewed popularity of prostate brachytherapy is largely due to the use of transrectal ultrasound of the prostate, which allows for more accurate isotope placement within the prostate when compared to the open approach. The present study investigates whether this improved cancer control is at the expense of increased morbidity by comparing the morbidity after transrectal ultrasound-guided prostate brachytherapy to the morbidity after prostate brachytherapy performed via an open approach. Methods and Materials: All men in the Medicare population who underwent prostate brachytherapy in the year 1991 were identified. These men were further stratified into those men who underwent prostate brachytherapy via an open approach and the men who underwent prostate brachytherapy with ultrasound guidance. All subsequent inpatient, outpatient, and physician (Part B) Medicare claims for these men from the years 1991-1993 were then analyzed to determine outcomes. Results: In the year 1991, 2124 men in the Medicare population underwent prostate brachytherapy. An open approach was used in 715 men (33.7%), and ultrasound guidance was used in 1409 men (66.3%). Mean age for both cohorts was 73.7 years with a range of 50.7-92.8 years for the ultrasound group and 60.6-92.1 years for the open group. A surgical procedure for the relief of bladder outlet obstruction was performed in 122 men (8.6%) in the ultrasound group and in 54 men (7.6%) in the open group. An artificial urinary sphincter was placed in 2 men (0.14%) in the ultrasound group and in 2 men (0.28%) in the open group. A penile prosthesis was implanted in 10 men (0.71%) in the ultrasound group and in 4 men (0.56%) in the open group. A diagnosis code for urinary incontinence was carried by 95 men (6.7%) in the ultrasound group and by 45 men (6.3%) in the open group. A diagnosis code for erectile dysfunction

  2. 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)

  3. A robotic device for MRI-guided prostate brachytherapy

    NARCIS (Netherlands)

    Lagerburg, V.

    2008-01-01

    One of the treatment options for prostate cancer is brachytherapy with iodine-125 sources. In prostate brachytherapy a high radiation dose is delivered to the prostate with a steep dose fall off to critical surrounding organs. The implantation of the iodine sources is currently performed under

  4. 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

  5. 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

  6. Robot-assisted 3D-TRUS guided prostate brachytherapy: System integration and validation

    International Nuclear Information System (INIS)

    Wei Zhouping; Wan Gang; Gardi, Lori; Mills, Gregory; Downey, Donal; Fenster, Aaron

    2004-01-01

    Current transperineal prostate brachytherapy uses transrectal ultrasound (TRUS) guidance and a template at a fixed position to guide needles along parallel trajectories. However, pubic arch interference (PAI) with the implant path obstructs part of the prostate from being targeted by the brachytherapy needles along parallel trajectories. To solve the PAI problem, some investigators have explored other insertion trajectories than parallel, i.e., oblique. However, parallel trajectory constraints in current brachytherapy procedure do not allow oblique insertion. In this paper, we describe a robot-assisted, three-dimensional (3D) TRUS guided approach to solve this problem. Our prototype consists of a commercial robot, and a 3D TRUS imaging system including an ultrasound machine, image acquisition apparatus and 3D TRUS image reconstruction, and display software. In our approach, we use the robot as a movable needle guide, i.e., the robot positions the needle before insertion, but the physician inserts the needle into the patient's prostate. In a later phase of our work, we will include robot insertion. By unifying the robot, ultrasound transducer, and the 3D TRUS image coordinate systems, the position of the template hole can be accurately related to 3D TRUS image coordinate system, allowing accurate and consistent insertion of the needle via the template hole into the targeted position in the prostate. The unification of the various coordinate systems includes two steps, i.e., 3D image calibration and robot calibration. Our testing of the system showed that the needle placement accuracy of the robot system at the 'patient's' skin position was 0.15 mm±0.06 mm, and the mean needle angulation error was 0.07 deg. . The fiducial localization error (FLE) in localizing the intersections of the nylon strings for image calibration was 0.13 mm, and the FLE in localizing the divots for robot calibration was 0.37 mm. The fiducial registration error for image calibration was 0

  7. 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

  8. 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

  9. 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-guided

  10. Prostate brachytherapy - discharge

    Science.gov (United States)

    Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge ... You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, ...

  11. SU-F-BRA-04: Prostate HDR Brachytherapy with Multichannel Robotic System

    International Nuclear Information System (INIS)

    Joseph, F Maria; Podder, T; Yu, Y

    2015-01-01

    Purpose: High-dose-rate (HDR) brachytherapy is gradually becoming popular in treating patients with prostate cancers. However, placement of the HDR needles at desired locations into the patient is challenging. Application of robotic system may improve the accuracy of the clinical procedure. This experimental study is to evaluate the feasibility of using a multichannel robotic system for prostate HDR brachytherapy. Methods: In this experimental study, the robotic system employed was a 6-DOF Multichannel Image-guided Robotic Assistant for Brachytherapy (MIRAB), which was designed and fabricated for prostate seed implantation. The MIRAB has the provision of rotating 16 needles while inserting them. Ten prostate HDR brachytherapy needles were simultaneously inserted using MIRAB into a commercially available prostate phantom. After inserting the needles into the prostate phantom at desired locations, 2mm thick CT slices were obtained for dosimetric planning. HDR plan was generated using Oncetra planning system with a total prescription dose of 34Gy in 4 fractions. Plan quality was evaluated considering dose coverage to prostate and planning target volume (PTV), with 3mm margin around prostate, as well as the dose limit to the organs at risk (OARs) following the American Brachytherapy Society (ABS) guidelines. Results: From the CT scan, it is observed that the needles were inserted straight into the desired locations and they were adequately spaced and distributed for a clinically acceptable HDR plan. Coverage to PTV and prostate were about 91% (V100= 91%) and 96% (V100=96%), respectively. Dose to 1cc of urethra, rectum, and bladder were within the ABS specified limits. Conclusion: The MIRAB was able to insert multiple needles simultaneously into the prostate precisely. By controlling the MIRAB to insert all the ten utilized needles into the prostate phantom, we could achieve the robotic HDR brachytherapy successfully. Further study for assessing the system

  12. 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.

  13. 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....

  14. Efficacy of prophylactic single-dose therapy using fluoroquinolone for prostate brachytherapy

    International Nuclear Information System (INIS)

    Nomura, Takeo; Hirai, Kenichi; Yamasaki, Mutsushi; Inoue, Toru; Takahashi, Mika; Kawashima, Takayuki; Sato, Fuminori; Mimata, Hiromitsu

    2012-01-01

    There is little definitive evidence to guide the use of prophylactic antibiotics for prostate brachytherapy. The purpose of this study is to evaluate the incidence of postimplant infections in patients who receive antimicrobial prophylaxis with pazufloxacin (PZFX). A total of 84 patients who underwent prostate brachytherapy received a single intravenous dose of PZFX at 500 mg perioperatively for 1 day. No postimplant antibiotic medication was prescribed. Urinalysis, plasma white blood cell (WBC) count, and C reactive protein (CRP) levels were evaluated before the implantation, on the day after implantation, and on the 7th and 28th days after brachytherapy. None of the 84 patients (0.0%) developed a symptomatic urinary tract infection or had febrile infectious complications after brachytherapy. There were statistically significant elevations in the levels of erythrocytes, leukocytes, bacteria in urine, plasma WBC and CRP postoperatively, but these values did not exceed the normal range or were only slightly elevated on the day after brachytherapy (day 1) and on day 7. All laboratory examinations had returned to the normal range on day 28. Single-dose therapy with fluoroquinolone helps to prevent infections after prostate brachytherapy. (author)

  15. 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.

  16. Prostate CT segmentation method based on nonrigid registration in ultrasound-guided CT-based HDR prostate brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Xiaofeng, E-mail: xyang43@emory.edu; Rossi, Peter; Ogunleye, Tomi; Marcus, David M.; Jani, Ashesh B.; Curran, Walter J.; Liu, Tian [Department of Radiation Oncology and Winship Cancer Institute, Emory University, Atlanta, Georgia 30322 (United States); Mao, Hui [Department of Radiology and Imaging Sciences, Emory University, Atlanta, Georgia 30322 (United States)

    2014-11-01

    Purpose: The technological advances in real-time ultrasound image guidance for high-dose-rate (HDR) prostate brachytherapy have placed this treatment modality at the forefront of innovation in cancer radiotherapy. Prostate HDR treatment often involves placing the HDR catheters (needles) into the prostate gland under the transrectal ultrasound (TRUS) guidance, then generating a radiation treatment plan based on CT prostate images, and subsequently delivering high dose of radiation through these catheters. The main challenge for this HDR procedure is to accurately segment the prostate volume in the CT images for the radiation treatment planning. In this study, the authors propose a novel approach that integrates the prostate volume from 3D TRUS images into the treatment planning CT images to provide an accurate prostate delineation for prostate HDR treatment. Methods: The authors’ approach requires acquisition of 3D TRUS prostate images in the operating room right after the HDR catheters are inserted, which takes 1–3 min. These TRUS images are used to create prostate contours. The HDR catheters are reconstructed from the intraoperative TRUS and postoperative CT images, and subsequently used as landmarks for the TRUS–CT image fusion. After TRUS–CT fusion, the TRUS-based prostate volume is deformed to the CT images for treatment planning. This method was first validated with a prostate-phantom study. In addition, a pilot study of ten patients undergoing HDR prostate brachytherapy was conducted to test its clinical feasibility. The accuracy of their approach was assessed through the locations of three implanted fiducial (gold) markers, as well as T2-weighted MR prostate images of patients. Results: For the phantom study, the target registration error (TRE) of gold-markers was 0.41 ± 0.11 mm. For the ten patients, the TRE of gold markers was 1.18 ± 0.26 mm; the prostate volume difference between the authors’ approach and the MRI-based volume was 7.28% ± 0

  17. Prostate CT segmentation method based on nonrigid registration in ultrasound-guided CT-based HDR prostate brachytherapy

    Science.gov (United States)

    Yang, Xiaofeng; Rossi, Peter; Ogunleye, Tomi; Marcus, David M.; Jani, Ashesh B.; Mao, Hui; Curran, Walter J.; Liu, Tian

    2014-01-01

    Purpose: The technological advances in real-time ultrasound image guidance for high-dose-rate (HDR) prostate brachytherapy have placed this treatment modality at the forefront of innovation in cancer radiotherapy. Prostate HDR treatment often involves placing the HDR catheters (needles) into the prostate gland under the transrectal ultrasound (TRUS) guidance, then generating a radiation treatment plan based on CT prostate images, and subsequently delivering high dose of radiation through these catheters. The main challenge for this HDR procedure is to accurately segment the prostate volume in the CT images for the radiation treatment planning. In this study, the authors propose a novel approach that integrates the prostate volume from 3D TRUS images into the treatment planning CT images to provide an accurate prostate delineation for prostate HDR treatment. Methods: The authors’ approach requires acquisition of 3D TRUS prostate images in the operating room right after the HDR catheters are inserted, which takes 1–3 min. These TRUS images are used to create prostate contours. The HDR catheters are reconstructed from the intraoperative TRUS and postoperative CT images, and subsequently used as landmarks for the TRUS–CT image fusion. After TRUS–CT fusion, the TRUS-based prostate volume is deformed to the CT images for treatment planning. This method was first validated with a prostate-phantom study. In addition, a pilot study of ten patients undergoing HDR prostate brachytherapy was conducted to test its clinical feasibility. The accuracy of their approach was assessed through the locations of three implanted fiducial (gold) markers, as well as T2-weighted MR prostate images of patients. Results: For the phantom study, the target registration error (TRE) of gold-markers was 0.41 ± 0.11 mm. For the ten patients, the TRE of gold markers was 1.18 ± 0.26 mm; the prostate volume difference between the authors’ approach and the MRI-based volume was 7.28% ± 0

  18. 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

  19. 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

  20. TU-F-BRF-02: MR-US Prostate Registration Using Patient-Specific Tissue Elasticity Property Prior for MR-Targeted, TRUS-Guided HDR Brachytherapy

    International Nuclear Information System (INIS)

    Yang, X; Rossi, P; Ogunleye, T; Jani, A; Curran, W; Liu, T

    2014-01-01

    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

  1. Permanent Prostate Brachytherapy in Prostate Glands 3

    International Nuclear Information System (INIS)

    Mayadev, Jyoti; Merrick, Gregory S.; Reed, Joshua R.; Butler, Wayne M.; Galbreath, Robert W.; Allen, Zachariah A.; Wallner, Kent E.

    2010-01-01

    Purpose: To investigate the dosimetry, treatment-related morbidity, and biochemical outcomes for brachytherapy in patients with prostate glands 3 . Methods and Materials: From November 1996 to October 2006, 104 patients with prostate glands 3 underwent brachytherapy. Multiple prostate, urethral, and rectal dosimetric parameters were evaluated. Treatment-related urinary and rectal morbidity were assessed from patient questionnaires. Cause-specific survival, biochemical progression-free survival, and overall survival were recorded. Results: The median patient age, follow up, and pre-treatment ultrasound volume was 64 years, 5.0 years and 17.6cm 3 , respectively. Median day 0 dosimetry was significant for the following: V100 98.5%, D90 126.1% and R100 <0.5% of prescription dose. The mean urethral and maximum urethral doses were 119.6% and 133.8% of prescription. The median time to International Prostate Symptom Score resolution was 4 months. There were no RTOG grade III or IV rectal complications. The cause-specific survival, biochemical progression-free survival, and overall survival rates were 100%, 92.5%, and 77.8% at 9 years. For biochemically disease-free patients, the median most recent postbrachytherapy PSA value was 0.02 ng/mL. Conclusion: Our results demonstrate that brachytherapy for small prostate glands is highly effective, with an acceptable morbidity profile, excellent postimplant dosimetry, acceptable treatment-related morbidity, and favorable biochemical outcomes.

  2. Methods for prostate stabilization during transperineal LDR brachytherapy.

    Science.gov (United States)

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

    2008-03-21

    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

  3. 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

  4. Local control after brachytherapy for localized prostatic carcinomas

    International Nuclear Information System (INIS)

    Wachter, T.; Peneau, M.; Sabattier, R.; Breteau, N.

    1996-01-01

    From 1991 to 1995; 31 patients (mid-age: 70 years) underwent prostatic brachytherapy for localized prostate cancers using Iridium 192 transperineal percutaneous interstitial implantation guided by transrectal ultrasonography. Initial staging included among other evaluations a bilateral staging, iliac and obturator lymph nodes dissection. Classification according to stage was : T1b=16%, T1c=36%, T2a=19%, T2b=13%, T2c=13%, T3a=3%. All patients were N (-). Gleason score was 5 for 55%. 77% of the initial PSA was < 25μg/l. Follow-up included one clinical control and psa determination at 1-3-6-12 and 18 months, bone scanning at 12 months and prostate biopsy guided by transrectal ultrasonography at 18, 24, 30 months. Up to now, mean follow-up is 32 months. At one month, psa was normal (< 2,5μg/l) in 21% of the patients, at 12 months 60% and 67% two years after brachytherapy. Biopsies at 18 months were negative for 60% of the patients and 63% at 24 months. 3 patients were metastased after 3 years. 4 patients had severe complications with colostomy and/or urinary derivation. This technic seems to be interesting for localized prostate cancers T1 and T2 with initial psa < 25μg/l. Two third of the patients had normal psa and negative biopsies after 2 years. The rate of ano-rectal and urinary morbidity is high but is explained by the technic used at the beginning of this study

  5. Protocol-based image-guided salvage brachytherapy. Early results in patients with local failure of prostate cancer after radiation therapy

    Energy Technology Data Exchange (ETDEWEB)

    Lahmer, G.; Lotter, M.; Kreppner, S.; Fietkau, R.; Strnad, V. [University Hospital Erlangen (Germany). Dept. of Radiation Oncology

    2013-08-15

    Purpose: To assess the overall clinical outcome of protocol-based image-guided salvage pulsed-dose-rate brachytherapy for locally recurrent prostate cancer after radiotherapy failure particularly regarding feasibility and side effects. Patients and methods: Eighteen consecutive patients with locally recurrent prostate cancer (median age, 69 years) were treated during 2005-2011 with interstitial PDR brachytherapy (PDR-BT) as salvage brachytherapy after radiotherapy failure. The treatment schedule was PDR-BT two times with 30 Gy (pulse dose 0.6 Gy/h, 24 h per day) corresponding to a total dose of 60 Gy. Dose volume adaptation was performed with the aim of optimal coverage of the whole prostate (V{sub 100} > 95 %) simultaneously respecting the protocol-based dose volume constraints for the urethra (D{sub 0.1} {sub cc} < 130 %) and the rectum (D{sub 2} {sub cc} < 50-60 %) taking into account the previous radiation therapy. Local relapse after radiotherapy (external beam irradiation, brachytherapy with J-125 seeds or combination) was confirmed mostly via choline-PET and increased PSA levels. The primary endpoint was treatment-related late toxicities - particularly proctitis, anal incontinence, cystitis, urinary incontinence, urinary frequency/urgency, and urinary retention according to the Common Toxicity Criteria. The secondary endpoint was PSA-recurrence-free survival. Results: We registered urinary toxicities only. Grade 2 and grade 3 toxicities were observed in up to 11.1 % (2/18) and 16.7 % (3/18) of patients, respectively. The most frequent late-event grade 3 toxicity was urinary retention in 17 % (3/18) of patients. No late gastrointestinal side effects occurred. The biochemical PSA-recurrence-free survival probability at 3 years was 57.1 %. The overall survival at 3 years was 88.9 %; 22 % (4/18) of patients developed metastases. The median follow-up time for all patients after salvage BT was 21 months (range, 8-77 months). Conclusion: Salvage PDR-brachytherapy

  6. 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.)

  7. Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

    OpenAIRE

    Joseph Safdieh; Andrew Wong; Joseph P. Weiner; David Schwartz; David Schreiber

    2016-01-01

    Purpose : Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Material and methods: Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy ...

  8. Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

    Science.gov (United States)

    Safdieh, Joseph; Wong, Andrew; Weiner, Joseph P; Schwartz, David; Schreiber, David

    2016-08-01

    Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ(2). Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage. There were 89,413 men included in this study, of which 37,054 (41.6%) received only external beam radiation, and 52,089 (58.4%) received prostate brachytherapy. The use of brachytherapy declined over time from 62.9% in 2004 to 51.3% in 2012 (p facilities (60.8% in 2004 to 47.0% in 2012, p facilities (63.7% in 2004 to 53.0% in 2012, p facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p usage. In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still remains the treatment of choice for 51.3% of patients as of 2012.

  9. 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

  10. Image guided, adaptive, accelerated, high dose brachytherapy as model for advanced small volume radiotherapy

    International Nuclear Information System (INIS)

    Haie-Meder, Christine; Siebert, Frank-Andre; Poetter, Richard

    2011-01-01

    Brachytherapy has consistently provided a very conformal radiation therapy modality. Over the last two decades this has been associated with significant improvements in imaging for brachytherapy applications (prostate, gynecology), resulting in many positive advances in treatment planning, application techniques and clinical outcome. This is emphasized by the increased use of brachytherapy in Europe with gynecology as continuous basis and prostate and breast as more recently growing fields. Image guidance enables exact knowledge of the applicator together with improved visualization of tumor and target volumes as well as of organs at risk providing the basis for very individualized 3D and 4D treatment planning. In this commentary the most important recent developments in prostate, gynecological and breast brachytherapy are reviewed, with a focus on European recent and current research aiming at the definition of areas for important future research. Moreover the positive impact of GEC-ESTRO recommendations and the highlights of brachytherapy physics are discussed what altogether presents a full overview of modern image guided brachytherapy. An overview is finally provided on past and current international brachytherapy publications focusing on 'Radiotherapy and Oncology'. These data show tremendous increase in almost all research areas over the last three decades strongly influenced recently by translational research in regard to imaging and technology. In order to provide high level clinical evidence for future brachytherapy practice the strong need for comprehensive prospective clinical research addressing brachytherapy issues is high-lighted.

  11. 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

    Purpose: The effect of a therapeutic modality on sexual potency is often an important consideration for patients choosing a treatment for prostate cancer. We prospectively assessed patients' penile erectile function before and following interactive ultrasound-guided transperineal permanent radioactive seed implantation to determine its effect on sexual function. Methods and Materials: Eighty-nine patients underwent permanent radioactive seed implantation from June 1990 to April 1994 for localized prostate cancer (T1-T2) and were followed for a median of 15 months (1.5-52 months). 125 I seeds were implanted in 73 patients with a combined Gleason grade of 2-6, and 103 Pd seeds were implanted in 16 patients with higher grade lesions. The sexual potency of these patients was assessed prior to, at 3 and 6 months, and every 6 months after implantation. Erectile function was graded using a numerical score of 0 to 3 (0 = impotent (no erections), 1 = ability to have erections but insufficient for vaginal penetration, 2 = erectile function sufficient for vaginal penetration but suboptimal, 3 = normal erectile function). The pretreatment potency scores were as follows: 0 in 24 patients, 1 in 6 patients, 2 in 22 patients, and 3 in 37 patients. Results: The actuarial impotency rates (score = 0) following implantation for those patients possessing some degree of erectile function prior to implantation (65 patients) were 2.5% at 1 year and 6% at 2 years. The actuarial decrease in sexual function rates (a drop in score of at least one point) were 29% at 1 year and 39% at 2 years. Only two patients became impotent following treatment and this occurred at 1 year and 16 months. The time period for a decrease in erectile function to occur ranged from 1.8 months to 32.7 months, with a median of 6.8 months. Patients with higher grade tumors showed a greater decrease in potency score compared to patients with lower grade tumors. Conclusion: Interactive ultrasound-guided transperineal

  12. 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.

  13. Utilization of prostate brachytherapy for low risk prostate cancer: Is the decline overstated?

    Directory of Open Access Journals (Sweden)

    Joseph Safdieh

    2016-08-01

    Full Text Available Purpose : Several prior studies have suggested that brachytherapy utilization has markedly decreased, coinciding with the recent increased utilization of intensity modulated radiation therapy, as well as an increase in urologist-owned centers. We sought to investigate the brachytherapy utilization in a large, hospital-based registry. Material and methods: Men with prostate cancer diagnosed between 2004-2012 and treated with either external beam radiation and/or prostate brachytherapy were abstracted from the National Cancer Database. In order to be included, men had to be clinically staged as T1c-T2aNx-0Mx-0, Gleason 6, PSA ≤ 10.0 ng/ml. Descriptive statistics were used to analyze brachytherapy utilization over time and were compared via χ2. Multivariate logistic regression was used to assess for covariables associated with increased brachytherapy usage. Results : There were 89,413 men included in this study, of which 37,054 (41.6% received only external beam radiation, and 52,089 (58.4% received prostate brachytherapy. The use of brachytherapy declined over time from 62.9% in 2004 to 51.3% in 2012 (p < 0.001. This decline was noted in both academic facilities (60.8% in 2004 to 47.0% in 2012, p < 0.001 as well as in non-academic facilities (63.7% in 2004 to 53.0% in 2012, p < 0.001. The decline was more pronounced in patients who lived closer to treatment facilities than those who lived further. The use of intensity modulated radiation therapy increased during this same time period from 18.4% in 2004 to 38.2% in 2012 (p < 0.001. On multivariate analysis, treatment at an academic center, increasing age, decreasing distance from the treatment center, and years of diagnosis from 2006-2012 were significantly associated with reduced brachytherapy usage. Conclusions : In this hospital-based registry, prostate brachytherapy usage has declined for low risk prostate cancer as intensity modulated radiation therapy usage has increased. However, it still

  14. Prognostic Importance of Small Prostate Size in Men Receiving Definitive Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Adamovich, Edward; Wallner, Kent E.

    2012-01-01

    Purpose: To assess whether small prostate size is an adverse prognostic factor in men undergoing brachytherapy in the same manner in which it seems to be for men undergoing radical prostatectomy. Methods and Materials: From April 1995 to June 2008, 2024 patients underwent brachytherapy by a single brachytherapist. Median follow-up was 7.4 years. The role of small prostate size (≤20 cm 3 ) as a prognostic factor for biochemical progression-free survival, cause-specific survival, and all-cause mortality was investigated. The differences in survival between men with small and larger prostates were compared using Kaplan-Meier curves and log-rank tests. Results: Median prostate size for the entire cohort was 32.7 cm 3 . For the 167 men with small prostates, median prostate size was 17.4 cm 3 . There was no difference in biochemical progression-free survival (95.2% vs 96.2%, P=.603), cause-specific survival (97.7% vs 98.3%, P=.546), or all-cause mortality (78.0% vs 77.2%, P=.838) at 10 years for men with small prostates compared with men with larger prostates. On univariate and multivariate analysis, small prostate size was not associated with any of the primary outcome measures. Conclusion: Men with small prostates treated with brachytherapy have excellent outcomes and are at no higher risk of treatment failure than men with larger glands. High-quality implants with adequate margins seem sufficient to address the increased adverse risk factors associated with small prostate size.

  15. 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.

  16. 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

  17. Perioperative Search for Circulating Tumor Cells in Patients Undergoing Prostate Brachytherapy for Clinically Nonmetastatic Prostate Cancer

    Directory of Open Access Journals (Sweden)

    Hideyasu Tsumura

    2017-01-01

    Full Text Available Despite the absence of local prostate cancer recurrence, some patients develop distant metastases after prostate brachytherapy. We evaluate whether prostate brachytherapy procedures have a potential risk for hematogenous spillage of prostate cancer cells. Fifty-nine patients who were undergoing high-dose-rate (HDR or low-dose-rate (LDR brachytherapy participated in this prospective study. Thirty patients with high-risk or locally advanced cancer were treated with HDR brachytherapy after neoadjuvant androgen deprivation therapy (ADT. Twenty-nine patients with clinically localized cancer were treated with LDR brachytherapy without neoadjuvant ADT. Samples of peripheral blood were drawn in the operating room before insertion of needles (preoperative and again immediately after the surgical manipulation (intraoperative. Blood samples of 7.5 mL were analyzed for circulating tumor cells (CTCs using the CellSearch System. While no preoperative samples showed CTCs (0%, they were detected in intraoperative samples in 7 of the 59 patients (11.8%; preoperative vs. intraoperative, p = 0.012. Positive CTC status did not correlate with perioperative variables, including prostate-specific antigen (PSA at diagnosis, use of neoadjuvant ADT, type of brachytherapy, Gleason score, and biopsy positive core rate. We detected CTCs from samples immediately after the surgical manipulation. Further study is needed to evaluate whether those CTCs actually can survive and proliferate at distant sites.

  18. Iodine-125 seed implantation (permanent brachytherapy) for clinically localized prostate cancer

    International Nuclear Information System (INIS)

    Ebara, Shin; Katayama, Yoshihisa; Tanimoto, Ryuta

    2008-01-01

    From January 2004 to March 2007, 308 patients with clinically localized prostate cancer were treated using iodine-125 ( 125 I) seed implantation (permanent brachytherapy) at Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences. We evaluated the treatment's efficacy and morbidity in 300 prostate cancer patients who were followed up for more than 1 month after brachytherapy. Based on the National Comprehensive Cancer Network (NCCN) guidelines, patients with a prostate volume of less than 40 ml in transrectal ultrasound imaging were classified as low or intermediate risk. The median patient age was 67 years (range 50 to 79 years), the median prostate-specific antigen (PSA) value before biopsy was 6.95 ng/ml (range 1.13 to 24.7 ng/ml), and the median prostate volume was 24.33 ml (range 9.3 to 41.76 ml). The median follow-up was 18 months (range 1 to 36 months) and the PSA levels decreased in almost all patients after brachytherapy. Although 194 of 300 patients (64.7%) complained of difficulty in urination, pollakisuria/urgency, miction pain, and/or urinary incontinence, all of which might be associated with radiation prostatitis during the first month after brachytherapy, these symptoms gradually improved. 125 I seed implantation brachytherapy is safe and effective for localized prostate cancer within short-term follow up. (author)

  19. Low dose rate Ir-192 interstitial brachytherapy for prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Oki, Yosuke; Dokiya, Takushi; Yorozu, Atsunori; Suzuki, Takayuki; Saito, Shiro; Monma, Tetsuo; Ohki, Takahiro [National Tokyo Medical Center (Japan); Murai, Masaru; Kubo, Atsushi

    2000-04-01

    From December 1997 through January 1999, fifteen prostatic cancer patients were treated with low dose rate Ir-192 interstitial brachytherapy using TRUS and perineal template guidance without external radiotherapy. Up to now, as no apparent side effects were found, the safety of this treatment is suggested. In the future, in order to treat prostatic cancer patients with interstitial brachytherapy using I-125 or Pd-103, more investigation for this low dose rate Ir-192 interstitial brachytherapy is needed. (author)

  20. 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.

  1. 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

  2. Evolution of brachytherapy for prostate carcinoma

    International Nuclear Information System (INIS)

    Qin Lan

    2005-01-01

    Brachytherapy is one of the most main management to prostate carcinoma. This method has been rapidly accepted in clinical application since it is a convenient, little-traumatic, and outpatient therapy. With the development of techniques of production of radio-seeds, imaging modality and three-dimensional radiotherapy plan system, brachytherapy has been made a virtually progress in improving curative-effect and reducing damage to surrounding normal tissue. (authors)

  3. Five-year biochemical outcome following permanent interstitial brachytherapy for clinical T1-T3 prostate cancer

    International Nuclear Information System (INIS)

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

    2001-01-01

    Purpose: To evaluate 5-year biochemical disease-free outcome for men with clinical T1b-T3a NxM0 1977 American Joint Committee on Cancer (1997 AJCC) adenocarcinoma of the prostate gland who underwent transperineal ultrasound-guided permanent prostate brachytherapy. Methods and Materials: Four hundred twenty-five patients underwent transperineal ultrasound-guided prostate brachytherapy using either 103 Pd or 125 I, for clinical T1b-T3a NxM0 (1997 AJCC) adenocarcinoma of the prostate gland, from April 1995 to October 1999. No patient underwent pathologic lymph-node staging. One hundred ninety patients were implanted with either 103 Pd or 125 I monotherapy; 235 patients received moderate-dose external beam radiation therapy (EBRT), followed by a prostate brachytherapy boost; 163 patients received neoadjuvant hormonal manipulation, in conjunction with either 103 Pd or 125 I monotherapy (77 patients) or in conjunction with moderate-dose EBRT and a prostate brachytherapy boost (86 patients). The median patient age was 68.0 years (range, 48.2-81.3 years). The median follow-up was 31 months (range, 11-69 months). Follow-up was calculated from the day of implantation. No patient was lost to follow-up. Biochemical disease-free survival was defined by the American Society of Therapeutic Radiation and Oncology (ASTRO) consensus definition. Results: For the entire cohort, the 5-year actuarial biochemical no evidence of disease (bNED) survival rate was 94%. For patients with low-, intermediate-, and high-risk disease, the 5-year biochemical disease-free rates were 97.1%, 97.5%, and 84.4%, respectively. For hormone-naive patients, 95.7%, 96.4%, and 79.9% of patients with low-, intermediate-, and high-risk disease were free of biochemical failure. Clinical and treatment parameters predictive of biochemical outcome included: clinical stage, pretreatment prostate-specific antigen (PSA), Gleason score, risk group, age > 65 years, and neoadjuvant hormonal therapy. Isotope choice was

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

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    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. 

  5. Can the prostate brachytherapy by permanent implants represent an alternative to external radiotherapy for the localised prostate cancers with intermediary risk?

    International Nuclear Information System (INIS)

    Farnault, B.; Duberge, T.; Salem, N.; Boher, J.M.; Gravis, G.; Bladou, F.; Jochen, W.; Resbeut, M.

    2009-01-01

    Purpose: the prostate brachytherapy stands out as treatment of low risk prostate cancers, but the data concerning its use as exclusive treatment of intermediary risk prostate cancer are rare. We present a retrospective analysis of intermediary risk prostate cancers which treatment was either an external conformal radiotherapy or an exclusive brachytherapy. conclusion: In this mono centric series, the brachytherapy brings excellent results in comparison with external conformal radiotherapy with dose escalation and could be proposed as alternative to patients suffering of intermediary risk prostate cancer. (N.C.)

  6. Radiation-Induced Leiomyosarcoma of the Prostate after Brachytherapy for Prostatic Adenocarcinoma

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    Hiroto Horiguchi

    2014-08-01

    Full Text Available Radiation therapy (RTx has been employed as a curative therapy for prostatic adenocarcinoma. RTx-induced sarcomas (RISs are rare, late adverse events, representing less than 0.2% of all irradiated patients. RISs are more aggressive tumors than prostatic adenocarcinomas. Herein, we present a case with RTx-induced prostatic leiomyosarcoma after permanent brachytherapy for prostatic adenocarcinoma. A 69-year-old male presented with dysuria and gross hematuria. Six years previously, he had been diagnosed with localized prostate cancer and was treated by permanent brachytherapy. Urethroscopy showed stenosis by a tumor at the prostate. Transurethral prostatectomy was performed for a diagnosis. Based on pathological findings, the diagnosis was leiomyosarcoma of the prostate. He was treated with three cycles of neoadjuvant chemotherapy (CTx that consisted of doxorubicin and ifosfamide (AI, followed by a prostatocystectomy with intrapelvic lymphadenectomy. The tumor extended from the prostate and infiltrated the bladder wall and serosa with lymphatic and venous invasion. The surgical margin was negative, and no residual prostatic adenocarcinoma was observed. The proportion of necrotic tumor cells by neoadjuvant CTx was around 50%. Subsequently, adjuvant CTx was offered, but the patient chose a follow-up without CTx. Local recurrence and lung metastasis were detected by computed tomography 3 months after the surgery. He was treated again with AI. However, CTx was not effective and he died 6 months after the operation. In conclusion, an effective treatment strategy for prostatic sarcoma should be developed in the near future, although the clinical feature of prostatic sarcoma remains unclear due to its rare incidence.

  7. Focal low-dose rate brachytherapy for the treatment of prostate cancer

    Directory of Open Access Journals (Sweden)

    Tong WY

    2013-09-01

    Full Text Available William Y Tong, Gilad Cohen, Yoshiya Yamada Memorial Sloan-Kettering Cancer Center, Department of Radiation Oncology, New York, NY, USA Abstract: Whole-gland low-dose rate (LDR brachytherapy has been a well-established modality of treating low-risk prostate cancer. Treatment in a focal manner has the advantages of reduced toxicity to surrounding organs. Focal treatment using LDR brachytherapy has been relatively unexplored, but it may offer advantages over other modalities that have established experiences with a focal approach. This is particularly true as prostate cancer is being detected at an earlier and more localized stage with the advent of better detection methods and newer imaging modalities. Keywords: prostate cancer, focal, low dose rate, brachytherapy

  8. 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

  9. Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost

    International Nuclear Information System (INIS)

    Singh, Anurag K; Godette, Denise J; Stall, Bronwyn R; Coleman, C Norman; Camphausen, Kevin; Ménard, Cynthia; Guion, Peter; Susil, Robert C; Citrin, Deborah E; Ning, Holly; Miller, Robert W; Ullman, Karen; Smith, Sharon; Crouse, Nancy Sears

    2006-01-01

    To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy (46 Gy). Two patients continued on hormones during follow-up and were censored for this analysis. Four patients discontinued hormone therapy after RT. Five patients did not receive hormones. PSA bounce is defined as a rise in PSA values with a subsequent fall below the nadir value or to below 20% of the maximum PSA level. Six previously published definitions of biochemical failure to distinguish true failure from were tested: definition 1, rise >0.2 ng/mL; definition 2, rise >0.4 ng/mL; definition 3, rise >35% of previous value; definition 4, ASTRO defined guidelines, definition 5 nadir + 2 ng/ml, and definition 6, nadir + 3 ng/ml. Median follow-up was 24 months (range 18–36 mo). During follow-up, the incidence of transient PSA elevation was: 55% for definition 1, 44% for definition 2, 55% for definition 3, 33% for definition 4, 11% for definition 5, and 11% for definition 6. We observed a substantial incidence of transient elevations in PSA following combined external beam radiation and HDR brachytherapy for prostate cancer. Such elevations seem to be self-limited and should not trigger initiation of salvage therapies. No definition of failure was completely predictive

  10. Temporal relationship between prostate brachytherapy and the diagnosis of colorectal cancer

    International Nuclear Information System (INIS)

    Gutman, Sarah A.; Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah A.; Galbreath, Robert W.; Adamovich, Edward

    2006-01-01

    Purpose: To identify the location of pretreatment and posttreatment colorectal malignancies and posttreatment colorectal polyps in patients with clinically localized prostate cancer managed with brachytherapy. Methods and Materials: From April 1995 through July 2004, 1,351 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (American Joint Committee on Cancer, 2002) prostate cancer. Supplemental external beam radiotherapy (XRT) was administered to 699 patients. The median follow-up was 4.6 years. Operative and pathology reports were reviewed for all patients with pretreatment and posttreatment colorectal cancer and posttreatment colorectal polyps. Multiple parameters were evaluated for the development of colorectal cancer or colorectal polyps. Results: Colorectal cancer was diagnosed in 23 and 25 patients before and after prostate brachytherapy, respectively. No differences were identified in the distribution of colorectal cancers either before or after treatment (3 and 4 rectal cancers in the pre- and postbrachytherapy cohorts). Thirty-five of the 48 colorectal cancers (73%) were diagnosed within 5 years of brachytherapy with a peak incidence 1 year after brachytherapy. One hundred ninety-two colorectal polyps were diagnosed after brachytherapy, 160 (83%) occurred within 4 years of brachytherapy, and only 27 (14%) were located in the rectum. In multivariate Cox regression analysis, prostate D 9 (minimum percentage of the dose covering 90% of the target volume) predicted for posttreatment colorectal cancer. Rectal polyps were most closely related to patient age and percent positive biopsies, whereas sigmoid/colon polyps were best predicted by patient age, planning volume, and supplemental XRT. Conclusions: Colorectal cancer was diagnosed with equal frequency before and after brachytherapy with comparable geographic distributions. In addition, the vast majority of postbrachytherapy colorectal polyps were located beyond the confines of the rectum

  11. 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)

  12. Prostate Brachytherapy in Men ≥75 Years of Age

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Wallner, Kent E.; Galbreath, Robert W.; Butler, Wayne M.; Brammer, Sarah G.; Allen, Zachariah A.; Adamovich, Edward

    2008-01-01

    Purpose: To evaluate cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in prostate cancer patients aged ≥75 years undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and August 2004, 145 consecutive patients aged ≥75 years underwent permanent prostate brachytherapy. Median follow-up was 5.8 years. Biochemical progression-free survival was defined by a prostate-specific antigen level ≤0.40 ng/mL after nadir. Patients with metastatic prostate cancer or hormone-refractory disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on survival. Results: Nine-year CSS, bPFS, and OS rates for the entire cohort were 99.3%, 97.1%, and 64.5%, respectively. None of the evaluated parameters predicted for CSS, whereas bPFS was most closely predicted by percentage positive biopsies. Overall survival and non-cancer deaths were best predicted by tobacco status. Thirty-seven patients have died, with 83.8% of the deaths due to cardiovascular disease (22 patients) or second malignancies (9 patients). To date, only 1 patient (0.7%) has died of metastatic prostate cancer. Conclusions: After brachytherapy, high rates of CSS and bPFS are noted in elderly prostate cancer patients. Overall, approximately 65% of patients are alive at 9 years, with survival most closely related to tobacco status. We believe our results support an aggressive locoregional approach in appropriately selected elderly patients

  13. Severe rectal complications after prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Sutlief, Stephen; Bergsagel, Carl; Merrick, Gregory S.

    2015-01-01

    Purpose: Some investigators have reported severe rectal complications after brachytherapy. Due to the low number of such events, their relationship to dosimetric parameters has not been well characterized. Methods and materials: A total of 3126 patients were treated with low dose rate brachytherapy from 1998 through 2010. 2464 had implant alone, and 313 had implant preceded by 44–46 Gy supplemental external beam radiation (EBRT). Post-implant dosimetry was based on a CT scan obtained on the day of implant, generally within 30 min of the procedure. Every patient’s record was reviewed for occurrence of rectal complications. Results: Eight of 2464 patients (0.32%) treated with brachytherapy alone developed a radiation-related rectal fistula. Average prostatic and rectal dose parameters were moderately higher for fistula patients than for patients without a severe rectal complication. For instance, the average R100 was 1.2 ± 0.75 cc for fistula patients, versus 0.37 ± 0.88 cc for non-fistula patients. However, the fistula patients’ values were well within the range of values for patients without a rectal complication. Four patients had some attempt at repair or reconstruction, but long-term functional outcomes were not favorable. Conclusions: Rectal fistulas are a very uncommon potential complication of prostate brachytherapy, which can occur even in the setting of acceptable day 0 rectal doses. Their occurrence is not easily explained by standard dosimetric or clinical factors

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

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    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

  15. Impact of pre-implant lower urinary tract symptoms on postoperative urinary morbidity after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Teishima, Jun; Iwamoto, Hideo; Miyamoto, Katsutoshi; Shoji, Koichi; Masumoto, Hiroshi; Inoue, Shogo; Kobayashi, Kanao; Kajiwara, Mitsuru; Matsubara, Akio

    2012-01-01

    The objectives of this study was to assess the impact of baseline lower urinary tract symptoms on postoperative urinary morbidity in patients being treated for prostate cancer with 125-I permanent prostate brachytherapy. A total of 104 prostate cancer patients were enrolled in this study. Their urinary morbidity was followed up using the International Prostate Symptom Score and Expanded Prostate Cancer Index Composite for 12 months or more after permanent prostate brachytherapy. Patients were classified into two groups based on their baseline International Prostate Symptom Score: the low International Prostate Symptom Score group (score≤7) and the high International Prostate Symptom Score group (score≥8). Urinary morbidity was estimated in each group based on the results of the International Prostate Symptom Score and Expanded Prostate Cancer Index Composite measured before permanent prostate brachytherapy, and at 1, 3, 6, 9 and 12 months after the end of all radiation therapy. The overall mean total International Prostate Symptom Score, International Prostate Symptom Score quality of life score, and urinary-related scores for Expanded Prostate Cancer Index Composite were significantly worse at 1 month after the end of treatment, but they improved gradually after the treatment and recovered to the baseline level within 12 months. Even in the high-International Prostate Symptom Score group, the International Prostate Symptom Score and International Prostate Symptom Score Quality of Life score were significantly worse at 1-3 months after permanent prostate brachytherapy, and then recovered to the baseline level without prolongation. Although the urination-related Expanded Prostate Cancer Index Composite score in the high-International Prostate Symptom Score group was significantly worse at 1 month after permanent prostate brachytherapy in comparison with that in the low-International Prostate Symptom Score group, it recovered to the baseline level without

  16. Erectile Function Durability Following Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Wallner, Kent E.; Kurko, Brian S.; Anderson, Richard; Lief, Jonathan H.

    2009-01-01

    Purpose: To evaluate long-term changes in erectile function following prostate brachytherapy. Methods and Materials: This study included 226 patients with prostate cancer and preimplant erectile function assessed by the International Index of Erectile Function-6 (IIEF-6) who underwent brachytherapy in two prospective randomized trials between February 2001 and January 2003. Median follow-up was 6.4 years. Pre- and postbrachytherapy potency was defined as IIEF-6 ≥ 13 without pharmacologic or mechanical support. The relationship among clinical, treatment, and dosimetric parameters and erectile function was examined. Results: The 7-year actuarial rate of potency preservation was 55.6% with median postimplant IIEF of 22 in potent patients. Potent patients were statistically younger (p = 0.014), had a higher preimplant IIEF (p < 0.001), were less likely to be diabetic (p = 0.002), and were more likely to report nocturnal erections (p = 0.008). Potency preservation in men with baseline IIEF scores of 29-30, 24-28, 18-23, and 13-17 were 75.5% vs. 73.6%, 51.7% vs. 44.8%, 48.0% vs. 40.0%, and 23.5% vs. 23.5% in 2004 vs. 2008. In multivariate Cox regression analysis, preimplant IIEF, hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly predicted for potency preservation. Impact of proximal penile dose was most pronounced for men with IIEF of 18-23 and aged 60-69. A significant minority of men who developed postimplant impotence ultimately regained erectile function. Conclusion: Potency preservation and median IIEF scores following brachytherapy are durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.

  17. 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.

  18. Implication for QOL after I-125 brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Teishima, Jun; Yasumoto, Hiroaki; Inoue, Syogo; Masumoto, Hiroshi; Hasegawa, Yasuhisa; Matsubara, Akio

    2009-01-01

    The aim of this study is to evaluate the quality of life (QOL) of patients following prostate brachytherapy. Between July 2004 and May 2008, 139 patients underwent I-125 permanent brachytherapy. Among those patients, 69 who were followed up for more than one year using the Expanded Prostate Index Composite (EPIC), Japanese version v1 TM , were enrolled in this study. Urinary summary scores became worse temporarily at 1 month after the end of treatment, but then recovered gradually to the level before treatment. Sexual summary scores before treatment were 42.2±16.3. They became worse temporarily at 1 month after treatment but then recovered gradually in patients whose sexual summary scores were more than 40. Urinary morbidity scores after prostate brachytherapy were not so severe and recovered within a short period. Further long-term observation is thought to be required in the future. Sexual function scores of patients before treatment in the present study were lower compared with those recorded in previous studies. (author)

  19. High and intermediate risk prostate cancer treated with three-dimensional computed tomography-guided brachytherapy: 2-8-year follow-up

    International Nuclear Information System (INIS)

    Koutrouvelis, Panos G.; Gillenwater, Jay; Lailas, Niko; Hendricks, Fred; Katz, Stuart; Sehn, James; Gil-Montero, Guillermo; Khawand, Nabil

    2003-01-01

    Purpose: To report post-brachytherapy results in high and intermediate risk patients of prostatic adenocarcinoma. Methods and materials: From June 1994 to June 2000, 356 consecutive high and intermediate risk patients were treated with three-dimensional computed tomography-guided stereotactic pararectal brachytherapy. The age was 42-90 years (median, 68 years), the initial prostate volume was 14-180 cm 3 (median, 59 cm 3 ), and initial PSA was 1.7-143 ng/ml (median, 10.5 ng/ml). Three hundred forty-eight patients were available for follow-up for 2 - 8 years (median, 4.5 years). Two hundred eighty patients had one or more high risk factors (PSA >20 ng/ml, Gleason>7, Stage T2b, T3a, or T3b). Sixty-eight patients had only one intermediate risk factor (PSA 10-20 ng/ml or Gleason=7). Patients with both intermediate risks were considered high risk. The high-risk group was further stratified into subgroups with similar risk profile. A dose of 144 Gy with 125 I or 120 Gy with 103 Pd was achieved in 90-100% of the target. Thirty (30) patients (9%) had prior transurethral resection and 229 (64%) were treated with 3 months neoadjuvant androgen ablation. Results: Biochemical disease-free survival was 92% of 280 high risk patients and 96% of 68 intermediate risk patients. Seven patients (2%) required catheterization during the first year for urinary retention, nine patients (3%) required TUR 1-3 years post-implant, three patients (1%) developed grade 1 or 2 incontinence after a second TUR, and four patients (1%) developed grade 3 rectal complications. Conclusion: This method produces a high level of biochemical control 2-8 years (median 4.5 years). Morbidity is acceptable regardless of risk profile or initial prostate volume

  20. 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.

  1. Robotic Needle Guide for Prostate Brachytherapy: Clinical Testing of Feasibility and Performance

    Science.gov (United States)

    Song, Danny Y; Burdette, Everette C; Fiene, Jonathan; Armour, Elwood; Kronreif, Gernot; Deguet, Anton; Zhang, Zhe; Iordachita, Iulian; Fichtinger, Gabor; Kazanzides, Peter

    2010-01-01

    Purpose Optimization of prostate brachytherapy is constrained by tissue deflection of needles and fixed spacing of template holes. We developed and clinically tested a robotic guide towards the goal of allowing greater freedom of needle placement. Methods and Materials The robot consists of a small tubular needle guide attached to a robotically controlled arm. The apparatus is mounted and calibrated to operate in the same coordinate frame as a standard template. Translation in x and y directions over the perineum ±40mm are possible. Needle insertion is performed manually. Results Five patients were treated in an IRB-approved study. Confirmatory measurements of robotic movements for initial 3 patients using infrared tracking showed mean error of 0.489 mm (SD 0.328 mm). Fine adjustments in needle positioning were possible when tissue deflection was encountered; adjustments were performed in 54/179 (30.2%) needles placed, with 36/179 (20.1%) adjustments of > 2mm. Twenty-seven insertions were intentionally altered to positions between the standard template grid to improve the dosimetric plan or avoid structures such as pubic bone and blood vessels. Conclusions Robotic needle positioning provided a means of compensating for needle deflections as well as the ability to intentionally place needles into areas between the standard template holes. To our knowledge, these results represent the first clinical testing of such a system. Future work will be incorporation of direct control of the robot by the physician, adding software algorithms to help avoid robot collisions with the ultrasound, and testing the angulation capability in the clinical setting. PMID:20729152

  2. 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

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

    Science.gov (United States)

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

    2002-06-01

    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. 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 >or=10.0 ng/mL, Gleason score >or=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. 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 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%. 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-specific survival with higher doses. These results, coupled with the low risk of complications, the advantage of not being radioactive after implantation, and the real-time interactive planning, define a new standard for treatment.

  4. 3-D conformal HDR brachytherapy as monotherapy for localized prostate cancer. A pilot study

    International Nuclear Information System (INIS)

    Martin, T.; Baltas, D.; Kurek, R.; Roeddiger, S.; Kontova, M.; Anagnostopoulos, G.; Skazikis, G.; Zamboglou, N.; Dannenberg, T.; Buhleier, T.; Tunn, U.

    2004-01-01

    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 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 90 , D 10 urethra, and D 10 rectum. Acute toxicity was evaluated using the CTC (common toxicity criteria) scales. Results: median D 90 was 106% of D ref (range: 93-115%), median D 10 urethra 159% of D ref (range: 127-192%), and median D 10 rectum 55% of D 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.)

  5. A comparison study on various low energy sources in interstitial prostate brachytherapy.

    Science.gov (United States)

    Bakhshabadi, Mahdi; Ghorbani, Mahdi; Khosroabadi, Mohsen; Knaup, Courtney; Meigooni, Ali S

    2016-02-01

    Low energy sources are routinely used in prostate brachytherapy. (125)I is one of the most commonly used sources. Low energy (131)Cs source was introduced recently as a brachytherapy source. The aim of this study is to compare dose distributions of (125)I, (103)Pd, and (131)Cs sources in interstitial brachytherapy of prostate. ProstaSeed (125)I brachytherapy source was simulated using MCNPX Monte Carlo code. Additionally, two hypothetical sources of (103)Pd and (131)Cs were simulated with the same geometry as the ProstaSeed (125)I source, while having their specific emitted gamma spectra. These brachytherapy sources were simulated with distribution of forty-eight seeds in a phantom including prostate. The prostate was considered as a sphere with radius of 1.5 cm. Absolute and relative dose rates were obtained in various distances from the source along the transverse and longitudinal axes inside and outside the tumor. Furthermore, isodose curves were plotted around the sources. Analyzing the initial dose profiles for various sources indicated that with the same time duration and air kerma strength, (131)Cs delivers higher dose to tumor. However, relative dose rate inside the tumor is higher and outside the tumor is lower for the (103)Pd source. The higher initial absolute dose in cGy/(h.U) of (131)Cs brachytherapy source is an advantage of this source over the others. The higher relative dose inside the tumor and lower relative dose outside the tumor for the (103)Pd source are advantages of this later brachytherapy source. Based on the total dose the (125)I source has advantage over the others due to its longer half-life.

  6. The effect of androgen deprivation on the early changes in prostate volume following transperineal ultrasound guided interstitial therapy for localized carcinoma of the prostate

    Energy Technology Data Exchange (ETDEWEB)

    Whittington, Richard; Broderick, Gregory A; Arger, Peter; Malkowicz, S Bruce; Epperson, Robert D; Arjomandy, Bijan; Kassaee, Alireza

    1999-07-15

    Purpose: To determine the change in volume of the prostate as a result of neoadjuvant androgen deprivation prior to prostate implant and in the early postimplant period following transperineal ultrasound guided palladium-103 brachytherapy for early-stage prostate cancer. Methods and Materials: Sixty-nine men received 3 to 6 months of androgen deprivation therapy followed by treatment planning ultrasound followed 4 to 8 weeks later by palladium-103 implant of the prostate. All patients had clinical and radiographic stage T1c-T2b adenocarcinoma of the prostate. A second ultrasound study was carried out 11 to 13 days following the implant to determine the change in volume of the prostate as a result of the implant. The prehormonal and preimplant volumes were compared to the postimplant volume to determine the effect of hormones and brachytherapy on prostate volume. Results: The median decrease in prostate volume as a result of androgen deprivation was 33% among the 54 patients with prostate volume determinations prior to hormonal therapy. The reduction in volume was greatest in the quartile of men with the largest initial gland volume (59%) and least in the quartile of men with smallest glands (10%). The median reduction in prostate volume between the treatment planning ultrasound and the follow-up study after implant was 3%, but 23 (33%) patients had an increase in prostate volume, including 16 (23%) who had an increase in volume >20%; 11 of these patients (16%) had an increase in volume >30%. The time course of development and resolution of this edema is not known. The severity of the edema was not related to initial or preimplant prostate volume or duration of hormonal therapy. Conclusions: Prostate edema may significantly affect the dose delivered to the prostate following transperineal ultrasound guided brachytherapy. The effect on the actual delivered dose will be greater when shorter lived isotopes are used. It remains to be observed whether this edema will

  7. 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

  8. 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

  9. Sequential evaluation of prostate edema after permanent seed prostate brachytherapy using CT-MRI fusion

    International Nuclear Information System (INIS)

    Taussky, Daniel; Austen, Lyn; Toi, Ants; Yeung, Ivan; Williams, Theresa; Pearson, Shannon; McLean, Michael; Pond, Gregory; Crook, Juanita

    2005-01-01

    Purpose: To analyze the extent and time course of prostate edema and its effect on dosimetry after permanent seed prostate brachytherapy. Methods and Materials: Twenty patients scheduled for permanent seed 125 I prostate brachytherapy agreed to a prospective study on postimplant edema. Implants were preplanned using transrectal ultrasonography. Postimplant dosimetry was calculated using computed tomography-magnetic resonance imaging (CT-MRI) fusion on the day of the implant (Day 1) and Days 8 and 30. The prostate was contoured on MRI, and the seeds were located on CT. Factors investigated for an influence on edema were the number of seeds and needles, preimplant prostate volume, transitional zone index (transition zone volume divided by prostate volume), age, and prostate-specific antigen level. Prostate dosimetry was evaluated by the percentage of the prostate volume receiving 100% of the prescribed dose (V 100 ) and percentage of prescribed dose received by 90% of the prostate volume (D 90 ). Results: Prostate edema was maximal on Day 1, with the median prostate volume 31% greater than preimplant transrectal ultrasound volume (range, 0.93-1.72; p 100 on Day 1 was 93.6% (range, 86.0-98.2%) and was 96.3% (range, 85.7-99.5%) on Day 30 (p = 0.079). Patients with a Day 1 V 100 >93% were less affected by edema resolution, showing a median increase in V 100 of 0.67% on Day 30 compared with 2.77% for patients with a V 100 100 >93%)

  10. SU-E-T-397: Include Organ Deformation Into Dose Calculation of Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Shao, Y; Shen, D; Chen, R; Wang, A; Lian, J

    2014-01-01

    Purpose: Prostate brachytherapy is an important curative treatment for patients with localized prostate cancer. In brachytherapy, rectal balloon is generally needed to adjust for unfavorable prostate position for seed placement. However, rectal balloon causes prostate deformation, which is not accounted for in dosimetric planning. Therefore, it is possible that brachytherapy dosimetry deviates significantly from initial plan when prostate returns to its non-deformed state (after procedure). The goal of this study is to develop a method to include prostate deformation into the treatment planning of brachytherapy dosimetry. Methods: We prospectively collected ultrasound images of prostate pre- and post- rectal balloon inflation from thirty five consecutive patients undergoing I-125 brachytherapy. Based on the cylinder coordinate systems, we learned the initial coordinate transformation parameters between the manual segmentations of both deformed and non-deformed prostates of each patient in training set. With the nearest-neighbor interpolation, we searched the best transformation between two coordinate systems to maximum the mutual information of deformed and non-deformed images. We then mapped the implanted seeds of five selected patients from the deformed prostate into non-deformed prostate. The seed position is marked on original pre-inflation US image and it is imported into VariSeed software for dose calculation. Results: The accuracy of image registration is 87.5% as quantified by Dice Index. The prostate coverage V100% dropped from 96.5±0.5% of prostate deformed plan to 91.9±2.6% (p<0.05) of non-deformed plan. The rectum V100% decreased from 0.44±0.26 cc to 0.10±0.18 cc (p<0.05). The dosimetry of the urethra showed mild change but not significant: V150% changed from 0.05±0.10 cc to 0.14±0.15 cc (p>0.05) and D1% changed from 212.9±37.3 Gy to 248.4±42.8 Gy (p>0.05). Conclusion: We have developed a deformable image registration method that allows

  11. Temporal resolution of urinary morbidity following prostate brachytherapy

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Lief, Jonathan H.; Dorsey, Anthony T.

    2000-01-01

    Purpose: To report the short-term urinary morbidity for prostate brachytherapy patients without a preimplant history of a transurethral resection of the prostate gland and who received prophylactic and prolonged α-blockers. α-blockers may decrease radiation-induced urethritis and increase urinary flow. Multiple clinical and treatment parameters were evaluated to identify factors associated with increased acute urinary morbidity. Materials and Methods: One hundred seventy consecutive patients without a prior history of a transurethral resection of the prostate gland underwent transperineal ultrasound guided prostate brachytherapy for clinical T1c-T3a carcinoma of the prostate gland. For all patients, an α-blocker was initiated prior to implantation and continued at least until the international prostate symptom score (IPSS) returned to baseline levels. Clinical parameters evaluated for short-term urinary morbidity included patient age, clinical T stage, preimplant IPSS (obtained within 3 weeks of implantation), and prostate ultrasound volume. Treatment parameters included the utilization of neoadjuvant hormonal manipulation, the utilization of moderate dose external beam radiation therapy before implantation, the choice of isotope, the urethral dose, the total implant activity in millicuries, and a variety of dosimetric quality indicators (D 90 and V 100 /V 150 /V 200 ). Catheter dependency and the duration of α-blocker dependency was also evaluated. On average, 11.2 IPSS surveys were obtained for each patient. Results: One hundred fifty of the 170 patients (88.2%) had the urinary catheter permanently removed on day 0. Only one patient required an urinary catheter for > 5 days. Two patients (1.2%) required a subsequent transurethral resection of the prostate gland because of prolonged obstructive/irritative symptoms. To date, no patient has developed an urinary stricture or urinary incontinence. The IPS score on average peaked at 2 weeks following implantation

  12. 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

  13. A comparison study on various low energy sources in interstitial prostate brachytherapy

    Directory of Open Access Journals (Sweden)

    Mahdi Bakhshabadi

    2016-02-01

    Full Text Available Purpose: Low energy sources are routinely used in prostate brachytherapy. 125 I is one of the most commonly used sources. Low energy 131 Cs source was introduced recently as a brachytherapy source. The aim of this study is to compare dose distributions of 125 I, 103 Pd, and 131 Cs sources in interstitial brachytherapy of prostate. Material and methods: ProstaSeed 125 I brachytherapy source was simulated using MCNPX Monte Carlo code. Additionally, two hypothetical sources of 103 Pd and 131 Cs were simulated with the same geometry as the ProstaSeed 125 I source, while having their specific emitted gamma spectra. These brachytherapy sources were simulated with distribution of forty-eight seeds in a phantom including prostate. The prostate was considered as a sphere with radius of 1.5 cm. Absolute and relative dose rates were obtained in various distances from the source along the transverse and longitudinal axes inside and outside the tumor. Furthermore, isodose curves were plotted around the sources. Results : Analyzing the initial dose profiles for various sources indicated that with the same time duration and air kerma strength, 131 Cs delivers higher dose to tumor. However, relative dose rate inside the tumor is higher and outside the tumor is lower for the 103 Pd source. Conclusions : The higher initial absolute dose in cGy/(h.U of 131 Cs brachytherapy source is an advantage of this source over the others. The higher relative dose inside the tumor and lower relative dose outside the tumor for the 103 Pd source are advantages of this later brachytherapy source. Based on the total dose the 125 I source has advantage over the others due to its longer half-life.

  14. LDR vs. HDR brachytherapy for localized prostate cancer: the view from radiobiological models.

    Science.gov (United States)

    King, Christopher R

    2002-01-01

    Permanent LDR brachytherapy and temporary HDR brachytherapy are competitive techniques for clinically localized prostate radiotherapy. Although a randomized trial will likely never be conducted comparing these two forms of brachytherapy, a comparative radiobiological modeling analysis proves useful in understanding some of their intrinsic differences, several of which could be exploited to improve outcomes. Radiobiological models based upon the linear quadratic equations are presented for fractionated external beam, fractionated (192)Ir HDR brachytherapy, and (125)I and (103)Pd LDR brachytherapy. These models incorporate the dose heterogeneities present in brachytherapy based upon patient-derived dose volume histograms (DVH) as well as tumor doubling times and repair kinetics. Radiobiological parameters are normalized to correspond to three accepted clinical risk factors based upon T-stage, PSA, and Gleason score to compare models with clinical series. Tumor control probabilities (TCP) for LDR and HDR brachytherapy (as monotherapy or combined with external beam) are compared with clinical bNED survival rates. Predictions are made for dose escalation with HDR brachytherapy regimens. Model predictions for dose escalation with external beam agree with clinical data and validate the models and their underlying assumptions. Both LDR and HDR brachytherapy achieve superior tumor control when compared with external beam at conventional doses (LDR brachytherapy as boost achieves superior tumor control than when used as monotherapy. Stage for stage, both LDR and current HDR regimens achieve similar tumor control rates, in agreement with current clinical data. HDR monotherapy with large-dose fraction sizes might achieve superior tumor control compared with LDR, especially if prostate cancer possesses a high sensitivity to dose fractionation (i.e., if the alpha/beta ratio is low). Radiobiological models support the current clinical evidence for equivalent outcomes in localized

  15. 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

  16. The role of brachytherapy in the definitive management of prostate cancer; Place de la curietherapie dans le traitement du cancer prostatique localise

    Energy Technology Data Exchange (ETDEWEB)

    Crook, J. [British Columbia Cancer Agency, Center for the Southern Interior, 399, Royal Avenue, Kelowna, British Columbia, V1Y 5L33 (Canada)

    2011-06-15

    Over the past two decades, brachytherapy has played an ever expanding role in the definitive radiotherapy of prostate cancer. Brachytherapy surpasses external beam radiotherapy in its ability to deliver intense intra-prostatic dose escalation. Although initially low dose rate permanent seed brachytherapy was favored for favorable risk prostate cancers, and high dose rate temporary brachytherapy for intermediate and advanced disease, both types of brachytherapy now have a place across all the risk groups of localized prostate cancer. This article will review indications and patient selection, planning and technical aspects, toxicity and efficacy for both low and high dose rate prostate brachytherapy. (author)

  17. 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)

  18. 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)

  19. 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)

  20. Interim report of image-guided conformal high-dose-rate brachytherapy for patients with unfavorable prostate cancer: the William Beaumont Phase II dose-escalating trial

    International Nuclear Information System (INIS)

    Martinez, Alvaro A.; Kestin, Larry L.; Stromberg, Jannifer S.; Gonzalez, Jose A.; Wallace, Michelle; Gustafson, Gary S.; Edmundson, Gregory K.; Spencer, William; Vicini, Frank A.

    2000-01-01

    Purpose: We analyzed our institution's experience treating patients with unfavorable prostate cancer in a prospective Phase II dose-escalating trial of external beam radiation therapy (EBRT) integrated with conformal high-dose-rate (HDR) brachytherapy boosts. This interim report discusses treatment outcome and prognostic factors using this treatment approach. Methods and Materials: From November 1991 through February 1998, 142 patients with unfavorable prostate cancer were prospectively treated in a dose-escalating trial with pelvic EBRT in combination with outpatient HDR brachytherapy at William Beaumont Hospital. Patients with any of the following characteristics were eligible: pretreatment prostate-specific antigen (PSA) ≥ 10.0 ng/ml, Gleason score ≥ 7, or clinical stage T2b or higher. All patients received pelvic EBRT to a median total dose of 46.0 Gy. Pelvic EBRT was integrated with ultrasound-guided transperineal conformal interstitial iridium-192 HDR implants. From 1991 to 1995, 58 patients underwent three conformal interstitial HDR implants during the first, second, and third weeks of pelvic EBRT. After October 1995, 84 patients received two interstitial implants during the first and third weeks of pelvic EBRT. The dose delivered via interstitial brachytherapy was escalated from 5.50 Gy to 6.50 Gy for each implant in those patients receiving three implants, and subsequently, from 8.25 Gy to 9.50 Gy per fraction in those patients receiving two implants. To improve implant quality and reduce operator dependency, an on-line, image-guided interactive dose optimization program was utilized during each HDR implant. No patient received hormonal therapy unless treatment failure was documented. The median follow-up was 2.1 years (range: 0.2-7.2 years). Biochemical failure was defined according to the American Society for Therapeutic Radiology and Oncology Consensus Panel definition. Results: The pretreatment PSA level was ≥ 10.0 ng/ml in 51% of patients. The

  1. Primary Causes of Death After Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Bittner, Nathan; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah A.; Brammer, Sarah G.; Moyad, Mark

    2008-01-01

    Purpose: To evaluate the primary causes of death in low-risk (low-risk), intermediate-risk (intermediate-risk), and high-risk (high-risk) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. Methods and Materials: From April 1995 through November 2004, a total of 1,354 consecutive patients underwent prostate brachytherapy. All patients underwent brachytherapy >3 years before analysis. Of the patients, 532 (39.3%) received androgen deprivation therapy and 703 (51.9%) received supplemental radiation therapy. The median follow-up was 5.4 years. Multiple parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific survival was 97.0% (99.7%, 99.0%, and 90.1% for low-risk, intermediate-risk, and high-risk patients). Overall survival was 76.7% (82.5%, 78.3%, and 67.6% for low-, intermediate-, and high-risk patients, respectively). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3%, and 19.8% for low-, intermediate-, and high-risk patients). The death rate from second malignancies (nonprostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0%, and 10.8% for low-, intermediate-, and high-risk patients. In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group, whereas death from cardiovascular disease, nonprostate cancer, and all other causes were most closely related to patient age and tobacco use. Conclusions: Although cardiovascular mortality was the predominant cause of death, prostate cancer was responsible for approximately 10% of all deaths. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients primarily

  2. Standardization of prostate brachytherapy treatment plans

    International Nuclear Information System (INIS)

    Ove, Roger; Wallner, Kent; Badiozamani, Kas; Korjsseon, Tammy; Sutlief, Steven

    2001-01-01

    Purpose: Whereas custom-designed plans are the norm for prostate brachytherapy, the relationship between linear prostate dimensions and volume calls into question the routine need for customized treatment planning. With the goal of streamlining the treatment-planning process, we have compared the treatment margins (TMs) achieved with one standard plan applied to patients with a wide range of prostate volumes. Methods and Materials: Preimplant transrectal ultrasound (TRUS) images of 50 unselected University of Washington patients with T1-T2 cancer and a prostate volume between 20 cc and 50 cc were studied. Patients were arbitrarily grouped into categories of 20-30 cc, 30-40 cc, and 40-50 cc. A standard 19-needle plan was devised for patients in the 30- to 40-cc range, using an arbitrary minimum margin of 5 mm around the gross tumor volume (GTV), making use of inverse planning technology to achieve 100% coverage of the target volume with accentuation of dose at the periphery and sparing of the central region. The idealized plan was applied to each patient's TRUS study. The distances (TMs) between the prostatic edge (GTV) and treated volume (TV) were determined perpendicular to the prostatic margin. Results: Averaged over the entire patient group, the ratio of thickness to width was 1.4, whereas the ratio of length to width was 1.3. These values were fairly constant over the range of volumes, emphasizing that the prostate retains its general shape as volume increases. The idealized standard plan was overlaid on the ultrasound images of the 17 patients in the 30- to 40-cc group and the V100, the percentage of target volume receiving 100% or more of the prescription dose, was 98% or greater for 15 of the 17 patients. The lateral and posterior TMs fell within a narrow range, most being within 2 mm of the idealized 5-mm TM. To estimate whether a 10-cc volume-interval stratification was reasonable, the standard plan generated from the 30- to 40-cc prostate model was

  3. Perineural invasion on prostate needle biopsy does not predict biochemical failure following brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Weight, Christopher J.; Ciezki, Jay P.; Reddy, Chandana A.; Zhou Ming; Klein, Eric A.

    2006-01-01

    Purpose: To determine if the presence of perineural invasion (PNI) predicts biochemical recurrence in patients who underwent low-dose-rate brachytherapy for the treatment of localized prostate cancer. Methods and Materials: A retrospective case control matching study was performed. The records of 651 patients treated with brachytherapy between 1996 and 2003 were reviewed. Sixty-three of these patients developed biochemical failure. These sixty-three patients were then matched in a one-to-one ratio to patients without biochemical failure, controlling for biopsy Gleason score, clinical stage, initial prostate-specific antigen, age, and the use of androgen deprivation. The pathology of the entire cohort was then reviewed for evidence of perineural invasion on initial prostate biopsy specimens. The biochemical relapse free survival rates for these two groups were compared. Results: Cases and controls were well matched, and there were no significant differences between the two groups in age, Gleason grade, clinical stage, initial prostate-specific antigen, and the use of androgen deprivation. PNI was found in 19 (17%) patients. There was no significant difference in the rates of PNI between cases and controls, 19.6% and 14.3% respectively (p 0.45). PNI did not correlate with biochemical relapse free survival (p 0.40). Conclusion: Perineural invasion is not a significant predictor of biochemical recurrence in patients undergoing brachytherapy for prostate cancer

  4. Indication of brachytherapy of prostate with permanent implants

    International Nuclear Information System (INIS)

    Chauveinc, L.; Solignac, S.; Rosenwald, J.C.; Firmin, F.; Cosset, J.M.; Flam, T.; Thiounn, N.

    2002-01-01

    In the last decade, brachytherapy emerged as a particularly appealing new way of treating localized prostate cancer. Recently published 10-12 years biochemical control results appear to be superimposable to the best percentages achieved by surgery or conformal radiotherapy, with a small percentage of complications. This applied to severely patients. Only patients with T1/T2, PSA 60 g, hip mobility limitations, a urinary obstructive syndrome and previous trans-urethral resection lead to difficulties in technical implantation and therefore must be taken into account when discussing brachytherapy. In conclusion, for adequately selected patients, brachytherapy offers a particularly applied alternative to surgery and external radiotherapy, with satisfactory long term biochemical control rates and limited complications. (author)

  5. 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.

  6. The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy

    International Nuclear Information System (INIS)

    Niehaus, Angela; Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah A.; Galbreath, Robert W.; Adamovich, Edward

    2006-01-01

    Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after prostate brachytherapy. Methods and Materials: Between January 1998 and June 2003, 976 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 American Joint Committee on Cancer) prostate cancer. Seven hundred eighty-nine (80.8%) were implanted with 103 Pd and 187 (19.2%) with 125 I. The median follow-up was 41.2 months. Patients were stratified into size cohorts ≤25 cm 3 , 25.1-35 cm 3 , 35.1-45 cm 3 , and >45 cm 3 . Four hundred eighteen patients (42.8%) received androgen deprivation therapy (ADT). Four hundred eighty-six patients (49.7%) received supplemental external-beam radiation therapy (XRT). In all patients, an alpha blocker was initiated before implantation and continued at least until the IPSS returned to baseline. IPSS resolution was defined as a return to within one point of baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V 100/150/20 , D 9 , urethral dose (average and maximum), supplemental XRT, ADT, and the duration of ADT (≤6 months vs. >6 months). Catheter dependency and the need for postsurgical intervention were also evaluated. Results: For both isotopes and all prostate size cohorts, IPSS peaked 1 month after implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope demonstrated no significant differences in prolonged catheter dependency (≥5 days), IPSS resolution, or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best predicted by preimplant IPSS, XRT, and

  7. 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

  8. 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

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

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan H.; Allen, Zachariah A.; Wallner, Kent E.

    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

  10. 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

  11. Brachytherapy for prostate cancer: Comparative characteristics of procedures

    Directory of Open Access Journals (Sweden)

    S. V. Kanaev

    2015-01-01

    Full Text Available The introduction of interstitial radiation sources is the «youngest» of the radical method of treatment of patients with prostate cancer (PC. The high level of efficiency comparable to prostatectomy at a significantly lower rate of complications causes rapid growth of clinical use of brachytherapy (BT. Depending on the radiation source and the mode of administration into the prostate gland are two types BT – high-dose rate (temporary (HDR-BT and low-dose rate (permanent (LDR-BT brachytherapy. At the heart of these two methods are based on a single principle of direct effect of the quantum gamma radiation on the area of interest. However, the differences between the characteristics of isotopes used and technical aspects of the techniques cause the difference in performance and complication rates for expression HDR-BT and LDR-BT.

  12. 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

  13. 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.

  14. 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)

  15. 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.

  16. Perineal recurrence of prostate cancer six years after trans-perineal brachytherapy

    NARCIS (Netherlands)

    Eppinga, Wietse; Vijverberg, Peter; Moerland, Rien; Brand, Eric; van der Voort van Zyp, Jochem; Noteboom, Juus; van Vulpen, Marco

    We report a case of perineal recurrence of prostate cancer 6 years after low-dose-rate (LDR) brachytherapy for localized prostate cancer. The most common approach to treat such perineal masses, including those occurring after prior biopsy or surgery, is local excision. We report the use of

  17. 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

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

    Energy Technology Data Exchange (ETDEWEB)

    Podder, Tarun K.; Buzurovic, Ivan; Huang Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan [Department of Radiation Oncology, Kimmel Cancer Center (NCI-designated), Thomas Jefferson University, Philadelphia, Pennsylvania 19107 (United States)

    2011-01-15

    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

  19. 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)

  20. 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.

  1. Current Brachytherapy Quality Assurance Guidance: Does It Meet the Challenges of Emerging Image-Guided Technologies?

    International Nuclear Information System (INIS)

    Williamson, Jeffrey F.

    2008-01-01

    In the past decade, brachytherapy has shifted from the traditional surgical paradigm to more modern three-dimensional image-based planning and delivery approaches. The role of intraoperative and multimodality image-based planning is growing. Published American Association of Physicists in Medicine, American College of Radiology, European Society for Therapeutic Radiology and Oncology, and International Atomic Energy Agency quality assurance (QA) guidelines largely emphasize the QA of planning and delivery devices rather than processes. These protocols have been designed to verify compliance with major performance specifications and are not risk based. With some exceptions, complete and clinically practical guidance exists for sources, QA instrumentation, non-image-based planning systems, applicators, remote afterloading systems, dosimetry, and calibration. Updated guidance is needed for intraoperative imaging systems and image-based planning systems. For non-image-based brachytherapy, the American Association of Physicists in Medicine Task Group reports 56 and 59 provide reasonable guidance on procedure-specific process flow and QA. However, improved guidance is needed even for established procedures such as ultrasound-guided prostate implants. Adaptive replanning in brachytherapy faces unsolved problems similar to that of image-guided adaptive external beam radiotherapy

  2. Prostate-specific antigen density is predictive of outcome in suboptimal prostate seed brachytherapy.

    Science.gov (United States)

    Benzaquen, David; Delouya, Guila; Ménard, Cynthia; Barkati, Maroie; Taussky, Daniel

    In prostate seed brachytherapy, a D 90 of prostate-specific antigen + 2). Univariate and multivariate analyses were performed, adjusting for known prognostic factors such as D 90 and prostate-specific antigen density (PSAD) of ≥0.15 ng/mL/cm 3 , to evaluate their ability to predict BF. Median followup for patients without BF was 72 months (interquartile range 56-96). BF-free recurrence rate at 5 years was 95% and at 8 years 88%. In univariate analysis, PSAD and cancer of the prostate risk assessment score were predictive of BF. On multivariate analysis, none of the factors remained significant. The best prognosis had patients with a low PSAD (<0.15 ng/mL/cm 3 ) and an optimal implant at 30 days after implantation (as defined by D 90  ≥ 130 Gy) compared to patients with both factors unfavorable (p = 0.006). A favorable PSAD was associate with a good prognosis, independently of the D 90 (<130 Gy vs. ≥130 Gy, p = 0.7). Patients with a PSAD of <0.15 ng/mL/cm 3 have little risk of BF, even in the case of a suboptimal implant. These results need to be validated in other patients' cohorts. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  3. Comparison of Real-Time Intraoperative Ultrasound-Based Dosimetry With Postoperative Computed Tomography-Based Dosimetry for Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Nag, Subir; Shi Peipei; Liu Bingren; Gupta, Nilendu; Bahnson, Robert R.; Wang, Jian Z.

    2008-01-01

    Purpose: To evaluate whether real-time intraoperative ultrasound (US)-based dosimetry can replace conventional postoperative computed tomography (CT)-based dosimetry in prostate brachytherapy. Methods and Materials: Between December 2001 and November 2002, 82 patients underwent 103 Pd prostate brachytherapy. An interplant treatment planning system was used for real-time intraoperative transrectal US-guided treatment planning. The dose distribution was updated according to the estimated seed position to obtain the dose-volume histograms. Postoperative CT-based dosimetry was performed a few hours later using the Theraplan-Plus treatment planning system. The dosimetric parameters obtained from the two imaging modalities were compared. Results: The results of this study revealed correlations between the US- and CT-based dosimetry. However, large variations were found in the implant-quality parameters of the two modalities, including the doses covering 100%, 90%, and 80% of the prostate volume and prostate volumes covered by 100%, 150%, and 200% of the prescription dose. The mean relative difference was 38% and 16% for doses covering 100% and 90% of the prostate volume and 10% and 21% for prostate volumes covered by 100% and 150% of the prescription dose, respectively. The CT-based volume covered by 200% of the prescription dose was about 30% greater than the US-based one. Compared with CT-based dosimetry, US-based dosimetry significantly underestimated the dose to normal organs, especially for the rectum. The average US-based maximal dose and volume covered by 100% of the prescription dose for the rectum was 72 Gy and 0.01 cm 3 , respectively, much lower than the 159 Gy and 0.65 cm 3 obtained using CT-based dosimetry. Conclusion: Although dosimetry using intraoperative US-based planning provides preliminary real-time information, it does not accurately reflect the postoperative CT-based dosimetry. Until studies have determined whether US-based dosimetry or

  4. Prostate specific antigen bounce is related to overall survival in prostate brachytherapy.

    Science.gov (United States)

    Hinnen, Karel A; Monninkhof, Evelyn M; Battermann, Jan J; van Roermund, Joep G H; Frank, Steven J; van Vulpen, Marco

    2012-02-01

    To investigate the association between prostate specific antigen (PSA) bounce and disease outcome after prostate brachytherapy. We analyzed 975 patients treated with (125)I implantation monotherapy between 1992 and 2006. All patients had tumor Stage ≤ 2c, Gleason score ≤ 7 prostate cancer, a minimum follow-up of 2 years with at least four PSA measurements, and no biochemical failure in the first 2 years. Median follow-up was 6 years. Bounce was defined as a PSA elevation of +0.2 ng/mL with subsequent decrease to previous nadir. We used the Phoenix +2 ng/mL definition for biochemical failure. Additional endpoints were disease-specific and overall survival. Multivariate Cox regression analysis was performed to adjust for potential confounding factors. Bounce occurred in 32% of patients, with a median time to bounce of 1.6 years. More than 90% of bounces took place in the first 3 years after treatment and had disappeared within 2 years of onset. Ten-year freedom from biochemical failure, disease-specific survival, and overall survival rates were, respectively, 90%, 99%, and 88% for the bounce group and 70%, 93%, and 82% for the no-bounce group. Only 1 patient (0.3%) died of prostate cancer in the bounce group, compared with 40 patients (6.1%) in the no-bounce group. Adjusted for confounding, a 70% biochemical failure risk reduction was observed for patients experiencing a bounce (hazard ratio 0.31; 95% confidence interval 0.20-0.48). A PSA bounce after prostate brachytherapy is strongly related to better outcome in terms of biochemical failure, disease-specific survival, and overall survival. Copyright © 2012 Elsevier Inc. All rights reserved.

  5. 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.

  6. Effect of edema, relative biological effectiveness, and dose heterogeneity on prostate brachytherapy

    International Nuclear Information System (INIS)

    Wang, Jian Z.; Mayr, Nina A.; Nag, Subir; Montebello, Joseph; Gupta, Nilendu; Samsami, Nina; Kanellitsas, Christos

    2006-01-01

    Many factors influence response in low-dose-rate (LDR) brachytherapy of prostate cancer. Among them, edema, relative biological effectiveness (RBE), and dose heterogeneity have not been fully modeled previously. In this work, the generalized linear-quadratic (LQ) model, extended to account for the effects of edema, RBE, and dose heterogeneity, was used to assess these factors and their combination effect. Published clinical data have shown that prostate edema after seed implant has a magnitude (ratio of post- to preimplant volume) of 1.3-2.0 and resolves exponentially with a half-life of 4-25 days over the duration of the implant dose delivery. Based on these parameters and a representative dose-volume histogram (DVH), we investigated the influence of edema on the implant dose distribution. The LQ parameters (α=0.15 Gy -1 and α/β=3.1 Gy) determined in earlier studies were used to calculate the equivalent uniform dose in 2 Gy fractions (EUD 2 ) with respect to three effects: edema, RBE, and dose heterogeneity for 125 I and 103 Pd implants. The EUD 2 analysis shows a negative effect of edema and dose heterogeneity on tumor cell killing because the prostate edema degrades the dose coverage to tumor target. For the representative DVH, the V 100 (volume covered by 100% of prescription dose) decreases from 93% to 91% and 86%, and the D 90 (dose covering 90% of target volume) decrease from 107% to 102% and 94% of prescription dose for 125 I and 103 Pd implants, respectively. Conversely, the RBE effect of LDR brachytherapy [versus external-beam radiotherapy (EBRT) and high-dose-rate (HDR) brachytherapy] enhances dose effect on tumor cell kill. In order to balance the negative effects of edema and dose heterogeneity, the RBE of prostate brachytherapy was determined to be approximately 1.2-1.4 for 125 I and 1.3-1.6 for 103 Pd implants. These RBE values are consistent with the RBE data published in the literature. These results may explain why in earlier modeling studies

  7. Needle segmentation using 3D Hough transform in 3D TRUS guided prostate transperineal therapy

    Energy Technology Data Exchange (ETDEWEB)

    Qiu Wu [Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074 (China); Imaging Research Laboratories, Robarts Research Institute, Western University, London, Ontario N6A 5K8 (Canada); Yuchi Ming; Ding Mingyue [Department of Biomedical Engineering, School of Life Science and Technology, Huazhong University of Science and Technology, Wuhan, Hubei 430074 (China); Tessier, David; Fenster, Aaron [Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario N6A 5K8 (Canada)

    2013-04-15

    Purpose: Prostate adenocarcinoma is the most common noncutaneous malignancy in American men with over 200 000 new cases diagnosed each year. Prostate interventional therapy, such as cryotherapy and brachytherapy, is an effective treatment for prostate cancer. Its success relies on the correct needle implant position. This paper proposes a robust and efficient needle segmentation method, which acts as an aid to localize the needle in three-dimensional (3D) transrectal ultrasound (TRUS) guided prostate therapy. Methods: The procedure of locating the needle in a 3D TRUS image is a three-step process. First, the original 3D ultrasound image containing a needle is cropped; the cropped image is then converted to a binary format based on its histogram. Second, a 3D Hough transform based needle segmentation method is applied to the 3D binary image in order to locate the needle axis. The position of the needle endpoint is finally determined by an optimal threshold based analysis of the intensity probability distribution. The overall efficiency is improved through implementing a coarse-fine searching strategy. The proposed method was validated in tissue-mimicking agar phantoms, chicken breast phantoms, and 3D TRUS patient images from prostate brachytherapy and cryotherapy procedures by comparison to the manual segmentation. The robustness of the proposed approach was tested by means of varying parameters such as needle insertion angle, needle insertion length, binarization threshold level, and cropping size. Results: The validation results indicate that the proposed Hough transform based method is accurate and robust, with an achieved endpoint localization accuracy of 0.5 mm for agar phantom images, 0.7 mm for chicken breast phantom images, and 1 mm for in vivo patient cryotherapy and brachytherapy images. The mean execution time of needle segmentation algorithm was 2 s for a 3D TRUS image with size of 264 Multiplication-Sign 376 Multiplication-Sign 630 voxels. Conclusions

  8. Needle segmentation using 3D Hough transform in 3D TRUS guided prostate transperineal therapy

    International Nuclear Information System (INIS)

    Qiu Wu; Yuchi Ming; Ding Mingyue; Tessier, David; Fenster, Aaron

    2013-01-01

    Purpose: Prostate adenocarcinoma is the most common noncutaneous malignancy in American men with over 200 000 new cases diagnosed each year. Prostate interventional therapy, such as cryotherapy and brachytherapy, is an effective treatment for prostate cancer. Its success relies on the correct needle implant position. This paper proposes a robust and efficient needle segmentation method, which acts as an aid to localize the needle in three-dimensional (3D) transrectal ultrasound (TRUS) guided prostate therapy. Methods: The procedure of locating the needle in a 3D TRUS image is a three-step process. First, the original 3D ultrasound image containing a needle is cropped; the cropped image is then converted to a binary format based on its histogram. Second, a 3D Hough transform based needle segmentation method is applied to the 3D binary image in order to locate the needle axis. The position of the needle endpoint is finally determined by an optimal threshold based analysis of the intensity probability distribution. The overall efficiency is improved through implementing a coarse-fine searching strategy. The proposed method was validated in tissue-mimicking agar phantoms, chicken breast phantoms, and 3D TRUS patient images from prostate brachytherapy and cryotherapy procedures by comparison to the manual segmentation. The robustness of the proposed approach was tested by means of varying parameters such as needle insertion angle, needle insertion length, binarization threshold level, and cropping size. Results: The validation results indicate that the proposed Hough transform based method is accurate and robust, with an achieved endpoint localization accuracy of 0.5 mm for agar phantom images, 0.7 mm for chicken breast phantom images, and 1 mm for in vivo patient cryotherapy and brachytherapy images. The mean execution time of needle segmentation algorithm was 2 s for a 3D TRUS image with size of 264 × 376 × 630 voxels. Conclusions: The proposed needle segmentation

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

    International Nuclear Information System (INIS)

    Momma, Tetsuo; Saito, Shiro; Ohki, Takahiro; Satoh, Hiroyuki; Toya, Kazuhito; Dokiya, Takushi; Murai, Masaru

    2000-01-01

    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

  10. 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)

  11. Brachytherapy in early prostate cancer--early experience.

    Science.gov (United States)

    Jose, B O; Bailen, J L; Albrink, F H; Steinbock, G S; Cornett, M S; Benson, D C; Schmied, W K; Medley, R N; Spanos, W J; Paris, K J; Koerner, P D; Gatenby, R A; Wilson, D L; Meyer, R

    1999-01-01

    Use of brachytherapy with radioactive seeds in the management of early prostate cancer is commonly used in the United States. The early experience has been reported from the prostate treatment centers in Seattle for the last 10 years. In this manuscript we are reporting our early experience of 150 radioactive seed implantations in early stage prostate cancer using either Iodine 125 or Palladium 103 seeds. The average age of the patient is 66 years and the median Gleason score is 5.4 with a median PSA of 6. A brief description of the evolution of the treatment of prostate cancer as well as the preparation for the seed implantation using the volume study with ultrasound of the prostate, pubic arch study using CT scan of the pelvis and the complete planning using the treatment planning computers are discussed. We also have described the current technique which is used in our experience based on the Seattle guidelines. We plan a follow-up report with the results of the studies with longer follow-up.

  12. A survey of current clinical practice in permanent and temporary prostate brachytherapy: 2010 update.

    Science.gov (United States)

    Buyyounouski, Mark K; Davis, Brian J; Prestidge, Bradley R; Shanahan, Thomas G; Stock, Richard G; Grimm, Peter D; Demanes, D Jeffrey; Zaider, Marco; Horwitz, Eric M

    2012-01-01

    To help establish patterns of care and standards of care of interstitial permanent low-dose-rate (LDR) and temporary high-dose-rate brachytherapy for prostate cancer and to compare the results with a similar 1998 American Brachytherapy Society (ABS) survey. A comprehensive questionnaire intended to survey specific details of current clinical brachytherapy practice was provided to the participants of the seventh ABS Prostate Brachytherapy School. Responses were tabulated and descriptive statistics are reported. Sixty-five brachytherapy practitioners responded to the survey. Eighty-nine percent (89%) of respondents performed LDR and 49% perform high-dose-rate brachytherapy. The median number of years of experience for LDR brachytherapists increased from 5 to 10 years over the course of the 12 years since the preceding survey. Compared with the first ABS, a smaller proportion of respondents received formal brachytherapy residency training (43% vs. 56%) or formal "hands-on" brachytherapy training (15% vs. 63%). There has been a marked decline in the utilization of the Mick applicator (Mick Radio-Nuclear Instruments, Inc., Mount Vernon, NY, USA) (60% vs. 28%) and an increase in the use of stranded seeds (40% vs. 11%). Compliance with postimplant dosimetry was higher in the 2010 survey. This survey does suggest an evolution in the practice of LDR brachytherapy since 1998 and aids in identifying aspects that require further progress or investigation. ABS guidelines and other practice recommendations appear to impact the practice of brachytherapy. Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  13. Dose reduction in LDR brachytherapy by implanted prostate gold fiducial markers.

    Science.gov (United States)

    Landry, Guillaume; Reniers, Brigitte; Lutgens, Ludy; Murrer, Lars; Afsharpour, Hossein; de Haas-Kock, Danielle; Visser, Peter; van Gils, Francis; Verhaegen, Frank

    2012-03-01

    The dosimetric impact of gold fiducial markers (FM) implanted prior to external beam radiotherapy of prostate cancer on low dose rate (LDR) brachytherapy seed implants performed in the context of combined therapy was investigated. A virtual water phantom was designed containing a single FM. Single and multi source scenarios were investigated by performing Monte Carlo dose calculations, along with the influence of varying orientation and distance of the FM with respect to the sources. Three prostate cancer patients treated with LDR brachytherapy for a recurrence following external beam radiotherapy with implanted FM were studied as surrogate cases to combined therapy. FM and brachytherapy seeds were identified on post implant CT scans and Monte Carlo dose calculations were performed with and without FM. The dosimetric impact of the FM was evaluated by quantifying the amplitude of dose shadows and the volume of cold spots. D(90) was reported based on the post implant CT prostate contour. Large shadows are observed in the single source-FM scenarios. As expected from geometric considerations, the shadows are dependent on source-FM distance and orientation. Large dose reductions are observed at the distal side of FM, while at the proximal side a dose enhancement is observed. In multisource scenarios, the importance of shadows appears mitigated, although FM at the periphery of the seed distribution caused underdosage (LDR brachytherapy seed implant dose distributions. Therefore, reduced tumor control could be expected from FM implanted in tumors, although our results are too limited to draw conclusions regarding clinical significance.

  14. Prostate brachytherapy seed migration to the heart seen on cardiovascular computed tomographic angiography

    Directory of Open Access Journals (Sweden)

    Shilpa Sachdeva, MD

    2017-03-01

    Full Text Available Brachytherapy consists of placing radioactive sources into or adjacent to tumors, to deliver conformal radiation treatment. The technique is used for treatment of primary malignancies and for salvage in recurrent disease. Permanent prostate brachytherapy seeds are small metal implants containing radioactive sources of I-125, Pd-103, or Cs-131 encased in a titanium shell. They can embolize through the venous system to the lungs or heart and subsequently be detected by cardiovascular computed tomography. Cardiovascular imagers should be aware of the appearance of migrated seeds, as their presence in the chest is generally benign, so that unnecessary worry and testing are avoided. We report a case of a patient who underwent brachytherapy for prostate cancer and developed a therapeutic seeds embolus to the right ventricle.

  15. Manual on brachytherapy. Incorporating: Applications guide, procedures guide, basics guide

    International Nuclear Information System (INIS)

    1992-01-01

    In addition to a basic guide to the principles of the production of ionizing radiation and to methods of radiation protection and dosimetry, this booklet includes information about radiation protection procedures for brachytherapy

  16. Outcomes following iodine-125 prostate brachytherapy with or without neoadjuvant androgen deprivation

    International Nuclear Information System (INIS)

    Ohashi, Toshio; Yorozu, Atsunori; Saito, Shiro; Momma, Tetsuo; Toya, Kazuhito; Nishiyama, Toru; Yamashita, Shoji; Shiraishi, Yutaka; Shigematsu, Naoyuki

    2013-01-01

    Purpose: To report the biochemical failure-free survival (BFFS), cause-specific survival (CSS), and overall survival (OS) outcomes of patients treated with iodine-125 (I-125) brachytherapy for clinically localized prostate cancer. Methods and materials: Between 2003 and 2009, I-125 permanent prostate brachytherapy without supplemental external-beam radiotherapy was performed for 663 patients with low-risk and low-tier intermediate-risk (defined as organ-confined disease, PSA <10 ng/mL, and Gleason score 3 + 4 with biopsy positive core rate <33%) prostate cancer. Early in the study period, the preplanning method was used in the first 104 patients, and later the real-time planning method was used. Biochemical failure was determined using the American Society for Therapeutic Radiology Oncology (ASTRO) and Phoenix definitions. Results: The 7-year BFFS rates for the ASTRO and Phoenix definitions were 96.1% and 95.9%, respectively. The corresponding BFFS rates by risk group were 97.6% and 96.7% for low-risk, and 91.8% and 93.6% for low-tier intermediate-risk disease (p = 0.007 and 0.08, respectively). The median times to biochemical failure in those who failed were 29.5 and 43.9 months according to the ASTRO and Phoenix definitions, respectively. The 7-year CSS and OS were 99.1% and 96.4%. There was no significant difference in CSS or OS between the low-risk and low-tier intermediate-risk groups. In multivariate Cox regression analysis, risk group and prostate D90 were independent predictors of BFFS for the ASTRO definition, while only the prostate D90 was significant for the Phoenix definition. Conclusion: I-125 prostate brachytherapy results in excellent 7-year BFFS, CSS, and OS for low-risk and low-tier intermediate-risk prostate cancer

  17. 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

  18. 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

  19. 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)

  20. Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Beyer, David C.; McKeough, Timothy; Thomas, Theresa

    2005-01-01

    Purpose: To review the impact of prior hormonal therapy on 10-year overall and prostate cancer specific survival after primary brachytherapy. Methods and Materials: A retrospective review was performed on the Arizona Oncology Services tumor registry for 2,378 consecutive permanent prostate brachytherapy cases from 1988 through 2001. Hormonal therapy was administered before the implant in 464 patients for downsizing of the prostate or at the discretion of the referring physician. All deceased patients with known clinical recurrence were considered to have died of prostate cancer, irrespective of the immediate cause of death. Risk groups were defined, with 1,135 favorable (prostate-specific antigen [PSA] 70 years (p = 0.0013), Gleason score ≥ 7 (p = 0.0005), and prior hormone use (p = 0.0065) on overall survival. Conclusions: At 10 years, in prostate cancer patients receiving brachytherapy, overall survival is worse in men receiving neoadjuvant hormonal therapy, compared with hormone naive patients. This does not appear to be due to other known risk factors for survival (i.e., stage, grade, PSA, age) on multivariate analysis. The leading causes of death were cardiovascular, prostate cancer, and other cancers with no obvious discrepancy between the two groups. This finding is unexpected and requires confirmation from other centers

  1. 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

  2. Standards, options and recommendations for brachytherapy of prostate cancer: efficacy and toxicity

    International Nuclear Information System (INIS)

    Pommier, P.; Villers, A.; Bataillard, A.

    2001-01-01

    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 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/The height of the urethra receiving more than 200 of the prescribed dose must be reported. The portion of the rectum receiving 100 and 120 % of the prescribed dose must be limited to 10

  3. 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

  4. Timing of computed tomography-based postimplant assessment following permanent transperineal prostate brachytherapy

    International Nuclear Information System (INIS)

    Prestidge, Bradley R.; Bice, William S.; Kiefer, Eric J.; Prete, James J.

    1998-01-01

    Purpose: To establish the rate of resolution of prostatic edema following transperineal interstitial permanent prostate brachytherapy, and to determine the results and impact of timing of the postimplant assessment on the dose-volume relationship. Methods and Materials: A series of 19 consecutive patients with early-stage adenocarcinoma of the prostate receiving transperineal interstitial permanent prostate brachytherapy, were enrolled in this study. Twelve received 125 I and seven received 103 Pd. Postoperative assessment included a computed tomographic (CT) scan on postoperative days 1, 8, 30, 90, and 180. On each occasion, CT scans were performed on a GE helical unit at 3-mm abutting slices, 15-cm field of view. Prostate volumes were outlined on CT scans by a single clinician. Following digitization of the volumes and radioactive sources, volumes and dose-volume histograms were calculated. The prostate volume encompassed by the 80% and 100% reference isodose volumes was calculated. Results: Preimplant transrectal ultrasound determined volumes varied from 17.5 to 38.6 cc (median 27.9 cc). Prostate volumes previously defined on 40 randomly selected postimplant CT scans were compared in a blinded fashion to a second CT-derived volume and ranged from -32% to +24%. The Pearson correlation coefficient for prostate CT volume reproducibility was 0.77 (p < 0.03). CT scan-determined volume performed on postoperative day 1 was an average of 41.4% greater than the volume determined by preimplant ultrasound. Significant decreases in average volume were seen during the first month postoperatively. Average volume decreased 14% from day 1 to day 8, 10% from day 8 to day 30, 3% from day 30 to day 90, and 2% thereafter. Coverage of the prostate volume by the 80% isodose volume increased from 85.6% on postoperative day 1 to 92.2% on postoperative day 180. The corresponding increase in the 100% reference dose coverage of the prostate volume ranged from 73.1% to 83.3% between

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

    International Nuclear Information System (INIS)

    Prada, Pedro J.; Anchuelo, Javier; Blanco, Ana Garcia; Paya, Gema; Cardenal, Juan; Acuña, Enrique; Ferri, Maria; Vazquez, Andres; Pacheco, Maite; Sanchez, Jesica

    2016-01-01

    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)

  6. 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)

  7. Early quality of life outcomes in patients with prostate cancer managed by high-dose-rate brachytherapy as monotherapy

    International Nuclear Information System (INIS)

    Komiya, Akira; Fujiuchi, Yasuyoshi; Ito, Takatoshi

    2013-01-01

    The purpose of this study was to evaluate the early quality of life outcomes in prostate cancer patients managed by high-dose-rate brachytherapy as monotherapy. A total of 51 patients with cT1c-T3aN0M0 prostate cancer treated between July 2007 and January 2010 were included in this study. The average age was 69?years, and the average initial serum prostate-specific antigen was 10.98?ng/mL. A total of 25, 18 and eight patients were considered to be low, intermediate and high risk, respectively. All patients received one implant of Ir-192 and seven fractions of 6.5?Gy within 3.5?days for a total prescribed dose of 45.5?Gy. For high-risk prostate cancer, neoadjuvant androgen deprivation therapy was carried out for at least 6?months, and continued after high-dose-rate brachytherapy. Quality of life outcomes were measured by using the International Prostate Symptom Score, the Functional Assessment of Cancer Therapy-Prostate and the International Index of Erectile Function Questionnaire. The oncological outcome was assessed by serum prostate-specific antigen and diagnostic imaging. Adverse events were also recorded. The Functional Assessment of Cancer Therapy-Prostate scores decreased for a few months after high-dose-rate brachytherapy, and recovered to pretreatment condition thereafter. The International Prostate Symptom Score significantly increased 2?weeks after treatment for each of its items and their sum, and it returned to baseline after 12?weeks. Sexual function decreased at 2 and 4?weeks, and recovered after 12?weeks. Severe complications were rare. Within a median follow up of 17.2?months, two patients showed a prostate-specific antigen recurrence. High-dose-rate brachytherapy for prostate cancer is a feasible treatment modality with acceptable toxicity and only a limited impact on the quality of life. (author)

  8. 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.

  9. Shifting brachytherapy monotherapy case mix toward intermediate-risk prostate cancer.

    Science.gov (United States)

    Muralidhar, Vinayak; Mahal, Brandon A; Ziehr, David R; Chen, Yu-Wei; Nezolosky, Michelle D; Viswanathan, Vidya B; Beard, Clair J; Devlin, Phillip M; Martin, Neil E; Orio, Peter F; Nguyen, Paul L

    2015-01-01

    The relative use of brachytherapy (BT) for prostate cancer has declined in recent years. In this setting, we sought to determine whether the case mix of BT monotherapy-treated men has changed over time in terms of risk group composition. The Surveillance, Epidemiology, and End Results database was used to identify 30,939 patients diagnosed with prostate adenocarcinoma between 2004 and 2011 who received BT monotherapy. The case mix of BT monotherapy patients was calculated by patient risk group and year of diagnosis. Between 2004 and 2011, the use of BT monotherapy declined overall. The relative percentage of men undergoing BT with low-risk disease declined by 4.5%, whereas the relative percentage of patients with intermediate-risk disease increased by 4.7%. Non-white patients and those from poorer counties did not show shifts in the risk group makeup of BT monotherapy patients, whereas white patients and those from wealthier counties did. Although fewer patients with prostate cancer are undergoing BT monotherapy, men with intermediate-risk disease comprised a significantly larger portion of the BT case mix in 2011 compared with 2004. Future research efforts by brachytherapists should be directed toward improving BT technique, optimizing radiation doses, and obtaining long-term followup data for patients with intermediate-risk prostate cancer. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  10. 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

  11. 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

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

    Science.gov (United States)

    Pujades, Ma Carmen; Camacho, Cristina; Perez-Calatayud, Jose; Richart, José; Gimeno, Jose; Lliso, Françoise; Carmona, Vicente; Ballester, Facundo; Crispín, Vicente; Rodríguez, Silvia; Tormo, Alejandro

    2011-09-01

    The common use of nomograms in Low Dose Rate (LDR) permanent prostate brachytherapy (BT) allows to estimate the number of seeds required for an implant. Independent dosimetry verification is recommended for each clinical dosimetry in BT. Also, nomograms can be useful for dose calculation quality assurance and they could be adapted to High Dose Rate (HDR). This work sets nomograms for LDR and HDR prostate-BT implants, which are applied to three different institutions that use different implant techniques. Patients treated throughout 2010 till April 2011 were considered for this study. This example was chosen to be the representative of the latest implant techniques and to ensure consistency in the planning. A sufficient number of cases for both BT modalities, prescription dose and different work methodology (depending on the institution) were taken into account. The specific nomograms were built using the correlation between the prostate volume and some characteristic parameters of each BT modality, such as the source Air Kerma Strength, number of implanted seeds in LDR or total radiation time in HDR. For each institution and BT modality, nomograms normalized to the prescribed dose were obtained and fitted 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 centre should construct its own nomograms. Nomograms for LDR and HDR prostate brachytherapy are simple quality assurance tools, specific for each institution. Nevertheless, their use should be complementary to the necessary independent verification.

  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. Posttreatment biopsy results following interstitial brachytherapy in early-stage prostate cancer

    International Nuclear Information System (INIS)

    Prestidge, Bradley R.; Hoak, David C.; Grimm, Peter D.; Ragde, Haakon; Cavanagh, William; Blasko, John C.

    1997-01-01

    Purpose: To assess pathologic control rates for prostatic carcinoma as determined by postimplant prostate biopsy in a large series of consecutive patients who have received permanent interstitial brachytherapy using a contemporary transrectal ultrasound-directed, transperineal, computer generated, volume technique. Methods and Materials: Four hundred and two patients received permanent 125 I or 103 Pd interstitial brachytherapy as primary treatment for early stage prostatic carcinoma at the Northwest Tumor Institute between January 1988 and January 1994. Of these, 201 have consented to biopsy 12 or more months postimplant with a median follow-up of 40 months (range: 12-83 months). None had received homonal manipulation. A total of 361 biopsies was performed on 201 patients with a range of one to six annual biopsies per patient (91 received multiple, serial biopsies). Of the 161 patients more than 12 months postimplant who have not been biopsied, most have been unwilling or unable to submit to biopsy. Only six patients with biochemical progression have not been biopsied. There was no difference in the presenting characteristics or implant parameters between those patients biopsied and those that were not. One hundred and forty-three received 125 I (71%) prescribed to a MPD of 160 Gy with a median activity of 35.5 mCi, and 58 (29%) received 103 Pd prescribed to a MPD of 115 Gy with a median activity of 123 mCi. Multiple biopsies were performed under transrectal ultrasound guidance, and all specimens were classified as either negative, indeterminate, or positive. Results: At the time of last biopsy, 161 (80%) have achieved negative pathology, 34 (17%) remain indeterminate, and 6 (3%) have been positive. Only 2 of the 186 patients with a PSA < 4.0 ng/ml at the time of biopsy were positive. Among those 33 indeterminate patients with a subsequent biopsy, 28 have converted to negative, 2 to positive, and 3 remain unchanged to date. Conclusions: These data demonstrate at

  15. 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

  16. 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

  17. Seed Implant Retention Score Predicts the Risk of Prolonged Urinary Retention After Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Lee, Hoon K.; Adams, Marc T.; Shi, Qiuhu; Basillote, Jay; LaMonica, Joanne; Miranda, Luis; Motta, Joseph

    2010-01-01

    Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS). Patients and Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had 125 I and 638 patients had 103 Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation. The final downsized prostate volume was used for the 424 patients who had neoadjuvant hormone therapy. Retention was defined as reinsertion of a Foley catheter after the implant. Results: Retention developed in 7.4% of patients, with an average duration of 6.7 weeks. On univariate analysis, implant without supplemental external-beam radiation (10% vs. 5.6%; p = 0.02), neoadjuvant hormone therapy (9.4% vs. 5.4%; p = 0.02), baseline α-blocker use (12.5% vs. 6.3%; p = 0.008), and increased prostate volume (13.4% vs. 6.9% vs. 2.9%, >45 cm 3 , 25-45 cm 3 , 3 ; p = 0.0008) were significantly correlated with increased rates of retention. On multivariate analysis, implant without supplemental external-beam radiation, neoadjuvant hormone therapy, baseline α-blocker use, and increased prostate volume were correlated with retention. A novel SIRS was modeled as the combined score of these factors, ranging from 0 to 5. There was a significant correlation between the SIRS and retention (p < 0.0001). The rates of retention were 0, 4%, 5.6%, 9%, 20.9%, and 36.4% for SIRS of 0 to 5, respectively. Conclusions: The SIRS may identify patients who are at high risk for prolonged retention after prostate brachytherapy. A prospective validation study of the SIRS is planned.

  18. 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

  19. Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Galbreath, Robert W.; Allen, Zachariah A. M.S.; Adamovich, Edward

    2006-01-01

    Purpose: To determine if androgen-deprivation therapy (ADT) has an impact on cause-specific, biochemical progression-free, or overall survival after prostate brachytherapy. Methods and Materials: From April 1995 through June 2002, 938 consecutive patients underwent brachytherapy for clinical Stage T1b to T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. A total of 382 patients (40.7%) received ADT with a duration of 6 months or less in 277 and more than 6 months in 105. The median follow-up was 5.4 years. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific, biochemical progression-free, and overall survival rates for the entire cohort were 96.4%, 95.9%, and 78.1%, respectively. Except for biochemical progression-free survival in high-risk patients, ADT did not statistically impact any of the three survival categories. A Cox linear-regression analysis demonstrated that Gleason score was the best predictor of cause-specific survival, whereas percent-positive biopsies, prostate volume, and risk group predicted for biochemical progression-free survival. Patient age and tobacco use were the strongest predictors of overall survival. One hundred two patients have died, with 80 of the deaths a result of cardiovascular disease (54) and second malignancies (26). To date, only 12 patients have died of metastatic prostate cancer. Conclusions: After brachytherapy, androgen-deprivation therapy did not have an impact on cause-specific or overall survival for any risk group; however, ADT had a beneficial effect on biochemical progression-free survival in high-risk patients. Cardiovascular disease and second malignancies far outweighed prostate cancer as competing causes of death

  20. 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.

  1. 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.

  2. A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Crook, Juanita; Patil, Nikhilesh; Wallace, Kris; Borg, Jette; Zhou, David; Ma, Clement; Pond, Greg

    2010-01-01

    Purpose: Nonsteroidal anti-inflammatory medication is used to reduce prostate edema and urinary symptoms following prostate brachytherapy. We hypothesized that a cyclooxygenase-2 (COX-2) inhibitor regimen started 1 week prior to seed implant might diminish the inflammatory response, thus reducing edema, retention rates, and symptom severity. Methods and Materials: From March 2004 to February 2008, 316 men consented to an institutional review board-approved randomized study of a 4-week course of meloxicam, 7.5 mg orally twice per day, starting either on the day of implant or 1 week prior to implant. Brachytherapy was performed using iodine-125 seeds and was preplanned and performed under transrectal ultrasound (TRUS) and fluoroscopic guidance. Prostate volume obtained by MR imaging at 1 month was compared to baseline prostate volume obtained by TRUS planimetry and expressed as an edema factor. The trial endpoints were prostate edema at 1 month, International Prostate Symptom Score (IPSS) questionnaire results at 1 and 3 months, and any need for catheterization. Results: Results for 300 men were analyzed. Median age was 61 (range, 45-79 years), and median TRUS prostate volume was 35.7 cc (range, 18.1-69.5 cc). Median IPSS at baseline was 5 (range, 0-24) and was 15 at 1 month, 16 at 3 months, and 10 at 6 months. Catheterization was required for 7% of patients (6.2% day 0 arm vs. 7.9% day -7 arm; p = 0.65). The median edema factor at 1 month was 1.02 (range, 0.73-1.7). 1.01 day 0 arm vs. 1.05 day -7 arm. Baseline prostate volume remained the primary predictor of postimplant urinary retention. Conclusions: Starting meloxicam 1 week prior to brachytherapy compared to starting immediately after the procedure did not reduce 1-month edema, improve IPSSs at 1 or 3 months, or reduce the need for catheterization.

  3. Effect of post-implant edema on prostate brachytherapy treatment margins

    International Nuclear Information System (INIS)

    Reed, Daniel R.; Wallner, Kent; Ford, Eric; Mueller, Amy; Merrick, Gregory; Maki, Jeffrey; Sutlief, Steven; Butler, Wayne

    2005-01-01

    Purpose: To determine if postimplant prostate brachytherapy treatment margins calculated on Day 0 differ substantially from those calculated on Day 30. Methods: Thirty patients with 1997 American Joint Commission on Cancer clinical stage T1-T2 prostatic carcinoma underwent prostate brachytherapy with I-125 prescribed to 144 Gy. Treatment planning methods included using loose seeds in a modified peripheral loading pattern and treatment margins (TMs) of 5-8 mm. Postimplant plain radiographs, computed tomography scans, and magnetic resonance scans were obtained 1-4 hours after implantation (Day 0). A second set of imaging studies was obtained at 30 days after implantation (Day 30) and similarly analyzed. Treatment margins were measured as the radial distance in millimeters from the prostate edge to the 100% isodose line. The TMs were measured and tabulated at 90 o intervals around the prostate periphery at 0.6-cm intervals. Each direction was averaged to obtain the mean anterior, posterior, left, and right margins. Results: The mean overall TM increased from 2.6 mm (±2.3) on Day 0 to 3.5 mm (±2.4) on Day 30. The mean anterior margin increased from 1.2 mm on Day 0 to 1.8 mm on Day 30. The posterior margin increased from 1.2 mm on Day 0 to 2.8 mm on Day 30. The lateral treatment margins increased most over time, with mean right treatment margin increasing from 3.9 mm on Day 0 to 4.7 mm on Day 30. Conclusion: Treatment margins appear to be durable in the postimplant period, with a clinically insignificant increase from Day 0 to Day 30

  4. 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.

  5. Post-treatment biopsy results following permanent transrectal ultrasound-guided interstitial brachytherapy in early stage prostate cancer

    International Nuclear Information System (INIS)

    Prestidge, Bradley R.; Blasko, John C.; Grimm, Peter D.; Hoak, David C.; Cavanagh, Bill; Ragde, Haakon

    1995-01-01

    PURPOSE/OBJECTIVE: Although some controversy remains, most authors agree that post-treatment prostatic biopsy is the best measure of local control in prostate cancer. Brachytherapy series reporting post-implant biopsy results have been few in number, limited in size, and involving older open or combined external beam techniques. The present study was undertaken to assess local control rates as determined by post-implant prostate biopsy in a large series of consecutive patients who have received permanent interstitial brachytherapy using a contemporary transrectal ultrasound directed, transperineal, computer generated, volume technique. METHOD/MATERIALS: From January 1988 to January 1994, 402 patients received permanent I-125 (285, 71%) or Pd-103 (117, 29%) interstitial brachytherapy as primary treatment for prostatic carcinoma at the Northwest Tumor Institute. Of these, 201 have consented to prostatic biopsy at least 12 months post-implant with a median follow-up of 40 months (range of 12 to 83 months). None had received hormone manipulation. A total of 361 biopsies were performed on 201 patients with a range of 1 to 6 yearly biopsies per patient; 91 receiving multiple biopsies. The other 201 patients were either unable (for geographic reasons) or unwilling to submit for biopsy. However, all patients with a rising PSA or clinical suspicion of recurrence underwent biopsy when possible. The 201 biopsy patients presented with a median age of 69 (range 47 to 89). Stages included 51 T1 (25%), 125 T2a (62%), 22 T2b (11%), and 3 T2c (1%). Gleason sums included 69 2-4 (34%), 117 5-6 (58%), 15 7-10 (7%), and 2 ungraded (1%). The initial PSA was 6.6 (range 0.7 to 74.6). There was no significant difference in the presenting characteristics or implant parameters between those patients biopsied and those that were not. 143 received I-125 (71%) prescribed to a minimum peripheral dose of 160 Gy with a median activity of 35.5 mCi, and 58 (29%) received Pd-103 prescribed to a

  6. 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.

  7. Isotope selection for patients undergoing prostate brachytherapy

    International Nuclear Information System (INIS)

    Cha, Christine M.; Potters, Louis; Ashley, Richard; Freeman, Katherine; Wang Xiaohong; Waldbaum, Robert; Leibel, Steven

    1999-01-01

    Purpose: Ultrasound-guided trans perineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103 Pd or 125 I. The use of 125 I for low Gleason score tumors and 103 Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected to use only a single isotope, regardless of Gleason score. No clinical data have been published comparing these isotopes. This study was undertaken to compare outcomes between 125 I and 103 Pd in a matched pair analysis for patients undergoing prostate brachytherapy. Methods and Materials: Six hundred forty-eight consecutively treated patients with clinically confined prostate cancer underwent TIPPB between June 1992 and February 1997. Five hundred thirty-two patients underwent TIPPB alone, whereas 116 received pelvic external beam irradiation and TIPPB. Ninety-three patients received androgen deprivation therapy prior to TIPPB. The prescribed doses for TIPPB were 160 Gy for 125 I (pre-TG43) and 120 Gy for 103 Pd. Patients treated with combination therapy received 41.4 or 45 Gy (1.8 Gy/fraction) external beam irradiation followed by a 3- to 5-week break and then received either a 120-Gy 125 I or a 90-Gy 103 Pd implant. Until November 1994, all patients underwent an 125 I implant after which the isotope selection was based on either Gleason score (Gleason score 2-5: 125 I; Gleason 5-8: 103 Pd) or isotope availability. A matched pair analysis was performed to assess any difference between isotopes. Two hundred twenty-two patients were matched according to Gleason score, prostate-specific antigen (PSA), and stage. PSA relapse-free survival (PSA-RFS) was calculated based on the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus Group definition of failure. Kaplan-Meier actuarial survival curves were compared to assess differences in

  8. WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR

    International Nuclear Information System (INIS)

    Craciunescu, O; Todor, D; Leeuw, A de

    2014-01-01

    In recent years, with the advent of high/pulsed dose rate afterloading technology, advanced treatment planning systems, CT/MRI compatible applicators, and advanced imaging platforms, image-guided adaptive brachytherapy treatments (IGABT) have started to play an ever increasing role in modern radiation therapy. The most accurate way to approach IGABT treatment is to provide the infrastructure that combines in a single setting an appropriate imaging device, a treatment planning system, and a treatment unit. The Brachytherapy Suite is not a new concept, yet the modern suites are incorporating state-of-the-art imaging (MRI, CBCT equipped simulators, CT, and /or US) that require correct integration with each other and with the treatment planning and delivery systems. Arguably, an MRI-equipped Brachytherapy Suite is the ideal setup for real-time adaptive brachytherapy treatments. The main impediment to MRI-IGABT adoption is access to MRI scanners. Very few radiation oncology departments currently house MRI scanners, and even fewer in a dedicated Brachytherapy Suite. CBCT equipped simulators are increasingly offered by manufacturers as part of a Brachytherapy Suite installation. If optimized, images acquired can be used for treatment planning, or can be registered with other imaging modalities. This infrastructure is relevant for all forms of brachytherapy, especially those utilizing multi-fractionated courses of treatment such as prostate and cervix. Moreover, for prostate brachytherapy, US imaging systems can be part of the suite to allow for real-time HDR/LDR treatments. Learning Objectives: Understand the adaptive workflow of MR-based IGBT for cervical cancer. Familiarize with commissioning aspects of a CBCT equipped simulator with emphasis on brachytherapy applications Learn about the current status and future developments in US-based prostate brachytherapy

  9. WE-F-BRD-01: HDR Brachytherapy II: Integrating Imaging with HDR

    Energy Technology Data Exchange (ETDEWEB)

    Craciunescu, O [Duke University Medical Center, Durham, NC (United States); Todor, D [Virginia Commonwealth University, Richmond, VA (United States); Leeuw, A de

    2014-06-15

    In recent years, with the advent of high/pulsed dose rate afterloading technology, advanced treatment planning systems, CT/MRI compatible applicators, and advanced imaging platforms, image-guided adaptive brachytherapy treatments (IGABT) have started to play an ever increasing role in modern radiation therapy. The most accurate way to approach IGABT treatment is to provide the infrastructure that combines in a single setting an appropriate imaging device, a treatment planning system, and a treatment unit. The Brachytherapy Suite is not a new concept, yet the modern suites are incorporating state-of-the-art imaging (MRI, CBCT equipped simulators, CT, and /or US) that require correct integration with each other and with the treatment planning and delivery systems. Arguably, an MRI-equipped Brachytherapy Suite is the ideal setup for real-time adaptive brachytherapy treatments. The main impediment to MRI-IGABT adoption is access to MRI scanners. Very few radiation oncology departments currently house MRI scanners, and even fewer in a dedicated Brachytherapy Suite. CBCT equipped simulators are increasingly offered by manufacturers as part of a Brachytherapy Suite installation. If optimized, images acquired can be used for treatment planning, or can be registered with other imaging modalities. This infrastructure is relevant for all forms of brachytherapy, especially those utilizing multi-fractionated courses of treatment such as prostate and cervix. Moreover, for prostate brachytherapy, US imaging systems can be part of the suite to allow for real-time HDR/LDR treatments. Learning Objectives: Understand the adaptive workflow of MR-based IGBT for cervical cancer. Familiarize with commissioning aspects of a CBCT equipped simulator with emphasis on brachytherapy applications Learn about the current status and future developments in US-based prostate brachytherapy.

  10. American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer

    International Nuclear Information System (INIS)

    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

    2011-01-01

    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 brachtherapy 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.

  11. Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: treatment description and preliminary results of a phase I/II clinical trial

    Energy Technology Data Exchange (ETDEWEB)

    Stromberg, Jannifer; Martinez, Alvaro; Gonzalez, Jose; Edmundson, Gregory; Ohanian, Neshan; Vicini, Frank; Hollander, Jay; Gustafson, Gary; Spencer, William; Di, Yan; Brabbins, Donald

    1995-08-30

    Purpose: To improve results for locally advanced prostate cancer, a prospective clinical trial of concurrent external beam irradiation and fractionated iridium-192 (Ir-192) high dose rate (HDR) conformal boost brachytherapy was initiated. Methods and Materials: Between November 1991 and February 1994, 99 implants were performed on 33 patients with prostatic adenocarcinoma at William Beaumont Hospital. Using AJCC staging criteria, 9 patients had T2b tumors, 17 patients had T2c tumors, and 7 patients had T3 disease. Patients were treated with (a) 45.6 Gy whole pelvis external irradiation and (b) three HDR fractions of 5.5 Gy each (18 patients) or 6 Gy each (15 patients) to the prostate. Transperineal needle implants using real-time ultrasound guidance with interactive on-line isodose distributions were performed on an outpatient basis during weeks 1, 2, and 3 of external irradiation. Acute toxicity was scored using the Radiation Therapy Oncology Group (RTOG) morbidity grading system. Results: This technique of concurrent external pelvic irradiation and conformal HDR brachytherapy was well tolerated. No significant intraoperative or perioperative complications occurred. Three patients (9%) experienced Grade 3 acute toxicity (two dysuria and one diarrhea). All toxicities were otherwise Grades 1 or 2 and were primarily as expected from pelvic external irradiation. Persistent implant-related toxicities included Grades 1-2 perineal pain (12%) and hematospermia (15%). Median follow-up time was 13 months. Serum prostatic-specific antigen (PSA) levels normalized in 91% of patients (29 out of 32) within 1-14 months (median 2.8 months) after irradiation. PSA levels were progressively decreasing in the other three patients at last measurement. Prospectively planned prostatic rebiopsies done at 18 months in the first 10 patients were negative in 9 out of 10 (90%). Conclusions: Acute toxicity has been acceptable with this unique approach using conformal high dose rate Ir-192

  12. Needle displacement during HDR brachytherapy in the treatment of prostate cancer

    International Nuclear Information System (INIS)

    Damore, Steven J.; Syed, A.M. Nisar; Puthawala, Ajmel A.; Sharma, Anil

    2000-01-01

    Purpose: We used clinical patient data to examine implant displacement between high dose rate (HDR) brachytherapy fractions for prostate cancer to determine its impact on treatment delivery. Materials and Methods: We analyzed the verification films taken prior to each fraction for 96 consecutive patients treated with HDR brachytherapy boosts as part of their radiation therapy for definitive treatment of organ-confined prostate cancer at our institution. Patients were treated with 18-24 Gy in 4 fractions of HDR delivered in 40 hours followed by 36-39.6 Gy external beam radiation to the prostate. We determined the mean and maximum displacement distances of marker seeds placed in the prostate and of the implanted needles between HDR fractions. Results: Mean and maximum displacement distances between fractions were documented up to 7.6 mm and 28.5 mm, respectively, for the implant needles and 3.6 mm and 11.4 mm, respectively, for the gold marker seeds. All displacement of implant needles occurred in the caudal direction. At least 1 cm caudal displacement of needles occurred prior to 15.5% all fractions. Manual adjustment of needles was required prior to 15% of fractions, and adjustment of the CLP only was required in 24%. Most of the displacement for both the marker seeds and needles occurred between the first and second fractions. Conclusions: There is significant caudal displacement of interstitial implant needles between HDR fractions in our prostate cancer patients. Obtaining verification films and making adjustments in the treatment volume prior to each fraction is necessary to avoid significant inaccuracies in treatment delivery

  13. Definition of medical event is to be based on the total source strength for evaluation of permanent prostate brachytherapy: A report from the American Society for Radiation Oncology.

    Science.gov (United States)

    Nag, Subir; Demanes, D Jeffrey; Hagan, Michael; Rivard, Mark J; Thomadsen, Bruce R; Welsh, James S; Williamson, Jeffrey F

    2011-10-01

    The Nuclear Regulatory Commission deems it to be a medical event (ME) if the total dose delivered differs from the prescribed dose by 20% or more. A dose-based definition of ME is not appropriate for permanent prostate brachytherapy as it generates too many spurious MEs and thereby creates unnecessary apprehension in patients, and ties up regulatory bodies and the licensees in unnecessary and burdensome investigations. A more suitable definition of ME is required for permanent prostate brachytherapy. The American Society for Radiation Oncology (ASTRO) formed a working group of experienced clinicians to review the literature, assess the validity of current regulations, and make specific recommendations about the definition of an ME in permanent prostate brachytherapy. The working group found that the current definition of ME in §35.3045 as "the total dose delivered differs from the prescribed dose by 20 percent or more" was not suitable for permanent prostate brachytherapy since the prostate volume (and hence the resultant calculated prostate dose) is dependent on the timing of the imaging, the imaging modality used, the observer variability in prostate contouring, the planning margins used, inadequacies of brachytherapy treatment planning systems to calculate tissue doses, and seed migration within and outside the prostate. If a dose-based definition for permanent implants is applied strictly, many properly executed implants would be improperly classified as an ME leading to a detrimental effect on brachytherapy. The working group found that a source strength-based criterion, of >20% of source strength prescribed in the post-procedure written directive being implanted outside the planning target volume is more appropriate for defining ME in permanent prostate brachytherapy. ASTRO recommends that the definition of ME for permanent prostate brachytherapy should not be dose based but should be based upon the source strength (air-kerma strength) administered.

  14. Salvage brachytherapy for local recurrences of prostate cancer treated previously with radiotherapy.

    Science.gov (United States)

    Gawkowska-Suwinska, Marzena; Fijałkowski, Marek; Białas, Brygida; Szlag, Marta; Kellas-Ślęczka, Sylwia; Nowicka, Elżbieta; Behrendt, Katarzyna; Plewicki, Grzegorz; Smolska-Ciszewska, Beata; Giglok, Monika; Zajusz, Aleksander; Owczarek, Grzegorz

    2009-12-01

    The aim of the study was to analyze early effects and toxicity of salvage high dose rate brachytherapy for local recurrences of adenocarcinoma of the prostate after external beam radiotherapy (EBRT). In MCS Memorial Institute of Oncology in Gliwice a research programme on salvage HDR brachytherapy for local recurrences of prostate cancer treated previously with EBRT has been ongoing since February 2008. The treatment consisted of 3 fractions of 10 Gy each given every 14 days. Maximal urethral doses were constrained to be ≤ 120% of the prescribed dose. Maximal bladder and rectum doses were constrained to be ≤ 70% of the prescribed dose. Fifteen eligible patients were treated and analyzed from February 2008. All patients completed the treatment without major complications. The most common early complications were: macroscopic haematuria, pain in lower part of the abdomen, and transient dysuria. During the first week after the procedure a transient increase in IPSS score was noticed. The Foley catheter was removed on day 2 to 5. No complications after spinal anaesthesia were observed. Acute toxicity according to EORTC/RTOG was low. For bladder EORTC/RTOG score ranged from 0 to 2. Only in two patients grade 1 toxicity for rectum was observed. The follow-up ranged from 3 to 9 months. In one patient grade 2 rectal toxicity was observed, and one had urethral stricture. Other patients did not have any other significant late toxicity of the treatment. Two patients developed bone metastases. Salvage brachytherapy for localized prostate cancer (3 × 10 Gy every 14 days) seems to be a safe and well tolerated procedure. A significant decline in prostate-specific antigen (PSA) level is seen in patients with hormone-responsive cancer. Long-term efficiency and toxicity of the procedure are yet to be established.

  15. MO-B-BRC-01: Introduction [Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Prisciandaro, J. [University of Michigan (United States)

    2016-06-15

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.

  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. 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. Meta-analysis of comparison between brachytherapy and radical prostatectomy for the treatment of localized prostate cancer

    International Nuclear Information System (INIS)

    Fan Xiaodong; Jiang Qing; Yuan Gengbiao; Wang Jiawu

    2012-01-01

    Objective: To compare the therapeutic effect of brachytherapy and radical prostatectomy for localized prostate cancer using a Meta-analysis. Methods: The published data with randomized control trials (RCT) on comparison of brachytherapy and radical prostatectomy for the treatment of localized prostate cancer in PubMed, Wanfang database, Chinese Biomedical Literature Database (CBMdisc), the Excerpta Medica Database (EMBASE), Ovid and Cochrane library were searched and screened. The quality of the studies included was evaluated and the data with 5-year event free survival rate for comparison were extracted. Meta-analysis was performed by RevMan 5.0 (Cochrane reviews software). Results: From six trials, there were 5903 patients that were eligible for the analysis, in which 3323 patients were treated by brachytherapy and other 2580 by radical prostatectomy. The odds ratio of all trials was 1.00 (95% CI: 0.69-1.45, P=0.99) and there was no significant difference of 5-year event free survival rate between two treatment groups. Conclusion: This Meta analysis shows that brachytherapy may have comparable treatment effect than radical prostatectomy. (authors)

  19. 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)

  20. 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.

  1. SU-E-J-215: Towards MR-Only Image Guided Identification of Calcifications and Brachytherapy Seeds: Application to Prostate and Breast LDR Implant Dosimetry

    Energy Technology Data Exchange (ETDEWEB)

    Elzibak, A; Fatemi-Ardekani, A; Soliman, A; Mashouf, S; Safigholi, H; Ravi, A; Morton, G; Song, WY [Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); Han, D [Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario (Canada); University of California, San Diego, La Jolla, CA (United States)

    2015-06-15

    Purpose: To identify and analyze the appearance of calcifications and brachytherapy seeds on magnitude and phase MRI images and to investigate whether they can be distinguished from each other on corrected phase images for application to prostate and breast low dose rate (LDR) implant dosimetry. Methods: An agar-based gel phantom containing two LDR brachytherapy seeds (Advantage Pd-103, IsoAid, 0.8mm diameter, 4.5mm length) and two spherical calcifications (large: 7mm diameter and small: 4mm diameter) was constructed and imaged on a 3T Philips MR scanner using a 16-channel head coil and a susceptibility weighted imaging (SWI) sequence (2mm slices, 320mm FOV, TR/ TE= 26.5/5.3ms, 15 degree flip angle). The phase images were unwrapped and corrected using a 32×32, 2D Hanning high pass filter to remove background phase noise. Appearance of the seeds and calcifications was assessed visually and quantitatively using Osirix (http://www.osirix-viewer.com/). Results: As expected, calcifications and brachytherapy seeds appeared dark (hypointense) relative to the surrounding gel on the magnitude MRI images. The diameter of each seed without the surrounding artifact was measured to be 0.1 cm on the magnitude image, while diameters of 0.79 and 0.37 cm were measured for the larger and smaller calcifications, respectively. On the corrected phase images, the brachytherapy seeds and the calcifications appeared bright (hyperintense). The diameter of the seeds was larger on the phase images (0.17 cm) likely due to the dipole effect. Conclusion: MRI has the best soft tissue contrast for accurate organ delineation leading to most accurate implant dosimetry. This work demonstrated that phase images can potentially be useful in identifying brachytherapy seeds and calcifications in the prostate and breast due to their bright appearance, which helps in their visualization and quantification for accurate dosimetry using MR-only. Future work includes optimizing phase filters to best identify

  2. A comparison of radiation dose to the neurovascular bundles in men with and without prostate brachytherapy-induced erectile dysfunction

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Dorsey, Anthony T.; Lief, Jonathan H.; Donzella, Joseph G.

    2000-01-01

    Purpose: The etiology of erectile dysfunction after definitive local therapy for carcinoma of the prostate gland represents a multifactorial phenomenon including neurogenic compromise, venous insufficiency, local trauma, and psychogenic causes. It has been suggested that impotence after prostate brachytherapy is a consequence of excessive radiation dose to the neurovascular bundles (NVB). Herein we evaluate the potential relationship between radiation dose to the NVB and the development of erectile dysfunction following prostate brachytherapy. Methods and Materials: The radiation dose to the NVB was evaluated for 33 patients who developed erectile dysfunction (ED) following brachytherapy plus 21 additional patients who were potent before and subsequent to brachytherapy. Of the 54 patient study group, the median follow up was 37 months, and 25 patients were managed with 125 I as a monotherapeutic approach and 29 received 103 Pd as a boost following 45 Gy of external beam radiation therapy. Radiographic localization of the NVB was performed via a two-dimensional geometric model that placed 3-NVB calculation points on the left and right posterolateral side of each 5-mm CT slice. Parameters evaluated included dose-surface histograms, dose parameters via point doses on each slice, the magnitude of the dose in relationship to the distance from the base, and the relationship between NVB radiation dose in patients with and without ED, patient response to sildenafil and case sequence number. Results: In terms of percent prescribed minimum peripheral dose (% mPD), there was no significant difference in mean neurovascular bundle dose between potent and impotent patients, between the isotopes ( 125 I or 103 Pd), mono- or boost therapy, or side of the prostate for which the overall average was 217% ± 55% of mPD. There was also no significant dosimetric difference in terms of response to sildenafil based on a multivariate analysis which included % mPD and various dose

  3. American Brachytherapy Society Task Group Report: Combination of brachytherapy and external beam radiation for high-risk prostate cancer.

    Science.gov (United States)

    Spratt, Daniel E; Soni, Payal D; McLaughlin, Patrick W; Merrick, Gregory S; Stock, Richard G; Blasko, John C; Zelefsky, Michael J

    To review outcomes for high-risk prostate cancer treated with combined modality radiation therapy (CMRT) utilizing external beam radiation therapy (EBRT) with a brachytherapy boost. The available literature for high-risk prostate cancer treated with combined modality radiation therapy was reviewed and summarized. At this time, the literature suggests that the majority of high-risk cancers are curable with multimodal treatment. Several large retrospective studies and three prospective randomized trials comparing CMRT to dose-escalated EBRT have demonstrated superior biochemical control with CMRT. Longer followup of the randomized trials will be required to determine if this will translate to a benefit in metastasis-free survival, disease-specific survival, and overall survival. Although greater toxicity has been associated with CMRT compared to EBRT, recent studies suggest that technological advances that allow better definition and sparing of critical adjacent structures as well as increasing experience with brachytherapy have improved implant quality and the toxicity profile of brachytherapy. The role of androgen deprivation therapy is well established in the external beam literature for high-risk disease, but there is controversy regarding the applicability of these data in the setting of dose escalation. At this time, there is not sufficient evidence for the omission of androgen deprivation therapy with dose escalation in this population. Comparisons with surgery remain limited by differences in patient selection, but the evidence would suggest better disease control with CMRT compared to surgery alone. Due to a series of technological advances, modern combination series have demonstrated unparalleled rates of disease control in the high-risk population. Given the evidence from recent randomized trials, combination therapy may become the standard of care for high-risk cancers. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All

  4. 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.

  5. 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

  6. Dosimetric study of permanent prostate brachytherapy utilizing 131Cs, 125I and 103Pd seeds

    International Nuclear Information System (INIS)

    Yang Ruijie; Wang Junjie; Zhang Hongzhi

    2009-01-01

    Objective: To compare the dosimetric differences of permanent prostate brachytherapy utilizing 131 Cs, 125 I and 103 Pd seeds. Methods: Twenty-five patients with T 1 -T 2 c prostate cancer who had previously implanted with 125 I seeds were randomly selected in our study. The patients were re-planned with 131 Cs, 125 I and 103 Pd seeds by using the Prowess Brachytherapy 3.1 planning system to the prescription doses of 115 Gy, 145 Gy and 125 Gy, respectively. The seed strengths were 1.8 U,0.5 U and 1.8 U, respectively. The prostate, prostatic urethra and anterior wall of the rectum were contoured on trans-rectal ultrasound images. PTV was outlined based on the prostate volume with no margin applied. The attempted planning goals were that V 100 (the percentage volume of the prostate receiving at least 100% of the prescription doses)= 95%, D 90 (the minimum percentage dose covering 90% of the prostate volume) ≥100%, and prostatic urethra UD 10 (the maximum percentage dose receiving by 10% of the contoured urethra) ≤150%. For the plan comparison, we also computed prostate V 150 , prostatic urethra UV 120 , rectum RV 100 , and the number of implanted seeds and needles. The significance of the differences was tested using one way analysis of variance. Results: The average V 200 in the 103 Pd, 125 I and 131 Cs plans were 28.7%, 20.9% and 19.6% (F=42.50, P=0.000); the average V 150 were 51.9%, 42.1% and 39.4% (F=26.15, P=0.000); the average UV 120 were 26.9%, 29.5% and 23.8% (F=0.37, P=0.691); and the average rectum RV 100 were 0.31 cm 3 , 0.22 cm 3 and 0.19 cm 3 (F=0.43, P=0.652). For 103 Pd, 125 I and 131 Cs, the average number of implanted seeds per cm 3 prostate were 2.02, 2.01 and 1.87 (F=1.92, P=0.154), and the average number of needles were 33.6, 32.9 and 31.6 (F=0.26,P=0.772). Conclusions: Comparing to 125 I and 103 Pd seeds used in permanent prostate brachytherapy, 131 Cs seeds has better dose homogeneity, and possible better sparing of the urethra and rectum

  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. 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.)

  9. The Impact of Brachytherapy on Prostate Cancer–Specific Mortality for Definitive Radiation Therapy of High-Grade Prostate Cancer: A Population-Based Analysis

    International Nuclear Information System (INIS)

    Shen Xinglei; Keith, Scott W.; Mishra, Mark V.; Dicker, Adam P.; Showalter, Timothy N.

    2012-01-01

    Purpose: This population-based analysis compared prostate cancer–specific mortality (PCSM) in a cohort of patients with high-risk prostate cancer after nonsurgical treatment with external beam radiation therapy (EBRT), brachytherapy (BT), or combination (BT + EBRT). Methods and Materials: We identified from the Surveillance, Epidemiology and End Results database patients diagnosed from 1988 through 2002 with T1–T3N0M0 prostate adenocarcinoma of poorly differentiated grade and treated with BT, EBRT, or BT + EBRT. During this time frame, the database defined high grade as prostate cancers with Gleason score 8–10, or Gleason grade 4–5 if the score was not recorded. This corresponds to a cohort primarily with high-risk prostate cancer, although some cases where only Gleason grade was recorded may have included intermediate-risk cancer. We used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on PCSM. Results: There were 12,745 patients treated with EBRT (73.5%), BT (7.1%), or BT + EBRT (19.4%) included in the analysis. The median follow-up time for all patients was 6.4 years. The use of BT or BT + EBRT increased from 5.1% in 1988–1992 to 31.4% in 1998–2002. Significant predictors of use of BT or BT + EBRT were younger age, later year of diagnosis, urban residence, and earlier T-stage. On multivariate analysis, treatment with either BT (hazard ratio, 0.66; 95% confidence interval, 0.49–0.86) or BT + EBRT (hazard ratio, 0.77; 95% confidence ratio, 0.66–0.90) was associated with significant reduction in PCSM compared with EBRT alone. Conclusion: In patients with high-grade prostate cancer, treatment with brachytherapy is associated with reduced PCSM compared with EBRT alone. Our results suggest that brachytherapy should be investigated as a component of definitive treatment strategies for patients with high-risk prostate cancer.

  10. 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)

  11. Prostate Brachytherapy With Oblique Needles to Treat Large Glands and Overcome Pubic Arch Interference

    International Nuclear Information System (INIS)

    Ryu, Bon; Bax, Jeff; Edirisinge, Chandima; Lewis, Craig; Chen, Jeff; D’Souza, David; Fenster, Aaron; Wong, Eugene

    2012-01-01

    Purpose: First, to show that low-dose-rate prostate brachytherapy plans using oblique needle trajectories are more successful than parallel trajectories for large prostates with pubic arch interference (PAI); second, to test the accuracy of delivering an oblique plan by using a three-dimensional (3D) transrectal ultrasonography (TRUS)-guided mechatronic system. Methods and Materials: Prostates were contoured for 5 subjects’ 3D TRUS images showing a maximum PAI of ≤1 cm and a prostate volume of <50 cc. Two planning studies were done. First, prostate contours were artificially enlarged to 45 to 80 cc in 5- to 10-cc increments for a single subject. Second, all subject prostate contours were enlarged to 60 cc. For each study, three types of plans were manually created for comparison: a parallel needle template (PT) plan, a parallel needle no-template (PNT) plan, and an oblique needle no-template (OBL) plan. Needle positions and angles were not discretized for nontemplate plans. European Society for Therapeutic Radiology and Oncology dose-volume histogram guidelines, iodine-125 (145-Gy prescription, 0.43 U), and needle angles of <15° were used. An OBL plan was delivered to a pubic arch containing a 60-cc prostate phantom that mimicked the anatomy of the subject with the greatest PAI (23% by volume). Results: In the increasing-prostate volume study, OBL plans were successful for prostates of ≤80 cc, and PT plans were successful for prostates of <65 cc. In paired, one-sided t tests for the 60-cc volume study, OBL plans showed dosimetric improvements for all organs compared to both of the parallel type plans (p < 0.05); PNT plans showed a benefit only in planning target volumes receiving more than 100 Gy compared to PT plans. A computed tomography scan of the phantom showed submillimeter seed placement accuracy in all directions. Conclusion: OBL plans were significantly better than parallel plans, and an OBL plan was accurately delivered to a 60-cc prostate phantom

  12. MRI-based preplanning in low-dose-rate 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

    2008-01-01

    Purpose: To compare the dosimetric results between MRI-based and TRUS-based preplanning in permanent prostate brachytherapy, and to estimate the accuracy of MRI-based preplanning by comparing with CT/MRI fusion-based postimplant dosimetry. Methods and materials: Twenty-one patients were entered in this prospective study with written informed consent. MRI-based and TRUS-based preplanning were performed. The seed and needle locations were identical according to MRI-based and TRUS-based preplanning. MRI-based and TRUS-based preplanning were compared using DVH-related parameters. Following brachytherapy, the accuracy of the MRI-based preplanning was evaluated by comparing it with CT/MRI fusion-based postimplant dosimetry. Results: Mean MRI-based prostate volume was slightly underestimated (0.73 cc in mean volume) in comparison to TRUS-based volume. There were no significant differences in the mean DVH-related parameters except with rectal V 100 (cc) between TRUS-based and MRI-based preplanning. Mean rectal V 100 (cc) was 0.74 cc in TRUS-based and 0.29 cc in MRI-based preplanning, respectively, and the values demonstrated a statistical difference. There was no statistical difference in mean rectal V 150 (cc), and rectal V 100 (cc) between MRI-based preplanning and CT/MRI fusion-based postimplant dosimetry. Conclusion: Prostate volume estimation and DVH-related parameters in MRI-based preplanning were almost identical to TRUS-based preplanning. From the results of CT/MRI fusion-based postimplant dosimetry, MRI-based preplanning was therefore found to be a reliable and useful modality, as well as being helpful for TRUS-based preplanning. MRI-based preplanning can more accurately predict postimplant rectal dose than TRUS-based preplanning

  13. 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

  14. Long term conservation of sexual functions after prostate brachytherapy by permanents implants

    International Nuclear Information System (INIS)

    Pena, P.C.; Hijal, T.; Pierrat, N.; Pontvert, D.; Cosset, J.M.; Thiounn, N.; Flam, T.; Chauveinc, L.

    2009-01-01

    These series suggest that the preservation of sexual abilities after prostate brachytherapy would be in relation with the previous performances and age. So, in patients aged over seventy years and with an satisfying initial IIEF5 score, the conservation rate at long term appears to go over the 50%. (N.C.)

  15. A compact mechatronic system for 3D ultrasound guided prostate interventions

    International Nuclear Information System (INIS)

    Bax, Jeffrey; Smith, David; Bartha, Laura; Montreuil, Jacques; Sherebrin, Shi; Gardi, Lori; Edirisinghe, Chandima; Fenster, Aaron

    2011-01-01

    Purpose: Ultrasound imaging has improved the treatment of prostate cancer by producing increasingly higher quality images and influencing sophisticated targeting procedures for the insertion of radioactive seeds during brachytherapy. However, it is critical that the needles be placed accurately within the prostate to deliver the therapy to the planned location and avoid complications of damaging surrounding tissues. Methods: The authors have developed a compact mechatronic system, as well as an effective method for guiding and controlling the insertion of transperineal needles into the prostate. This system has been designed to allow guidance of a needle obliquely in 3D space into the prostate, thereby reducing pubic arch interference. The choice of needle trajectory and location in the prostate can be adjusted manually or with computer control. Results: To validate the system, a series of experiments were performed on phantoms. The 3D scan of the string phantom produced minimal geometric error, which was less than 0.4 mm. Needle guidance accuracy tests in agar prostate phantoms showed that the mean error of bead placement was less then 1.6 mm along parallel needle paths that were within 1.2 mm of the intended target and 1 deg. from the preplanned trajectory. At oblique angles of up to 15 deg. relative to the probe axis, beads were placed to within 3.0 mm along a trajectory that were within 2.0 mm of the target with an angular error less than 2 deg. Conclusions: By combining 3D TRUS imaging system to a needle tracking linkage, this system should improve the physician's ability to target and accurately guide a needle to selected targets without the need for the computer to directly manipulate and insert the needle. This would be beneficial as the physician has complete control of the system and can safely maneuver the needle guide around obstacles such as previously placed needles.

  16. 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.

  17. 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.

  18. Argon plasma coagulation for rectal bleeding after prostate brachytherapy

    International Nuclear Information System (INIS)

    Smith, Stephen; Wallner, Kent; Dominitz, Jason A.; Han, Ben; True, Lawrence; Sutlief, Steven; Billingsley, Kevin

    2001-01-01

    Purpose: To better define the efficacy and safety of argon plasma coagulation (APC), specifically for brachytherapy-related proctitis, we reviewed the clinical course of 7 patients treated for persistent rectal bleeding. Approximately 2-10% of prostate cancer patients treated with 125 I or 103 Pd brachytherapy will develop radiation proctitis. The optimum treatment for patients with persistent bleeding is unclear from the paucity of available data. Prior reports lack specific dosimetric information, and patients with widely divergent forms of radiation were grouped together in the analyses. Methods and Materials: Seven patients were treated with APC at the Veterans Affairs Puget Sound Health Care System and the University of Washington from 1997 to 1999 for persistent rectal bleeding due to prostate brachytherapy-related proctitis. Four patients received supplemental external beam radiation, delivered by a four-field technique. A single gastroenterologist at the Veterans Affairs Puget Sound Health Care System treated 6 of the 7 patients. If the degree of proctitis was limited, all sites of active bleeding were coagulated in symptomatic patients. An argon plasma coagulator electrosurgical system was used to administer treatments every 4-8 weeks as needed. The argon gas flow was set at 1.6 L/min, with an electrical power setting of 40-45 W. Results: The rectal V100 (the total rectal volume, including the lumen, receiving the prescription dose or greater) for the 7 patients ranged from 0.13 to 4.61 cc. Rectal bleeding was first noticed 3-18 months after implantation. APC (range 1-3 sessions) was performed 9-22 months after implantation. Five patients had complete resolution of their bleeding, usually within days of completing APC. Two patients had only partial relief from bleeding, but declined additional APC therapy. No patient developed clinically evident progressive rectal wall abnormalities after APC, (post-APC follow-up range 4-13 months). Conclusions: Most

  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. 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.

  1. Towards clinical application of RayStretch for heterogeneity corrections in LDR permanent 125I prostate brachytherapy.

    Science.gov (United States)

    Hueso-González, Fernando; Ballester, Facundo; Perez-Calatayud, Jose; Siebert, Frank-André; Vijande, Javier

    RayStretch is a simple algorithm proposed for heterogeneity corrections in low-dose-rate brachytherapy. It is built on top of TG-43 consensus data, and it has been validated with Monte Carlo (MC) simulations. In this study, we take a real clinical prostate implant with 71 125 I seeds as reference and we apply RayStretch to analyze its performance in worst-case scenarios. To do so, we design two cases where large calcifications are located in the prostate lobules. RayStretch resilience under various calcification density values is also explored. Comparisons against MC calculations are performed. Dose-volume histogram-related parameters like prostate D 90 , rectum D 2cc , or urethra D 10 obtained with RayStretch agree within a few percent with the detailed MC results for all cases considered. The robustness and compatibility of RayStretch with commercial treatment planning systems indicate its applicability in clinical practice for dosimetric corrections in prostate calcifications. Its use during intraoperative ultrasound planning is foreseen. Copyright © 2017 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  2. Radiation safety parameters following prostate brachytherapy

    International Nuclear Information System (INIS)

    Smathers, Sesalie; Wallner, Kent; Korssjoen, Tammy; Bergsagel, Carl; Hudson, Rick H.; Sutlief, Steven; Blasko, John

    1999-01-01

    Purpose: To determine the degree and variability of radiation exposure to the general public from patients after I-125 or Pd-103 prostate brachytherapy. Methods and Materials: Radiation exposure measurements were made from 38 consecutive, unselected patients with stage T1 or T2 prostatic carcinoma who had trans perineal I-125 or Pd-103 implants at the University of Washington in 1998. Results: The exposure rate at the anterior skin surface following a I-125 implant ranged from 2.2 to 8.9 mrem/hour (average: 5.0). The exposure rate at the anterior skin surface from a Pd-103 implant ranged from 0.5 to 4.9 mrem/hour (average: 1.7). Based on the current Nuclear Regulatory Commission (NRC) regulations the time required to reach the annual limit at the anterior skin surface would be 20 hours for I-125 and 59 hours for Pd-103. For exposure at the lateral skin surface, the times would exceed 500 hours for either isotope. Conclusions: This data suggest that patients need not be concerned about being a radiation risk to the general public following their procedure

  3. Manual on brachytherapy. Incorporating: Applications guide, procedures guide, basics guide

    International Nuclear Information System (INIS)

    1996-01-01

    This publication is part of practical radiation safety manual series for different fields of application aimed primarily at persons handling radiation sources on a daily routine basis, which could at same time be used by the competent authorities, supporting their efforts in the radiation protection training of workers or medical assistance personnel or helping on-site management to set up local radiation protection rules. It is dedicated to brachytherapy: its application and procedures guides

  4. 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.

  5. 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.

  6. Salvage prostate HDR brachytherapy combined with interstitial hyperthermia for local recurrence after radiation therapy failure

    Energy Technology Data Exchange (ETDEWEB)

    Kukielka, A.M.; Hetnal, M.; Dabrowski, T.; Walasek, T.; Brandys, P.; Reinfuss, M. [Centre of Oncology, M. Sklodowska - Curie Institute, Krakow Branch, Department of Radiotherapy, Krakow (Poland); Nahajowski, D.; Kudzia, R.; Dybek, D. [Centre of Oncology, M. Sklodowska - Curie Institute, Krakow Branch, Department of Medical Physics, Department of Radiotherapy, Krakow (Poland)

    2014-02-15

    The aim of the present retrospective study is to evaluate toxicity and early clinical outcomes of interstitial hyperthermia (IHT) combined with high-dose rate (HDR) brachytherapy as a salvage treatment in patients with biopsy-confirmed local recurrence of prostate cancer after previous external beam radiotherapy. Between September 2008 and March 2013, 25 patients with local recurrence of previously irradiated prostate cancer were treated. The main eligibility criteria for salvage prostate HDR brachytherapy combined with interstitial hyperthermia were biopsy confirmed local recurrence and absence of nodal and distant metastases. All patients were treated with a dose of 30 Gy in 3 fractions at 21-day intervals. We performed 62 hyperthermia procedures out of 75 planned (83 %). The aim of the hyperthermia treatment was to heat the prostate to 41-43 C for 60 min. Toxicity for the organs of the genitourinary system and rectum was assessed according to the Common Terminology Criteria for Adverse Events (CTCAE, v. 4.03). Determination of subsequent biochemical failure was based on the Phoenix definition (nadir + 2 ng/ml). The median age was 71 years (range 62-83 years), the median initial PSA level was 16.3 ng/ml (range 6.37-64 ng/ml), and the median salvage PSA level was 2.8 ng/ml (1.044-25.346 ng/ml). The median follow-up was 13 months (range 4-48 months). The combination of HDR brachytherapy and IHT was well tolerated. The most frequent complications were nocturia, weak urine stream, urinary frequency, hematuria, and urgency. Grade 2 rectal hemorrhage was observed in 1 patient. No grade 3 or higher complications were observed. The 2-year Kaplan-Meier estimate of biochemical control after salvage treatment was 74 %. The PSA in 20 patients decreased below the presalvage level, while 11 patients achieved a PSA nadir < 0.5 ng/ml. All patients are still alive. Of the 7 patients who experienced biochemical failure, bone metastases were found in 2 patients. IHT in combination

  7. 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

  8. 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.

  9. 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.

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

    International Nuclear Information System (INIS)

    Grant, Stephen R.; Walker, Gary V.; Koshy, Matthew; Shaitelman, Simona F.; Klopp, Ann H.; Frank, Steven J.; Pugh, Thomas J.; Allen, Pamela K.; Mahmood, Usama

    2015-01-01

    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.

  11. Radiation exposure after permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Cattani, Federica; Vavassori, Andrea; Polo, Alfredo; Rondi, Elena; Cambria, Raffaella; Orecchia, Roberto; Tosi, Giampiero

    2006-01-01

    Background and purpose: Limited information is available on the true radiation exposure and associated risks for the relatives of the patients submitted to prostate brachytherapy with permanent implant of radioactive sources and for any other people coming into contact with them. In order to provide appropriate information, we analyzed the radiation exposure data from 216 prostate cancer patients who underwent 125 I or 103 Pd implants at the European Institute of Oncology of Milan, Italy. Patients and methods: Between October 1999 and October 2004, 216 patients with low risk prostate carcinoma were treated with 125 I (200 patients) or 103 Pd (16 patients) permanent seed implantation. One day after the procedure, radiation exposure measurements around the patients were performed using an ionization chamber survey meter (Victoreen RPO-50) calibrated in dose rate at an accredited calibration center (calibration Centre SIT 104). Results: The mean dose rate at the posterior skin surface (gluteal region) following 125 I implants was 41.3 μSv/h (range: 6.2-99.4 μSv/h) and following 103 Pd implants was 18.9 μSv/h (range 5.0-37.3 μSv/h). The dose rate at 50 cm from the skin decreased to the mean value of 6.4 μSv/h for the 125 I implants and to the mean value of 1.7 μSv/h for the 103 Pd implants. Total times required to reach the annual dose limit (1 mSv/year) recommended for the general population by the European Directive 96/29/Euratom and by the Italian law (Decreto Legislativo 241/2000) at a distance of 50 cm from the posterior skin surface of the implanted patient would be 7.7 and 21.6 days for 125 I and for 103 Pd. Good correlation between the measured dose rates and both the total implanted activity and the distance between the most posteriorly implanted seed and the skin surface of the patients was found. Conclusions: Our data show that the dose rates at 50 cm away from the prostate brachytherapy patients are very low and that the doses possibly absorbed by the

  12. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Ishiyama, Hiromichi, E-mail: hishiyam@kitasato-u.ac.jp [Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Nakamura, Ryuji [Department of Radiology, Iwate Medical University, Morioka, Iwate (Japan); Satoh, Takefumi [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Tanji, Susumu [Department of Urology, Iwate Medical University, Morioka, Iwate (Japan); Teh, Bin S. [Department of Radiation Oncology, The Methodist Hospital, Houston, TX (United States); Uemae, Mineko [Division of Radiation Oncology, Kitasato University Hospital, Sagamihara, Kanagawa (Japan); Baba, Shiro [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Hayakawa, Kazushige [Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan)

    2012-04-01

    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.

  14. 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

  15. Combined transperineal radiofrequency (RF) interstitial hyperthermia and brachytherapy for localized prostate cancer (PC)

    International Nuclear Information System (INIS)

    Urakami, Shinji; Gonda, Nobuko; Kikuno, Nobuyuki

    2001-01-01

    Hyperthermia has been used effectively as a radiation sensitizer. Interstitial hyperthermoradiotherapy has been therefore utilized as a minimal invasive therapy in attempts to improve local tumor control for various cancers, but not for urological cancer. The purpose of this study was to investigate the safety and feasibility of transperineal hyperthermoradiotherapy for localized PC. Based on our basic study of hyperthermoradiotherapy, we devised the procedure of combined transperineal RF interstitial hyperthermia and brachytherapy for localized prostate cancer. Two patients with localized PC underwent transperineal RF interstitial hyperthermia combined with brachytherapy operation the 192-Ir remote after-loading system (RALS). Under transrectal ultrasound guidance, a total number of 12-18 stainless steel needles for 192-Ir RALS were implanted into the prostatic gland and seminal vesicles (SV) in an optimized pattern. Eight of the needles were used as electrodes for hyperthermia, and were electrically insultated using the vinyl catheter along the length of the subdermal fatty tissue to protect from overheating. Three other needles were utilized for continuous temperature mapping in the prostate. Rectal temperature was also monitored. Total radiation doses of 70 Gy to the prostate and SV were planned as a combination of brachytherapy (24 Gy/4 fraction) and external irradiation using a four-field box technique (46 Gy/23 fraction). Hyperthermic treatment (goal of 42 to 43 deg C for 60 minutes) was performed twice following the 1st and 4th brachytherapy at an interval of more than 48 hours for the recovery of cancer cells from thermotolerance. Both patients reached the treatment goal of all intraprostatic temperatures >43.0 deg C, which was considered favorable for hyperthermia, and the rectal temperatures of both patients remained <38 deg C during hyperthermia. In serial PSA measurements of both patients, serum PSA was less than 1.0 ng/ml within 3 months and has since

  16. Short-lag spatial coherence beamforming of photoacoustic images for enhanced visualization of prostate brachytherapy seeds

    OpenAIRE

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

    2013-01-01

    Prostate brachytherapy, administered by implanting tiny radioactive seeds to treat prostate cancer, currently relies on transrectal ultrasound imaging for intraoperative visualization of the metallic seeds. Photoacoustic (PA) imaging has been suggested as a feasible alternative to ultrasound imaging due to its superior sensitivity to metal surrounded by tissue. However, PA images suffer from poor contrast when seeds are distant from the light source. We propose a transperineal light delivery ...

  17. A comprehensive review of prostate cancer brachytherapy: defining an optimal technique

    International Nuclear Information System (INIS)

    Vicini, Frank A.; Kini, Vijay R.; Edmundson, Gregory B.S.; Gustafson, Gary S.; Stromberg, Jannifer; Martinez, Alvaro

    1999-01-01

    Purpose: A comprehensive review of prostate cancer brachytherapy literature was performed to determine if an optimal method of implantation could be identified, and to compare and contrast techniques currently in use. Methods and Materials: A MEDLINE search was conducted to obtain all articles in the English language on prostate cancer brachytherapy from 1985 through 1998. Articles were reviewed and grouped to determine the primary technique of implantation, the method or philosophy of source placement and/or dose specification, the technique to evaluate implant quality, overall treatment results (based upon pretreatment prostate specific antigen, (PSA), and biochemical control) and clinical, pathological or biochemical outcome based upon implant quality. Results: A total of 178 articles were identified in the MEDLINE database. Of these, 53 studies discussed evaluable techniques of implantation and were used for this analysis. Of these studies, 52% used preoperative ultrasound to determine the target volume to be implanted, 16% used preoperative computerized tomography (CT) scans, and 18% placed seeds with an open surgical technique. An additional 11% of studies placed seeds or needles under ultrasound guidance using interactive real-time dosimetry. The number and distribution of radioactive sources to be implanted or the method used to prescribe dose was determined using nomograms in 27% of studies, a least squares optimization technique in 11%, or not stated in 35%. In the remaining 26%, sources were described as either uniformly, differentially, or peripherally placed in the gland. To evaluate implant quality, 28% of studies calculated some type of dose-volume histogram, 21% calculated the matched peripheral dose, 19% the minimum peripheral dose, 14% used some type of CT-based qualitative review and, in 18% of studies, no implant quality evaluation was mentioned. Six studies correlated outcome with implant dose. One study showed an association of implant dose

  18. Evaluation of radiation dose on people adjacent to implant patients during brachytherapy for prostate cancer using {sup 192}Ir

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Jung Hoon; Ko, Seong Jin; Kang, Se Sik; Kim, Chang Soo [Catholic University, Busan (Korea, Republic of)

    2009-10-15

    The incidence of prostate cancer is rapidly increasing due to aging of the population and westernization of dietary habits, etc. As a result, the frequency of prostate cancer has become the fifth highest among all male cancers and the first among urological cancers. Brachytherapy is commonly used for locally progressing prostate cancers. Since the mid 1980s, therapies using radio-isotopes, such as low-invasive {sup 125}I, {sup 103}Pd and {sup 192}Ir, have been widely performed in the U.S. and Europe. However, brachytherapy involves implanting radio-isotopes into the human body which is of concern because it may expose the health care professionals administering the therapy to unnecessary radiation. Accordingly, this study intends to predict the radiation dose that people adjacent to patients implanted with a radio-isotope are exposed to during prostate cancer radiation therapy by using a mathematical anthropomorphic phantom and {sup 192}Ir.

  19. 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)

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

    Energy Technology Data Exchange (ETDEWEB)

    Thaker, Nikhil G. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Kudchadker, Rajat J. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Swanson, David A. [Department of Urology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Albert, Jeffrey M. [Department of Radiation Oncology, Banner Health, Loveland/Greeley, Colorado (United States); Mahmood, Usama; Pugh, Thomas J.; Boehling, Nicholas S. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Bruno, Teresa L. [Department of Radiation Physics, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Prestidge, Bradley R. [Department of Radiation Oncology, Bon Secours Health System, Norfolk, Virginia (United States); Crook, Juanita M. [Department of Radiation Oncology, Cancer Center for the Southern Interior, Kelowna, British Columbia (Canada); Cox, Brett W.; Potters, Louis [Department of Radiation Medicine, North Shore-LIJ Health System, New Hyde Park, New York (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, Illinois (United States); Keyes, Mira [Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Center, Vancouver, British Columbia (Canada); Kuban, Deborah A. [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Frank, Steven J., E-mail: sjfrank@mdanderson.org [Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas (United States)

    2014-11-01

    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 ({sup 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.

  1. 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

  2. Robotic radiotherapy for prostate cancer with CyberKnife

    International Nuclear Information System (INIS)

    Hannoun-Levi, J.M.; Benezery, K.; Bondiau, P.Y.; Marcie, S.; Gerard, J.P.; Chamorey, E.

    2007-01-01

    After 3D conformal radiation therapy without and with modulated intensity, image-guided radiation therapy represents a new technological step. Should prostate cancer treatment using radiotherapy with the CyberKnife robotic system be considered as a new treatment and then investigated through classical clinical research procedure rather than a technical improvement of an already validated treatment? After a general presentation of the CyberKnife, the authors focused on prostate cancer treatment assuming that, according to dosimetric and biological considerations, the treatment by robotic system appears comparable to high dose rate brachytherapy. For prostate cancer treatment are discussed: biological rational for hypo fractionated treatment, high dose rate brachytherapy boost and interest of dose escalation. A comparison is presented between CyberKnife and other validated treatment for prostate cancer (radical prostatectomy, 3D conformal radiation therapy and low and high dose rate brachytherapy). In summary, CyberKnife treatment could be considered as a technical improvement of an already validated treatment in order to deliver a prostate boost after pelvic or peri-prostatic area irradiation. However, the clinical, biological and economical results must be precisely analyzed and could be assessed in the frame of a National Observatory based on shared therapeutic program. (authors)

  3. 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

  4. 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.

  5. Fast GPU-based Monte Carlo simulations for LDR prostate brachytherapy

    Science.gov (United States)

    Bonenfant, Éric; Magnoux, Vincent; Hissoiny, Sami; Ozell, Benoît; Beaulieu, Luc; Després, Philippe

    2015-07-01

    The aim of this study was to evaluate the potential of bGPUMCD, a Monte Carlo algorithm executed on Graphics Processing Units (GPUs), for fast dose calculations in permanent prostate implant dosimetry. It also aimed to validate a low dose rate brachytherapy source in terms of TG-43 metrics and to use this source to compute dose distributions for permanent prostate implant in very short times. The physics of bGPUMCD was reviewed and extended to include Rayleigh scattering and fluorescence from photoelectric interactions for all materials involved. The radial and anisotropy functions were obtained for the Nucletron SelectSeed in TG-43 conditions. These functions were compared to those found in the MD Anderson Imaging and Radiation Oncology Core brachytherapy source registry which are considered the TG-43 reference values. After appropriate calibration of the source, permanent prostate implant dose distributions were calculated for four patients and compared to an already validated Geant4 algorithm. The radial function calculated from bGPUMCD showed excellent agreement (differences within 1.3%) with TG-43 accepted values. The anisotropy functions at r = 1 cm and r = 4 cm were within 2% of TG-43 values for angles over 17.5°. For permanent prostate implants, Monte Carlo-based dose distributions with a statistical uncertainty of 1% or less for the target volume were obtained in 30 s or less for 1 × 1 × 1 mm3 calculation grids. Dosimetric indices were very similar (within 2.7%) to those obtained with a validated, independent Monte Carlo code (Geant4) performing the calculations for the same cases in a much longer time (tens of minutes to more than a hour). bGPUMCD is a promising code that lets envision the use of Monte Carlo techniques in a clinical environment, with sub-minute execution times on a standard workstation. Future work will explore the use of this code with an inverse planning method to provide a complete Monte Carlo-based planning solution.

  6. 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

  7. 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.

  8. Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Price, Jeremy G. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stone, Nelson N. [Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States)

    2013-08-01

    Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ≥grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following

  9. 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

    2015-01-01

    Purpose 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. Material and methods 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: 125I fixed spacing, 125I variable spacing, 103Pd fixed spacing, and 103Pd variable spacing. The primary planning objective was to achieve a prostate V100 of 100% while minimizing dose to urethra and rectum. Results 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 103Pd, and 0.007 and 0.029 with 125I plans. Similarly dose reductions for mean and maximum rectal dose using variable spacing had p values of 0.007 and 0.052 with 103Pd, and 0.012 and 0.037 with 125I plans. Conclusions 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. PMID:26622227

  10. Towards Clinically Optimized MRI-guided Surgical Manipulator for Minimally Invasive Prostate Percutaneous Interventions: Constructive Design*

    Science.gov (United States)

    Eslami, Sohrab; Fischer, Gregory S.; Song, Sang-Eun; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Iordachita, Iulian

    2013-01-01

    This paper undertakes the modular design and development of a minimally invasive surgical manipulator for MRI-guided transperineal prostate interventions. Severe constraints for the MRI-compatibility to hold the minimum artifact on the image quality and dimensions restraint of the bore scanner shadow the design procedure. Regarding the constructive design, the manipulator kinematics has been optimized and the effective analytical needle workspace is developed and followed by proposing the workflow for the manual needle insertion. A study of the finite element analysis is established and utilized to improve the mechanism weaknesses under some inevitable external forces to ensure the minimum structure deformation. The procedure for attaching a sterile plastic drape on the robot manipulator is discussed. The introduced robotic manipulator herein is aimed for the clinically prostate biopsy and brachytherapy applications. PMID:24683502

  11. 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

  12. Multivariable model development and internal validation for prostate cancer specific survival and overall survival after whole-gland salvage Iodine-125 prostate brachytherapy

    NARCIS (Netherlands)

    Peters, Max; van der Voort van Zyp, Jochem R N; Moerland, Marinus A; Hoekstra, Carel J; van de Pol, Sandrine; Westendorp, Hendrik; Maenhout, Metha; Kattevilder, Rob; Verkooijen, Helena M; van Rossum, Peter S N; Ahmed, Hashim U; Shah, Taimur T; Emberton, Mark; van Vulpen, Marco

    BACKGROUND: Whole-gland salvage Iodine-125-brachytherapy is a potentially curative treatment strategy for localised prostate cancer (PCa) recurrences after radiotherapy. Prognostic factors influencing PCa-specific and overall survival (PCaSS & OS) are not known. The objective of this study was to

  13. A study of optimization techniques in HDR brachytherapy for the prostate

    Science.gov (United States)

    Pokharel, Ghana Shyam

    Several studies carried out thus far are in favor of dose escalation to the prostate gland to have better local control of the disease. But optimal way of delivery of higher doses of radiation therapy to the prostate without hurting neighboring critical structures is still debatable. In this study, we proposed that real time high dose rate (HDR) brachytherapy with highly efficient and effective optimization could be an alternative means of precise delivery of such higher doses. This approach of delivery eliminates the critical issues such as treatment setup uncertainties and target localization as in external beam radiation therapy. Likewise, dosimetry in HDR brachytherapy is not influenced by organ edema and potential source migration as in permanent interstitial implants. Moreover, the recent report of radiobiological parameters further strengthen the argument of using hypofractionated HDR brachytherapy for the management of prostate cancer. Firstly, we studied the essential features and requirements of real time HDR brachytherapy treatment planning system. Automating catheter reconstruction with fast editing tools, fast yet accurate dose engine, robust and fast optimization and evaluation engine are some of the essential requirements for such procedures. Moreover, in most of the cases we performed, treatment plan optimization took significant amount of time of overall procedure. So, making treatment plan optimization automatic or semi-automatic with sufficient speed and accuracy was the goal of the remaining part of the project. Secondly, we studied the role of optimization function and constraints in overall quality of optimized plan. We have studied the gradient based deterministic algorithm with dose volume histogram (DVH) and more conventional variance based objective functions for optimization. In this optimization strategy, the relative weight of particular objective in aggregate objective function signifies its importance with respect to other objectives

  14. 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

  15. SU-F-T-46: The Effect of Inter-Seed Attenuation and Tissue Composition in Prostate 125I Brachytherapy Dose Calculations

    Energy Technology Data Exchange (ETDEWEB)

    Tamura, K; Araki, F; Ohno, T [Kumamoto University, Kumamoto, Kumamoto (Japan)

    2016-06-15

    Purpose: To investigate the difference of dose distributions with/without the effect of inter-seed attenuation and tissue compositions in prostate {sup 125}I brachytherapy dose calculations, using Monte Carlo simulations of Particle and Heavy Ion Transport code System (PHITS). Methods: The dose distributions in {sup 125}I prostate brachytherapy were calculated using PHITS for non-simultaneous and simultaneous alignments of STM1251 sources in water or prostate phantom for six patients. The PHITS input file was created from DICOM-RT file which includes source coordinates and structures for clinical target volume (CTV) and organs at risk (OARs) of urethra and rectum, using in-house Matlab software. Photon and electron cutoff energies were set to 1 keV and 100 MeV, respectively. The dose distributions were calculated with the kerma approximation and the voxel size of 1 × 1 × 1 mm{sup 3}. The number of incident photon was set to be the statistical uncertainty (1σ) of less than 1%. The effect of inter-seed attenuation and prostate tissue compositions was evaluated from dose volume histograms (DVHs) for each structure, by comparing to results of the AAPM TG-43 dose calculation (without the effect of inter-seed attenuation and prostate tissue compositions). Results: The dose reduction due to the inter-seed attenuation by source capsules was approximately 2% for CTV and OARs compared to those of TG-43. In additions, by considering prostate tissue composition, the D{sub 90} and V{sub 100} of CTV reduced by 6% and 1%, respectively. Conclusion: It needs to consider the dose reduction due to the inter-seed attenuation and tissue composition in prostate {sup 125}I brachytherapy dose calculations.

  16. 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.)

  17. 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.

  18. Long-Term Outcome for Clinically Localized Prostate Cancer Treated With Permanent Interstitial Brachytherapy

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Butler, Wayne M.; Galbreath, Robert W.; Lief, Jonathan; Adamovich, Edward; Wallner, Kent E.

    2011-01-01

    Purpose: To present the largest series of prostate cancer brachytherapy patients treated with modern brachytherapy techniques and postimplant day 0 dosimetric evaluation. Methods and Materials: Between April 1995 and July 2006, 1,656 consecutive patients were treated with permanent interstitial brachytherapy. Risk group stratification was carried out according to the Mt. Sinai guidelines. Median follow-up was 7.0 years. The median day 0 minimum dose covering at least 90% of the target volume was 118.8% of the prescription dose. Cause of death was determined for each deceased patient. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on the evaluated survival parameters. Results: At 12 years, biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) for the entire cohort was 95.6%, 98.2%, and 72.6%, respectively. For low-, intermediate-, and high-risk patients, bPFS was 98.6%, 96.5%, and 90.5%; CSS was 99.8%, 99.3%, and 95.2%; and OS was 77.5%, 71.1%, and 69.2%, respectively. For biochemically controlled patients, the median posttreatment prostate-specific antigen (PSA) concentration was 0.02 ng/ml. bPFS was most closely related to percent positive biopsy specimens and risk group, while Gleason score was the strongest predictor of CSS. OS was best predicted by patient age, hypertension, diabetes, and tobacco use. At 12 years, biochemical failure and cause-specific mortality were 1.8% and 0.2%, 5.1% and 2.1%, and 10.4% and 7.1% for Gleason scores 5 to 6 and 7 and ≥8, respectively. Conclusions: Excellent long-term outcomes are achievable with high-quality brachytherapy for low-, intermediate-, and high-risk patients. These results compare favorably to alternative treatment modalities including radical prostatectomy.

  19. 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

  20. [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.

  1. Design and optimization of a brachytherapy robot

    Science.gov (United States)

    Meltsner, Michael A.

    Trans-rectal ultrasound guided (TRUS) low dose rate (LDR) interstitial brachytherapy has become a popular procedure for the treatment of prostate cancer, the most common type of non-skin cancer among men. The current TRUS technique of LDR implantation may result in less than ideal coverage of the tumor with increased risk of negative response such as rectal toxicity and urinary retention. This technique is limited by the skill of the physician performing the implant, the accuracy of needle localization, and the inherent weaknesses of the procedure itself. The treatment may require 100 or more sources and 25 needles, compounding the inaccuracy of the needle localization procedure. A robot designed for prostate brachytherapy may increase the accuracy of needle placement while minimizing the effect of physician technique in the TRUS procedure. Furthermore, a robot may improve associated toxicities by utilizing angled insertions and freeing implantations from constraints applied by the 0.5 cm-spaced template used in the TRUS method. Within our group, Lin et al. have designed a new type of LDR source. The "directional" source is a seed designed to be partially shielded. Thus, a directional, or anisotropic, source does not emit radiation in all directions. The source can be oriented to irradiate cancerous tissues while sparing normal ones. This type of source necessitates a new, highly accurate method for localization in 6 degrees of freedom. A robot is the best way to accomplish this task accurately. The following presentation of work describes the invention and optimization of a new prostate brachytherapy robot that fulfills these goals. Furthermore, some research has been dedicated to the use of the robot to perform needle insertion tasks (brachytherapy, biopsy, RF ablation, etc.) in nearly any other soft tissue in the body. This can be accomplished with the robot combined with automatic, magnetic tracking.

  2. Comparison of Oncentra® Brachy IPSA and graphical optimisation techniques: a case study of HDR brachytherapy head and neck and prostate plans

    International Nuclear Information System (INIS)

    Jameson, Michael G; Ohanessian, Lucy; Batumalai, Vikneswary; Patel, Virendra; Holloway, Lois C

    2015-01-01

    There are a number of different dwell positions and time optimisation options available in the Oncentra® Brachy (Elekta Brachytherapy Solutions, Veenendaal, The Netherlands) brachytherapy treatment planning system. The purpose of this case study was to compare graphical (GRO) and inverse planning by simulated annealing (IPSA) optimisation techniques for interstitial head and neck (HN) and prostate plans considering dosimetry, modelled radiobiology outcome and planning time. Four retrospective brachytherapy patients were chosen for this study, two recurrent HN and two prostatic boosts. Manual GRO and IPSA plans were generated for each patient. Plans were compared using dose–volume histograms (DVH) and dose coverage metrics including; conformity index (CI), homogeneity index (HI) and conformity number (CN). Logit and relative seriality models were used to calculate tumour control probability (TCP) and normal tissue complication probability (NTCP). Approximate planning time was also recorded. There was no significant difference between GRO and IPSA in terms of dose metrics with mean CI of 1.30 and 1.57 (P > 0.05) respectively. IPSA achieved an average HN TCP of 0.32 versus 0.12 for GRO while for prostate there was no significant difference. Mean GRO planning times were greater than 75 min while average IPSA planning times were less than 10 min. Planning times for IPSA were greatly reduced compared to GRO and plans were dosimetrically similar. For this reason, IPSA makes for a useful planning tool in HN and prostate brachytherapy

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

    International Nuclear Information System (INIS)

    Chatzikonstantinou, Georgios; Zamboglou, Nikolaos; Roedel, Claus; Tselis, Nikolaos; Zoga, Eleni; Strouthos, Iosif; Butt, Saeed Ahmed

    2017-01-01

    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.) [de

  4. Prostate brachytherapy

    Science.gov (United States)

    Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate; High dose radiation (HDR) ... place the seeds that deliver radiation into your prostate. The seeds are placed with needles or special ...

  5. American brachytherapy society recommends no change for prostate permanent implant dose prescriptions using iodine-125 or palladium-103

    International Nuclear Information System (INIS)

    Rivard, M.J.; Butler, W.M.; Merrick, G.S.; Devlin, P.M.; Hayes, J.K.; Hearn, R.A.; Lief, E.P.; Meigooni, A.S.; Williamson, J.F.

    2008-01-01

    Purpose - In 2004, the American Association of Physicists in Medicine (AAPM) issued a report outlining recommended 125 I and 103 Pd datasets for consistency in calculating brachytherapy dose distributions. In 2005, to aid evaluating the clinical impact of implementing these datasets, the AAPM assessed the historical dependence of how prescribed doses differed from administered doses for 125 I and 103 Pd for permanent implantation of the prostate. Consequently, the American Brachytherapy Society (ABS) considered the nature of these changes towards issuing recommended dose prescriptions for 125 I and 103 Pd interstitial brachytherapy implants for mono-therapy and standard boosts. Methods and materials - An investigation was performed of the 2005 AAPM analysis to determine changes in administered dose while affixing prescribed dose using 2004 AAPM 125 I and 103 Pd brachytherapy dosimetry datasets for prostate implants. For 125 I and 103 Pd, administered dose would change by +1.4% and +4.2%, respectively. The biological and societal impact of changing prescribed dose was considered. Results - Based on the need for clinical constancy and in recognition of overall uncertainties, the ABS recommends immediate implementation of the 2004 AAPM consensus brachytherapy dosimetry datasets and no changes to 125 I and 103 Pd dose prescriptions at this time. Conclusions - Radiation oncologists should continue to prescribe mono-therapy doses of 145 Gy and 125 Gy for 125 I and 105 Pd, respectively, and standard boost doses of 100-110 Gy and 90-100 Gy for 125 I and 103 Pd, respectively. (authors)

  6. Detection and correction of patient movement in prostate brachytherapy seed reconstruction

    Science.gov (United States)

    Lam, Steve T.; Cho, Paul S.; Marks, Robert J., II; Narayanan, Sreeram

    2005-05-01

    Intraoperative dosimetry of prostate brachytherapy can help optimize the dose distribution and potentially improve clinical outcome. Evaluation of dose distribution during the seed implant procedure requires the knowledge of 3D seed coordinates. Fluoroscopy-based seed localization is a viable option. From three x-ray projections obtained at different gantry angles, 3D seed positions can be determined. However, when local anaesthesia is used for prostate brachytherapy, the patient movement during fluoroscopy image capture becomes a practical problem. If uncorrected, the errors introduced by patient motion between image captures would cause seed mismatches. Subsequently, the seed reconstruction algorithm would either fail to reconstruct or yield erroneous results. We have developed an algorithm that permits detection and correction of patient movement that may occur between fluoroscopy image captures. The patient movement is decomposed into translational shifts along the tabletop and rotation about an axis perpendicular to the tabletop. The property of spatial invariance of the co-planar imaging geometry is used for lateral movement correction. Cranio-caudal movement is corrected by analysing the perspective invariance along the x-ray axis. Rotation is estimated by an iterative method. The method can detect and correct for the range of patient movement commonly seen in the clinical environment. The algorithm has been implemented for routine clinical use as the preprocessing step for seed reconstruction.

  7. SU-F-J-157: Effect of Contouring Uncertainty in Post Implant Dosimetry of Low-Dose-Rate Prostate Permanent Seed Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Mashouf, S; Merino, T; Ravi, A; Morton, G; Song, W [Sunnybrook Health Sciences Center, Odette Cancer Centre, Toronto, ON (Canada); University of Toronto, Dept. of Radiation Oncology, Toronto, ON (Canada); Safigholi, H; Soliman, A [Sunnybrook Research Institute, Toronto, ON (Canada)

    2016-06-15

    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.

  8. 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.

  9. 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)

  10. High-Dose-Rate Brachytherapy as a Monotherapy for Favorable-Risk Prostate Cancer: A Phase II Trial

    International Nuclear Information System (INIS)

    Barkati, Maroie; Williams, Scott G.; Foroudi, Farshad; Tai, Keen Hun; Chander, Sarat; Dyk, Sylvia van; See, Andrew; Duchesne, Gillian M.

    2012-01-01

    Purpose: There are multiple treatment options for favorable-risk prostate cancer. High-dose-rate (HDR) brachytherapy as a monotherapy is appealing, but its use is still investigational. A Phase II trial was undertaken to explore the value of such treatment in low-to-intermediate risk prostate cancer. Methods and Materials: This was a single-institution, prospective study. Eligible patients had low-risk prostate cancer features but also Gleason scores of 7 (51% of patients) and stage T2b to T2c cancer. Treatment with HDR brachytherapy with a single implant was administered over 2 days. One of four fractionation schedules was used in a dose escalation study design: 3 fractions of 10, 10.5, 11, or 11.5 Gy. Patients were assessed with the Common Terminology Criteria for Adverse Events version 2.0 for urinary toxicity, the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring schema for rectal toxicity, and the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to measure patient-reported health-related quality of life. Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/ml. Results: Between 2003 and 2008, 79 patients were enrolled. With a median follow-up of 39.5 months, biochemical relapse occurred in 7 patients. Three- and 5-year actuarial biochemical control rates were 88.4% (95% confidence interval [CI], 78.0-96.2%) and 85.1% (95% CI, 72.5-94.5%), respectively. Acute grade 3 urinary toxicity was seen in only 1 patient. There was no instance of acute grade 3 rectal toxicity. Rates of late grade 3 rectal toxicity, dysuria, hematuria, urinary retention, and urinary incontinence were 0%, 10.3%, 1.3%, 9.0%, and 0%, respectively. No grade 4 or greater toxicity was recorded. Among the four (urinary, bowel, sexual, and hormonal) domains assessed with the EPIC questionnaire, only the sexual domain did not recover with time. Conclusions: HDR brachytherapy as a monotherapy for favorable

  11. High-Dose-Rate Brachytherapy as a Monotherapy for Favorable-Risk Prostate Cancer: A Phase II Trial

    Energy Technology Data Exchange (ETDEWEB)

    Barkati, Maroie [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Williams, Scott G., E-mail: scott.williams@petermac.org [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia); Foroudi, Farshad; Tai, Keen Hun; Chander, Sarat [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia); Dyk, Sylvia van [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); See, Andrew [Ballarat Austin Radiation Oncology Centre, Ballarat (Australia); Duchesne, Gillian M. [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia)

    2012-04-01

    Purpose: There are multiple treatment options for favorable-risk prostate cancer. High-dose-rate (HDR) brachytherapy as a monotherapy is appealing, but its use is still investigational. A Phase II trial was undertaken to explore the value of such treatment in low-to-intermediate risk prostate cancer. Methods and Materials: This was a single-institution, prospective study. Eligible patients had low-risk prostate cancer features but also Gleason scores of 7 (51% of patients) and stage T2b to T2c cancer. Treatment with HDR brachytherapy with a single implant was administered over 2 days. One of four fractionation schedules was used in a dose escalation study design: 3 fractions of 10, 10.5, 11, or 11.5 Gy. Patients were assessed with the Common Terminology Criteria for Adverse Events version 2.0 for urinary toxicity, the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring schema for rectal toxicity, and the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to measure patient-reported health-related quality of life. Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/ml. Results: Between 2003 and 2008, 79 patients were enrolled. With a median follow-up of 39.5 months, biochemical relapse occurred in 7 patients. Three- and 5-year actuarial biochemical control rates were 88.4% (95% confidence interval [CI], 78.0-96.2%) and 85.1% (95% CI, 72.5-94.5%), respectively. Acute grade 3 urinary toxicity was seen in only 1 patient. There was no instance of acute grade 3 rectal toxicity. Rates of late grade 3 rectal toxicity, dysuria, hematuria, urinary retention, and urinary incontinence were 0%, 10.3%, 1.3%, 9.0%, and 0%, respectively. No grade 4 or greater toxicity was recorded. Among the four (urinary, bowel, sexual, and hormonal) domains assessed with the EPIC questionnaire, only the sexual domain did not recover with time. Conclusions: HDR brachytherapy as a monotherapy for favorable

  12. 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)

  13. 103PD brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma

    International Nuclear Information System (INIS)

    Dattoli, Michael; Wallner, Kent; Sorace, Richard; Koval, John; Cash, Jennifer; Acosta, Rudolph; Brown, Charles; Etheridge, James; Binder, Michael; Brunelle, Richard; Kirwan, Novelle; Sanchez, Servando; Stein, Douglas; Wasserman, Stuart

    1996-01-01

    Purpose: To summarize biochemical failure rates and morbidity of external beam irradiation (EBRT) combined with palladium ( 103 Pd) boost for clinically localized high-risk prostate carcinoma. Methods and Materials: Seventy-three consecutive patients with stage T2a-T3 prostatic carcinoma were treated from 1991 through 1994. Each patient had at least one of the following risk factors for extracapsular disease extension: Stage T2b or greater (71 patients), Gleason score 7-10 (40 patients), prostate specific antigen (PSA) >15 (32 patients), or elevated prostatic acid phosphatase (PAP) (17 patients). Patients received 41 Gy EBRT to a limited pelvic field, followed 4 weeks later by a 103 Pd boost (prescription dose: 80 Gy). Biochemical failure was defined as a PSA greater than 1.0 ng/ml (normal 103 Pd brachytherapy for clinically localized, high-risk prostate cancer compare favorably with that reported after conventional dose EBRT alone. Morbidity has been acceptable

  14. 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

  15. 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)

  16. The impact of body mass index on dosimetric quality in low-dose-rate prostate brachytherapy

    Directory of Open Access Journals (Sweden)

    Michelle I. Echevarria

    2016-11-01

    Full Text Available Purpose : Low-dose-rate (LDR brachytherapy has been established as an effective and safe treatment option for men with low and intermediate risk prostate cancer. In this retrospective analysis, we sought to study the effect of body mass index (BMI on post-implant dosimetric quality. Material and methods : After institutional approval, records of patients with non-metastatic prostate cancer treated in Puerto Rico with LDR brachytherapy during 2008-2013 were reviewed. All patients were implanted with 125I seeds to a prescription dose of 145 Gy. Computed tomography (CT based dosimetry was performed 1 month after implant. Patients with at least 1 year of prostate-specific antigen (PSA follow-up were included. Factors predictive of adequate D90 coverage (≥ 140 Gy were compared via the Pearson χ2 or Wilcoxon rank-sum test as appropriate. Results : One-hundred and four patients were included in this study, with 53 (51% patients having a D90 ≥ 140 Gy. The only factor associated with a dosimetric coverage detriment (D90 < 140 Gy was BMI ≥ 25 kg/m2 (p = 0.03. Prostate volume (p = 0.26, initial PSA (p = 0.236, age (p = 0.49, hormone use (p = 0.93, percent of cores positive (p = 0.95, risk group (p = 0.24, tumor stage (p = 0.66, and Gleason score (p = 0.61 did not predict D90. Conclusions : In this study we show that BMI is a significant pre-implant predictor of D90 (< 140 Gy vs. ≥ 140 Gy. Although other studies have reported that prostate volume also affects D90, our study did not find this correlation to be statistically significant, likely because all of our patients had a prostate volume 140 Gy.

  17. 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)

  18. Ultrasonography-guided cobalt-60 brachytherapy for malignant glioma

    International Nuclear Information System (INIS)

    Sakai, Noboru; Takenaka, Katsunobu; Ueda, Tatsuya

    1989-01-01

    Brachytherapy with cobalt-60 source is reported. In this method it is characterized that the source is inserted interstitially with remote control system by after-loading method via outer catheter (using tandem tube), which was established in the center of residual tumor, using ultrasonography guide with trepanation, or intraoperatively put within the dead space after tumor resection. Six cases of deep-seated and recurrent malignant glioma, were treated with this method. A total dose of 20 to 45 Gy (10 to 15 Gy/day for 2 to 3 days) was delivered to the target. Additionally conventional external irradiation was followed. The effect of cobalt-60 brachytherapy on such tumors were favorable especially for well-circumscribed glioma less than 3 cm on CT scan. (author)

  19. Acute genitourinary toxicity after high dose rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: Second analysis to determine the correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity

    International Nuclear Information System (INIS)

    Akimoto, Tetsuo; Katoh, Hiroyuki; Noda, Shin-ei; Ito, Kazuto; Yamamoto, Takumi; Kashiwagi, Bunzo; Nakano, Takashi

    2005-01-01

    Purpose: We have been treating localized prostate cancer with high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiation therapy (EBRT) at our institution. We recently reported the existence of a correlation between the severity of acute genitourinary (GU) toxicity and the urethral radiation dose in HDR brachytherapy by using different fractionation schema. The purpose of this study was to evaluate the role of the urethral dose in the development of acute GU toxicity more closely than in previous studies. For this purpose, we conducted an analysis of patients who had undergone HDR brachytherapy with a fixed fractionation schema combined with hypofractionated EBRT. Methods and Materials: Among the patients with localized prostate cancer who were treated by 192-iridium HDR brachytherapy combined with hypofractionated EBRT at Gunma University Hospital between August 2000 and November 2004, we analyzed 67 patients who were treated by HDR brachytherapy with the fractionation schema of 9 Gy x two times combined with hypofractionated EBRT. Hypofractionated EBRT was administered at a fraction dose of 3 Gy three times weekly, and a total dose of 51 Gy was delivered to the prostate gland and 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-guided HDR brachytherapy. The planning target volume was defined as the prostate gland with a 5-mm margin all around, and the planning was conducted based on computed tomography images. The tumor stage was T1c in 13 patients, T2 in 31 patients, and T3 in 23 patients. The Gleason score was 2-6 in 12 patients, 7 in 34 patients, and 8-10 in 21 patients. Androgen ablation was performed in all the patients. The median follow-up duration was 11 months (range 3-24 months). The toxicities were graded based on the Radiation Therapy Oncology Group and the European Organization

  20. 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

  1. Fast cross-projection algorithm for reconstruction of seeds in prostate brachytherapy

    International Nuclear Information System (INIS)

    Narayanan, Sreeram; Cho, Paul S.; Marks, Robert J. II

    2002-01-01

    A fast method of seed matching and reconstruction in prostrate brachytherapy is proposed. Previous approaches have required all seeds to be matched with all other seeds in other projections. The fast cross-projection algorithm for the reconstruction of seeds (Fast-CARS) allows for matching of a given seed with a subset of seeds in other projections. This subset lies in a proximal region centered about the projection of a line, connecting the seed to its source, onto other projection planes. The proposed technique permits a significant reduction in computational overhead, as measured by the required number of matching tests. The number of multiplications and additions is also vastly reduced at no trade-off in accuracy. Because of its speed, Fast-CARS can be used in applications requiring real-time performance such as intraoperative dosimetry of prostate brachytherapy. Furthermore, the proposed method makes practical the use of a larger number of views as opposed to previous techniques limited to a maximum use of three views

  2. High dose rate brachytherapy for oral cancer.

    Science.gov (United States)

    Yamazaki, Hideya; Yoshida, Ken; Yoshioka, Yasuo; Shimizutani, Kimishige; Furukawa, Souhei; Koizumi, Masahiko; Ogawa, Kazuhiko

    2013-01-01

    Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer.

  3. Comparison of prostate contours between conventional stepping transverse imaging and Twister-based sagittal imaging in permanent interstitial prostate brachytherapy.

    Science.gov (United States)

    Kawakami, Shogo; Ishiyama, Hiromichi; Satoh, Takefumi; Tsumura, Hideyasu; Sekiguchi, Akane; Takenaka, Kouji; Tabata, Ken-Ichi; Iwamura, Masatsugu; Hayakawa, Kazushige

    2017-08-01

    To compare prostate contours on conventional stepping transverse image acquisitions with those on twister-based sagittal image acquisitions. Twenty prostate cancer patients who were planned to have permanent interstitial prostate brachytherapy were prospectively accrued. A transrectal ultrasonography probe was inserted, with the patient in lithotomy position. Transverse images were obtained with stepping movement of the transverse transducer. In the same patient, sagittal images were also obtained through rotation of the sagittal transducer using the "Twister" mode. The differences of prostate size among the two types of image acquisitions were compared. The relationships among the difference of the two types of image acquisitions, dose-volume histogram (DVH) parameters on the post-implant computed tomography (CT) analysis, as well as other factors were analyzed. The sagittal image acquisitions showed a larger prostate size compared to the transverse image acquisitions especially in the anterior-posterior (AP) direction ( p transverse image acquisitions was correlated to DVH parameters such as D 90 ( R = 0.518, p = 0.019), and V 100 ( R = 0.598, p = 0.005). There were small but significant differences in the prostate contours between the transverse and the sagittal planning image acquisitions. Furthermore, our study suggested that the differences between the two types of image acquisitions might correlated to dosimetric results on CT analysis.

  4. 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)

  5. Poster - 10: QA of Ultrasound Images for Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Szpala, Stanislaw; Kohli, Kirpal S. [BCCA-Fraser Valley Centre (Canada)

    2016-08-15

    Purpose: The current QA protocol of ultrasound systems used in prostate brachytherapy (TG128) addresses geometrical verifications, but the scope of evaluation of image quality is limited. We recognized importance of the latter in routine practice, and designed a protocol for QA of the images. Methods: Images of an ultrasound prostate phantom (CIRS053) were collected with BK Flex Focus 400. The images were saved as bmp after adjusting the gain to 50% for consistent results. Mean pixel values and signal to noise ratio were inspected in the representative sections of the phantom, including the mock prostate and the unechoic medium. Constancy of these numbers over a one year period was looked at. Results: The typical intensity in the mock prostate region in the transverse images ranged between 95 and 118 (out of 256), and the signal to noise was about 10. The intensity in the urethra region was about 170±40, and the unechoic medium was 2±2. The mean and the signal to noise ratio remained almost unchanged after a year, while the signal in the unechoic medium increased to about 7±4. Similar values were obtained in the sagittal images. Conclusions: The image analysis discussed above allows quick evaluation of constancy of the image quality. This may be also useful in troubleshooting image-quality problems during routine exams, which might not be due to deterioration of the US system, but other reasons, e.g. variations in tissue properties or air being trapped between the probe and the anatomy.

  6. Health related quality of life patterns in patients treated with interstitial prostate brachytherapy for localized prostate cancer--data from CaPSURE.

    Science.gov (United States)

    Downs, Tracy M; Sadetsky, Natalia; Pasta, David J; Grossfeld, Gary D; Kane, Christopher J; Mehta, Shilpa S; Carroll, Peter R; Lubeck, Deborah P

    2003-11-01

    We measured the impact brachytherapy monotherapy (BMT) has on general and disease specific health related quality of life (HRQOL) compared to patients treated with radical prostatectomy (RP). We studied 419 men with newly diagnosed prostate cancer who enrolled in CaPSURE (Cancer of the Prostate Strategic Urological Research Endeavor) data base whose primary treatment was brachytherapy monotherapy (92) or radical prostatectomy (327). The validated RAND 36-Item Health Survey and the UCLA Prostate Cancer Index were used to measure HRQOL before treatment and at 6-month intervals during the first 2 years after treatment. Patients treated with BMT or RP did not differ greatly in general HRQOL after treatment. Both treatment groups showed early functional impairment in most general domains with scores returning to or approaching baseline in most domains 18 to 24 months after treatment. Patients treated with BMT had significantly higher urinary function scores at 0 to 6 months after treatment (84.5, SD 18.7) than patients treated with RP (63.3, SD 26.6). Urinary bother scores at 0 to 6 months after treatment were not significantly different between patients treated with BMT (67.7, SD 31.2) and those treated with RP (67.4, SD 29.1). Both treatment groups had decreases in sexual function that did not return to pretreatment levels. Overall BMT and RP are well tolerated procedures that cause mild changes in general HRQOL. Disease specific HRQOL patterns are different in patients treated with BMT or RP. Baseline and serial HRQOL measurements after treatment can provide valuable information regarding expected quality of life outcome after treatment for localized prostate cancer.

  7. WE-FG-BRA-02: Docetaxel Eluting Brachytherapy Spacers for Local Chemo-Radiation Therapy in Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Belz, J [Northeastern University, Boston, MA (United States); Kumar, R; Sridhar, S [Northeastern University & Dana Farber Cancer Institute, Boston, MA (United States); Makrigiorgos, G; Nguyen, P [Dana Farber Cancer Institute, Boston, MA (United States); D’Amico, A [Brigham & Women’s Hospital, Boston, MA (United States); Cormack, R [Harvard Medical School, Boston, MA (United States)

    2016-06-15

    Purpose: We propose an innovative combinatorial treatment strategy of Local ChemoRadiation Therapy (LCRT) using a sustained drug delivery platform in the form of a spacer to locally radio-sensitize the prostate with Docetaxel (DTX) enabling a synergistic cure with the use of lower radiation doses. These biodegradable spacers are physically similar to the inert spacers routinely used in prostate brachytherapy but are now loaded with formulations of DTX. Methods: Spacers were loaded with ∼500µg Docetaxel (DTX) for prostate cancer studies. The implants were characterized in vitro using SEM and HPLC. The release kinetic studies were carried out in buffer (pH 6.0) at 37°C. Subcutaneous PC3 tumors were xenografted in nude mice. Prostate cancer studies were done with and without radiation using SARRP at 5Gy, 10Gy, and 15Gy. Drug-loaded implants were injected once intratumorally using an 18G brachytherapy needle. Results: The release study in vitro showed a highly sustained release for multiple weeks at therapeutically relevant doses. The monotherapy with local DTX spacer showed sustained tumor inhibition compared to empty implants and an equivalent DTX dose given systemically. At 40 days, 89% survival was observed for mice treated with DTX implants compared with 0% in all other treatment groups. The combined treatment with local DTX spacer and radiation (10Gy) showed the highest degree of tumor suppression (significant tumor growth inhibition by day 90). The control mice showed continuous tumor growth and were scarified by day 56. Groups of mice treated with DTX-spacer or radiation alone showed initial tumor suppression but growth continued after day 60. A larger experiment is ongoing. Conclusion: This approach provides localized delivery of the chemotherapeutic sensitizer directly to the tumor and avoids the toxicities associated with both brachytherapy and current systemic delivery of docetaxel. Sustained release of DTX is an effective chemotherapy option alone or

  8. Development of a tapping device: a new needle insertion method for prostate brachytherapy

    International Nuclear Information System (INIS)

    Lagerburg, V; Moerland, M A; Konings, M K; Vosse, R E van de; Lagendijk, J J W; Battermann, J J

    2006-01-01

    The purpose of this study is to develop and test a tapping device for needle insertion for prostate brachytherapy. This device will tap the needle into the prostate with a certain, well-defined, amount of momentum, instead of the currently used method of pushing the needle. Because of the high needle insertion velocity, we expect prostate motion and deformation to be less compared to current methods. We measured the momentum that is applied when manually tapping the needle into the prostate and found a mean momentum of 0.50 ± 0.07 N s. The tapping device is pneumatically driven and we found that the delivered momentum increased linearly with the applied air pressure. The efficacy of the tapping device was tested on a piece of beef, placed on a freely moving and rotating platform. A significant correlation was found between the applied pressure and the rotation and displacement of the beef. Displacements and rotations were minimal for the highest pressure (4 bar) and amounted to only 2 mm and 6 deg., respectively. Higher air pressures will further reduce displacements and rotations

  9. CT-guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver malignancies; CT-gesteuerte Brachytherapie. Eine neue perkutane Technik zur interstitiellen Ablation von Lebermetastasen

    Energy Technology Data Exchange (ETDEWEB)

    Ricke, J.; Wust, P.; Stohlmann, A.; Beck, A.; Cho, C.H.; Pech, M.; Wieners, G.; Spors, B.; Werk, M.; Rosner, C.; Haenninen, E.L.; Felix, R. [Klinik fuer Strahlenheilkunde, Charite Virchow-Klinikum, Humboldt-Univ. zu Berlin (Germany)

    2004-05-01

    Purpose: to assess safety and efficacy of CT-guided brachytherapy of liver malignancies. Patients and methods: 21 patients with 21 liver malignancies (19 metastases, two primary liver tumors) were treated with interstitial CT-guided brachytherapy applying a {sup 192}Ir source. In all patients, the use of image-guided thermal tumor ablation such as by radiofrequency or laser-induced thermotherapy (LITT) was impeded either by tumor size {>=} 5 cm in seven, adjacent portal or hepatic vein in ten, or adjacent bile duct bifurcation in four patients. Dosimetry was performed using three-dimensional CT data sets acquired after CT-guided positioning of the brachytherapy catheters. Results: the mean tumor diameter was 4.6 cm (2.5-11 cm). The mean minimal tumor dose inside the tumor margin amounted to 17 Gy (12-20 Gy). The proportion of the liver parenchyma exposed to > 5 gy was 18% (5-39%) of total liver parenchyma minus tumor volume. Nausea and vomiting were observed in six patients after brachytherapy (28%). One patient demonstrated obstructive jaundice due to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. We commonly encountered asymptomatic increases of liver enzymes. Local control rates after 6 and 12 months were 87% and 70%, respectively. Conclusion: CT-guided brachytherapy is safe and effective. This technique displays broader indications compared to image-guided thermal ablation by radiofrequency or LITT with respect to tumor size or localization. (orig.) [German] Ziel: Analyse der Sicherheit und Effektivitaet CT-gesteuerter Brachytherapie zur Ablation von Lebermalignomen. Patienten und Methodik: 21 Patienten mit 21 Lebermalignomen (19 Metastasen, zwei primaere Lebermalignome) wurden mit perkutaner, CT-gesteuerter interstitieller Brachytherapie mit {sup 192}Ir behandelt. Alle Patienten wiesen Umstaende auf, die eine bildgefuehrte thermische Ablation mit Radiofrequenz oder laserinduzierter Thermotherapie (LITT) einschraenkten

  10. Impact of prostate edema on cell survival and tumor control after permanent interstitial brachytherapy for early stage prostate cancers

    Science.gov (United States)

    Chen, Zhe (Jay); Roberts, Kenneth; Decker, Roy; Pathare, Pradip; Rockwell, Sara; Nath, Ravinder

    2011-01-01

    Previous studies have shown that the procedure-induced prostate edema during permanent interstitial brachytherapy (PIB) can cause significant variations in the dose delivered to the prostate gland. Because the clinical impact of edema-induced dose variations depends strongly on the magnitude of the edema, the temporal pattern of its resolution and its interplay with the decay of radioactivity and the underlying biological processes of tumor cells (such as tumor potential doubling time), we investigated the impact of edema-induced dose variations on the tumor cell survival and tumor control probability after PIB with the 131Cs, 125I and 103Pd sources used in current clinical practice. The exponential edema resolution model reported by Waterman et al. (Int. J. Radiat. Oncol. Biol. Phys. 41, 1069–1077–1998) was used to characterize the edema evolutions observed previously during clinical PIB for prostate cancer. The concept of biologically effective dose (BED), taking into account tumor cell proliferation and sublethal damage repair during dose delivery, was used to characterize the effects of prostate edema on cell survival and tumor control probability. Our calculation indicated that prostate edema, if not taken into account appropriately, can increase the cell survival and decrease the probability of local control of PIB. The edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life for radioactive decay and decreasing energy of the photons energy emitted by the source. At the doses currently prescribed for PIB and for prostate cancer cells characterized by nominal radiobiology parameters recommended by AAPM TG-137, PIB using 125I sources was less affected by edema than PIB using 131Cs or 103Pd sources due to the long radioactive decay half-life of 125I. The effect of edema on PIB using 131Cs or 103Pd was similar. The effect of edema on 103Pd PIB was slightly greater, even though the decay half-life of 103Pd (17 days

  11. High dose rate brachytherapy for oral cancer

    International Nuclear Information System (INIS)

    Yamazaki, Hideya; Yoshida, Ken; Yoshioka, Yasuo; Shimizutani, Kimishige; Koizumi, Masahiko; Ogawa, Kazuhiko; Furukawa, Souhei

    2013-01-01

    Brachytherapy results in better dose distribution compared with other treatments because of steep dose reduction in the surrounding normal tissues. Excellent local control rates and acceptable side effects have been demonstrated with brachytherapy as a sole treatment modality, a postoperative method, and a method of reirradiation. Low-dose-rate (LDR) brachytherapy has been employed worldwide for its superior outcome. With the advent of technology, high-dose-rate (HDR) brachytherapy has enabled health care providers to avoid radiation exposure. This therapy has been used for treating many types of cancer such as gynecological cancer, breast cancer, and prostate cancer. However, LDR and pulsed-dose-rate interstitial brachytherapies have been mainstays for head and neck cancer. HDR brachytherapy has not become widely used in the radiotherapy community for treating head and neck cancer because of lack of experience and biological concerns. On the other hand, because HDR brachytherapy is less time-consuming, treatment can occasionally be administered on an outpatient basis. For the convenience and safety of patients and medical staff, HDR brachytherapy should be explored. To enhance the role of this therapy in treatment of head and neck lesions, we have reviewed its outcomes with oral cancer, including Phase I/II to Phase III studies, evaluating this technique in terms of safety and efficacy. In particular, our studies have shown that superficial tumors can be treated using a non-invasive mold technique on an outpatient basis without adverse reactions. The next generation of image-guided brachytherapy using HDR has been discussed. In conclusion, although concrete evidence is yet to be produced with a sophisticated study in a reproducible manner, HDR brachytherapy remains an important option for treatment of oral cancer. (author)

  12. Oncological outcome, complications, lower urinary tract symptoms, and health-related quality of life after low-dose-rate salvage brachytherapy for recurrent prostate cancer following primary radiotherapy: a report of 8 cases

    Directory of Open Access Journals (Sweden)

    Makito Miyake

    2017-07-01

    Full Text Available Purpose: We evaluated our experience with low-dose-rate salvage brachytherapy for local recurrence after primary prostate radiotherapy, and described the changes in lower urinary tract symptoms and health-related quality of life. Material and methods: Between 2011 and 2016, eight men with local recurrence after primary prostate radiotherapy underwent iodine-125 salvage brachytherapy with a prescribed dose of 110 or 145 Gy. Recurrence-free survival was evaluated with a post-treatment prostate-specific antigen profile. The toxicity and changes in lower urinary tract symptoms and health-related quality of life during the follow-up were evaluated on the Common Terminology Criteria for Adverse Events version 4.0, International Prostate Symptom Score, Short Form-8, and Expanded Prostate Cancer Index Composite, respectively. Results: The median follow-up was 12.2 months (range, 8.3-71.9 after salvage brachytherapy. Of all eight patients, two (25% experienced treatment failure, one of whom developed left seminal vesicle recurrence 36 months after salvage brachytherapy for the right seminal vesicle recurrence, while the other developed bone metastases after 6 months. The International Prostate Symptom Scores peaked at 3 months, and returned to baseline by 6 months. The scores of all domains of health-related quality of life remained unchanged during the 12-month follow-up after salvage brachytherapy. Early grade ≤ 2 genitourinary toxicity was observed in five patients (63%, and late grade 2 gastrointestinal toxicity in one patient (13% having persistent diarrhea. No patient required intermittent catheterization and no grade 3 or greater toxicity occurred during follow-up. Conclusions: The present study is our experiment of eight patients undergoing salvage brachytherapy, suggesting that this modality is noninvasive, safe, and an effective salvage local treatment in selected patients. To our knowledge, this is the first study to evaluate lower urinary

  13. A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: A radiobiological modeling study

    Energy Technology Data Exchange (ETDEWEB)

    Fatyga, M.; Williamson, J. F.; Dogan, N.; Todor, D.; Siebers, J. V.; George, R.; Barani, I.; Hagan, M. [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, 401 College Street, Richmond, Virginia 23298 (United States)

    2009-09-15

    A course of one to three large fractions of high dose rate (HDR) interstitial brachytherapy is an attractive alternative to intensity modulated radiation therapy (IMRT) for delivering boost doses to the prostate in combination with additional external beam irradiation for intermediate risk disease. The purpose of this work is to quantitatively compare single-fraction HDR boosts to biologically equivalent fractionated IMRT boosts, assuming idealized image guided delivery (igIMRT) and conventional delivery (cIMRT). For nine prostate patients, both seven-field IMRT and HDR boosts were planned. The linear-quadratic model was used to compute biologically equivalent dose prescriptions. The cIMRT plan was evaluated as a static plan and with simulated random and setup errors. The authors conclude that HDR delivery produces a therapeutic ratio which is significantly better than the conventional IMRT and comparable to or better than the igIMRT delivery. For the HDR, the rectal gBEUD analysis is strongly influenced by high dose DVH tails. A saturation BED, beyond which no further injury can occur, must be assumed. Modeling of organ motion uncertainties yields mean outcomes similar to static plan outcomes.

  14. SU-G-JeP2-14: MRI-Based HDR Prostate Brachytherapy: A Phantom Study for Interstitial Catheter Reconstruction with 0.35T MRI Images

    International Nuclear Information System (INIS)

    Park, S; Kamrava, M; Yang, Y

    2016-01-01

    Purpose: To evaluate the accuracy of interstitial catheter reconstruction with 0.35T MRI images for MRI-based HDR prostate brachytherapy. Methods: Recently, a real-time MRI-guided radiotherapy system combining a 0.35T MRI system and three cobalt 60 heads (MRIdian System, ViewRay, Cleveland, OH, USA) was installed in our department. A TrueFISP sequence for MRI acquisition at lower field on Viewray was chosen due to its fast speed and high signal-to-noise efficiency. Interstitial FlexiGuide needles were implanted into a tissue equivalent ultrasound prostate phantom (CIRS, Norfolk, Virginia, USA). After an initial 15s pilot MRI to confirm the location of the phantom, planning MRI was acquired with a 172s TrueFISP sequence. The pulse sequence parameters included: flip angle = 60 degree, echo time (TE) =1.45 ms, repetition time (TR) = 3.37 ms, slice thickness = 1.5 mm, field of view (FOV) =500 × 450mm. For a reference image, a CT scan was followed. The CT and MR scans were then fused with the MIM Maestro (MIM software Inc., Cleveland, OH, USA) and sent to the Oncentra Brachy planning system (Elekta, Veenendaal, Netherlands). Automatic catheter reconstruction using CT and MR image intensities followed by manual reconstruction was used to digitize catheters. The accuracy of catheter reconstruction was evaluated from the catheter tip location. Results: The average difference between the catheter tip locations reconstructed from the CT and MR in the transverse, anteroposterior, and craniocaudal directions was −0.1 ± 0.1 mm (left), 0.2 ± 0.2 mm (anterior), and −2.3 ± 0.5 mm (cranio). The average distance in 3D was 2.3 mm ± 0.5 mm. Conclusion: This feasibility study proved that interstitial catheters can be reconstructed with 0.35T MRI images. For more accurate catheter reconstruction which can affect final dose distribution, a systematic shift should be applied to the MR based catheter reconstruction in HDR prostate brachytherapy.

  15. High-Dose-Rate Brachytherapy Boost for Prostate Cancer: Comparison of Two Different Fractionation Schemes

    International Nuclear Information System (INIS)

    Kaprealian, Tania; Weinberg, Vivian; Speight, Joycelyn L.; Gottschalk, Alexander R.; Roach, Mack; Shinohara, Katsuto; Hsu, I.-Chow

    2012-01-01

    Purpose: This is a retrospective study comparing our experience with high-dose-rate (HDR) brachytherapy boost for prostate cancer, using two different fractionation schemes, 600 cGy × 3 fractions (patient group 1) and 950 cGy × 2 fractions (patient group 2). Methods and Materials: A total of 165 patients were treated for prostate cancer using external beam radiation therapy up to a dose of 45 Gy, followed by an HDR brachytherapy prostate radiation boost. Between July 1997 and Nov 1999, 64 patients were treated with an HDR boost of 600 cGy × 3 fractions; and between June 2000 and Nov 2005, 101 patients were treated with an HDR boost of 950 cGy × 2 fractions. All but 9 patients had at least one of the following risk features: pretreatment prostate-specific antigen (PSA) level >10, a Gleason score ≥7, and/or clinical stage T3 disease. Results: Median follow-up was 105 months for group 1 and 43 months for group 2. Patients in group 2 had a greater number of high-risk features than group 1 (p = 0.02). Adjusted for comparable follow-up, there was no difference in biochemical no-evidence-of-disease (bNED) rate between the two fractionation scheme approaches, with 5-year Kaplan-Meier estimates of 93.5% in group 1 and 87.3% in group 2 (p = 0.19). The 5-year estimates of progression-free survival were 86% for group 1 and 83% for group 2 (p = 0.53). Among high-risk patients, there were no differences in bNED or PFS rate due to fractionation. Conclusions: Results were excellent for both groups. Adjusted for comparable follow-up, no differences were found between groups.

  16. MO-B-BRC-02: Ultrasound Based Prostate HDR

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Z. [Duke University Medical Center (United States)

    2016-06-15

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.

  17. MO-B-BRC-02: Ultrasound Based Prostate HDR

    International Nuclear Information System (INIS)

    Chang, Z.

    2016-01-01

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions

  18. MO-B-BRC-04: MRI-Based Prostate HDR

    International Nuclear Information System (INIS)

    Mourtada, F.

    2016-01-01

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions

  19. MO-B-BRC-03: CT-Based Prostate HDR

    International Nuclear Information System (INIS)

    Zoberi, J.

    2016-01-01

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions

  20. MO-B-BRC-04: MRI-Based Prostate HDR

    Energy Technology Data Exchange (ETDEWEB)

    Mourtada, F. [Christiana Care Hospital (United States)

    2016-06-15

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.

  1. MO-B-BRC-03: CT-Based Prostate HDR

    Energy Technology Data Exchange (ETDEWEB)

    Zoberi, J. [Washington University School of Medicine (United States)

    2016-06-15

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.

  2. 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)

  3. A quantitative analysis of two-dimensional manually segmented transrectal ultrasound axial images in planning high dose rate brachytherapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Dabić-Stanković Kata

    2017-01-01

    Full Text Available Background/Aim. Prostate delineation, pre-planning and catheter implantation procedures, in high-dose rate brachytherapy (HDR-BT, are commonly based on the prostate manually segmented transrectal ultrasound (TRUS images. The aim of this study was to quantitatively analyze the consistency of prostate capsule delineation, done by a single therapist, prior to each HDR-BT fraction and the changes in the shape of the prostate capsule during HDR-BT, using two dimensional (2D TRUS axial image. Methods. A group of 16 patients were treated at the Medical System Belgrade Brachytherapy Department with definitive HDRBT. The total applied median dose of 52 Gy was divided into four individual fractions, each fraction being delivered 2– 3 weeks apart. Real time prostate axial visualization and the manual segmentation prior to each fraction were performed using B-K Medical ultrasound. Quantitative analyses, analysis of an area and shape were applied on 2D-TRUS axial images of the prostate. Area analyses were used to calculate the average value of the cross-sectional area of the prostate image. The parameters of the prostate shape, the fractal dimension and the circularity ratio of the prostate capsule contour were estimated at the maximum axial cross section of the prostate image. Results. The sample group consisted of four phases, each phase being performed prior to the first, second, third and fourth HDR-BT fraction, respectively. Statistical analysis showed that during HDR-BT fractions there were no significant differences in the average value of area, as well as in the maximum shape of prostate capsule. Conclusions. Quantitative analysis of TRUS axial prostate segmented images shows a successful capsule delineation in the series of manually segmented TRUS images, and the prostate maximum shape remaining unchanged during HDR-BT fractions.

  4. Simulation of measurement absorbed dose on prostate brachytherapy with radius of prostate 2 cm using MCNP5 with seed implant model isoaid AdvantageTM IAPd-103A

    International Nuclear Information System (INIS)

    Poundra Setiawan; Suharyana; Riyatun

    2015-01-01

    Simulation of measurement absorbed dose on prostate brachytherapy with radius of prostate 2 cm using MCNP5 with seed implant model IsoAid Advantage TM IAPd-103A has been conducted. 103 Pd used as a radioactive source in the seed implant and it has energy gamma emission 20,8 keV with half live 16,9 days and has activity 4 mCi. The prostate cancer is modeled with spherical and it has radius 3 cm, after planting the seed implant 103 Pdover 24,4 days, prostate cancer has absorbed dose 2,172Gy. Lethal dose maximum use 103 Pd is 125 Gy and it was reached with 59 seeds. (author)

  5. Robustness of IPSA optimized high-dose-rate prostate brachytherapy treatment plans to catheter displacements.

    Science.gov (United States)

    Poder, Joel; Whitaker, May

    2016-06-01

    Inverse planning simulated annealing (IPSA) optimized brachytherapy treatment plans are characterized with large isolated dwell times at the first or last dwell position of each catheter. The potential of catheter shifts relative to the target and organs at risk in these plans may lead to a more significant change in delivered dose to the volumes of interest relative to plans with more uniform dwell times. This study aims to determine if the Nucletron Oncentra dwell time deviation constraint (DTDC) parameter can be optimized to improve the robustness of high-dose-rate (HDR) prostate brachytherapy plans to catheter displacements. A set of 10 clinically acceptable prostate plans were re-optimized with a DTDC parameter of 0 and 0.4. For each plan, catheter displacements of 3, 7, and 14 mm were retrospectively applied and the change in dose volume histogram (DVH) indices and conformity indices analyzed. The robustness of clinically acceptable prostate plans to catheter displacements in the caudal direction was found to be dependent on the DTDC parameter. A DTDC value of 0 improves the robustness of planning target volume (PTV) coverage to catheter displacements, whereas a DTDC value of 0.4 improves the robustness of the plans to changes in hotspots. The results indicate that if used in conjunction with a pre-treatment catheter displacement correction protocol and a tolerance of 3 mm, a DTDC value of 0.4 may produce clinically superior plans. However, the effect of the DTDC parameter in plan robustness was not observed to be as strong as initially suspected.

  6. 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.

  7. Poster - 09: A MATLAB-based Program for Automated Quality Assurance of a Prostate Brachytherapy Ultrasound System

    Energy Technology Data Exchange (ETDEWEB)

    Poon, Justin; Sabondjian, Eric; Sankreacha, Raxa [University of British Columbia, Dept. of Physics and Astronomy, Vancouver, BC (Canada); Trillium Health Partners – Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, ON, Trillium Health Partners – Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, ON, Trillium Health Partners – Credit Valley Hospital, Peel Regional Cancer Centre, Mississauga, ON (Canada); University of Toronto, Dept. of Radiation Oncology, Toronto, ON (Canada)

    2016-08-15

    Purpose: A robust Quality Assurance (QA) program is essential for prostate brachytherapy ultrasound systems due to the importance of imaging accuracy during treatment and planning. Task Group 128 of the American Association of Physicists in Medicine has recommended a set of QA tests covering grayscale visibility, depth of penetration, axial and lateral resolution, distance measurement, area measurement, volume measurement, and template/electronic grid alignment. Making manual measurements on the ultrasound system can be slow and inaccurate, so a MATLAB program was developed for automation of the described tests. Methods: Test images were acquired using a BK Medical Flex Focus 400 ultrasound scanner and 8848 transducer with the CIRS Brachytherapy QA Phantom – Model 045A. For each test, the program automatically segments the inputted image(s), makes the appropriate measurements, and indicates if the test passed or failed. The program was tested by analyzing two sets of images, where the measurements from the first set were used as baseline values. Results: The program successfully analyzed the images for each test and determined if any action limits were exceeded. All tests passed – the measurements made by the program were consistent and met the requirements outlined by Task Group 128. Conclusions: The MATLAB program we have developed can be used for automated QA of an ultrasound system for prostate brachytherapy. The GUI provides a user-friendly way to analyze images without the need for any manual measurement, potentially removing intra- and inter-user variability for more consistent results.

  8. Poster - 09: A MATLAB-based Program for Automated Quality Assurance of a Prostate Brachytherapy Ultrasound System

    International Nuclear Information System (INIS)

    Poon, Justin; Sabondjian, Eric; Sankreacha, Raxa

    2016-01-01

    Purpose: A robust Quality Assurance (QA) program is essential for prostate brachytherapy ultrasound systems due to the importance of imaging accuracy during treatment and planning. Task Group 128 of the American Association of Physicists in Medicine has recommended a set of QA tests covering grayscale visibility, depth of penetration, axial and lateral resolution, distance measurement, area measurement, volume measurement, and template/electronic grid alignment. Making manual measurements on the ultrasound system can be slow and inaccurate, so a MATLAB program was developed for automation of the described tests. Methods: Test images were acquired using a BK Medical Flex Focus 400 ultrasound scanner and 8848 transducer with the CIRS Brachytherapy QA Phantom – Model 045A. For each test, the program automatically segments the inputted image(s), makes the appropriate measurements, and indicates if the test passed or failed. The program was tested by analyzing two sets of images, where the measurements from the first set were used as baseline values. Results: The program successfully analyzed the images for each test and determined if any action limits were exceeded. All tests passed – the measurements made by the program were consistent and met the requirements outlined by Task Group 128. Conclusions: The MATLAB program we have developed can be used for automated QA of an ultrasound system for prostate brachytherapy. The GUI provides a user-friendly way to analyze images without the need for any manual measurement, potentially removing intra- and inter-user variability for more consistent results.

  9. The impact of prostate edema on cell survival and tumor control after permanent interstitial brachytherapy for early stage prostate cancers

    International Nuclear Information System (INIS)

    Chen Zhe; Roberts, Kenneth; Decker, Roy; Pathare, Pradip; Rockwell, Sara; Nath, Ravinder

    2011-01-01

    Previous studies have shown that procedure-induced prostate edema during permanent interstitial brachytherapy (PIB) can cause significant variations in the dose delivered to the prostate gland. Because the clinical impact of edema-induced dose variations strongly depends on the magnitude of the edema, the temporal pattern of its resolution and its interplay with the decay of radioactivity and the underlying biological processes of tumor cells (such as tumor potential doubling time), we investigated the impact of edema-induced dose variations on the tumor cell survival and tumor control probability after PIB with the 131 Cs, 125 I and 103 Pd sources used in current clinical practice. The exponential edema resolution model reported by Waterman et al (1998 Int. J. Radiat. Oncol. Biol. Phys. 41 1069-77) was used to characterize the edema evolutions previously observed during clinical PIB for prostate cancer. The concept of biologically effective dose, taking into account tumor cell proliferation and sublethal damage repair during dose delivery, was used to characterize the effects of prostate edema on cell survival and tumor control probability. Our calculation indicated that prostate edema, if not appropriately taken into account, can increase the cell survival and decrease the probability of local control of PIB. The magnitude of an edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life of radioactive decay and decreasing photon energy emitted by the source. At the doses currently prescribed for PIB and for prostate cancer cells characterized by nominal radiobiology parameters recommended by AAPM TG-137, PIB using 125 I sources was less affected by edema than PIB using 131 Cs or 103 Pd sources due to the long radioactive decay half-life of 125 I. The effect of edema on PIB using 131 Cs or 103 Pd was similar. The effect of edema on 103 Pd PIB was slightly greater, even though the decay half-life of 103 Pd (17 days) is

  10. Brachytherapy Boost Utilization and Survival in Unfavorable-risk Prostate Cancer.

    Science.gov (United States)

    Johnson, Skyler B; Lester-Coll, Nataniel H; Kelly, Jacqueline R; Kann, Benjamin H; Yu, James B; Nath, Sameer K

    2017-11-01

    There are limited comparative survival data for prostate cancer (PCa) patients managed with a low-dose rate brachytherapy (LDR-B) boost and dose-escalated external-beam radiotherapy (DE-EBRT) alone. To compare overall survival (OS) for men with unfavorable PCa between LDR-B and DE-EBRT groups. Using the National Cancer Data Base, we identified men with unfavorable PCa treated between 2004 and 2012 with androgen suppression (AS) and either EBRT followed by LDR-B or DE-EBRT (75.6-86.4Gy). Treatment selection was evaluated using logistic regression and annual percentage proportions. OS was analyzed using the Kaplan-Meier method, log-rank test, Cox proportional hazards, and propensity score matching. We identified 25038 men between 2004 and 2012, during which LDR-B boost utilization decreased from 29% to 14%. LDR-B was associated with better OS on univariate (7-yr OS: 82% vs 73%; pLDR-B boost (HR 0.74, 95% CI 0.66-0.89). The OS benefit of LDR-B boost persisted when limited to men aged LDR-B boost utilization declined and was associated with better OS compared to DE-EBRT alone. LDR-B boost is probably the ideal treatment option for men with unfavorable PCa, pending long-term results of randomized trials. We compared radiotherapy utilization and survival for prostate cancer (PCa) patients using a national database. We found that low-dose rate brachytherapy (LDR-B) boost, a method being used less frequently, was associated with better overall survival when compared to dose-escalated external-beam radiotherapy alone for men with unfavorable PCa. Randomized trials are needed to confirm that LDR-B boost is the ideal treatment. Copyright © 2017 European Association of Urology. Published by Elsevier B.V. All rights reserved.

  11. Brachytherapy boost and cancer-specific mortality in favorable high-risk versus other high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Vinayak Muralidhar

    2016-02-01

    Full Text Available Purpose : Recent retrospective data suggest that brachytherapy (BT boost may confer a cancer-specific survival benefit in radiation-managed high-risk prostate cancer. We sought to determine whether this survival benefit would extend to the recently defined favorable high-risk subgroup of prostate cancer patients (T1c, Gleason 4 + 4 = 8, PSA 20 ng/ml. Material and methods: We identified 45,078 patients in the Surveillance, Epidemiology, and End Results database with cT1c-T3aN0M0 intermediate- to high-risk prostate cancer diagnosed 2004-2011 treated with external beam radiation therapy (EBRT only or EBRT plus BT. We used multivariable competing risks regression to determine differences in the rate of prostate cancer-specific mortality (PCSM after EBRT + BT or EBRT alone in patients with intermediate-risk, favorable high-risk, or other high-risk disease after adjusting for demographic and clinical factors. Results : EBRT + BT was not associated with an improvement in 5-year PCSM compared to EBRT alone among patients with favorable high-risk disease (1.6% vs. 1.8%; adjusted hazard ratio [AHR]: 0.56; 95% confidence interval [CI]: 0.21-1.52, p = 0.258, and intermediate-risk disease (0.8% vs. 1.0%, AHR: 0.83, 95% CI: 0.59-1.16, p = 0.270. Others with high-risk disease had significantly lower 5-year PCSM when treated with EBRT + BT compared with EBRT alone (3.9% vs. 5.3%; AHR: 0.73; 95% CI: 0.55-0.95; p = 0.022. Conclusions : Brachytherapy boost is associated with a decreased rate of PCSM in some men with high-risk prostate cancer but not among patients with favorable high-risk disease. Our results suggest that the recently-defined “favorable high-risk” category may be used to personalize therapy for men with high-risk disease.

  12. Magnetic resonance image-guided brachytherapy for cervical cancer. Prognostic factors for survival

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yeon-Joo; Kim, Joo-Young [National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); National Cancer Center, Center for Uterine Cancer, Goyang (Korea, Republic of); Kim, Youngkyong; Lim, Young Kyung; Jeong, Jonghwi [National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Jeong, Chiyoung [National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); University of Ulsan College of Medicine, Department of Radiation Oncology, Asan Medical Center, Seoul (Korea, Republic of); Kim, Meyoung [National Cancer Center, Proton Therapy Center, Goyang (Korea, Republic of); Dongnam Inst. of Radiology and Medical Sciences, Research center, Busan (Korea, Republic of); Lim, Myong Cheol; Seo, Sang-Soo; Park, Sang-Yoon [National Cancer Center, Center for Uterine Cancer, Goyang (Korea, Republic of)

    2016-12-15

    The purpose of this work was to identify prognostic factors for survival after magnetic resonance image (MRI)-guided brachytherapy combined with external beam radiotherapy for cervical cancer. External beam radiotherapy of 45-50.4 Gy was delivered by either three-dimensional conformal radiotherapy or helical tomotherapy. Patients also received high-dose-rate MRI-guided brachytherapy of 5 Gy in 6 fractions. We analyzed 128 patients with International Federation of Gynecology and Obstetrics stage IB-IVB cervical cancer who underwent MRI-guided brachytherapy. Most patients (96 %) received concurrent chemotherapy. Pelvic lymph node metastases and para-aortic lymphadenopathies were found in 62 % and 14 % of patients, respectively. The median follow-up time was 44 months. Complete remission was achieved in 119 of 128 patients (93 %). The 5-year local recurrence-free, cancer-specific, and overall survival rates were 94, 89, and 85 %, respectively. Negative pelvic lymphadenopathy, gross tumor volume (GTV) dose covering 90 % of the target (GTV D90) of >110 Gy, and treatment duration ≤56 days were associated with better overall survival in univariate analyses. Multivariable analysis showed that GTV D90 of >110 Gy and treatment duration ≤56 days were possibly associated with overall survival with near-significant P-values of 0.062 and 0.073, respectively. The outcome of MRI-guided brachytherapy combined with external beam radiotherapy in patients with cervical cancer was excellent. GTV D90 of >110 Gy and treatment duration ≤56 days were potentially associated with overall survival. (orig.) [German] Ziel der Arbeit war es, prognostische Faktoren nach magnetresonanztomographisch (MRT-)gesteuerter Brachytherapie in Verbindung mit externer Strahlentherapie fuer Gebaermutterhalskrebs zu identifizieren. Externe Strahlentherapie von 45-50,4 Gy erfolgte entweder mittels dreidimensionaler konformaler Strahlentherapie oder helikaler Tomotherapie. Die Patientinnen erhielten auch

  13. 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

  14. Whole-Pelvis Radiotherapy in Combination With Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High-Risk Prostate Cancer?

    International Nuclear Information System (INIS)

    Bittner, Nathan; Merrick, Gregory S.; Wallner, Kent E.; Butler, Wayne M.; Galbreath, Robert; Adamovich, Edward

    2010-01-01

    Purpose: To compare biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) rates among high-risk prostate cancer patients treated with brachytherapy and supplemental external beam radiation (EBRT) using either a mini-pelvis (MP) or a whole-pelvis (WP) field. Methods and Materials: From May 1995 to October 2005, 186 high-risk prostate cancer patients were treated with brachytherapy and EBRT with or without androgen-deprivation therapy (ADT). High-risk prostate cancer was defined as a Gleason score of ≥8 and/or a prostate-specific antigen (PSA) concentration of ≥20 ng/ml. Results: With a median follow-up of 6.7 years, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 91.7% vs. 84.4% (p = 0.126), 95.5% vs. 92.6% (p = 0.515), and 79.5% vs. 67.1% (p = 0.721), respectively. Among those patients who received ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 93.6% vs. 90.1% (p = 0.413), 94.2% vs. 96.0% (p = 0.927), and 73.7% vs. 70.2% (p = 0.030), respectively. Among those patients who did not receive ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 82.4% vs. 75.0% (p = 0.639), 100% vs. 88% (p = 0.198), and 87.5% vs. 58.8% (p = 0.030), respectively. Based on multivariate analysis, none of the evaluated parameters predicted for CSS, while bPFS was best predicted by ADT and percent positive biopsy results. OS was best predicted by age and percent positive biopsy results. Conclusions: For high-risk prostate cancer patients receiving brachytherapy, there is a nonsignificant trend toward improved bPFS, CSS, and OS rates when brachytherapy is given with WPRT. This trend is most apparent among ADT-naive patients, for whom a significant improvement in OS was observed.

  15. SU-E-J-93: Parametrisation of Dose to the Mucosa of the Anterior Rectal Wall in Transrectal Ultrasound Guided High-Dose-Rate Brachytherapy of the Prostate

    Energy Technology Data Exchange (ETDEWEB)

    Aitkenhead, A; Hamlett, L; Wood, D; Choudhury, A [The Christie Hospital NHS Foundation Trust, Manchester, Greater Manchester (United Kingdom)

    2014-06-01

    Purpose: In high-dose-rate (HDR) brachytherapy of the prostate, radiation is delivered from a number of radioactive sources which are inserted via catheter into the target volume. The rectal mucosa also receives dose during the treatment, which may lead to late toxicity effects. To allow possible links between rectal dose and toxicity to be investigated, suitable methods of parametrising the rectal dose are needed. Methods: During treatment of a series of 95 patients, anatomy and catheter locations were monitored by transrectal ultrasound, and target volume positions were contoured on the ultrasound scan by the therapist. The anterior rectal mucosal wall was identified by contouring the transrectal ultrasound balloon within the ultrasound scan. Source positions and dwell times, along with the dose delivered to the patient were computed using the Oncentra Prostate treatment planning system (TPS). Data for the series of patients were exported from the TPS in Dicom format, and a series of parametrisation methods were developed in a Matlab environment to assess the rectal dose. Results: Contours of the anterior rectal mucosa were voxelised within Matlab to allow the dose to the rectal mucosa to be analysed directly from the 3D dose grid. Dose parametrisations based on dose-surface (DSH) and dose-line (DLH) histograms were obtained. Both lateral and longitudinal extents of the mucosal dose were parametrised using dose-line histograms in the relevant directions. Conclusion: We have developed a series of dose parametrisations for quantifying the dose to the rectal mucosa during HDR prostate brachytherapy which are suitable for future studies investigating potential associations between mucosal dose and late toxicity effects. The geometry of the transrectal probe standardises the rectal anatomy, making this treatment technique particularly suited to studies of this nature.

  16. SU-E-J-93: Parametrisation of Dose to the Mucosa of the Anterior Rectal Wall in Transrectal Ultrasound Guided High-Dose-Rate Brachytherapy of the Prostate

    International Nuclear Information System (INIS)

    Aitkenhead, A; Hamlett, L; Wood, D; Choudhury, A

    2014-01-01

    Purpose: In high-dose-rate (HDR) brachytherapy of the prostate, radiation is delivered from a number of radioactive sources which are inserted via catheter into the target volume. The rectal mucosa also receives dose during the treatment, which may lead to late toxicity effects. To allow possible links between rectal dose and toxicity to be investigated, suitable methods of parametrising the rectal dose are needed. Methods: During treatment of a series of 95 patients, anatomy and catheter locations were monitored by transrectal ultrasound, and target volume positions were contoured on the ultrasound scan by the therapist. The anterior rectal mucosal wall was identified by contouring the transrectal ultrasound balloon within the ultrasound scan. Source positions and dwell times, along with the dose delivered to the patient were computed using the Oncentra Prostate treatment planning system (TPS). Data for the series of patients were exported from the TPS in Dicom format, and a series of parametrisation methods were developed in a Matlab environment to assess the rectal dose. Results: Contours of the anterior rectal mucosa were voxelised within Matlab to allow the dose to the rectal mucosa to be analysed directly from the 3D dose grid. Dose parametrisations based on dose-surface (DSH) and dose-line (DLH) histograms were obtained. Both lateral and longitudinal extents of the mucosal dose were parametrised using dose-line histograms in the relevant directions. Conclusion: We have developed a series of dose parametrisations for quantifying the dose to the rectal mucosa during HDR prostate brachytherapy which are suitable for future studies investigating potential associations between mucosal dose and late toxicity effects. The geometry of the transrectal probe standardises the rectal anatomy, making this treatment technique particularly suited to studies of this nature

  17. Treatment of localized prostate cancer using a combination of high dose rate lridium-192 brachytherapy and external beam irradiation: Initial Australian experience

    International Nuclear Information System (INIS)

    Stevens, M.J.; Stricker, P.D.; Brenner, P.C.; Kooner, R.; O'Neil, G.F.A.; Duval, P.J.; Jagavkar, R.S.; Cross, P.; Saalfeld, J.; Martland, J.

    2003-01-01

    Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate- and high-risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate-specific antigen progression-free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability. Copyright (2003) Blackwell Science Pty Ltd

  18. Dosimetric impact of prostate volume change between CT-based HDR brachytherapy fractions

    International Nuclear Information System (INIS)

    Kim, Yongbok; Hsu, I-C.; Lessard, Etienne; Vujic, Jasmina; Pouliot, Jean

    2004-01-01

    Purpose: The objective is to evaluate the prostate volume change and its dosimetric consequences after the insertion of catheters for high-dose-rate brachytherapy. Methods and Materials: For 13 consecutive patients, a spiral CT scan was acquired before each of the 2 fractions, separated on average by 20 hours. The coordinates of the catheters were obtained on 3 axial CT slices corresponding to apex, mid portion, and base portion of the prostate. A mathematical expansion model was used to evaluate the change of prostate volumes between the 2 fractions. It is based on the difference in the cube of the average distance between the centroid and catheter positions. The variation of implant dose-volume histograms between fractions was computed for plans produced by either inverse planning based on simulated annealing or geometric optimization. Results: The average magnitude of either increase or reduction in prostate volume was 7.8% (range, 2-17%). This volume change corresponds to an average prostate radius change of only 2.5% (range, 0.7-5.4%). For 5 patients, the prostate volume increased on average by 9% (range, 2-17%), whereas a reduction was observed for 8 patients by an average of 7% (range, 2-13%). More variation was observed at the prostate base than at mid or apex gland. The comparison of implant dose-volume histograms showed a small reduction of V100 receiving the prescription dose, with an average of 3.5% (range, 0.5-12%) and 2.2% (range, 1-6%) for inverse planning based on our simulated annealing and geometric optimization plans, respectively. Conclusion: Small volume change was observed between treatment fractions. This translates into small changes in dose delivered to the prostate volume

  19. 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

  20. Dosimetric equivalence of nonstandard HDR brachytherapy catheter patterns

    International Nuclear Information System (INIS)

    Cunha, J. A. M.; Hsu, I-C.; Pouliot, J.

    2009-01-01

    Purpose: To determine whether alternative high dose rate prostate brachytherapy catheter patterns can result in similar or improved dose distributions while providing better access and reducing trauma. Materials and Methods: Standard prostate cancer high dose rate brachytherapy uses a regular grid of parallel needle positions to guide the catheter insertion. This geometry does not easily allow the physician to avoid piercing the critical structures near the penile bulb nor does it provide position flexibility in the case of pubic arch interference. This study used CT datasets with 3 mm slice spacing from ten previously treated patients and digitized new catheters following three hypothetical catheter patterns: conical, bi-conical, and fireworks. The conical patterns were used to accommodate a robotic delivery using a single entry point. The bi-conical and fireworks patterns were specifically designed to avoid the critical structures near the penile bulb. For each catheter distribution, a plan was optimized with the inverse planning algorithm, IPSA, and compared with the plan used for treatment. Irrelevant of catheter geometry, a plan must fulfill the RTOG-0321 dose criteria for target dose coverage (V 100 Prostate >90%) and organ-at-risk dose sparing (V 75 Bladder 75 Rectum 125 Urethra <<1 cc). Results: The three nonstandard catheter patterns used 16 nonparallel, straight divergent catheters, with entry points in the perineum. Thirty plans from ten patients with prostate sizes ranging from 26 to 89 cc were optimized. All nonstandard patterns fulfilled the RTOG criteria when the clinical plan did. In some cases, the dose distribution was improved by better sparing the organs-at-risk. Conclusion: Alternative catheter patterns can provide the physician with additional ways to treat patients previously considered unsuited for brachytherapy treatment (pubic arch interference) and facilitate robotic guidance of catheter insertion. In addition, alternative catheter

  1. 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

  2. Impact of national guidelines on brachytherapy monotherapy practice patterns for prostate cancer.

    Science.gov (United States)

    Tseng, Yolanda D; Paciorek, Alan T; Martin, Neil E; D'Amico, Anthony V; Cooperberg, Matthew R; Nguyen, Paul L

    2014-03-15

    In 1999 and 2000, 2 national guidelines recommended brachytherapy monotherapy (BT) primarily for treatment of low-risk prostate cancer but not high-risk prostate cancer. This study examined rates of BT use before and after publication of these guidelines, as compared with 4 other treatment options. From 1990 to 2011, 8128 men with localized prostate cancer (≤ T3cN0M0) were treated definitively within the Cancer of the Prostate Strategic Urologic Research Endeavor (CaPSURE) registry with 1 of 5 primary treatments: BT, external beam radiotherapy (EBRT), EBRT with androgen deprivation therapy, EBRT+BT, or radical prostatectomy. Men were categorized into low-, intermediate-, and high-risk groups based on the guidelines' risk-group definitions. Within each risk group, logistic regression was used to estimate odds ratios (OR) comparing BT with other treatment options between the 1990-1998 and 1999-2011 periods, adjusting for age, disease characteristics, and clinic type. In total, 1117 men received BT alone for low- (n = 658), intermediate- (n = 244), or high-risk disease (n = 215). BT comprised 6.1% of all treatments in 1990-1998 versus 16.6% in 1999-2011 (P guidelines did not appear to influence practice patterns, as BT monotherapy use increased relative to other treatments from the 1990-1998 to 1999-2011 periods in unfavorable risk groups including men with high-risk prostate cancer. © 2013 American Cancer Society.

  3. Long-Term Results of a Phase II Trial of Ultrasound-Guided Radioactive Implantation of the Prostate for Definitive Management of Localized Adenocarcinoma of the Prostate (RTOG 98-05)

    International Nuclear Information System (INIS)

    Lawton, Colleen A.; Hunt, Daniel; Lee, W. Robert; Gomella, Leonard; Grignon, David; Gillin, Michael; Morton, Gerard; Pisansky, Thomas M.; Sandler, Howard

    2011-01-01

    Purpose: To evaluate the long-term effectiveness of transrectal ultrasound-guided permanent radioactive I 125 implantation of the prostate for organ confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting. Methods and Materials: Patients accrued to this study had histologically confirmed, locally confined adenocarcinoma of the prostate clinical stage T1b, T1c, or T2a; no nodal or metastatic disease; prostate-specific antigen level of ≤10 ng/ml; and a Gleason score of ≤6. All patients underwent transrectal ultrasound-guided radioactive I 125 seed implantation into the prostate. The prescribed dose was 145 Gy to the prostate planning target volume. Results: A total of 101 patients from 27 institutions were accrued to this protocol; by design, no single institution accrued more than 8 patients. There were 94 eligible patients. The median follow up was 8.1 years (range, 0.1-9.2 years). After 8 years, 8 patients had protocol-defined biochemical (prostate-specific antigen) failure (cumulative incidence, 8.0%); 5 patients had local failure (cumulative incidence, 5.5%); and 1 patient had distant failure (cumulative incidence, 1.1%; this patient also had biochemical failure and died of causes not related to prostate cancer). The 8-year overall survival rate was 88%. At last follow-up, no patient had died of prostate cancer or related toxicities. Three patients had maximum late toxicities of Grade 3, all of which were genitourinary. No Grade 4 or 5 toxicities were observed. Conclusions: The long-term results of this clinical trial have demonstrated that this kind of trial can be successfully completed through the RTOG and that results in terms of biochemical failure and toxicity compare very favorably with other brachytherapy published series as well as surgical and external beam radiotherapy series. In addition, the prospective, multicenter design highlights the probable

  4. SU-G-TeP1-01: A Simulation Study to Investigate Maximum Allowable Deformations of Implant Geometry Before Plan Objectives Are Violated in Prostate HDR Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Babier, A [Department of Physics, Engineering Physics and Astronomy, Queens University, Kingston, Ontario (Canada); Joshi, C [Department of Physics, Engineering Physics and Astronomy, Queens University, Kingston, Ontario (Canada); Cancer Center of Southeastern Ontario, Kingston General Hospital, Kingston, Ontario (Canada)

    2016-06-15

    Purpose: In prostate HDR brachytherapy dose distributions are highly sensitive to changes in prostate volume and catheter displacements. We investigate the maximum deformations in implant geometry before planning objectives are violated. Methods: A typical prostate Ir-192 HDR brachytherapy reference plan was calculated on the Oncentra planning system, which used CT images from a tissue equivalent prostate phantom (CIRS Model 053S) embedded inside a pelvis wax phantom. The prostate was deformed and catheters were displaced in simulations using a code written in MATLAB. For each deformation dose distributions were calculated, based on TG43 methods, using the MATLAB code. The calculations were validated through comparison with Oncentra calculations for the reference plan, and agreed within 0.12%SD and 0.3%SD for dose and volume, respectively. Isotropic prostate volume deformations of up to +34% to −27% relative to its original volume, and longitudinal catheter displacements of 7.5 mm in superior and inferior directions were simulated. Planning objectives were based on American Brachytherapy Society guidelines for prostate and urethra volumes. A plan violated the planning objectives when less than 90% of the prostate volume received the prescribed dose or higher (V{sub 100}), or the urethral volume receiving 125% of prescribed dose or higher was more than 1 cc (U{sub 125}). Lastly, the dose homogeneity index (DHI=1-V{sub 150}/V{sub 100}) was evaluated; a plan was considered sub-optimal when the DHI fell below 0.62. Results and Conclusion: Planning objectives were violated when the prostate expanded by 10.7±0.5% or contracted by 11.0±0.2%; objectives were also violated when catheters were displaced by 4.15±0.15 mm and 3.70±0.15 mm in the superior and inferior directions, respectively. The DHI changes did not affect the plan optimality, except in the case of prostate compression. In general, catheter displacements have a significantly larger impact on plan

  5. Placement of empty catheters for an HDR-emulating LDR prostate brachytherapy technique: comparison to standard intraoperative planning.

    Science.gov (United States)

    Niedermayr, Thomas R; Nguyen, Paul L; Murciano-Goroff, Yonina R; Kovtun, Konstantin A; Neubauer Sugar, Emily; Cail, Daniel W; O'Farrell, Desmond A; Hansen, Jorgen L; Cormack, Robert A; Buzurovic, Ivan; Wolfsberger, Luciant T; O'Leary, Michael P; Steele, Graeme S; Devlin, Philip M; Orio, Peter F

    2014-01-01

    We sought to determine whether placing empty catheters within the prostate and then inverse planning iodine-125 seed locations within those catheters (High Dose Rate-Emulating Low Dose Rate Prostate Brachytherapy [HELP] technique) would improve concordance between planned and achieved dosimetry compared with a standard intraoperative technique. We examined 30 consecutive low dose rate prostate cases performed by standard intraoperative technique of planning followed by needle placement/seed deposition and compared them to 30 consecutive low dose rate prostate cases performed by the HELP technique. The primary endpoint was concordance between planned percentage of the clinical target volume that receives at least 100% of the prescribed dose/dose that covers 90% of the volume of the clinical target volume (V100/D90) and the actual V100/D90 achieved at Postoperative Day 1. The HELP technique had superior concordance between the planned target dosimetry and what was actually achieved at Day 1 and Day 30. Specifically, target D90 at Day 1 was on average 33.7 Gy less than planned for the standard intraoperative technique but was only 10.5 Gy less than planned for the HELP technique (p 0.05). Placing empty needles first and optimizing the plan to the known positions of the needles resulted in improved concordance between the planned and the achieved dosimetry to the target, possibly because of elimination of errors in needle placement. Copyright © 2014 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  6. 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.

  7. PSA Nadir of <0.5 ng/mL Following Brachytherapy for Early-Stage Prostate Adenocarcinoma is Associated With Freedom From Prostate-Specific Antigen Failure

    Energy Technology Data Exchange (ETDEWEB)

    Ko, Eric C. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Stone, Nelson N. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Department of Urology, Mount Sinai Medical Center, New York, NY (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States)

    2012-06-01

    Purpose: Because limited information exists regarding whether the rate or magnitude of PSA decline following brachytherapy predicts long-term clinical outcomes, we evaluated whether achieving a prostate-specific antigen (PSA) nadir (nPSA) <0.5 ng/mL following brachytherapy is associated with decreased PSA failure and/or distant metastasis. Methods and Materials: We retrospectively analyzed our database of early-stage prostate adenocarcinoma patients who underwent brachytherapy, excluding those receiving androgen-deprivation therapy and those with <2 years follow-up. Median and mean pretreatment PSA were 6 ng/mL and 7.16 ng/mL, respectively. By clinical stage, 775 were low risk ({<=}T2a), 126 were intermediate risk (T2b), and 20 were high risk (>T2b). By Gleason score, 840 were low risk ({<=}6), 71 were intermediate risk (7), and 10 were high risk (>7). Patients were treated with brachytherapy only (I-125, n = 779, or Pd-103, n = 47), or brachytherapy + external-beam radiation therapy (n = 95). Median follow-up was 6.3 years. We noted whether nPSA <0.5 ng/mL was achieved and the time to achieve this nadir and tested for associations with pretreatment risk factors. We also determined whether this PSA endpoint was associated with decreased PSA failure or distant metastasis. Results: Absence of high-risk factors in clinical stage ({<=}T2b), Gleason score ({<=}7), and pretreatment PSA ({<=}20 ng/mL) was significantly associated with achieving nPSA <0.5 ng/mL. By Kaplan-Meier analysis, patients achieving nPSA <0.5 ng/mL had significantly higher long-term freedom from biochemical failure (FFBF) than nonresponders (5-year FFBF: 95.2 {+-} 0.8% vs. 71.5 {+-} 6.7%; p < 0.0005). Among responders, those who achieved nPSA <0.5 ng/mL in {<=}5 years had higher FFBF than those requiring >5 years (5-year FFBF: 96.7 {+-} 0.7% vs. 80.8 {+-} 4.6%; p < 0.0005). On multivariate analysis, patients who achieved nPSA <0.5 ng/mL in {<=}5 years had significantly higher FFBF than other

  8. Natural History of Clinically Staged Low- and Intermediate-Risk Prostate Cancer Treated With Monotherapeutic Permanent Interstitial Brachytherapy

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Wallner, Kent E.; Butler, Wayne M.

    2010-01-01

    Purpose: To evaluate the natural history of clinically staged low- and intermediate-risk prostate cancer treated with permanent interstitial seed implants as monotherapy. Methods and Materials: Between April 1995 and May 2005, 463 patients with clinically localized prostate cancer underwent brachytherapy as the sole definitive treatment. Men who received supplemental external beam radiotherapy or androgen deprivation therapy were excluded. Dosimetric implant quality was determined based on the minimum dose that covered 90% of the target volume and the volume of the prostate gland receiving 100% of the prescribed dose. Multiple parameters were evaluated as predictors of treatment outcomes. Results: The 12-year biochemical progression-free survival (bPFS), cause-specific survival, and overall survival rates for the entire cohort were 97.1%, 99.7%, and 75.4%, respectively. Only pretreatment prostate-specific antigen level, percent positive biopsy cores, and minimum dose that covered 90% of the target volume were significant predictors of biochemical recurrence. The bPFS, cause-specific survival, and overall survival rates were 97.4%, 99.6%, and 76.2%, respectively, for low-risk patients and 96.4%, 100%, and 74.0%, respectively, for intermediate-risk patients. The bPFS rate was 98.8% for low-risk patients with high-quality implants versus 92.1% for those with less adequate implants (p < 0.01), and it was 98.3% for intermediate-risk patients with high-quality implants versus 86.4% for those with less adequate implants (p < 0.01). Conclusions: High-quality brachytherapy implants as monotherapy can provide excellent outcomes for men with clinically staged low- and intermediate-risk prostate cancer. For these men, a high-quality implant can achieve results comparable to high-quality surgery in the most favorable pathologically staged patient subgroups.

  9. The future perspectives in transrectal prostate ultrasound guided biopsy

    Directory of Open Access Journals (Sweden)

    Sung Il Hwang

    2014-12-01

    Full Text Available Prostate cancer is one of the most common neoplasms in men. Transrectal ultrasound (TRUS-guided systematic biopsy has a crucial role in the diagnosis of prostate cancer. However, it shows limited value with gray-scale ultrasound alone because only a small number of malignancies are visible on TRUS. Recently, new emerging technologies in TRUS-guided prostate biopsy were introduced and showed high potential in the diagnosis of prostate cancer. High echogenicity of ultrasound contrast agent reflect the increased status of angiogenesis in tumor. Molecular imaging for targeting specific biomarker can be also used using ultrasound contrast agent for detecting angiogenesis or surface biomarker of prostate cancer. The combination of TRUS-guided prostate biopsy and ultrasound contrast agents can increase the accuracy of prostate cancer diagnosis. Elastography is an emerging ultrasound technique that can provide the information regarding tissue elasticity and stiffness. Tumors are usually stiffer than the surrounding soft tissue. In two types of elastography techniques, shearwave elastography has many potential in that it can provide quantitative information on tissue elasticity. Multiparametric magnetic resonance imaging (MRI from high resolution morphologic and functional magnetic resonance (MR technique enables to detect more prostate cancers. The combination of functional techniques including apparent diffusion coefficient map from diffusion weighted imaging, dynamic contrast enhanced MR and MR spectroscopy are helpful in the localization of the prostate cancer. MR-ultrasound (US fusion image can enhance the advantages of both two modalities. With MR-US fusion image, targeted biopsy of suspicious areas on MRI is possible and fusion image guided biopsy can provide improved detection rate. In conclusion, with recent advances in multiparametric-MRI, and introduction of new US techniques such as contrast-enhanced US and elastography, TRUS-guided biopsy

  10. Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Ávila, Mónica; Becerra, Virginia; Guedea, Ferran; Suárez, José Francisco; Fernandez, Pablo; Macías, Víctor; Mariño, Alfonso

    2015-01-01

    Purpose: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. Methods and Materials: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Results: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Conclusions: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical

  11. Estimating Preferences for Treatments in Patients With Localized Prostate Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Ávila, Mónica [Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona (Spain); CIBER en Epidemiología y Salud Pública (CIBERESP) (Spain); Universitat Pompeu Fabra, Barcelona (Spain); Becerra, Virginia [Health Services Research Unit, IMIM (Hospital del Mar Medical Research Institute), Barcelona (Spain); Guedea, Ferran [Servicio de Oncología Radioterápica, Institut Català d' Oncologia, L' Hospitalet de Llobregat (Spain); Suárez, José Francisco [Servicio de Urología, Hospital Universitari de Bellvitge, L' Hospitalet de Llobregat (Spain); Fernandez, Pablo [Servicio de Oncología Radioterápica, Instituto Oncológico de Guipúzcoa, San Sebastián (Spain); Macías, Víctor [Servicio de Oncología Radioterápica, Hospital Clínico Universitario de Salamanca, Salamanca (Spain); Servicio de Oncología Radioterápica, Institut Oncologic del Valles-Hospital General de Catalunya, Sant Cugat del Vallès (Spain); Mariño, Alfonso [Servicio de Oncología Radioterápica, Centro Oncológico de Galicia, A Coruña (Spain); and others

    2015-02-01

    Purpose: Studies of patients' preferences for localized prostate cancer treatments have assessed radical prostatectomy and external radiation therapy, but none of them has evaluated brachytherapy. The aim of our study was to assess the preferences and willingness to pay of patients with localized prostate cancer who had been treated with radical prostatectomy, external radiation therapy, or brachytherapy, and their related urinary, sexual, and bowel side effects. Methods and Materials: This was an observational, prospective cohort study with follow-up until 5 years after treatment. A total of 704 patients with low or intermediate risk localized prostate cancer were consecutively recruited from 2003 to 2005. The estimation of preferences was conducted using time trade-off, standard gamble, and willingness-to-pay methods. Side effects were measured with the Expanded Prostate Index Composite (EPIC), a prostate cancer-specific questionnaire. Tobit models were constructed to assess the impact of treatment and side effects on patients' preferences. Propensity score was applied to adjust for treatment selection bias. Results: Of the 580 patients reporting preferences, 165 were treated with radical prostatectomy, 152 with external radiation therapy, and 263 with brachytherapy. Both time trade-off and standard gamble results indicated that the preferences of patients treated with brachytherapy were 0.06 utilities higher than those treated with radical prostatectomy (P=.01). Similarly, willingness-to-pay responses showed a difference of €57/month (P=.004) between these 2 treatments. Severe urinary incontinence presented an independent impact on the preferences elicited (P<.05), whereas no significant differences were found by bowel and sexual side effects. Conclusions: Our findings indicate that urinary incontinence is the side effect with the highest impact on preferences and that brachytherapy and external radiation therapy are more valued than radical

  12. High-dose regions versus likelihood of cure after prostate brachytherapy

    International Nuclear Information System (INIS)

    Wallner, Kent; Merrick, Gregory; Sutlief, Steven; True, Laurence; Butler, Wayne

    2005-01-01

    Purpose: To analyze the effect of high-dose regions on biochemical cancer control rates after prostate brachytherapy. Methods and Materials: Patients with 1997 American Joint Committee on Cancer clinical Stage T1c-T2a prostate carcinoma (Gleason grade 5-6, prostate-specific antigen level 4-10 ng/mL) were randomized to implantation with 125 I (144 Gy) vs. 103 Pd (125 Gy, National Institute of Standards and Technology 1999). Isotope implantation was performed by standard techniques, using a modified peripheral loading pattern. Of the 313 patients entered in the protocol, 270 were included in this analysis. The 125 I source strength ranged from 0.4 to 0.89 mCi (median, 0.55 mCi), and the 103 Pd source strength ranged from 1.3 to 1.6 mCi (median, 1.5 mCi). CT was performed within 4 h after implantation. The dosimetric parameters analyzed included the percentage of the postimplant prostate volume covered by the 100%, 150%, 200%, and 300% prescription dose (V 100 , V 150 , V 200 , and V 300 , respectively). The median time to the last follow-up for patients without failure was 2.7 years. Freedom from biochemical failure was defined as a serum prostate-specific antigen level of ≤0.5 ng/mL at last follow-up. Patients were censored at last follow-up if their serum prostate-specific antigen level was still decreasing. Results: The mean V 100 , V 150 , V 200 , and V 300 value was 90% (±8%), 63% (±14), 35% (±13%), and 14% (±7%), respectively. Patients with a V 100 of ≥90% had a 3-year freedom from biochemical failure rate of 96% vs. 87% for those with a V 100 of 100 of ≥90% were analyzed, no relationship was found between higher dose regions and the likelihood of cancer control. This lack of effect on biochemical control was apparent for both isotopes. Conclusion: High-dose regions do not appear to affect cancer control rates, as long as >90% of the prostate volume is covered by the prescription dose

  13. 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.

  14. An automated optimization tool for high-dose-rate (HDR) prostate brachytherapy with divergent needle pattern

    Science.gov (United States)

    Borot de Battisti, M.; Maenhout, M.; de Senneville, B. Denis; Hautvast, G.; Binnekamp, D.; Lagendijk, J. J. W.; van Vulpen, M.; Moerland, M. A.

    2015-10-01

    Focal high-dose-rate (HDR) for prostate cancer has gained increasing interest as an alternative to whole gland therapy as it may contribute to the reduction of treatment related toxicity. For focal treatment, optimal needle guidance and placement is warranted. This can be achieved under MR guidance. However, MR-guided needle placement is currently not possible due to space restrictions in the closed MR bore. To overcome this problem, a MR-compatible, single-divergent needle-implant robotic device is under development at the University Medical Centre, Utrecht: placed between the legs of the patient inside the MR bore, this robot will tap the needle in a divergent pattern from a single rotation point into the tissue. This rotation point is just beneath the perineal skin to have access to the focal prostate tumor lesion. Currently, there is no treatment planning system commercially available which allows optimization of the dose distribution with such needle arrangement. The aim of this work is to develop an automatic inverse dose planning optimization tool for focal HDR prostate brachytherapy with needle insertions in a divergent configuration. A complete optimizer workflow is proposed which includes the determination of (1) the position of the center of rotation, (2) the needle angulations and (3) the dwell times. Unlike most currently used optimizers, no prior selection or adjustment of input parameters such as minimum or maximum dose or weight coefficients for treatment region and organs at risk is required. To test this optimizer, a planning study was performed on ten patients (treatment volumes ranged from 8.5 cm3to 23.3 cm3) by using 2-14 needle insertions. The total computation time of the optimizer workflow was below 20 min and a clinically acceptable plan was reached on average using only four needle insertions.

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

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    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.

  16. 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)

  17. Twelve-Month Prostate-Specific Antigen Values and Perineural Invasion as Strong Independent Prognostic Variables of Long-Term Biochemical Outcome After Prostate Seed Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Ding, William, E-mail: billyding888@gmail.com [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Lee, John [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Chamberlain, David [Department of Radiation Oncology, St. Mary' s Regional Medical Center, Reno, Nevada (United States); Cunningham, James [Carson Urology, Carson City, Nevada (United States); Yang Lixi [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Tay, Jonathan [Department of Radiation Oncology, St. Mary' s Regional Medical Center, Reno, Nevada (United States)

    2012-11-15

    Purpose: To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy. Methods and Materials: Records of 204 hormone-naieve patients with localized adenocarcinoma of the prostate treated at St. Mary's Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml. Results: Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of {<=}1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p = 0.009). Conclusions: Presence of PNI and ptPSA values at 12 months are strong prognostic

  18. Twelve-Month Prostate-Specific Antigen Values and Perineural Invasion as Strong Independent Prognostic Variables of Long-Term Biochemical Outcome After Prostate Seed Brachytherapy

    International Nuclear Information System (INIS)

    Ding, William; Lee, John; Chamberlain, David; Cunningham, James; Yang Lixi; Tay, Jonathan

    2012-01-01

    Purpose: To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy. Methods and Materials: Records of 204 hormone-naïve patients with localized adenocarcinoma of the prostate treated at St. Mary’s Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml. Results: Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of ≤1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at ≤1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p = 0.009). Conclusions: Presence of PNI and ptPSA values at 12 months are strong prognostic variables for

  19. On the use of Kodak CR film for quality assurance of needle loading in I-125 seed prostate brachytherapy.

    Science.gov (United States)

    Fog, L S; Nicholls, R; van Doom, T

    2007-09-01

    Low dose rate brachytherapy using implanted I-125 seeds as a monotherapy for prostate cancer is now in use in many hospitals. In contrast to fractionated brachytherapy treatments, where the effect of incorrect positioning of the source in one treatment fraction can be diminished by correcting the position in subsequent fractions, the I-125 seed implant is permanent, making correct positioning of the seeds in the prostate essential. The seeds are inserted into the prostate using needles. Correct configuration of seeds in the needles is essential in order to deliver the planned treatment. A comparison of an autoradiograph obtained by exposing film to the seed-loaded needles with the patient treatment plan is a valuable quality assurance tool. However, the time required to sufficiently expose Kodak XOMAT V film, currently used in this department is significant. This technical note presents the use of Kodak CR film for acquisition of the radiograph. The digital radiograph can be acquired significantly faster, has superior signal-to-noise ratio and contrast and has the usual benefits of digital film, e.g. a processing time which is shorter than that required for non-digital film, the possibility of image manipulation, possibility of paper printing and electronic storage.

  20. 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.

  1. DuraSeal® as a spacer to reduce rectal doses in low-dose rate brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Heikkilä, Vesa-Pekka; Kärnä, Aarno; Vaarala, Markku H.

    2014-01-01

    The purpose of this study was to evaluate the utility of off-label use of DuraSeal® polyethylene glycol (PEG) gel in low-dose rate (LDR) prostate brachytherapy seed implantation to reduce rectal doses. Diluted DuraSeal® was easy to use and, in spite of a clearance effect, useful in decreasing D 2cc rectal doses

  2. Magnetic resonance tomography-guided interventional procedure for diagnosis of prostate cancer

    International Nuclear Information System (INIS)

    Schernthaner, M.; Helbich, T.H.; Fueger, B.J.; Memarsadeghi, M.; Stiglbauer, A.; Linhart, H.G.; Doan, A.; Pinker, K.; Brader, P.; Margreiter, M.

    2011-01-01

    In recent years magnetic resonance imaging (MRI) has been increasingly established in the diagnosis of prostate cancer in addition to transrectal ultrasonography (TRUS). The use of T2-weighted imaging allows an exact delineation of the zonal anatomy of the prostate and its surrounding structures. Other MR imaging tools, such as dynamic contrast-enhanced T1-weighted imaging or diffusion-weighted imaging allow an inference of the biochemical characteristics (multiparametric MRI). Prostate cancer, which could only be diagnosed using MR imaging or lesions suspected as being prostate cancer, which are localized in the anterior aspect of the prostate and were missed with repetitive TRUS biopsy, need to undergo MR guided biopsy. Recent studies have shown a good correlation between MR imaging and histopathology of specimens collected by MR-guided biopsy. Improved lesion targeting is therefore possible with MR-guided biopsy. So far data suggest that MR-guided biopsy of the prostate is a promising alternative diagnostic tool to TRUS-guided biopsy. (orig.) [de

  3. A study on image reconstruction for seed localization for permanent prostate brachytherapy

    International Nuclear Information System (INIS)

    Hong, Ju Young; Rah, Jeong Eun; Suh, Tae Suk

    2007-01-01

    This study was to design and fabricate a phantom for prostate cancer brachytherapy to validate a developed program applying a 3-film technique, and to compare it with the conventional 2-film technique for determining the location of an implanted seed. The images were obtained from overlapped seeds by randomly placing a maximum of 63 seeds in the interior-posterior (AP) position and at -30 .deg. to 30 .deg. at 15 .deg. intervals. Images obtained by use of the phantom were applied to the image processing procedure, and were then processed into the development program for seed localization. In this study, cases were set where one seed overlapped, where two seeds overlapped and where none of the three views resolved all seeds. The distance between the centers of each seed to the reference seed was calculated in a prescribed region. This distance determined the location of each seed in a given band. The location of the overlapped seeds was compared with that of the 2-film technique. With this program, the detection rate was 92.2% (at ± 15 .deg. ), 94.1% (at ± 30 .deg.) and 70.6% (compared to the use of the 2-film technique). The overlaps were caused by one or more than two seeds that overlapped; the developed program can identify the location of each seed perfectly. However, for the third case the program was not able to resolve the overlap of the seeds. This program can be used to improve treatment outcome for the brachytherapy of prostate cancer by reducing the number of errors in the process of reconstructing the locations of perfectly overlapped seeds

  4. Urinary morbidity following ultrasound-guided transperineal prostate seed implantation

    International Nuclear Information System (INIS)

    Gelblum, Daphna Y.; Potters, Louis; Ashley, Richard; Waldbaum, Robert; Wang Xiaohong; Leibel, Steven

    1999-01-01

    Purpose: To assess the urinary morbidity experienced by patients undergoing ultrasound-guided, permanent transperineal seed implantation for adenocarcinoma of the prostate. Methods and Materials: Between September 1992 and September 1997, 693 consecutive patients presented with a diagnosis of clinically localized adenocarcinoma of the prostate, and were treated with ultrasound-guided transperineal interstitial permanent brachytherapy (TPIPB). Ninety-three patients are excluded from this review, having received neoadjuvant antiandrogen therapy. TPIPB was performed with 125 I in 165 patients and with 103 Pd in 435 patients. Patients treated with implant alone received 160 Gy with 125 I (pre TG43) or 120 Gy with 103 Pd. One hundred two patients received preimplant, pelvic external beam radiation (XRT) to a dose of either 41.4 or 45 Gy because of high-risk features including PSA ≥ 10 and/or Gleason score ≥ 7. Combined modality patients received 120 Gy and 90 Gy, respectively for 125 I or 103 Pd. All patients underwent postimplant cystoscopy and placement of an indwelling Foley catheter for 24-48 h. Follow-up was at 5 weeks after implant, every 3 months for the first 2 years, and then every 6 months for subsequent years. Patients completed AUA urinary symptom scoring questionnaires at initial consultation and at each follow-up visit. Urinary toxicity was classified by the RTOG toxicity scale with the following adaptations; grade 1 urinary toxicity was symptomatic nocturia or frequency requiring none or minimal medical intervention such as phenazopyridine; grade 2 urinary toxicity was early obstructive symptomatology requiring alpha-blocker therapy; and grade 3 toxicity was considered that requiring indwelling catheters or posttreatment transurethral resection of the prostate for symptom relief. Log-rank analysis and Chi-square testing was performed to assess AUA score, prostate size, isotope selection, and the addition of XRT as possible prognosticators of

  5. 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)

  6. 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)

  7. Correlations of post-implant regional dosimetric parameters at 24 hours and one month, with clinical results of low-dose-rate brachytherapy for localized prostate cancer

    Directory of Open Access Journals (Sweden)

    Eiichiro Okazaki

    2017-12-01

    Full Text Available Purpose : To evaluate the correlations of post-implant regional dosimetrics at 24 hours (24 h and 1 month after implant procedures, with clinical outcomes of low-dose-rate (LDR brachytherapy for localized prostate cancer. Material and methods : Between January 2008 and December 2014, 130 consecutive patients treated for localized prostate cancer, receiving definitive iodine-125 ( 125 I brachytherapy treatment were retrospectively analyzed. All patients underwent post-implant CT imaging for dosimetric analysis at 24 h and 1 month after implantation procedure. Prostate contours were divided into quadrants: anterior-superior (ASQ, posterior-superior (PSQ, anterior-inferior (AIQ, and posterior-inferior (PIQ. Predictive factors and cut-off values of biochemical failure-free survival (BFFS and toxicities of LDR brachytherapy were analyzed. Results : The median follow-up time was 69.5 months. Seven patients (5.4% had biochemical failure. The 3-year and 5-year BFFS rates were 96.7% and 93.1%, respectively. On multivariate analysis, prostate-specific antigen and Gleason score were significant prognostic factors for biochemical failure. D 90 (the minimal dose received by 90% of the volume of PSQ and PIQ at 24 h, and D 90 of PSQ at 1 month were also significant factors. The cut-off values of PSQ D 90 were 145 Gy at 24 h and 160 Gy at 1 month. D 90 of the whole prostate was not significant at 24 h and at 1 month. D 90 of PSQ at 1 month was a significant factor for rectal hemorrhage. Conclusions : Post-implant D 90 of PSQ is significantly associated with BFFS for localized prostate cancer not only at 1 month, but also at 24 hours. D 90 of PSQ at 1 month is also a significant factor for rectal hemorrhage.

  8. WE-AB-BRA-11: Improved Imaging of Permanent Prostate Brachytherapy Seed Implants by Combining an Endorectal X-Ray Sensor with a CT Scanner

    International Nuclear Information System (INIS)

    Steiner, J; Matthews, K; Jia, G

    2016-01-01

    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

  9. 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

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

    International Nuclear Information System (INIS)

    Molina, Sarah; Guerif, Stéphane; Garcia, Alexandre; Debiais, Céline; Irani, Jacques; Fromont, Gaëlle

    2016-01-01

    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.

  11. 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.

  12. Assessment of the feasibility of using transrectal ultrasound for postimplant dosimetry in low-dose-rate prostate brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Davies, Rhian Siân, E-mail: rhian.s.davies@wales.nhs.uk; Perrett, Teresa; Powell, Jane; Barber, Jim; Tanguay, Jacob; Button, Michael; Cochlin, Dennis; Smith, Christian; Lester, Jason Francis

    2016-01-01

    A study was performed to establish whether transrectal ultrasound (TRUS)-based postimplant dosimetry (PID) is both practically feasible and comparable to computed tomography (CT)-based PID, recommended in current published guidelines. In total, 22 patients treated consecutively at a single cancer center with low-dose-rate (LDR) brachytherapy for early-stage prostate cancer had a transrectal ultrasound performed immediately after implant (d0-TRUS) and computed tomography scan 30 days after implant (d30-CT). Postimplant dosimetry planning was performed on both image sets and the results were compared. The interobserver reproducibility of the transrectal ultrasound postimplant dosimetry planning technique was also assessed. It was noticed that there was no significant difference in mean prostate D{sub 90} (136.5 Gy and 144.4 Gy, p = 0.2197), V{sub 100} (86.4% and 89.1%, p = 0.1480) and V{sub 150} (52.0% and 47.8%, p = 0.1657) for d30-CT and d0-TRUS, respectively. Rectal doses were significantly higher for d0-TRUS than d30-CT. Urethral doses were available with d0-TRUS only. We have shown that d0-TRUS PID is a useful tool for assessing the quality of an implant after low-dose-rate prostate brachytherapy and is comparable to d30-CT PID. There are clear advantages to its use in terms of resource and time efficiency both for the clinical team and the patient.

  13. Image guided prostate cancer treatments

    Energy Technology Data Exchange (ETDEWEB)

    Bard, Robert L. [Bard Cancer Center, Biofoundation for Angiogenesis Research and Development, New York, NY (United States); Fuetterer, Jurgen J. [Radboud Univ. Nijmegen, Medical Centre (Netherlands). Dept. of Radiology; Sperling, Dan (ed.) [Sperling Prostate Center, Alpha 3TMRI, New York, NY (United States)

    2014-07-01

    Systematic overview of the application of ultrasound and MRI in the diagnosis and treatment of diseases of the lower urinary tract. Detailed information on image-guided therapies, including focused ultrasound, photodynamic therapy, and microwave and laser ablation. Numerous high-quality illustrations based on high-end equipment. Represents the state of the art in Non Invasive Imaging and Minimally Invasive Ablation Treatment (MIAT). Image-Guided Prostate Cancer Treatments is a comprehensive reference and practical guide on the technology and application of ultrasound and MRI in the male pelvis, with special attention to the prostate. The book is organized into three main sections, the first of which is devoted to general aspects of imaging and image-guided treatments. The second section provides a systematic overview of the application of ultrasound and MRI to the diagnosis and treatment of diseases of the lower urinary tract. Performance of the ultrasound and MRI studies is explained, and the normal and abnormal pathological anatomy is reviewed. Correlation with the ultrasound in the same plane is provided to assist in understanding the MRI sequences. Biopsy and interventional procedures, ultrasound-MRI fusion techniques, and image-guided therapies, including focused ultrasound, photodynamic therapy, microwave and laser ablation, are all fully covered. The third section focuses on securing treatment effectiveness and the use of follow-up imaging to ensure therapeutic success and detect tumor recurrence at an early stage, which is vital given that prompt focal treatment of recurrence is very successful. Here, particular attention is paid to the role of Doppler ultrasound and DCE-MRI technologies. This book, containing a wealth of high-quality illustrations based on high-end equipment, will acquaint beginners with the basics of prostate ultrasound and MRI, while more advanced practitioners will learn new skills, means of avoiding pitfalls, and ways of effectively

  14. 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.

  15. Image Guided Cervical Brachytherapy: 2014 Survey of the American Brachytherapy Society

    Energy Technology Data Exchange (ETDEWEB)

    Grover, Surbhi, E-mail: Surbhi.grover@uphs.upenn.edu [Department of Radiation Oncology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania (United States); Harkenrider, Matthew M. [Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois (United States); Cho, Linda P. [Department of Radiation Oncology, Brigham & Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Erickson, Beth [Department Radiation Oncology, Froedtert Hospital and Medical College of Wisconsin, Milwaukee, Wisconsin (United States); Small, Christina [Department of Public Health Sciences, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois (United States); Small, William [Department of Radiation Oncology, Stritch School of Medicine, Loyola University Chicago, Chicago, Illinois (United States); Viswanathan, Akila N. [Department of Radiation Oncology, Brigham & Women' s Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2016-03-01

    Purpose: To provide an update of the 2007 American brachytherapy survey on image-based brachytherapy, which showed that in the setting of treatment planning for gynecologic brachytherapy, although computed tomography (CT) was often used for treatment planning, most brachytherapists used point A for dose specification. Methods and Materials: A 45-question electronic survey on cervical cancer brachytherapy practice patterns was sent to all American Brachytherapy Society members and additional radiation oncologists and physicists based in the United States between January and September 2014. Responses from the 2007 survey and the present survey were compared using the χ{sup 2} test. Results: There were 370 respondents. Of those, only respondents, not in training, who treat more than 1 cervical cancer patient per year and practice in the United States, were included in the analysis (219). For dose specification to the target (cervix and tumor), 95% always use CT, and 34% always use MRI. However, 46% use point A only for dose specification to the target. There was a lot of variation in parameters used for dose evaluation of target volume and normal tissues. Compared with the 2007 survey, use of MRI has increased from 2% to 34% (P<.0001) for dose specification to the target. Use of volume-based dose delineation to the target has increased from 14% to 52% (P<.0001). Conclusion: Although use of image-based brachytherapy has increased in the United States since the 2007 survey, there is room for further growth, particularly with the use of MRI. This increase may be in part due to educational initiatives. However, there is still significant heterogeneity in brachytherapy practice in the United States, and future efforts should be geared toward standardizing treatment.

  16. MO-B-BRC-00: Prostate HDR Treatment Planning - Considering Different Imaging Modalities

    International Nuclear Information System (INIS)

    2016-01-01

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions

  17. MO-B-BRC-00: Prostate HDR Treatment Planning - Considering Different Imaging Modalities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    2016-06-15

    Brachytherapy has proven to be an effective treatment option for prostate cancer. Initially, prostate brachytherapy was delivered through permanently implanted low dose rate (LDR) radioactive sources; however, high dose rate (HDR) temporary brachytherapy for prostate cancer is gaining popularity. Needle insertion during prostate brachytherapy is most commonly performed under ultrasound (U/S) guidance; however, treatment planning may be performed utilizing several imaging modalities either in an intra- or post-operative setting. During intra-operative prostate HDR, the needles are imaged during implantation, and planning may be performed in real time. At present, the most common imaging modality utilized for intra-operative prostate HDR is U/S. Alternatively, in the post-operative setting, following needle implantation, patients may be simulated with computed tomography (CT) or magnetic resonance imaging (MRI). Each imaging modality and workflow provides its share of benefits and limitations. Prostate HDR has been adopted in a number of cancer centers across the nation. In this educational session, we will explore the role of U/S, CT, and MRI in HDR prostate brachytherapy. Example workflows and operational details will be shared, and we will discuss how to establish a prostate HDR program in a clinical setting. Learning Objectives: Review prostate HDR techniques based on the imaging modality Discuss the challenges and pitfalls introduced by the three imagebased options for prostate HDR brachytherapy Review the QA process and learn about the development of clinical workflows for these imaging options at different institutions.

  18. Topological methods for the comparison of structures using LDR-brachytherapy of the prostate as an example.

    Science.gov (United States)

    Schiefer, H; von Toggenburg, F; Seelentag, W W; Plasswilm, L; Ries, G; Schmid, H-P; Leippold, T; Krusche, B; Roth, J; Engeler, D

    2009-08-21

    The dose coverage of low dose rate (LDR)-brachytherapy for localized prostate cancer is monitored 4-6 weeks after intervention by contouring the prostate on computed tomography and/or magnetic resonance imaging sets. Dose parameters for the prostate (V100, D90 and D80) provide information on the treatment quality. Those depend strongly on the delineation of the prostate contours. We therefore systematically investigated the contouring process for 21 patients with five examiners. The prostate structures were compared with one another using topological procedures based on Boolean algebra. The coincidence number C(V) measures the agreement between a set of structures. The mutual coincidence C(i, j) measures the agreement between two structures i and j, and the mean coincidence C(i) compares a selected structure i with the remaining structures in a set. All coincidence parameters have a value of 1 for complete coincidence of contouring and 0 for complete absence. The five patients with the lowest C(V) values were discussed, and rules for contouring the prostate have been formulated. The contouring and assessment were repeated after 3 months for the same five patients. All coincidence parameters have been improved after instruction. This shows objectively that training resulted in more consistent contouring across examiners.

  19. 15-Year biochemical relapse free survival in clinical Stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience

    International Nuclear Information System (INIS)

    Sylvester, John E.; Grimm, Peter D.; Blasko, John C.; Millar, Jeremy; Orio, Peter F.; Skoglund, Scott; Galbreath, Robert W.; Merrick, Gregory

    2007-01-01

    Purpose: Long-term biochemical relapse-free survival (BRFS) rates in patients with clinical Stages T1-T3 prostate cancer continue to be scrutinized after treatment with external beam radiation therapy and brachytherapy. Methods and Materials: We report 15-year BRFS rates on 223 patients with clinically localized prostate cancer that were consecutively treated with I 125 or Pd 103 brachytherapy after 45-Gy neoadjuvant EBRT. Multivariate regression analysis was used to create a pretreatment clinical prognostic risk model using a modified American Society for Therapeutic Radiology and Oncology consensus definition (two consecutive serum prostate-specific antigen rises) as the outcome. Gleason scoring was performed by the pathologists at a community hospital. Time to biochemical failure was calculated and compared by using Kaplan-Meier plots. Results: Fifteen-year BRFS for the entire treatment group was 74%. BRFS using the Memorial Sloan-Kettering risk cohort analysis (95% confidence interval): low risk, 88%, intermediate risk 80%, and high risk 53%. Grouping by the risk classification described by D'Amico, the BRFS was: low risk 85.8%, intermediate risk 80.3%, and high risk 67.8% (p = 0.002). Conclusions: I 125 or Pd 103 brachytherapy combined with supplemental EBRT results in excellent 15-year biochemical control. Different risk group classification schemes lead to different BRFS results in the high-risk group cohorts

  20. 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.

  1. 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.

  2. Long term results of a prospective dose escalation phase-II trial: Interstitial pulsed-dose-rate brachytherapy as boost for intermediate- and high-risk prostate cancer

    International Nuclear Information System (INIS)

    Lettmaier, Sebastian; Lotter, Michael; Kreppner, Stephan; Strnad, Annedore; Fietkau, Rainer; Strnad, Vratislav

    2012-01-01

    stricture requiring dilation or new onset incontinence. Conclusions: Image-guided conformal PDR-brachytherapy using up to 35 Gy as boost dose after 50 Gy of external beam radiation therapy (total dose up to 85 Gy) is a very effective treatment option with very low morbidity in patients with intermediate or high risk prostate cancer. Further dose escalation seems possible.

  3. Evaluation of the effect of prostate volume change on tumor control probability in LDR brachytherapy.

    Science.gov (United States)

    Knaup, Courtney; Mavroidis, Panayiotis; Stathakis, Sotirios; Smith, Mark; Swanson, Gregory; Papanikolaou, Niko

    2011-09-01

    This study evaluates low dose-rate brachytherapy (LDR) prostate plans to determine the biological effect of dose degradation due to prostate volume changes. In this study, 39 patients were evaluated. Pre-implant prostate volume was determined using ultrasound. These images were used with the treatment planning system (Nucletron Spot Pro 3.1(®)) to create treatment plans using (103)Pd seeds. Following the implant, patients were imaged using CT for post-implant dosimetry. From the pre and post-implant DVHs, the biologically equivalent dose and the tumor control probability (TCP) were determined using the biologically effective uniform dose. The model used RBE = 1.75 and α/β = 2 Gy. The prostate volume changed between pre and post implant image sets ranged from -8% to 110%. TCP and the mean dose were reduced up to 21% and 56%, respectively. TCP is observed to decrease as the mean dose decreases to the prostate. The post-implant tumor dose was generally observed to decrease, compared to the planned dose. A critical uniform dose of 130 Gy was established. Below this dose, TCP begins to fall-off. It was also determined that patients with a small prostates were more likely to suffer TCP decrease. The biological effect of post operative prostate growth due to operative trauma in LDR was evaluated using the concept. The post-implant dose was lower than the planned dose due to an increase of prostate volume post-implant. A critical uniform dose of 130 Gy was determined, below which TCP begun to decline.

  4. Evaluation of the effect of prostate volume change on tumor control probability in LDR brachytherapy

    Directory of Open Access Journals (Sweden)

    Courtney Knaup

    2011-09-01

    Full Text Available Purpose: This study evaluates low dose-rate brachytherapy (LDR prostate plans to determine the biological effectof dose degradation due to prostate volume changes. Material and methods: In this study, 39 patients were evaluated. Pre-implant prostate volume was determinedusing ultrasound. These images were used with the treatment planning system (Nucletron Spot Pro 3.1® to create treatmentplans using 103Pd seeds. Following the implant, patients were imaged using CT for post-implant dosimetry. Fromthe pre and post-implant DVHs, the biologically equivalent dose and the tumor control probability (TCP were determinedusing the biologically effective uniform dose. The model used RBE = 1.75 and α/β = 2 Gy. Results: The prostate volume changed between pre and post implant image sets ranged from –8% to 110%. TCP andthe mean dose were reduced up to 21% and 56%, respectively. TCP is observed to decrease as the mean dose decreasesto the prostate. The post-implant tumor dose was generally observed to decrease, compared to the planned dose.A critical uniform dose of 130 Gy was established. Below this dose, TCP begins to fall-off. It was also determined thatpatients with a small prostates were more likely to suffer TCP decrease. Conclusions: The biological effect of post operative prostate growth due to operative trauma in LDR was evaluatedusing the concept. The post-implant dose was lower than the planned dose due to an increase of prostate volumepost-implant. A critical uniform dose of 130 Gy was determined, below which TCP begun to decline.

  5. 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.

  6. Orgasm after prostate curietherapy with iodine 125 permanent implants for localized cancer of the prostate

    International Nuclear Information System (INIS)

    Delaunay, B.; Plante, P.; Huyghe, E.; Delannes, M.; Bachaud, J.-M.; Salloum, A.; Thoulouzan, M.; Soulie, M.; Delavierre, D.; Wagner, F.; Jonca, F.

    2011-01-01

    Orgasm is a domain of male sexuality that remains underreported in literature. Our aim was to realize the first detailed analysis of orgasm in patients treated by 125 I permanent prostate brachytherapy for localized prostate cancer. In a series of 270 sexually active men treated by prostate brachytherapy ( 125 I permanent implantation), 241 (89%), mean age of 65 (43 80), participated in a mailed survey about sexual function after a mean time of 36 months (9 70). Erectile and ejaculatory functions and orgasm were explored using a mailed questionnaire. Two questions focused on orgasm. The first was about quality of orgasm (fast/intense/late, difficult/weak/absent) and the second about the presence of painful orgasm and its frequency (always/sometimes/often). After prostate brachytherapy, 81.3% of sexually active men conserved ejaculation and 90% orgasm. There was a significant deterioration of the quality of orgasm (P ≡ 0.0001). More than 50% of the patients had an altered orgasm (weak, difficult, absent) after brachytherapy, vs 16% before implantation (P ≡ 0.001). Men with a diminished ejaculation volume often had a weak/difficult orgasm (P ≡ 0.007). Neoadjuvant hormonal therapy did not seem to impact the quality of orgasm or the frequency of painful ejaculation. Patients who had an IIEF-5 score higher than 12 had frequently intense orgasm (26.7% vs 2.7%; P < 0.001) after brachytherapy. Sixty patients (30.3%) experienced often/sometimes painful ejaculation 12.9% (n ≡ 31) before implantation (P ≡ 0.0001). Most of the patients treated by prostate brachytherapy conserved orgasm after treatment. However, most of the patients described a deterioration of the quality of orgasm. (authors)

  7. Impact of oedema on implant geometry and dosimetry for temporary high dose rate brachytherapy of the prostate

    International Nuclear Information System (INIS)

    Kiffer, J.D.; Schumer, W.A.; Mantle, C.A.; McKenzie, B.J.; Feigen, M.; Quong, G.G.; Waterman, F.M.

    2003-01-01

    The optimal timing of dosimetry for permanent seed prostatic implants remains contentious given the half life of post-implant oedema resolution. The aim of this study was to establish whether prostatic oedematous change over the duration of a temporary high dose rate (HDR) interstitial brachytherapy (BR) boost would result in significant needle displacement, and whether this change in geometry would influence dosimetry. Two CT scans, one for dosimetric purposes on the day of the implant and the second just prior to implant removal, were obtained for four patients receiving transperineal interstitial prostate brachytherapy. The relative changes in cross-sectional dimensions of the implants were calculated by establishing the change in mean radial distance (MRD) of the needle positions from the geometric centre of the implant for each patient's pair of CT studies. The treatment plan, as calculated from the first CT scan, was used in the second set of CT images to allow a comparison of dose distribution. The percentage change in MRD over the duration of the temporary implants ranged from -1.91% to 1.95%. The maximum change in estimated volume was 3.94%. Dosimetric changes were negligible. In the four cases studied, the degree of oedematous change and consequent displacement of flexiguide needle positions was negligible and did not impact on the dosimetry. The rate and direction of oedematous change can be extremely variable but on the basis of the four cases studied and the results of a larger recent study, it might not be necessary to re-image patients for dosimetric purposes over the duration of a fractionated HDR BT boost to the prostate where flexiguide needles are utilized. Nevertheless, further investigation with larger patient numbers is required. Copyright (2003) Blackwell Science Pty Ltd

  8. 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

  9. SU-E-J-181: Effect of Prostate Motion On Combined Brachytherapy and External Beam Dose Based On Daily Motion of the Prostate

    Energy Technology Data Exchange (ETDEWEB)

    Narayana, V; McLaughlin, P [Providence Cancer Center, Southfield, MI (United States); University of Michigan, Ann Arbor, MI (United States); Ealbaj, J [University of Michigan, Ann Arbor, MI (United States)

    2015-06-15

    Purpose: In this study, the adequacy of target expansions on the combined external beam and implant dose was examined based on the measured daily motion of the prostate. Methods: Thirty patients received an I–125 prostate implant prescribed to dose of 90Gy. This was followed by external beam to deliver a dose of 90Gyeq (external beam equivalent) to the prostate over 25 to 30 fractions. An ideal IMRT plan was developed by optimizing the external beam dose based on the delivered implant dose. The implant dose was converted to an equivalent external beam dose using the linear quadratic model. Patients were set up on the treatment table by daily orthogonal imaging and aligning the marker seeds in the prostate. Orthogonal images were obtained at the end of treatment to assess prostate intrafraction motion. Based on the observed motion of the markers between the initial and final images, 5 individual plans showing the actual dose delivered to the patient were calculated. A final true dose distribution was established based on summing the implant dose and the 5 external beam plans. Dose to the prostate, seminal vesicles, lymphnodes and normal tissues, rectal wall, urethra and lower sphincter were calculated and compared to ideal. On 18 patients who were sexually active, dose to the corpus cavernosum and internal pudendal artery was also calculated. Results: The average prostate motion in 3 orthogonal directions was less than 1 mm with a standard deviation of less than +2 mm. Dose and volume parameters showed that there was no decrease in dose to the targets and a marginal decrease in dose to in normal tissues. Conclusion: Dose delivered by seed implant moves with the prostate, decreasing the impact of intrafractions dose movement on actual dose delivered. Combined brachytherapy and external beam dose delivered to the prostate was not sensitive to prostate motion.

  10. Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer.

    Science.gov (United States)

    Tanaka, Nobumichi; Asakawa, Isao; Fujimoto, Kiyohide; Anai, Satoshi; Hirayama, Akihide; Hasegawa, Masatoshi; Konishi, Noboru; Hirao, Yoshihiko

    2012-09-14

    To clarify the significant clinicopathological and postdosimetric parameters to predict PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer. We studied 200 consecutive patients who received LDR-brachytherapy between July 2004 and November 2008. Of them, 137 patients did not receive neoadjuvant or adjuvant androgen deprivation therapy. One hundred and forty-two patients were treated with LDR-brachytherapy alone, and 58 were treated with LDR-brachytherapy in combination with external beam radiation therapy. The cut-off value of PSA bounce was 0.1 ng/mL. The incidence, time, height, and duration of PSA bounce were investigated. Clinicopathological and postdosimetric parameters were evaluated to elucidate independent factors to predict PSA bounce in hormone-naïve patients who underwent LDR-brachytherapy alone. Fifty patients (25%) showed PSA bounce and 10 patients (5%) showed PSA failure. The median time, height, and duration of PSA bounce were 17 months, 0.29 ng/mL, and 7.0 months, respectively. In 103 hormone-naïve patients treated with LDR-brachytherapy alone, and univariate Cox proportional regression hazard model indicated that age and minimal percentage of the dose received by 30% and 90% of the urethra were independent predictors of PSA bounce. With a multivariate Cox proportional regression hazard model, minimal percentage of the dose received by 90% of the urethra was the most significant parameter of PSA bounce. Minimal percentage of the dose received by 90% of the urethra was the most significant predictor of PSA bounce in hormone-naïve patients treated with LDR-brachytherapy alone.

  11. Preliminary results of a new workflow for MRI/CT-based image-guided brachytherapy in cervical carcinoma.

    Science.gov (United States)

    Nemoto, Miho Watanabe; Iwai, Yuma; Togasaki, Gentaro; Kurokawa, Marie; Harada, Rintarou; Kobayashi, Hiroki; Uno, Takashi

    2017-12-01

    We propose a method of image-guided brachytherapy (IGBT) that combines MRI-based target volume delineation for the first fraction with CT datasets of subsequent fractions, using an automatic, applicator-based co-registration, and report our preliminary experience. The MRI of the first fraction was used for the first brachytherapy planning. For each subsequent brachytherapy fraction, after the same applicator insertion, a new CT scan with the applicator in place was obtained. The MR image set was registered to the subsequent brachytherapy treatment planning CT using the applicator for rigid body registration. To demonstrate the registration quality, we used here the Dice index as a measurement of tandem delineation overlap between CT and MRI. The median Dice index was 0.879 (range 0.610-0.932), which indicated that the contours on CT and MRI fitted well. With this combination method, the median D90 of HR CTV and the calculated D2 cm 3 of the bladder, rectum, and sigmoid in each fraction were 7.2 (4.0-10.4), 5.9 (2.3-7.7), 4.0 (1.9-6.7), and 3.8 (0.6-7.2) Gy, respectively. Our described method of MRI-guided IGBT offers a practical option for the benefits of target delineation.

  12. Permanent LDR implants in treatment of prostate cancer

    International Nuclear Information System (INIS)

    Skowronek, J.; Kanikowski, M.; Chichel, A.; Zwierzchowski, G.

    2009-01-01

    Low-dose rate brachytherapy (LDR-BT) is a radiation method known for several years in the treatment of localized prostate cancer. The main idea of this method is to implant small radioactive seeds directly into the prostate gland. LDR brachytherapy is applied as a monotherapy and also used along with external beam radiation therapy (EBRT) as a boost. In most cases it is used as a sole radical treatment modality, but not as a palliative treatment. The application of permanent seed implants is a curative treatment alternative in patients with organ- confined cancer, without extracapsular extension of the tumour. This technique is particularly popular in the United States. In Europe, however, high-dose rate brachytherapy (HDR-BT) is more popular in early-stage prostate cancer treatment (as a boost). The aim of this publication is to describe methods, indications, complications and selected results of prostate cancer LDR brachytherapy. (authors)

  13. Radioactive seed immobilization techniques for interstitial brachytherapy

    International Nuclear Information System (INIS)

    Yan, K.; Podder, T.; Buzurovic, I.; Hu, Y.; Dicker, A.; Valicenti, R.; Yu, Y.; Messing, E.; Rubens, D.; Sarkar, N.; Ng, W.

    2008-01-01

    In prostate brachytherapy, seeds can detach from their deposited sites and move locally in the pelvis or migrate to distant sites including the pulmonary and cardiac regions. Undesirable consequences of seed migration include inadequate dose coverage of the prostate and tissue irradiation effects at the site of migration. Thus, it is clinically important to develop seed immobilization techniques. We first analyze the possible causes for seed movement, and propose three potential techniques for seed immobilization: (1) surgical glue, (2) laser coagulation and (3) diathermy coagulation. The feasibility of each method is explored. Experiments were carried out using fresh bovine livers to investigate the efficacy of seed immobilization using surgical glue. Results have shown that the surgical glue can effectively immobilize the seeds. Evaluation of the radiation dose distribution revealed that the non-immobilized seed movement would change the planned isodose distribution considerably; while by using surgical glue method to immobilize the seeds, the changes were negligible. Prostate brachytherapy seed immobilization is necessary and three alternative mechanisms are promising for addressing this issue. Experiments for exploring the efficacy of the other two proposed methods are ongoing. Devices compatible with the brachytherapy procedure will be designed in future. (orig.)

  14. High-Dose-Rate Brachytherapy of a Single Implant With Two Fractions Combined With External Beam Radiotherapy for Hormone-Naive Prostate Cancer

    International Nuclear Information System (INIS)

    Sato, Morio; Mori, Takashi; Shirai, Shintaro; Kishi, Kazushi; Inagaki, Takeshi; Hara, Isao

    2008-01-01

    Purpose: To evaluate the preliminary outcomes of high-dose-rate (HDR) brachytherapy of a single implant with two fractions and external beam radiotherapy (EBRT) for hormone-naive prostate cancer. Methods and Materials: Between March 2000 and Sept 2003, a total of 53 patients with tumor Stage T1c-T3b N0 M0 prostate cancer were treated with HDR brachytherapy boost doses (7.5 Gy/fraction) and 50-Gy EBRT during a 5.5-week period. Median follow-up was 61 months. Patients were divided into groups with localized (T1c-T2b) and advanced disease (T3a-T3b). We used the American Society for Therapeutic Radiology and Oncology (ASTRO) definition for biochemical failure. According to recommendations of the Radiation Therapy Oncology Group-ASTRO Phoenix Consensus Conference, biochemical failure-free control rates (BF-FCRs) at 3 years were investigated as 2 years short of the median follow-up. Results: Between April 2000 and Sept 2007, Common Terminology Criteria for Adverse Events Version 2.0 late Grade 2 genitourinary and gastrointestinal toxicity rates were 0% and 3.8%, respectively. Erectile preservation was 25% at 5 years. Overall survival was 88.1% and cause-specific survival was 100%. At 3 years, ASTRO BF-FCRs of the localized and advanced groups were 100% and 42%, respectively (p = 0.001). Conclusions: The HDR brachytherapy of a single implant with two fractions plus EBRT is effective in treating patients with localized hormone-naive prostate cancer, with the least genitourinary and gastrointestinal toxicities; however, longer median BF-FCR follow-up is required to assess these findings

  15. 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.

  16. Sexual dysfunction after curietherapy and external radiotherapy of the prostate for localized prostate cancer

    International Nuclear Information System (INIS)

    Huyghe, E.; Bachaud, J.-M.; Achard, J.-L.; Bossi, A.; Droupy, S.

    2009-01-01

    Knowing the importance of sexuality items in the choice by the patient of the modality of treatment of localized prostate cancer, we aimed at reviewing and updating the effects of prostate radiotherapy and brachytherapy on sexual functions. A PubMed search was done using the keywords: prostate cancer, erectile dysfunction, radiotherapy, brachytherapy, ejaculation and orgasm. After both radiotherapy and brachytherapy, sexual troubles occur progressively, the onset of occurrence of erectile dysfunction being 12-18 months after both treatments. Even though the pathophysiological pathways by which radiotherapy and brachytherapy result in erectile dysfunction have not yet been fully clarified, arterial damage and exposure of neurovascular bundle to high levels of radiation seem to be two main causes of erectile dysfunction after radiotherapy and brachytherapy. The radiation dose received by the corpora cavernosa at the crurae of the penis may also be important in the etiology of erectile dysfunction. Another important factor following radiotherapy is the treatment modality. Not many data about ejaculation and orgasm after radiation treatments have been published yet. Recent data show that most of the population treated by brachytherapy conserves ejaculation and orgasm after treatment, even if a majority describe reduction of volume and deterioration of orgasm. Patients need to be correctly informed on the possible sequela of radiotherapy and brachytherapy on their sexual well-being while planning their treatment. Patients should also be informed about the possible treatment modalities for erectile dysfunction. (authors)

  17. Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy

    International Nuclear Information System (INIS)

    Riaz, Nadeem; Afaq, Asim; Akin, Oguz; Pei Xin; Kollmeier, Marisa A.; Cox, Brett; Hricak, Hedvig; Zelefsky, Michael J.

    2012-01-01

    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.

  18. 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

  19. Does combination therapy with tamsulosin and trospium chloride improve lower urinary tract symptoms after SEEDS brachytherapy for prostate cancer compared with tamsulosin alone? : A prospective, randomized, controlled trial.

    Science.gov (United States)

    Yan, Miao; Xue, Peng; Wang, Kunpeng; Gao, Guojun; Zhang, Wei; Sun, Fanghu

    2017-09-01

    To compare the efficacy of combination therapy with an alpha-blocker and an anticholinergic to monotherapy with an alpha blocker on lower urinary tract symptoms (LUTS) following brachytherapy in prostate cancer patients. A total of 124 patients that had been clinically diagnosed with localized prostate cancer and underwent prostate brachytherapy were enrolled in the present study. Patients were randomized and allocated to two groups, including 60 to the combination group (tamsulosin 0.2 mg/day and trospium chloride 20 mg twice daily) and 64 to the monotherapy group (tamsulosin 0.2 mg/day). Treatment began 1 day after brachytherapy and continued for 6 months. LUTS were compared between the two groups using the total International Prostate Symptom Score (IPSS), storage and voiding IPSS subscores, quality of life (QoL) scores, maximum flow rate (Qmax), and postvoid residual (PVR) urine volume at 1, 3, 6, and 12 months after implantation. In all, 111 patients were ultimately analyzed in the study. Compared with pretreatment scores, a significant increase in total IPSS was found at 1, 3, and 6 months in both groups, but no statistically significant differences were observed between the two groups. The combination therapy group showed a greater decrease in the IPSS storage score compared with the monotherapy group at 1, 3, and 6 months (p = 0.031, 0.030 and 0.042, respectively). Patients receiving tamsulosin plus trospium chloride also showed significant improvements in QoL at 1 and 3 months compared with tamsulosin alone (P = 0.039, P = 0.047). Between the two groups, there was no significant difference in IPSS voiding score, Qmax, and PVR from baseline to each point of the study period. Combination therapy with tamsulosin and trospium chloride helped to improve IPSS storage symptoms and Qol scores in prostate brachytherapy patients with LUTS compared with tamsulosin monotherapy.

  20. Urethral toxicity after LDR brachytherapy: experience in Japan.

    Science.gov (United States)

    Tanaka, Nobumichi; Asakawa, Isao; Hasegawa, Masatoshi; Fujimoto, Kiyohide

    2015-01-01

    Urinary toxicity is common after low-dose-rate (LDR) brachytherapy, and the resolution of urinary toxicity is a concern. In particular, urinary frequency is the most common adverse event among the urinary toxicities. We have previously reported that approximately 70% of patients experience urinary frequency during the first 6 months after seed implantation. Most urinary adverse events were classified as Grade 1, and Grade 2 or higher adverse events were rare. The incidence of urinary retention was approximately 2-4%. A high International Prostate Symptom Score before seed implantation was an independent predictor of acute urinary toxicity of Grade 2 or higher. Several previous reports from the United States also supported this trend. In Japan, LDR brachytherapy was legally approved in 2003. A nationwide prospective cohort study entitled Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation was initiated in July 2005. It is an important issue to limit urinary toxicities in patients who undergo LDR brachytherapy. Copyright © 2015 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  1. Distant Metastases Following Permanent Interstitial Brachytherapy for Patients With Clinically Localized Prostate Cancer

    International Nuclear Information System (INIS)

    Taira, Al V.; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan; Adamovich, Edward; Wallner, Kent E.

    2012-01-01

    Purpose: Recent publications have suggested high-risk patients undergoing radical prostatectomy have a lower risk of distant metastases and improved cause-specific survival (CSS) than patients receiving definitive external beam radiation therapy (XRT). To date, none of these studies has compared distant metastases and CSS in brachytherapy patients. In this study, we evaluate such parameters in a consecutive cohort of brachytherapy patients. Methods and Materials: From April 1995 to June 2007, 1,840 consecutive patients with clinically localized prostate cancer were treated with brachytherapy. Risk groups were stratified according to National Comprehensive Cancer Network ( (www.nccn.org)) guidelines. Subgroups of 658, 893, and 289 patients were assigned to low, intermediate, and high-risk categories. Median follow-up was 7.2 years. Along with brachytherapy implantation, 901 (49.0%) patients received supplemental XRT, and 670 (36.4%) patients received androgen deprivation therapy (median duration, 4 months). The mode of failure (biochemical, local, or distant) was determined for each patient for whom therapy failed. Cause of death was determined for each deceased patient. Multiple parameters were evaluated for impact on outcome. Results: For the entire cohort, metastases-free survival (MFS) and CSS at 12 years were 98.1% and 98.2%, respectively. When rates were stratified by low, intermediate, and high-risk groups, the 12-year MFS was 99.8%, 98.1%, and 93.8% (p < 0.001), respectively. CSS rates were 99.8%, 98.0%, and 95.3% (p < 0.001) for low, intermediate, and high-risk groups, respectively. Biochemical progression-free survival was 98.7%, 95.9% and 90.4% for low, intermediate, and high-risk patients, respectively (p < 0.001). In multivariate Cox-regression analysis, MFS was mostly closely related to Gleason score and year of treatment, whereas CSS was most closely associated with Gleason score. Conclusions: Excellent CSS and MFS rates are achievable with high

  2. 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

  3. A review of transrectal ultrasound guided prostate biopsies: Is there ...

    African Journals Online (AJOL)

    Objective: We compared our institution's initial experience with transrectal ultrasound-guided (TRUS) prostate biopsies in a single arm prospective study to a historical cohort of finger guided (FG) biopsies. The primary outcome measure was prostate cancer detection. We documented our findings on TRUS including the ...

  4. Comparison between external beam radiotherapy (70 Gy/74 Gy) and permanent interstitial brachytherapy in 890 intermediate risk prostate cancer patients

    International Nuclear Information System (INIS)

    Goldner, Gregor; Pötter, Richard; Battermann, Jan J.; Kirisits, Christian; Schmid, Maximilian P.; Sljivic, Samir; Vulpen, Marco van

    2012-01-01

    Purpose: Aim of this analysis was to compare biochemical no evidence of disease (bNED) rates in intermediate-risk prostate-cancer patients treated at two centres of excellence using different approaches: permanent interstitial brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 890 intermediate-risk prostate-cancer patients, who were treated from 1998 to 2008, were identified in the two local databases. In Utrecht 601 patients received I-125 BT applying a dose of 144 Gy. In Vienna 289 patients were treated by EBRT, applying a local dose of 70 Gy in 105 patients and 74 Gy in 184 patients. bNED-rates (Phoenix-definition) were assessed. Results: Median follow-up was 48 months (1–150). 5-Year actuarial bNED-rates were 81% for BT-patients and 75% for EBRT-patients (67% for 70 Gy and 82% for 74 Gy), respectively. In univariate analysis no difference between BT and EBRT could be detected. In multivariate analysis including tumour-stage, GleasonScore, initial PSA, hormonal therapy and treatment-centre (BT vs. EBRT) only T-stage, GleasonScore and PSA were found to be significant. Additional analysis including radiation dose showed the same outcome. Conclusions: Intermediate-risk prostate cancer patients treated by permanent interstitial brachytherapy show biochemical tumour-control-rates which are comparable to EBRT of 74 Gy.

  5. 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

  6. BrachyView: proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy.

    Science.gov (United States)

    Petasecca, M; Loo, K J; Safavi-Naeini, M; Han, Z; Metcalfe, P E; Meikle, S; Pospisil, S; Jakubek, J; Bucci, J A; Zaider, M; Lerch, M L F; Qi, Y; Rosenfeld, A B

    2013-04-01

    The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom. BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry. The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5-3 mm for a 10-60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for real-time imaging (using a 3 s

  7. BrachyView: Proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy

    International Nuclear Information System (INIS)

    Petasecca, M.; Loo, K. J.; Safavi-Naeini, M.; Han, Z.; Metcalfe, P. E.; Lerch, M. L. F.; Qi, Y.; Rosenfeld, A. B.; Meikle, S.; Pospisil, S.; Jakubek, J.; Bucci, J. A.; Zaider, M.

    2013-01-01

    Purpose: The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom. Methods: BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry. Results: The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5–3 mm for a 10–60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for

  8. Rectal fistulas after prostate brachytherapy

    International Nuclear Information System (INIS)

    Tran, Audrey; Wallner, Kent; Merrick, Gregory; Seeberger, Jergen M.S.; Armstrong, Julius R.T.T.; Mueller, Amy; Cavanagh, William M.S.; Lin, Daniel; Butler, Wayne

    2005-01-01

    Purpose: To compare the rectal and prostatic radiation doses for a prospective series of 503 patients, 44 of whom developed persistent rectal bleeding, and 2 of whom developed rectal-prostatic fistulas. Methods and Materials: The 503 patients were randomized and treated by implantation with 125 I vs. 103 Pd alone (n = 290) or to 103 Pd with 20 Gy vs. 44 Gy supplemental external beam radiotherapy (n = 213) and treated at the Puget Sound Veterans Affairs Medical Center (n = 227), Schiffler Cancer Center (n 242) or University of Washington (n = 34). Patients were treated between September 1998 and October 2001 and had a minimum of 24 months of follow-up. The patient groups were treated concurrently. Treatment-related morbidity was monitored by mailed questionnaires, using standard American Urological Association and Radiation Therapy Oncology Group criteria, at 1, 3, 6, 12, 18, and 24 months. Patients who reported Grade 1 or greater Radiation Therapy Oncology Group rectal morbidity were interviewed by telephone to clarify details regarding their rectal bleeding. Those who reported persistent bleeding, lasting for >1 month were included as having Grade 2 toxicity. Three of the patients with rectal bleeding required a colostomy, two of whom developed a fistula. No patient was lost to follow-up. The rectal doses were defined as the rectal volume in cubic centimeters that received >50%, 100%, 200%, or 300% of the prescription dose. The rectum was considered as a solid structure defined by the outer wall, without attempting to differentiate the inner wall or contents. Results: Persistent rectal bleeding occurred in 44 of the 502 patients, 32 of whom (73%) underwent confirmatory endoscopy. In univariate analysis, multiple parameters were associated with late rectal bleeding, including all rectal brachytherapy indexes. In multivariate analysis, however, only the rectal volume that received >100% of the dose was significantly predictive of bleeding. Rectal fistulas occurred

  9. A new robotic needle insertion method to minimise attendant prostate motion

    International Nuclear Information System (INIS)

    Lagerburg, Vera; Moerland, Marinus A.; Vulpen, Marco van; Lagendijk, Jan J.W.

    2006-01-01

    Background and purpose: The purpose of this study is to investigate the efficacy of a new needle insertion method (tapping instead of pushing) in reducing attendant tissue motion. This can be useful in applications where tissue motion due to needle insertion is problematic such as e.g. MRI-guided prostate brachytherapy and breast biopsies. In this study we will focus on prostate motion due to needle insertion. Material and methods: Prostate motion due to needle insertion was measured in 30 patients, who were transperineally implanted with fiducial gold markers for position verification in prostate intensity modulated radiotherapy. In total 32 needles were manually pushed into the prostate and 29 were tapped with a prototype robotic system. The prostate motion in the cranio-caudal direction was measured on the video record of the ultrasound images. Differences in prostate motion between the two needle insertion methods were analysed making use of SPSS. Results: The mean prostate motion was 5.6 mm (range 0.3-21.6) when the needle was pushed and 0.9 mm (range 0-2.0) when the needle was tapped into the prostate (p < 0.001). Conclusion: Prostate motion was significantly less when the needle was tapped into the prostate compared to when the needle was pushed. This result is important for the development of a tapping, MRI-guided, prostate implant robotic system

  10. A novel method for accurate needle-tip identification in trans-rectal ultrasound-based high-dose-rate prostate brachytherapy.

    Science.gov (United States)

    Zheng, Dandan; Todor, Dorin A

    2011-01-01

    In real-time trans-rectal ultrasound (TRUS)-based high-dose-rate prostate brachytherapy, the accurate identification of needle-tip position is critical for treatment planning and delivery. Currently, needle-tip identification on ultrasound images can be subject to large uncertainty and errors because of ultrasound image quality and imaging artifacts. To address this problem, we developed a method based on physical measurements with simple and practical implementation to improve the accuracy and robustness of needle-tip identification. Our method uses measurements of the residual needle length and an off-line pre-established coordinate transformation factor, to calculate the needle-tip position on the TRUS images. The transformation factor was established through a one-time systematic set of measurements of the probe and template holder positions, applicable to all patients. To compare the accuracy and robustness of the proposed method and the conventional method (ultrasound detection), based on the gold-standard X-ray fluoroscopy, extensive measurements were conducted in water and gel phantoms. In water phantom, our method showed an average tip-detection accuracy of 0.7 mm compared with 1.6 mm of the conventional method. In gel phantom (more realistic and tissue-like), our method maintained its level of accuracy while the uncertainty of the conventional method was 3.4mm on average with maximum values of over 10mm because of imaging artifacts. A novel method based on simple physical measurements was developed to accurately detect the needle-tip position for TRUS-based high-dose-rate prostate brachytherapy. The method demonstrated much improved accuracy and robustness over the conventional method. Copyright © 2011 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  11. Patterns of care for brachytherapy in Europe. Results in Spain.

    Science.gov (United States)

    López Torrecilla, J; Guedea, F; Heeren, G; Nissin, R; Ellison, T; Cottier, B

    2006-05-01

    In 2003 ESTRO began a project whose primary objective, was to make a map in the European area of infrastructures in technology and personnel for brachytherapy. A survey and a web site were elaborated. The survey was sent to the 76 Spanish Radiation Oncology departments in May 2003. By the end of 2003, 66 (86.8%) services had responded, 40 (71.4%) of which had brachytherapy. The services with brachytherapy treated 73.5% of the total patients, an average of 1,199 patients. The mean number of patients treated with brachytherapy by department was 135.5 and the number of applications was 265 annually. The average number of specialists was 7, 4 of them trained in brachytherapy. The average weekly work load of the radiation oncologists, physicists, and technicians was 22.6 h, 13.8 h and 21.0 h, respectively. The mean time dedicated to each patient by radiation oncologists, physicists and technicians was 9.2 h; 6.19 h; 7.2 h, respectively. The total number of afterloaders was 43 (22 HDR, 18 LDR, 3 PDR). The tumours most frequently treated with brachytherapy were gynaecological (56.24%), breast (14.2%) and prostate (11.7%). High dose rate was used in 47.46% of the patients and low dose rate in 47.24%. Between 1997 and 2002 there was an increase of 50.53% in patients treated with brachytherapy. The survey shows the brachytherapy resources and activity in Spain up to 2003. Increased use of brachytherapy in prostate tumours, prevalence of gynaecology brachytherapy and similar number of treatments with HDR and LDR are demonstrated in the Patterns of Care of Brachytherapy in Europe (PCBE) study in Spain.

  12. 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

  13. Fiber Bragg gratings-based sensing for real-time needle tracking during MR-guided brachytherapy

    NARCIS (Netherlands)

    Borot, Maxence; Denis de Senneville, Baudouin; Maenhout, Metha; Lagendijk, JJW; van Vulpen, Marco; Hautvast, Gilion; Binnekamp, Dirk; Moerland, Rien

    2016-01-01

    PURPOSE: The development of MR-guided high dose rate (HDR) brachytherapy is under investigation due to the excellent tumor and organs at risk visualization of MRI. However, MR-based localization of needles (including catheters or tubes) has inherently a low update rate and the required image

  14. Comprehensive brachytherapy physical and clinical aspects

    CERN Document Server

    Baltas, Dimos; Meigooni, Ali S; Hoskin, Peter J

    2013-01-01

    Modern brachytherapy is one of the most important oncological treatment modalities requiring an integrated approach that utilizes new technologies, advanced clinical imaging facilities, and a thorough understanding of the radiobiological effects on different tissues, the principles of physics, dosimetry techniques and protocols, and clinical expertise. A complete overview of the field, Comprehensive Brachytherapy: Physical and Clinical Aspects is a landmark publication, presenting a detailed account of the underlying physics, design, and implementation of the techniques, along with practical guidance for practitioners. Bridging the gap between research and application, this single source brings together the technological basis, radiation dosimetry, quality assurance, and fundamentals of brachytherapy. In addition, it presents discussion of the most recent clinical practice in brachytherapy including prostate, gynecology, breast, and other clinical treatment sites. Along with exploring new clinical protocols, ...

  15. A Bayesian nonrigid registration method to enhance intraoperative target definition in image-guided prostate procedures through uncertainty characterization

    International Nuclear Information System (INIS)

    Pursley, Jennifer; Risholm, Petter; Fedorov, Andriy; Tuncali, Kemal; Fennessy, Fiona M.; Wells, William M. III; Tempany, Clare M.; Cormack, Robert A.

    2012-01-01

    Purpose: This study introduces a probabilistic nonrigid registration method for use in image-guided prostate brachytherapy. Intraoperative imaging for prostate procedures, usually transrectal ultrasound (TRUS), is typically inferior to diagnostic-quality imaging of the pelvis such as endorectal magnetic resonance imaging (MRI). MR images contain superior detail of the prostate boundaries and provide substructure features not otherwise visible. Previous efforts to register diagnostic prostate images with the intraoperative coordinate system have been deterministic and did not offer a measure of the registration uncertainty. The authors developed a Bayesian registration method to estimate the posterior distribution on deformations and provide a case-specific measure of the associated registration uncertainty. Methods: The authors adapted a biomechanical-based probabilistic nonrigid method to register diagnostic to intraoperative images by aligning a physician's segmentations of the prostate in the two images. The posterior distribution was characterized with a Markov Chain Monte Carlo method; the maximum a posteriori deformation and the associated uncertainty were estimated from the collection of deformation samples drawn from the posterior distribution. The authors validated the registration method using a dataset created from ten patients with MRI-guided prostate biopsies who had both diagnostic and intraprocedural 3 Tesla MRI scans. The accuracy and precision of the estimated posterior distribution on deformations were evaluated from two predictive distance distributions: between the deformed central zone-peripheral zone (CZ-PZ) interface and the physician-labeled interface, and based on physician-defined landmarks. Geometric margins on the registration of the prostate's peripheral zone were determined from the posterior predictive distance to the CZ-PZ interface separately for the base, mid-gland, and apical regions of the prostate. Results: The authors observed

  16. Individualised 3D printed vaginal template for MRI guided brachytherapy in locally advanced cervical cancer

    DEFF Research Database (Denmark)

    Lindegaard, Jacob Christian; Lænsø Madsen, Mads; Hansen, Anders Traberg

    2016-01-01

    Intracavitary–interstitial applicators for MRI guided brachytherapy are becoming increasingly important in locally advanced cervical cancer. The 3D printing technology enables a versatile method for obtaining a high degree of individualisation of the implant. Our clinical workflow is presented...

  17. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    International Nuclear Information System (INIS)

    Geinitz, Hans

    2015-01-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  18. Optimal matching for prostate brachytherapy seed localization with dimension reduction.

    Science.gov (United States)

    Lee, Junghoon; Labat, Christian; Jain, Ameet K; Song, Danny Y; Burdette, Everette C; Fichtinger, Gabor; Prince, Jerry L

    2009-01-01

    In prostate brachytherapy, x-ray fluoroscopy has been used for intra-operative dosimetry to provide qualitative assessment of implant quality. More recent developments have made possible 3D localization of the implanted radioactive seeds. This is usually modeled as an assignment problem and solved by resolving the correspondence of seeds. It is, however, NP-hard, and the problem is even harder in practice due to the significant number of hidden seeds. In this paper, we propose an algorithm that can find an optimal solution from multiple projection images with hidden seeds. It solves an equivalent problem with reduced dimensional complexity, thus allowing us to find an optimal solution in polynomial time. Simulation results show the robustness of the algorithm. It was validated on 5 phantom and 18 patient datasets, successfully localizing the seeds with detection rate of > or = 97.6% and reconstruction error of < or = 1.2 mm. This is considered to be clinically excellent performance.

  19. 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)

  20. 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)

  1. CT-based postimplant dosimetry of prostate brachytherapy. Comparison of 1-mm and 5-mm section CT

    International Nuclear Information System (INIS)

    Tanaka, Osamu; Hayashi, Shinya; Kanematsu, Masayuki; Matsuo, Masayuki; Hoshi, Hiroaki; Nakano, Masahiro; Maeda, Sanaho; Deguchi, Takashi; Hoshi, Hiroaki

    2007-01-01

    The aim of this study was to compare the outcomes between 1-mm and 5-mm section computed tomography (CT)-based postimplant dosimetry. A series of 21 consecutive patients underwent permanent prostate brachytherapy. The postimplant prostate volume was calculated using 1-mm and 5-mm section CT. One radiation oncologist contoured the prostate on CT images to obtain the reconstructed prostate volume (pVol), prostate V 100 (percent of the prostate volume receiving at least the full prescribed dose), and prostate D 90 (mean dose delivered to 90% of the prostate gland). The same radiation oncologist performed the contouring three times to evaluate intraobserver variation and subjectively scored the quality of the CT images. The mean ±1 standard deviation (SD) postimplant pVol was 20.17±6.66 cc by 1-mm section CT and 22.24±8.48 cc by 5-mm section CT; the difference in the mean values was 2.06 cc (P 100 was 80.44%±7.06% by 1-mm section CT and 77.33%±10.22% by 5-mm section CT. The mean postimplant prostate D 90 was 83.28%±10.81% by 1-mm section CT and 78.60%±15.75% by 5-mm section CT. In the evaluation of image quality, 5-mm section CT was assigned significantly higher scores than 1-mm section CT. In regard to intraobserver variation, 5-mm section CT revealed less intraobserver variation than 1-mm section CT. Our current results suggested that the outcomes of postimplant dosimetry using 1-mm section CT did not improved the results over those obtained using 5-mm section CT in terms of the quality of the CT image or reproducibility. (author)

  2. 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.

  3. 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

  4. 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.

  5. High biologically effective dose radiation therapy using brachytherapy in combination with external beam radiotherapy for high-risk prostate cancer

    Directory of Open Access Journals (Sweden)

    Keisei Okamoto

    2017-02-01

    Full Text Available Purpose : To evaluate the outcomes of high-risk prostate cancer patients treated with biologically effective dose (BED ≥ 220 Gy of high-dose radiotherapy, using low-dose-rate (LDR brachytherapy in combination with external beam radiotherapy (EBRT and short-term androgen deprivation therapy (ADT. Material and methods : From 2005 to 2013, a total of 143 patients with high-risk prostate cancer were treated by radiotherapy of BED ≥ 220 Gy with a combination of LDR brachytherapy, EBRT, and androgen deprivation therapy (ADT. The high-risk patients in the present study included both high-risk and very high-risk prostate cancer. The number of high-risk features were: 60 patients with 1 high-risk factor (42%, 61 patients with 2 high-risk factors (43%, and 22 patients with 3 high-risk factors (15% including five N1 disease. External beam radiotherapy fields included prostate and seminal vesicles only or whole pelvis depending on the extension of the disease. Biochemical failure was defined by the Phoenix definition. Results : Six patients developed biochemical failure, thus providing a 5-year actual biochemical failure-free survival (BFFS rate of 95.2%. Biochemical failure was observed exclusively in cases with distant metastasis in the present study. All six patients with biochemical relapse had clinical failure due to bone metastasis, thus yielding a 5-year freedom from clinical failure (FFCF rate of 93.0%. None of the cases with N1 disease experienced biochemical failure. We observed four deaths, including one death from prostate cancer, therefore yielding a cause-specific survival (CSS rate of 97.2%, and an overall survival (OS rate of 95.5%. Conclusions : High-dose (BED ≥ 220 Gy radiotherapy by LDR in combination with EBRT has shown an excellent outcome on BFFS in high-risk and very high-risk cancer, although causal relationship between BED and BFFS remain to be explained further.

  6. Palladium-103 brachytherapy for clinical T1/T2 prostate carcinomas

    International Nuclear Information System (INIS)

    Dattoli, M.J.; Wallner, K.E.; Cash, J.C.; Ross, R.E.; Koval, J.M.; Sorace, R.A.

    1997-01-01

    Purpose: To evaluate the efficacy of Pd-103 brachytherapy as sole modality for patients having clinical T1/T2 prostate carcinomas Materials and Methods: The initial 103 consecutive patients treated at our hospital are available for biochemical failure and toxicity data following Pd-103 brachytherapy. Minimum peripheral target dose of 11,500cGy (median) was prescribed. Follow-up range: 4-6 years (56 months median). Mean pre-treatment PSA = 11.7ng/ml. All patients have been followed in prospective fashion with respect to PSA response, clinical evidence of disease progression and complications. Criteria for biochemical failure was relatively strict, and was analyzed using PSA>1.0. Patients whose PSA was still decreasing at last follow-up were censored at that time. Freedom from failure rates were calculated by the method of Kaplan and Meier. Differences between groups were determined by the Log-rank method. Sexual potency was defined as the ability to attain and maintain an erection sufficient for intercourse. Results: Actuarial freedom from biochemical failure at 6 years after treatment is 68%. Toxicity has been low with no patient developing rectal ulceration or incontinence (despite 16 pts having prior TURP). The impotency rate is 12%. Of the 33 pts with a post treatment PSA >1.0, 29 pts actually had one or more adverse features determined to be PSA>10 (26 pts), Gleason's score ≥ 7 (5 pts), AJC clinical stage≥T2b (10 pts). Mean pre-treatment PSA's of the 33 failures = 18.3ng/ml. For the 74 pts without high risk features, the actuarial 6 years biochemical freedom from progression rate using PSA<1.0 as an endpoint for success is 93%. Conclusion: This biochemical freedom from progression rate compares favorably to other modalities and supports the use of Pd-103 brachytherapy as sole modality in properly selected patients. Morbidity has been relatively low. Pd-103 implant alone is currently being used in patients having PSA<10, Gleason's score<7, and clinical stage

  7. 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

  8. Evaluation of a Machine-Learning Algorithm for Treatment Planning in Prostate Low-Dose-Rate Brachytherapy

    International Nuclear Information System (INIS)

    Nicolae, Alexandru; Morton, Gerard; Chung, Hans; Loblaw, Andrew; Jain, Suneil; Mitchell, Darren; Lu, Lin; Helou, Joelle; Al-Hanaqta, Motasem; Heath, Emily; Ravi, Ananth

    2017-01-01

    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

  9. Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients

    Energy Technology Data Exchange (ETDEWEB)

    Goldner, G.; Poetter, R.; Schmid, M.P.; Kirisits, C. [University Hospital of Vienna (Austria). Dept. of Radiotherapy and Radiobiology; Battermann, J.J.; Sljivic, S.; Vulpen, M. van [University Medical Center Utrecht (Netherlands). Dept. of Radiation Oncology

    2012-04-15

    The aim of this analysis was to compare the biochemical no evidence of disease (bNED) rates in low-risk prostate cancer patients treated at two centers of excellence using different approaches: seed brachytherapy (BT) and external beam radiotherapy (EBRT). Materials and methods: A total of 919 low-risk prostate cancer patients, treated from 1998-2008, were identified in the two databases. In Utrecht, 667 patients received I-125 BT applying a dose of 144 Gy. In Vienna, 252 patients were treated with EBRT, applying a local dose of 70 Gy in 82 patients and 74 Gy in 170 patients. bNED rates (Phoenix definition) were assessed. Results: The median follow-up was 46 months (range 1-148 months). The 5-year actuarial bNED rates were 94% for BT patients and 88% for EBRT patients (p = 0.002) - 84% for patients receiving 70 Gy and 91% for patients receiving 74 Gy, respectively. In the univariate analysis, patients receiving 70 Gy showed significantly worse outcome compared to BT (p = 0.001) and a difference close to significance compared to 74 Gy (p = 0.06). In the multivariate analysis including tumor stage, Gleason score, initial PSA, hormonal therapy, and dose, patients receiving 70 Gy EBRT showed significantly worse bNED rates compared to BT patients. Conclusion: Low-risk prostate cancer patients receiving 74 Gy by EBRT show comparable biochemical control rates to patients receiving seed brachytherapy, whereas patients receiving 70 Gy show significantly worse outcome. (orig.)

  10. Comparison of Combined X-Ray Radiography and Magnetic Resonance (XMR) Imaging-Versus Computed Tomography-Based Dosimetry for the Evaluation of Permanent Prostate Brachytherapy Implants

    International Nuclear Information System (INIS)

    Acher, Peter; Rhode, Kawal; Morris, Stephen; Gaya, Andrew; Miquel, Marc; Popert, Rick; Tham, Ivan; Nichol, Janette; McLeish, Kate; Deehan, Charles; Dasgupta, Prokar; Beaney, Ronald; Keevil, Stephen F.

    2008-01-01

    Purpose: To present a method for the dosimetric analysis of permanent prostate brachytherapy implants using a combination of stereoscopic X-ray radiography and magnetic resonance (MR) imaging (XMR) in an XMR facility, and to compare the clinical results between XMR- and computed tomography (CT)-based dosimetry. Methods and Materials: Patients who had received nonstranded iodine-125 permanent prostate brachytherapy implants underwent XMR and CT imaging 4 weeks later. Four observers outlined the prostate gland on both sets of images. Dose-volume histograms (DVHs) were derived, and agreement was compared among the observers and between the modalities. Results: A total of 30 patients were evaluated. Inherent XMR registration based on prior calibration and optical tracking required a further automatic seed registration step that revealed a median root mean square registration error of 4.2 mm (range, 1.6-11.4). The observers agreed significantly more closely on prostate base and apex positions as well as outlining contours on the MR images than on those from CT. Coefficients of variation were significantly higher for observed prostate volumes, D90, and V100 parameters on CT-based dosimetry as opposed to XMR. The XMR-based dosimetry showed little agreement with that from CT for all observers, with D90 95% limits of agreement ranges of 65, 118, 79, and 73 Gy for Observers 1, 2, 3, and 4, respectively. Conclusions: The study results showed that XMR-based dosimetry offers an alternative to other imaging modalities and registration methods with the advantages of MR-based prostate delineation and confident three-dimensional reconstruction of the implant. The XMR-derived dose-volume histograms differ from the CT-derived values and demonstrate less interobserver variability

  11. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

    Energy Technology Data Exchange (ETDEWEB)

    Yang, Ruijie, E-mail: ruijyang@yahoo.com; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-10-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D{sub 90} of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD{sub 2}) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D{sub mean} (EQD{sub 2}) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D{sub mean} (EQD{sub 2}) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD{sub 2}) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.

  12. Dosimetric and radiobiological comparison of volumetric modulated arc therapy, high-dose rate brachytherapy, and low-dose rate permanent seeds implant for localized prostate cancer

    International Nuclear Information System (INIS)

    Yang, Ruijie; Zhao, Nan; Liao, Anyan; Wang, Hao; Qu, Ang

    2016-01-01

    To investigate the dosimetric and radiobiological differences among volumetric modulated arc therapy (VMAT), high-dose rate (HDR) brachytherapy, and low-dose rate (LDR) permanent seeds implant for localized prostate cancer. A total of 10 patients with localized prostate cancer were selected for this study. VMAT, HDR brachytherapy, and LDR permanent seeds implant plans were created for each patient. For VMAT, planning target volume (PTV) was defined as the clinical target volume plus a margin of 5 mm. Rectum, bladder, urethra, and femoral heads were considered as organs at risk. A 78 Gy in 39 fractions were prescribed for PTV. For HDR and LDR plans, the dose prescription was D 90 of 34 Gy in 8.5 Gy per fraction, and 145 Gy to clinical target volume, respectively. The dose and dose volume parameters were evaluated for target, organs at risk, and normal tissue. Physical dose was converted to dose based on 2-Gy fractions (equivalent dose in 2 Gy per fraction, EQD 2 ) for comparison of 3 techniques. HDR and LDR significantly reduced the dose to rectum and bladder compared with VMAT. The D mean (EQD 2 ) of rectum decreased 22.36 Gy in HDR and 17.01 Gy in LDR from 30.24 Gy in VMAT, respectively. The D mean (EQD 2 ) of bladder decreased 6.91 Gy in HDR and 2.53 Gy in LDR from 13.46 Gy in VMAT. For the femoral heads and normal tissue, the mean doses were also significantly reduced in both HDR and LDR compared with VMAT. For the urethra, the mean dose (EQD 2 ) was 80.26, 70.23, and 104.91 Gy in VMAT, HDR, and LDR brachytherapy, respectively. For localized prostate cancer, both HDR and LDR brachytherapy were clearly superior in the sparing of rectum, bladder, femoral heads, and normal tissue compared with VMAT. HDR provided the advantage in sparing of urethra compared with VMAT and LDR.

  13. Sci-Thur AM: YIS – 03: Combining sagittally-reconstructed 3D and live-2D ultrasound for high-dose-rate prostate brachytherapy needle segmentation

    Energy Technology Data Exchange (ETDEWEB)

    Hrinivich, Thomas; Hoover, Douglas; Surry, Kathleen; Edirisinghe, Chandima; D’Souza, David; Fenster, Aaron; Wong, Eugene [University of Western Ontario, London Regional Cancer Program/LHSC, London Regional Cancer Program/LHSC, Robarts Research Institute, London Regional Cancer Program/LHSC, Robarts Research Institute, University of Western Ontario (Canada)

    2016-08-15

    Ultrasound-guided high-dose-rate prostate brachytherapy (HDR-BT) needle segmentation is performed clinically using live-2D sagittal images. Organ segmentation is then performed using axial images, introducing a source of geometric uncertainty. Sagittally-reconstructed 3D (SR3D) ultrasound enables both needle and organ segmentation, but suffers from shadow artifacts. We present a needle segmentation technique augmenting SR3D with live-2D sagittal images using mechanical probe tracking to mitigate image artifacts and compare it to the clinical standard. Seven prostate cancer patients underwent TRUS-guided HDR-BT during which the clinical and proposed segmentation techniques were completed in parallel using dual ultrasound video outputs. Calibrated needle end-length measurements were used to calculate insertion depth errors (IDEs), and the dosimetric impact of IDEs was evaluated by perturbing clinical treatment plan source positions. The proposed technique provided smaller IDEs than the clinical approach, with mean±SD of −0.3±2.2 mm and −0.5±3.7mm respectively. The proposed and clinical techniques resulted in 84% and 43% of needles with IDEs within ±3mm, and IDE ranges across all needles of [−7.7mm, 5.9mm] and [−9.3mm, 7.7mm] respectively. The proposed and clinical IDEs lead to mean±SD changes in the volume of the prostate receiving the prescription dose of −0.6±0.9% and −2.0±5.3% respectively. The proposed technique provides improved HDR-BT needle segmentation accuracy over the clinical technique leading to decreased dosimetric uncertainty by eliminating the axial-to-sagittal registration, and mitigates the effect of shadow artifacts by incorporating mechanically registered live-2D sagittal images.

  14. SU-F-BRA-13: Knowledge-Based Treatment Planning for Prostate LDR Brachytherapy Based On Principle Component Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Roper, J; Bradshaw, B; Godette, K; Schreibmann, E [Winship Cancer Institute of Emory University, Atlanta, GA (United States); Chanyavanich, V [Rocky Mountain Cancer Centers, Denver, CO (United States)

    2015-06-15

    Purpose: To create a knowledge-based algorithm for prostate LDR brachytherapy treatment planning that standardizes plan quality using seed arrangements tailored to individual physician preferences while being fast enough for real-time planning. Methods: A dataset of 130 prior cases was compiled for a physician with an active prostate seed implant practice. Ten cases were randomly selected to test the algorithm. Contours from the 120 library cases were registered to a common reference frame. Contour variations were characterized on a point by point basis using principle component analysis (PCA). A test case was converted to PCA vectors using the same process and then compared with each library case using a Mahalanobis distance to evaluate similarity. Rank order PCA scores were used to select the best-matched library case. The seed arrangement was extracted from the best-matched case and used as a starting point for planning the test case. Computational time was recorded. Any subsequent modifications were recorded that required input from a treatment planner to achieve an acceptable plan. Results: The computational time required to register contours from a test case and evaluate PCA similarity across the library was approximately 10s. Five of the ten test cases did not require any seed additions, deletions, or moves to obtain an acceptable plan. The remaining five test cases required on average 4.2 seed modifications. The time to complete manual plan modifications was less than 30s in all cases. Conclusion: A knowledge-based treatment planning algorithm was developed for prostate LDR brachytherapy based on principle component analysis. Initial results suggest that this approach can be used to quickly create treatment plans that require few if any modifications by the treatment planner. In general, test case plans have seed arrangements which are very similar to prior cases, and thus are inherently tailored to physician preferences.

  15. 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.

  16. SU-G-TeP4-05: An Evaluation of a Low Dose Rate (LDR) Prostate Brachytherapy Procedure Using a Failure Modes and Effects Analysis (FMEA)

    International Nuclear Information System (INIS)

    Cheong, S-K; Kim, J

    2016-01-01

    Purpose: The aim of the study is the application of a Failure Modes and Effects Analysis (FMEA) to access the risks for patients undergoing a Low Dose Rate (LDR) Prostate Brachytherapy Treatment. Methods: FMEA was applied to identify all the sub processes involved in the stages of identifying patient, source handling, treatment preparation, treatment delivery, and post treatment. These processes characterize the radiation treatment associated with LDR Prostate Brachytherapy. The potential failure modes together with their causes and effects were identified and ranked in order of their importance. Three indexes were assigned for each failure mode: the occurrence rating (O), the severity rating (S), and the detection rating (D). A ten-point scale was used to score each category, ten being the number indicating most severe, most frequent, and least detectable failure mode, respectively. The risk probability number (RPN) was calculated as a product of the three attributes: RPN = O X S x D. The analysis was carried out by a working group (WG) at UPMC. Results: The total of 56 failure modes were identified including 32 modes before the treatment, 13 modes during the treatment, and 11 modes after the treatment. In addition to the protocols already adopted in the clinical practice, the prioritized risk management will be implanted to the high risk procedures on the basis of RPN score. Conclusion: The effectiveness of the FMEA method was established. The FMEA methodology provides a structured and detailed assessment method for the risk analysis of the LDR Prostate Brachytherapy Procedure and can be applied to other radiation treatment modes.

  17. SU-G-TeP4-05: An Evaluation of a Low Dose Rate (LDR) Prostate Brachytherapy Procedure Using a Failure Modes and Effects Analysis (FMEA)

    Energy Technology Data Exchange (ETDEWEB)

    Cheong, S-K; Kim, J [University of Pittsburgh Medical Center, Pittsburgh, PA (United States)

    2016-06-15

    Purpose: The aim of the study is the application of a Failure Modes and Effects Analysis (FMEA) to access the risks for patients undergoing a Low Dose Rate (LDR) Prostate Brachytherapy Treatment. Methods: FMEA was applied to identify all the sub processes involved in the stages of identifying patient, source handling, treatment preparation, treatment delivery, and post treatment. These processes characterize the radiation treatment associated with LDR Prostate Brachytherapy. The potential failure modes together with their causes and effects were identified and ranked in order of their importance. Three indexes were assigned for each failure mode: the occurrence rating (O), the severity rating (S), and the detection rating (D). A ten-point scale was used to score each category, ten being the number indicating most severe, most frequent, and least detectable failure mode, respectively. The risk probability number (RPN) was calculated as a product of the three attributes: RPN = O X S x D. The analysis was carried out by a working group (WG) at UPMC. Results: The total of 56 failure modes were identified including 32 modes before the treatment, 13 modes during the treatment, and 11 modes after the treatment. In addition to the protocols already adopted in the clinical practice, the prioritized risk management will be implanted to the high risk procedures on the basis of RPN score. Conclusion: The effectiveness of the FMEA method was established. The FMEA methodology provides a structured and detailed assessment method for the risk analysis of the LDR Prostate Brachytherapy Procedure and can be applied to other radiation treatment modes.

  18. 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

  19. Isotope and Patient Age Predict for PSA Spikes After Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Bostancic, Chelsea; Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Allen, Zachariah; Galbreath, Robert; Lief, Jonathan; Gutman, Sarah E.

    2007-01-01

    Purpose: To evaluate prostate-specific antigen (PSA) spikes after permanent prostate brachytherapy in low-risk patients. Methods and Materials: The study population consisted of 164 prostate cancer patients who were part of a prospective randomized trial comparing 103 Pd and 125 I for low-risk disease. Of the 164 patients, 61 (37.2%) received short-course androgen deprivation therapy. The median follow-up was 5.4 years. On average, 11.1 post-treatment PSA measurements were obtained per patient. Biochemical disease-free survival was defined as a PSA level of ≤0.40 ng/mL after nadir. A PSA spike was defined as an increase of ≥0.2 ng/mL, followed by a durable decline to prespike levels. Multiple parameters were evaluated as predictors for a PSA spike. Results: Of the 164 patients, 44 (26.9%) developed a PSA spike. Of the 46 hormone-naive 125 I patients and 57 hormone-naive 103 Pd patients, 21 (45.7%) and 8 (14.0%) developed a PSA spike. In the hormone-naive patients, the mean time between implantation and the spike was 22.6 months and 18.7 months for 125 I and 103 Pd, respectively. In patients receiving neoadjuvant androgen deprivation therapy, the incidence of spikes was comparable between isotopes ( 125 I 28.1% and 103 Pd 20.7%). The incidence of spikes was substantially different in patients 125 I and/or <65 years of age. Differences in isotope-related spikes are most pronounced in hormone-naive patients

  20. 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

  1. Iodine-125 seed brachytherapy for early stage prostate cancer: a single-institution review

    International Nuclear Information System (INIS)

    Zuber, Simon; Weiß, Susan; Baaske, Dieter; Schöpe, Michael; Stevens, Simon; Bodis, Stephan; Zwahlen, Daniel R

    2015-01-01

    We are reporting the five-year biochemical control, toxicity profile and dosimetric parameters using iodine-125 low dose rate brachytherapy (BT) as monotherapy for early stage prostate cancer at a single institution. Between April 2006 and December 2010, 169 men with early stage prostate cancer were treated with BT. Biochemical failure was defined using the Phoenix definition (nadir + 2 ng/mL). Treatment-related morbidities, including urinary, rectal and sexual function, were measured, applying the International Prostate Symptom Score (IPSS), the 7-grade Quality of Life Scale (QoL) and medical status, the International Consultation on Incontinence Modular Questionnaire (ICIQ), the International Index of Erectile Function (IIEF-5) and the Common Terminology Criteria for Adverse Events (CTCAE v4.03). Seed migration and loss, dosimetric parameters and learning effects were also analyzed. Medium follow-up time was 50 months (range, 1–85 months). The five-year biochemical failure rate was 7%. Acute proctitis rates were 19% (grade 1) and 1% (grade 2), respectively. The overall incidence of incontinence was 19% (mild), 16% (moderate) and < 1% (severe). An increase in IPSS ≥ 5 points was detected in 59% of patients, with 38% regaining their baseline. Seed dislocation was found in 24% of patients and correlated with D90 and V100. A learning curve was found for seed migration, D90 and V100. QoL correlated with the general health condition of patient, incontinence symptoms and IPSS. BT for early stage prostate cancer offers excellent five-year biochemical control with low toxicities. QoL aspects are favorable. A learning curve was detected for procedural aspects but its impact on patient relevant endpoints remains inconclusive

  2. 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.

  3. Rectal toxicity profile after transperineal interstitial permanent prostate brachytherapy: Use of a comprehensive toxicity scoring system and identification of rectal dosimetric toxicity predictors

    International Nuclear Information System (INIS)

    Shah, Jinesh N.; Ennis, Ronald D.

    2006-01-01

    Purpose: To better understand rectal toxicity after prostate brachytherapy, we employed the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0), a comprehensive system with distinct and separately reported gastrointestinal adverse event items (unlike Radiation Therapy Oncology Group morbidity scoring), to evaluate item-specific postimplant rectal toxicities. Methods and Materials: We analyzed 135 patients treated with brachytherapy ± hormonal therapy, using CTCAE v3.0 to score acute/late rectal toxicities (median follow-up, 41 months). Dosimetric parameters were evaluated for ability to predict toxicities. Results: Use of CTCAE yielded a novel rectal toxicity profile consisting of diarrhea, incontinence, urgency, proctitis, pain, spasms, and hemorrhage event rates. No item had a 25 (percent of rectal volume receiving 25% of prescribed prostate dose) ≤ 25% vs. 60% for %V 25 > 25% (p 1 ≤ 40% vs. 44% for %V 1 > 40% (p = 0.007). Conclusions: A comprehensive understanding of item-specific postimplant rectal toxicities was obtained using CTCAE. Rectal %V 25 > 25% and %V 1 > 40% predicted worse late diarrhea and maximum toxicity, respectively

  4. Modeling the impact of prostate edema on LDR brachytherapy: a Monte Carlo dosimetry study based on a 3D biphasic finite element biomechanical model

    Science.gov (United States)

    Mountris, K. A.; Bert, J.; Noailly, J.; Rodriguez Aguilera, A.; Valeri, A.; Pradier, O.; Schick, U.; Promayon, E.; Gonzalez Ballester, M. A.; Troccaz, J.; Visvikis, D.

    2017-03-01

    Prostate volume changes due to edema occurrence during transperineal permanent brachytherapy should be taken under consideration to ensure optimal dose delivery. Available edema models, based on prostate volume observations, face several limitations. Therefore, patient-specific models need to be developed to accurately account for the impact of edema. In this study we present a biomechanical model developed to reproduce edema resolution patterns documented in the literature. Using the biphasic mixture theory and finite element analysis, the proposed model takes into consideration the mechanical properties of the pubic area tissues in the evolution of prostate edema. The model’s computed deformations are incorporated in a Monte Carlo simulation to investigate their effect on post-operative dosimetry. The comparison of Day1 and Day30 dosimetry results demonstrates the capability of the proposed model for patient-specific dosimetry improvements, considering the edema dynamics. The proposed model shows excellent ability to reproduce previously described edema resolution patterns and was validated based on previous findings. According to our results, for a prostate volume increase of 10-20% the Day30 urethra D10 dose metric is higher by 4.2%-10.5% compared to the Day1 value. The introduction of the edema dynamics in Day30 dosimetry shows a significant global dose overestimation identified on the conventional static Day30 dosimetry. In conclusion, the proposed edema biomechanical model can improve the treatment planning of transperineal permanent brachytherapy accounting for post-implant dose alterations during the planning procedure.

  5. Radiotherapy in prostate cancer. Innovative techniques and current controversies

    Energy Technology Data Exchange (ETDEWEB)

    Geinitz, Hans [Krankenhaus der Barmherzigen Schwestern, Linz (Austria). Dept. of Radiation Oncology; Linz Univ. (Austria). Medical Faculty; Roach, Mack III [California Univ., San Francisco, CA (United States). Dept. of Radiation Oncology; Van As, Nicholas (ed.) [The Institute of Cancer Research, Sutton Surrey (United Kingdom)

    2015-04-01

    Examines in detail the role of innovative radiation techniques in the management of prostate cancer, including IMRT, IGRT, BART, and modern brachytherapy. Explores a range of current controversies in patient treatment. Intended for both radiation oncologists and urologists. Radiation treatment is rapidly evolving owing to the coordinated research of physicists, engineers, computer and imaging specialists, and physicians. Today, the arsenal of ''high-precision'' or ''targeted'' radiotherapy includes multimodal imaging, in vivo dosimetry, Monte Carlo techniques for dose planning, patient immobilization techniques, intensity-modulated radiotherapy (IMRT), image-guided radiotherapy (IGRT), biologically adapted radiotherapy (BART), quality assurance methods, novel methods of brachytherapy, and, at the far end of the scale, particle beam radiotherapy using protons and carbon ions. These approaches are like pieces of a puzzle that need to be put together to provide the prostate cancer patient with high-level optimized radiation treatment. This book examines in detail the role of the above-mentioned innovative radiation techniques in the management of prostate cancer. In addition, a variety of current controversies regarding treatment are carefully explored, including whether prophylactic treatment of the pelvic lymphatics is essential, the magnitude of the effect of dose escalation, whether a benefit accrues from hypofractionation, and what evidence exists for the superiority of protons or heavy ions. Radiotherapy in Prostate Cancer: Innovative Techniques and Current Controversies is intended for both radiation oncologists and urologists with an interest in the up-to-date capabilities of modern radiation oncology for the treatment of prostate cancer.

  6. Percutaneous MR-guided cryoablation of prostate cancer: initial experience

    International Nuclear Information System (INIS)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier; Mathelin, Michel de; Jacqmin, Didier; Lang, Herve

    2012-01-01

    We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. (orig.)

  7. Percutaneous MR-guided cryoablation of prostate cancer: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Gangi, Afshin; Tsoumakidou, Georgia; Abdelli, Omar; Buy, Xavier [University Hospital of Strasbourg, Department of Interventional Radiology, Strasbourg (France); Mathelin, Michel de [University of Strasbourg, Lsiit, Strasbourg (France); Jacqmin, Didier; Lang, Herve [University Hospital of Strasbourg, Department of Urology, Strasbourg (France)

    2012-08-15

    We report our initial experience and the technical feasibility of transperineal prostate cryoablation under MR guidance. Percutaneous MR-guided cryoablation was performed in 11 patients with prostatic adenocarcinoma contraindicated for surgery (mean age: 72 years, mean Gleason score: 6.45, mean prostate-specific antigen (PSA): 6.21 ng/ml, T1-2c/N0/M0, mean: prostate volume 36.44 ml). Free-hand probe positioning was performed under real-time MR imaging. Four to seven cryoprobes were inserted into the prostate, depending on gland volume. The ice ball was monitored using real-time and high-resolution BLADE multi-planar imaging. Patients were followed at 1, 3, 6, 9 and 12 months after the procedure with serum PSA level and post-ablation MRI. Prostate cryoablation was technically feasible in 10/11 patients. The ice ball was clearly and sharply visualised in all cases as a signal-void area. Mean ice-ball volume was 53.3 ml. Mean follow-up was 15 months (range: 1-25). Mean PSA nadir was 0.33 ng/ml (range: 0.02-0.94 ng/ml). Mean hospitalisation was 5 days (range: 3-13). Complications included a urethro-rectal fistula, urinary infection, transient dysuria and scrotal pain. MR-guided prostate cryoablation is feasible and promising, with excellent monitoring of the ice ball. Future perspectives could include the use of MR guidance for focal prostate cancer cryotherapy. (orig.)

  8. Whole-Pelvic Nodal Radiation Therapy in the Context of Hypofractionation for High-Risk Prostate Cancer Patients: A Step Forward

    International Nuclear Information System (INIS)

    Kaidar-Person, Orit; Roach, Mack; Créhange, Gilles

    2013-01-01

    Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer

  9. Whole-Pelvic Nodal Radiation Therapy in the Context of Hypofractionation for High-Risk Prostate Cancer Patients: A Step Forward

    Energy Technology Data Exchange (ETDEWEB)

    Kaidar-Person, Orit [Division of Oncology, Rambam Health Care Campus, Haifa (Israel); Roach, Mack [Department of Radiation Oncology, University of California, San Francisco, San Francisco, California (United States); Créhange, Gilles, E-mail: gcrehange@cgfl.fr [Department of Radiation Oncology, Georges-François Leclerc Cancer Center, Dijon (France)

    2013-07-15

    Given the low α/β ratio of prostate cancer, prostate hypofractionation has been tested through numerous clinical studies. There is a growing body of literature suggesting that with high conformal radiation therapy and even with more sophisticated radiation techniques, such as high-dose-rate brachytherapy or image-guided intensity modulated radiation therapy, morbidity associated with shortening overall treatment time with higher doses per fraction remains low when compared with protracted conventional radiation therapy to the prostate only. In high-risk prostate cancer patients, there is accumulating evidence that either dose escalation to the prostate or hypofractionation may improve outcome. Nevertheless, selected patients who have a high risk of lymph node involvement may benefit from whole-pelvic radiation therapy (WPRT). Although combining WPRT with hypofractionated prostate radiation therapy is feasible, it remains investigational. By combining modern advances in radiation oncology (high-dose-rate prostate brachytherapy, intensity modulated radiation therapy with an improved image guidance for soft-tissue sparing), it is hypothesized that WPRT could take advantage of recent results from hypofractionation trials. Moreover, the results from hypofractionation trials raise questions as to whether hypofractionation to pelvic lymph nodes with a high risk of occult involvement might improve the outcomes in WPRT. Although investigational, this review discusses the challenging idea of WPRT in the context of hypofractionation for patients with high-risk prostate cancer.

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

    Energy Technology Data Exchange (ETDEWEB)

    Dadkhah, H; Wu, X [University of Iowa, Iowa City, Iowa (United States); Kim, Y; Flynn, R [University of Iowa Hospitals and Clinics, Iowa City, IA (United States)

    2016-06-15

    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{sub 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 {sup 153}Gd sources is 117 min. Conclusions: The proposed RSBT delivery apparatus in conjunction with multiple nitinol catheter-mounted platinum-shielded {sup 153}Gd sources enables a mechanically feasible

  11. Defining the value framework for prostate brachytherapy using patient-centered outcome metrics and time-driven activity-based costing.

    Science.gov (United States)

    Thaker, Nikhil G; Pugh, Thomas J; Mahmood, Usama; Choi, Seungtaek; Spinks, Tracy E; Martin, Neil E; Sio, Terence T; Kudchadker, Rajat J; Kaplan, Robert S; Kuban, Deborah A; Swanson, David A; Orio, Peter F; Zelefsky, Michael J; Cox, Brett W; Potters, Louis; Buchholz, Thomas A; Feeley, Thomas W; Frank, Steven J

    2016-01-01

    Value, defined as outcomes over costs, has been proposed as a measure to evaluate prostate cancer (PCa) treatments. We analyzed standardized outcomes and time-driven activity-based costing (TDABC) for prostate brachytherapy (PBT) to define a value framework. Patients with low-risk PCa treated with low-dose-rate PBT between 1998 and 2009 were included. Outcomes were recorded according to the International Consortium for Health Outcomes Measurement standard set, which includes acute toxicity, patient-reported outcomes, and recurrence and survival outcomes. Patient-level costs to 1 year after PBT were collected using TDABC. Process mapping and radar chart analyses were conducted to visualize this value framework. A total of 238 men were eligible for analysis. Median age was 64 (range, 46-81). Median followup was 5 years (0.5-12.1). There were no acute Grade 3-5 complications. Expanded Prostate Cancer Index Composite 50 scores were favorable, with no clinically significant changes from baseline to last followup at 48 months for urinary incontinence/bother, bowel bother, sexual function, and vitality. Ten-year outcomes were favorable, including biochemical failure-free survival of 84.1%, metastasis-free survival 99.6%, PCa-specific survival 100%, and overall survival 88.6%. TDABC analysis demonstrated low resource utilization for PBT, with 41% and 10% of costs occurring in the operating room and with the MRI scan, respectively. The radar chart allowed direct visualization of outcomes and costs. We successfully created a visual framework to define the value of PBT using the International Consortium for Health Outcomes Measurement standard set and TDABC costs. PBT is associated with excellent outcomes and low costs. Widespread adoption of this methodology will enable value comparisons across providers, institutions, and treatment modalities. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  12. An analysis of intraoperative versus post-operative dosimetry with CT, CT-MRI fusion and XMR for the evaluation of permanent prostate brachytherapy implants

    International Nuclear Information System (INIS)

    Acher, Peter; Puttagunta, Srikanth; Rhode, Kawal; Morris, Stephen; Kinsella, Janette; Gaya, Andrew; Dasgupta, Prokar; Deehan, Charles; Beaney, Ronald; Popert, Rick; Keevil, Stephen

    2010-01-01

    Background and purpose: To assess the agreement between intraoperative and post-operative dosimetry and to identify factors that influence dose calculations of prostate brachytherapy implants. Materials and methods: Patients treated with prostate brachytherapy implants underwent post-operative CT and XMR (combined X-ray and MR) imaging. Dose-volume histograms were calculated from CT, XMR and CT-MR fusion data and compared with intraoperative values for two observers. Multiple linear regression models assessed the influences of intraoperative D90, gland oedema, gland volume, source loss and migration, and implanted activity/volume prostate on post-operative D90. Results: Forty-nine patients were studied. The mean D90 differences (95% confidence limits) between intraoperative and post-operative CT, XMR and CT-MR fusion assessments were: 11 Gy (-22, 45), 18 Gy (-13, 49) and 20 Gy (-17, 58) for Observer 1; and 15 Gy (-34, 63), 13 Gy (-29, 55) and 14 Gy (-27, 54) for Observer 2. Multiple linear regression modelling showed that the observed oedema and intraoperative D90 were significant independent variables for the prediction of post-operative D90 values for both observers using all modalities. Conclusion: This is the first study to report Bland-Altman agreement analysis between intraoperative and post-operative dosimetry. Agreement is poor. Post-operative dosimetry is dependent on the intraoperative D90 and the subjectively outlined gland volume.

  13. 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

  14. 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

  15. Value of prostate specific antigen and prostatic volume ratio (PSA/V) as the selection criterion for US-guided prostatic biopsy

    International Nuclear Information System (INIS)

    Veneziano, S.; Paulica, P.; Querze', R.; Viglietta, G.; Trenta, A.

    1991-01-01

    US-guided biopsy was performed in 94 patients with suspected lesions at transerectal US. Histology demonstrated carcinoma in 43 cases, benign hyperplasia in 44, and prostatis in 7. In all cases the prostate specific antigen (PSA) was calculated, by means of US, together with prostatic volume (v). PSA was related to the corresponding gland volume, which resulted in PSA/V ratio. Our study showed PSA/V ration to have higher sensitivity and specificity than absolulute PSA value in the diagnosis of prostatic carcinoma. The authors believe prostate US-guided biopsy to be: a) necessary when the suspected area has PSA/V ratio >0.15, and especially when PSA/V >0.30; b) not indicated when echo-structural alterations are associated with PSA/V <0.15, because they are most frequently due to benign lesions. The combined use of PSA/V ratio and US is therefore suggested to select the patients in whom biopsy is to be performed

  16. Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam

    International Nuclear Information System (INIS)

    Merrick, Gregory S.; Butler, Wayne M.; Wallner, Kent E.; Galbreath, Robert W.; Allen, Zachariah A.; Adamovich, Edward; Lief, Jonathan

    2007-01-01

    Purpose: To determine cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in high-risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and July 2002, 204 patients with high-risk prostate cancer (Gleason score ≥8 or prostate-specific antigen [PSA] >20 ng/mL or clinical stage ≥T2c) underwent brachytherapy. Median follow-up was 7.0 years. The bPFS was defined by a PSA ≤0.40 ng/mL after nadir. Multiple clinical, treatment, and dosimetric parameters were evaluated for the impact on survival. Results: The 10-year CSS, bPFS, and OS were 88.9%, 86.6%, and 68.6%, respectively. A statistically significant difference in bPFS was discerned between hormone naive, ADT ≤6 months, and ADT >6 month cohorts (79.7% vs. 95.% vs. 89.9%, p = 0.032). Androgen deprivation therapy (ADT) did not impact CSS or OS. For bPFS patients, the median posttreatment PSA was <0.04 ng/mL. A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS, whereas percent positive biopsies and duration of ADT best predicted for bPFS. The OS was best predicted by Gleason score and diabetes. Thirty-eight patients have died, with 26 of the deaths from cardiovascular/pulmonary disease or second malignancy. Eleven patients have died of metastatic prostate cancer. Conclusions: The ADT improved 10-year bPFS without statistical impact on CSS or OS. Death as a result of cardiovascular/pulmonary disease and second malignancies were more than twice as common as prostate cancer deaths. Strategies to improve cardiovascular health should positively impact OS

  17. 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.

  18. Prostate-specific antigen bounce following stereotactic body radiation therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Charles C. Vu

    2014-01-01

    Full Text Available Introduction: Prostate-specific antigen (PSA bounce after brachytherapy has been well-documented. This phenomenon has also been identified in patients undergoing stereotactic body radiation therapy (SBRT. While the parameters that predict PSA bounce have been extensively studied in prostate brachytherapy patients, this study is the first to analyze the clinical and pathologic predictors of PSA bounce in prostate SBRT patients. Materials and Methods: Our institution has maintained a prospective database of patients undergoing SBRT for prostate cancer since 2006. Our study population includes patients between May 2006 and November 2011 who have at least 18 months of follow-up. All patients were treated using the CyberKnife treatment system. The prescription dose was 3500-3625cGy in 5 fractions.Results: 120 patients were included in our study. Median PSA follow-up was 24 months (range 18-78 months. 34 (28% patients had a PSA bounce. The median time to PSA bounce was 9 months, and the median bounce size was 0.50ng/mL. On univariate analysis, only younger age (p = .011 was shown to be associated with an increased incidence of PSA bounce. Other patient factors, including race, prostate size, prior treatment by hormones, and family history of prostate cancer, did not predict PSA bounces. None of the tumor characteristics studied, including Gleason score, pre-treatment PSA, T-stage, or risk classification by NCCN guidelines, was associated with increased incidence of PSA bounces. Younger age was the only statistically significant predictor of PSA bounce on multivariate analysis (OR = 0.937, p = 0.009.Conclusion: PSA bounce, which has been reported after prostate brachytherapy, is also seen in a significant percentage of patients after CyberKnife SBRT. Close observation rather than biopsy can be considered for these patients. Younger age was the only factor that predicted PSA bounce.

  19. Impact of delineation uncertainties on dose to organs at risk in CT-guided intracavitary brachytherapy.

    LENUS (Irish Health Repository)

    Duane, Frances K

    2014-08-07

    This study quantifies the inter- and intraobserver variations in contouring the organs at risk (OARs) in CT-guided brachytherapy (BT) for the treatment of cervical carcinoma. The dosimetric consequences are reported in accordance with the current Gynecological Groupe Européen de Curiethérapie\\/European Society for Therapeutic Radiology and Oncology guidelines.

  20. 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

    International Nuclear Information System (INIS)

    Keyes, Mira; Miller, Stacy; Pickles, Tom; Halperin, Ross; Kwan, Winkle; Lapointe, Vincent; McKenzie, Michael; Spadinger, Ingrid; Pai, Howard; Chan, Elisa K.; Morris, W. James

    2014-01-01

    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 ( 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 follow

  1. 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

  2. The effect of ultrasound-guided compression immediately after transrectal ultrasound-guided prostate biopsy on postbiopsy bleeding: a randomized controlled pilot study.

    Science.gov (United States)

    Park, Bong Hee; Kim, Jung Im; Bae, Sang Rak; Lee, Yong Seok; Kang, Sung Hak; Han, Chang Hee

    2017-08-01

    To evaluate whether ultrasound-guided compression performed immediately after transrectal ultrasound (TRUS)-guided prostate biopsy decreases bleeding complications. We prospectively evaluated a total of 148 consecutive patients who underwent TRUS-guided prostate biopsy between March 2015 and July 2016. Systematic 12-core prostate biopsy was performed in all patients. Of these, 100 patients were randomly assigned to one of two groups: the compression group (n = 50) underwent TRUS-guided compression on bleeding biopsy tracts immediately after prostate biopsy, while the non-compression group (n = 50) underwent TRUS-guided prostate biopsy alone. The incidence rate and duration of hematuria, hematospermia, and rectal bleeding were compared between the two groups. The incidence rates of hematuria and hematospermia were not significantly different between the two groups (60 vs. 64%, p = 0.68; 22 vs. 30%, p = 0.362, respectively, for compression vs. non-compression group). The rectal bleeding incidence was significantly lower in the compression group as compared to the non-compression group (20 vs. 44%, p = 0.01). However, there were no significant differences in the median duration of hematuria, hematospermia, or rectal bleeding between the two groups (2, 8, and 2 days vs. 2, 10, and 1 days, p > 0.05, respectively, for compression vs. non-compression group). TRUS-guided compression [p = 0.004, odds ratio (OR) 0.25] and patient age (p = 0.013, OR 0.93) were significantly protective against the occurrence of rectal bleeding after prostate biopsy in multivariable analysis. Although it has no impact on other complications, ultrasound-guided compression on bleeding biopsy tracts performed immediately after TRUS-guided prostate biopsy is an effective and practical method to treat or decrease rectal bleeding.

  3. SU-G-201-15: Nomogram as an Efficient Dosimetric Verification Tool in HDR Prostate Brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Liang, J; Todor, D [Virginia Commonwealth University, Richmond, VA (United States)

    2016-06-15

    Purpose: Nomogram as a simple QA tool for HDR prostate brachytherapy treatment planning has been developed and validated clinically. Reproducibility including patient-to-patient and physician-to-physician variability was assessed. Methods: The study was performed on HDR prostate implants from physician A (n=34) and B (n=15) using different implant techniques and planning methodologies. A nomogram was implemented as an independent QA of computer-based treatment planning before plan execution. Normalized implant strength (total air kerma strength Sk*t in cGy cm{sup 2} divided by prescribed dose in cGy) was plotted as a function of PTV volume and total V100. A quadratic equation was used to fit the data with R{sup 2} denoting the model predictive power. Results: All plans showed good target coverage while OARs met the dose constraint guidelines. Vastly different implant and planning styles were reflected on conformity index (entire dose matrix V100/PTV volume, physician A implants: 1.27±0.14, physician B: 1.47±0.17) and PTV V150/PTV volume ratio (physician A: 0.34±0.09, physician B: 0.24±0.07). The quadratic model provided a better fit for the curved relationship between normalized implant strength and total V100 (or PTV volume) than a simple linear function. Unlike the normalized implant strength versus PTV volume nomogram which differed between physicians, a unique quadratic model based nomogram (Sk*t)/D=−0.0008V2+0.0542V+1.1185 (R{sup 2}=0.9977) described the dependence of normalized implant strength on total V100 over all the patients from both physicians despite two different implant and planning philosophies. Normalized implant strength - total V100 model also generated less deviant points distorting the smoothed ones with a significantly higher correlation. Conclusion: A simple and universal, excel-based nomogram was created as an independent calculation tool for HDR prostate brachytherapy. Unlike similar attempts, our nomogram is insensitive to implant

  4. A randomized trial of the effect of training in relaxation and guided imagery techniques in improving psychological and quality-of-life indices for gynecologic and breast brachytherapy patients.

    Science.gov (United States)

    León-Pizarro, Concha; Gich, Ignasi; Barthe, Emma; Rovirosa, Angeles; Farrús, Blanca; Casas, Francesc; Verger, Eugènia; Biete, Albert; Craven-Bartle, Jordi; Sierra, Jordi; Arcusa, Angeles

    2007-11-01

    The randomized study aimed to determine the efficacy of psychological intervention consisting of relaxation and guided imagery to reduce anxiety and depression in gynecologic and breast cancer patients undergoing brachytherapy during hospitalization. Sixty-six patients programmed to receive brachytherapy in two hospitals in Barcelona (Spain) were included in this study. The patients were randomly allocated to either the study group (n=32) or the control group (n=34). Patients in both groups received training regarding brachytherapy, but only study group patients received training in relaxation and guided imagery. After collection of sociodemographic data, all patients were given a set of questionnaires on anxiety and depression: the Hospital Anxiety and Depression Scale (HADS), and on quality of life: Cuestionario de Calidad de Vida QL-CA-AFex (CCV), prior to, during and after brachytherapy. The study group demonstrated a statistically significant reduction in anxiety (p=0.008), depression (p=0.03) and body discomfort (p=0.04) compared with the control group. The use of relaxation techniques and guided imagery is effective in reducing the levels of anxiety, depression and body discomfort in patients who must remain isolated while undergoing brachytherapy. This simple and inexpensive intervention enhances the psychological wellness in patients undergoing brachytherapy.State: This study has passed Ethical Committee review.

  5. Polyethylene glycol hydrogel rectal spacer implantation in patients with prostate cancer undergoing combination high-dose-rate brachytherapy and external beam radiotherapy.

    Science.gov (United States)

    Yeh, Jekwon; Lehrich, Brandon; Tran, Carolyn; Mesa, Albert; Baghdassarian, Ruben; Yoshida, Jeffrey; Torrey, Robert; Gazzaniga, Michael; Weinberg, Alan; Chalfin, Stuart; Ravera, John; Tokita, Kenneth

    2016-01-01

    To present rectal toxicity rates in patients administered a polyethylene glycol (PEG) hydrogel rectal spacer in conjunction with combination high-dose-rate brachytherapy and external beam radiotherapy. Between February 2010 and April 2015, 326 prostate carcinoma patients underwent combination high-dose-rate brachytherapy of 16 Gy (average dose 15.5 Gy; standard deviation [SD] = 1.6 Gy) and external beam radiotherapy of 59.4 Gy (average dose 60.2 Gy; SD = 2.9 Gy). In conjunction with the radiation therapy regimen, each patient was injected with 10 mL of a PEG hydrogel in the anterior perirectal fat space. The injectable spacer (rectal spacer) creates a gap between the prostate and the rectum. The rectum is displaced from the radiation field, and rectal dose is substantially reduced. The goal is a reduction in rectal radiation toxicity. Clinical efficacy was determined by measuring acute and chronic rectal toxicity using the National Cancer Center Institute Common Terminology Criteria for Adverse Events v4.0 grading scheme. Median followup was 16 months. The mean anterior-posterior separation achieved was 1.6 cm (SD = 0.4 cm). Rates of acute Grade 1 and 2 rectal toxicity were 37.4% and 2.8%, respectively. There were no acute Grade 3/4 toxicities. Rates of late Grade 1, 2, and 3 rectal toxicity were 12.7%, 1.4%, and 0.7%, respectively. There were no late Grade 4 toxicities. PEG rectal spacer implantation is safe and well tolerated. Acute and chronic rectal toxicities are low despite aggressive dose escalation. Copyright © 2016 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  6. Iodine 125 seed migration after prostate brachytherapy: a study of 170 patients

    International Nuclear Information System (INIS)

    Chauveinc, L.; Osseili, A.; Rosenwald, J.C.; Cosset, J.M.; Flam, T.; Thiounn, N.; Savignoni, A.

    2004-01-01

    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 (77< r i. only one seed migrated. A significant relationship (P = 0.04) vs as found between the number of migrating seeds and the number of implanted ones (or with the prostate 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)

  7. 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.

  8. MRI-guided biopsies and minimally invasive therapy for prostate cancer

    Directory of Open Access Journals (Sweden)

    Sangeet Ghai

    2015-01-01

    Full Text Available Recent advances in multiparametric magnetic resonance imaging (mp-MRI have led to a paradigm shift in the diagnosis and management of prostate cancer (PCa. Its sensitivity in detecting clinically significant cancer and the ability to localize the tumor within the prostate gland has opened up discussion on targeted diagnosis and therapy in PCa. Use of mp-MRI in conjunction with prostate-specific antigen followed by targeted biopsy allows for a better diagnostic pathway than transrectal ultrasound (TRUS biopsy and improves the diagnosis of PCa. Improved detection of PCa by mp-MRI has also opened up opportunities for focal therapy within the organ while reducing the incidence of side-effects associated with the radical treatment methods for PCa. This review discusses the evidence and techniques for in-bore MRI-guided prostate biopsy and provides an update on the status of MRI-guided targeted focal therapy in PCa.

  9. 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

  10. Overview of brachytherapy resources in Europe: A survey of patterns of care study for brachytherapy in Europe

    International Nuclear Information System (INIS)

    Guedea, Ferran; Ellison, Tracey; Venselaar, Jack; Borras, Josep Maria; Hoskin, Peter; Poetter, Richard; Heeren, Germaine; Nisin, Roselinne; Francois, Guy; Mazeron, Jean Jacques; Limbergen, Erik Van; Ventura, Montserrat; Taillet, Michel; Cottier, Brian

    2007-01-01

    Background and purpose: The Patterns of Care for Brachytherapy in Europe (PCBE) study is aimed at establishing a detailed information system on brachytherapy throughout Europe. Materials and methods: The questionnaire was web-based and the analysis used data from each radiotherapy department with brachytherapy. There were three groups: Group I with 19 countries (15 initial European Community (EC) countries plus Iceland, Monaco, Norway and Switzerland -EC+4-), Group II with 10 countries (New European Community countries -NEC-) and Group III with 14 countries (Other European Countries -OEC-). Results: In the European area there are 36 of 43 countries (85%) which achieved data collection from at least 50% of centres, and were included in the analysis. The tumour site that had the largest number of treated patients was gynaecological tumours. Several variations have been found in the mean number of patients treated per consultant radiation oncologist and physicist; and in the proportion of brachytherapy patients with gynaecology, prostate and breast tumours, by country and by European area. The provided data showed that the average number of brachytherapy patients per centre increased by 10% between 1997 and 2002. Conclusions: A European wide evaluation of brachytherapy practice using a web-based questionnaire is feasible and that there is considerable variation in both patterns of practice and available resources

  11. 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

  12. Fractionation and protraction for radiotherapy of prostate carcinoma

    International Nuclear Information System (INIS)

    Brenner, David J.; Hall, Eric J.

    1999-01-01

    Purpose: To investigate whether current fractionation and brachytherapy protraction schemes for the treatment of prostatic cancer with radiation are optimal, or could be improved. Methods and Materials: We analyzed two mature data sets on radiotherapeutic tumor control for prostate cancer, one using EBRT and the other permanent seed implants, to extract the sensitivity to changes in fractionation of prostatic tumors. The standard linear-quadratic model was used for the analysis. Results: Prostatic cancers appear significantly more sensitive to changes in fractionation than most other cancers. The estimated α/β value is 1.5 Gy [0.8, 2.2]. This result is not too surprising as there is a documented relationship between cellular proliferative status and sensitivity to changes in fractionation, and prostatic tumors contain exceptionally low proportions of proliferating cells. Conclusions: High dose rate (HDR) brachytherapy would be a highly appropriate modality for treating prostate cancer. Appropriately designed HDR brachytherapy regimens would be expected to be as efficacious as low dose rate, but with added advantages of logistic convenience and more reliable dose distributions. Similarly, external beam treatments for prostate cancer can be designed using larger doses per fraction; appropriately designed hypofractionation schemes would be expected to maintain current levels of tumor control and late sequelae, but with reduced acute morbidity, together with the logistic and financial advantages of fewer numbers of fractions

  13. Phase I/II trial of single-fraction high-dose-rate brachytherapy-boosted hypofractionated intensity-modulated radiation therapy for localized adenocarcinoma of the prostate.

    Science.gov (United States)

    Myers, Michael A; Hagan, Michael P; Todor, Dorin; Gilbert, Lynn; Mukhopadhyay, Nitai; Randolf, Jessica; Heimiller, Jeffrey; Anscher, Mitchell S

    2012-01-01

    A Phase I/II protocol was conducted to examine the toxicity and efficacy of the combination of intensity-modulated radiation therapy (IMRT) with a single-fraction high-dose-rate (HDR) brachytherapy implant. From 2001 through 2006, 26 consecutive patients were treated on the trial. The primary objective was to demonstrate a high rate of completion without experiencing a treatment-limiting toxicity. Eligibility was limited to patients with T stage ≤2b, prostate-specific antigen (PSA) ≤20, and Gleason score ≤7. Treatment began with a single HDR fraction of 6Gy to the entire prostate and 9Gy to the peripheral zone, followed by IMRT optimized to deliver in 28 fractions with a normalized total dose of 70Gy. Patients received 50.4Gy to the pelvic lymph node. The prostate dose (IMRT and HDR) resulted in an average biologic equivalent dose >128Gy (α/β=3). Patients whose pretreatment PSA was ≥10ng/mL, Gleason score 7, or stage ≥T2b received short-term androgen ablation. Median followup was 53 months (9-68 months). There were no biochemical failures by either the American Society of Therapeutic Radiology and Oncology or the Phoenix definitions. The median nadir PSA was 0.32ng/mL. All the 26 patients completed the treatment as prescribed. The rate of Grade 3 late genitourinary toxicity was 3.8% consisting of a urethral stricture. There was no other Grade 3 or 4 genitourinary or gastrointestinal toxicities. Single-fraction HDR-boosted IMRT is a safe effective method of dose escalation for localized prostate cancer. Copyright © 2012 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

  14. Hypoxic Prostate/Muscle PO2 Ratio Predicts for Outcome in Patients With Localized Prostate Cancer: Long-Term Results

    International Nuclear Information System (INIS)

    Turaka, Aruna; Buyyounouski, Mark K.; Hanlon, Alexandra L.; Horwitz, Eric M.; Greenberg, Richard E.; Movsas, Benjamin

    2012-01-01

    Purpose: To correlate tumor oxygenation status with long-term biochemical outcome after prostate brachytherapy. Methods and Materials: Custom-made Eppendorf PO 2 microelectrodes were used to obtain PO 2 measurements from the prostate (P), focused on positive biopsy locations, and normal muscle tissue (M), as a control. A total of 11,516 measurements were obtained in 57 men with localized prostate cancer immediately before prostate brachytherapy was given. The Eppendorf histograms provided the median PO 2 , mean PO 2 , and % 2 ratio on BF. Results: With a median follow-up time of 8 years, 12 men had ASTRO BF and 8 had Phoenix BF. On multivariate analysis, P/M PO 2 ratio 2 ratio 2 ratio) significantly predicts for poor long-term biochemical outcome, suggesting that novel hypoxic strategies should be investigated.

  15. AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: Report of Task Group 192

    Energy Technology Data Exchange (ETDEWEB)

    Podder, Tarun K., E-mail: tarun.podder@uhhospitals.org [Department of Radiation Oncology, University Hospitals, Case Western Reserve University, Cleveland, Ohio 44122 (United States); Beaulieu, Luc [Department of Radiation Oncology, Centre Hospitalier Univ de Quebec, Quebec G1R 2J6 (Canada); Caldwell, Barrett [Schools of Industrial Engineering and Aeronautics and Astronautics, Purdue University, West Lafayette, Indiana 47907 (United States); Cormack, Robert A. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts 02115 (United States); Crass, Jostin B. [Department of Radiation Oncology, Vanderbilt University, Nashville, Tennessee 37232 (United States); Dicker, Adam P.; Yu, Yan [Department of Radiation Oncology, Thomas Jefferson University, Philadelphia, Pennsylvania 19107 (United States); Fenster, Aaron [Department of Imaging Research, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Fichtinger, Gabor [School of Computer Science, Queen’s University, Kingston, Ontario K7L 3N6 (Canada); Meltsner, Michael A. [Philips Radiation Oncology Systems, Fitchburg, Wisconsin 53711 (United States); Moerland, Marinus A. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht, 3508 GA (Netherlands); Nath, Ravinder [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, Connecticut 06520 (United States); Rivard, Mark J. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States); Salcudean, Tim [Department of Electrical and Computer Engineering, University of British Columbia, Vancouver, British Columbia V6T 1Z4 (Canada); Song, Danny Y. [Department of Radiation Oncology, Johns Hopkins University School of Medicine, Baltimore, Maryland 21231 (United States); Thomadsen, Bruce R. [Department of Medical Physics, University of Wisconsin, Madison, Wisconsin 53705 (United States)

    2014-10-15

    In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3–6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests

  16. AAPM and GEC-ESTRO guidelines for image-guided robotic brachytherapy: Report of Task Group 192

    International Nuclear Information System (INIS)

    Podder, Tarun K.; Beaulieu, Luc; Caldwell, Barrett; Cormack, Robert A.; Crass, Jostin B.; Dicker, Adam P.; Yu, Yan; Fenster, Aaron; Fichtinger, Gabor; Meltsner, Michael A.; Moerland, Marinus A.; Nath, Ravinder; Rivard, Mark J.; Salcudean, Tim; Song, Danny Y.; Thomadsen, Bruce R.

    2014-01-01

    In the last decade, there have been significant developments into integration of robots and automation tools with brachytherapy delivery systems. These systems aim to improve the current paradigm by executing higher precision and accuracy in seed placement, improving calculation of optimal seed locations, minimizing surgical trauma, and reducing radiation exposure to medical staff. Most of the applications of this technology have been in the implantation of seeds in patients with early-stage prostate cancer. Nevertheless, the techniques apply to any clinical site where interstitial brachytherapy is appropriate. In consideration of the rapid developments in this area, the American Association of Physicists in Medicine (AAPM) commissioned Task Group 192 to review the state-of-the-art in the field of robotic interstitial brachytherapy. This is a joint Task Group with the Groupe Européen de Curiethérapie-European Society for Radiotherapy and Oncology (GEC-ESTRO). All developed and reported robotic brachytherapy systems were reviewed. Commissioning and quality assurance procedures for the safe and consistent use of these systems are also provided. Manual seed placement techniques with a rigid template have an estimated in vivo accuracy of 3–6 mm. In addition to the placement accuracy, factors such as tissue deformation, needle deviation, and edema may result in a delivered dose distribution that differs from the preimplant or intraoperative plan. However, real-time needle tracking and seed identification for dynamic updating of dosimetry may improve the quality of seed implantation. The AAPM and GEC-ESTRO recommend that robotic systems should demonstrate a spatial accuracy of seed placement ≤1.0 mm in a phantom. This recommendation is based on the current performance of existing robotic brachytherapy systems and propagation of uncertainties. During clinical commissioning, tests should be conducted to ensure that this level of accuracy is achieved. These tests

  17. Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy.

    Science.gov (United States)

    Chaswal, V; Thomadsen, B R; Henderson, D L

    2012-02-21

    The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10(Ur), D90(Ur) and V150(Ur) and for the rectum region the V100cc, D2cc, D90(Re) and V90(Re) all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

  18. Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy

    Science.gov (United States)

    Chaswal, V.; Thomadsen, B. R.; Henderson, D. L.

    2012-02-01

    The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10Ur, D90Ur and V150Ur and for the rectum region the V100cc, D2cc, D90Re and V90Re all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

  19. Quality Assurance/Quality Control Issues for Intraoperative Planning and Adaptive Repeat Planning of Image-Guided Prostate Implants

    International Nuclear Information System (INIS)

    Zaider, Marco; Cohen, Gilad; Meli, Jerome; Rosenfeld, Anatoly B.

    2008-01-01

    The quality assurance/quality control purpose is this. We design a treatment plan, and we wish to be as certain as reasonably possible that the treatment is delivered as planned. In the case of conventionally planned prostate brachytherapy, implementing to the letter the implantation plan is rarely attainable and therefore can require adaptive replanning (a quality control issue). The reasons for this state of affairs include changes in the prostate shape and volume during implantation and treatment delivery (e.g., edema resolution) and unavoidable inaccuracy in the placement of the seeds in the prostate. As a result, quality-control activities (e.g., the need to monitor-ideally, on the fly-the target and urethral and rectal dosage) must be also addressed

  20. Intensity-Modulated Radiotherapy Causes Fewer Side Effects than Three-Dimensional Conformal Radiotherapy When Used in Combination With Brachytherapy for the Treatment of Prostate Cancer

    International Nuclear Information System (INIS)

    Forsythe, Kevin; Blacksburg, Seth; Stone, Nelson; Stock, Richard G.

    2012-01-01

    Purpose: To measure the benefits of intensity-modulated radiotherapy (IMRT) compared with three-dimensional conformal radiotherapy (3D-CRT) when used in combination with brachytherapy for the treatment of prostate cancer. Methods and Materials: We conducted a retrospective review of all patients with localized prostate cancer who received external-beam radiotherapy (EBRT) in combination with brachytherapy with at least 1 year follow-up (n = 812). Combination therapy consisted of 103 Pd or 125 I implant, followed by a course of EBRT. From 1993 to March 2003 521 patients were treated with 3D-CRT, and from April 2003 to March 2009 291 patients were treated with IMRT. Urinary symptoms were prospectively measured with the International Prostate Symptom Score questionnaire with a single quality of life (QOL) question; rectal bleeding was assessed per the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer Late Radiation Morbidity Scoring Schema. The Pearson χ 2 test was used to compare toxicities experienced by patients who were treated with either IMRT or 3D-CRT. Logistic regression analyses were also performed to rule out possible confounding factors. Results: Within the first 3 months after treatment, patients treated with 3D-CRT scored their urinary symptoms as follows: 19% mild, 44% moderate, and 37% severe; patients treated with IMRT scored their urinary symptoms as follows: 36% mild, 47% moderate, and 17% severe (p < 0.001). The 3D-CRT patients rated their QOL as follows: 35% positive, 20% neutral, and 45% negative; IMRT patients rated their QOL as follows: 51% positive, 18% neutral, and 31% negative (p < 0.001). After 1 year of follow-up there was no longer any difference in urinary morbidity between the two groups. Logistic regression confirmed the differences in International Prostate Symptom Score and QOL in the acute setting (p < 0.001 for both). Grade ≥2 rectal bleeding was reported by 11% of 3D-CRT patients and 7

  1. Ultrasound-guided interstitial brachytherapy in the treatment of advanced vaginal recurrences from cervical and endometrial carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Weitmann, H.D.; Knocke, T.H.; Waldhaeusl, C.; Poetter, R. [Dept. of Radiotherapy and Radiobiology, Medical Univ. of Vienna (Austria)

    2006-02-01

    Background: in advanced vaginal recurrences of cervical and endometrial carcinomas therapeutic options are rare because of preceding therapy. Patients and methods: 23 patients developing advanced vaginal recurrences of cervical and endometrial carcinomas were included. 15 patients started with external-beam therapy to the pelvis and eight patients after preceding radiotherapy underwent brachytherapy alone. All patients had ultrasound-guided implantation of transvaginal or transperineal interstitial needles for brachytherapy. Median prescribed total dose was 64 Gy. Results: 18 patients (78%) achieved complete remission. Six patients are alive without tumor and one with tumor after a median follow-up of 64 months. 14 patients died of tumor and two of intercurrent disease. 5-year disease-specific survival and local control rate were 43% and 47%, respectively, in patients with complete remission. Univariate analysis found time to relapse > 2 years, initial diameter {<=} 4 cm, initial volume < 15 cm{sup 3}, no extension to the pelvic side wall, volume before brachytherapy < 7.5 cm{sup 3}, brachytherapy coverage index > 0.8, and prescribed total dose > 64 Gy being positive predictors for local control and survival. Conclusion: the use of ultrasound guidance for placement of interstitial needles in template-based brachytherapy of advanced recurrent gynecologic malignancies is a feasible, safe, and cheap method with encouraging results. Today, ultrasound imaging can be also used to some extent for treatment planning which requires further development. Patient- and treatment-related prognostic factors can be defined. (orig.)

  2. Image guided adaptive brachytherapy with combined intracavitary and interstitial technique improves the therapeutic ratio in locally advanced cervical cancer: Analysis from the retroEMBRACE study

    DEFF Research Database (Denmark)

    LU, Fokdal; Sturdza, Alina; Mazeron, Renaud

    2016-01-01

    Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC/IS) applicat...... IC/IS brachytherapy improves the therapeutic ratio in LACC by enabling a tumour specific dose escalation resulting in significantly higher local control in large tumours without adding treatment related late morbidity.......Background and purpose Image guided adaptive brachytherapy (IGABT) using intracavitary applicators (IC) has led to a significant improvement of local control in locally advanced cervical cancer (LACC). Further improvement has been obtained with combined intracavitary/interstitial (IC....../IS) applicators. The aim of this analysis was to evaluate the impact on local control and late morbidity of application of combined IS/IC brachytherapy in a large multicentre population. Material/methods 610 patients with LACC from the retroEMBRACE study were included. Patients were divided into an IC group (N...

  3. TU-H-CAMPUS-JeP3-05: Adaptive Determination of Needle Sequence HDR Prostate Brachytherapy with Divergent Needle-By-Needle Delivery

    International Nuclear Information System (INIS)

    Borot de Battisti, M; Maenhout, M; Lagendijk, J J W; Van Vulpen, M; Moerland, M A; Denis de Senneville, B; Hautvast, G; Binnekamp, D

    2016-01-01

    Purpose: To develop a new method which adaptively determines the optimal needle insertion sequence for HDR prostate brachytherapy involving divergent needle-by-needle dose delivery by e.g. a robotic device. A needle insertion sequence is calculated at the beginning of the intervention and updated after each needle insertion with feedback on needle positioning errors. Methods: Needle positioning errors and anatomy changes may occur during HDR brachytherapy which can lead to errors in the delivered dose. A novel strategy was developed to calculate and update the needle sequence and the dose plan after each needle insertion with feedback on needle positioning errors. The dose plan optimization was performed by numerical simulations. The proposed needle sequence determination optimizes the final dose distribution based on the dose coverage impact of each needle. This impact is predicted stochastically by needle insertion simulations. HDR procedures were simulated with varying number of needle insertions (4 to 12) using 11 patient MR data-sets with PTV, prostate, urethra, bladder and rectum delineated. Needle positioning errors were modeled by random normally distributed angulation errors (standard deviation of 3 mm at the needle’s tip). The final dose parameters were compared in the situations where the needle with the largest vs. the smallest dose coverage impact was selected at each insertion. Results: Over all scenarios, the percentage of clinically acceptable final dose distribution improved when the needle selected had the largest dose coverage impact (91%) compared to the smallest (88%). The differences were larger for few (4 to 6) needle insertions (maximum difference scenario: 79% vs. 60%). The computation time of the needle sequence optimization was below 60s. Conclusion: A new adaptive needle sequence determination for HDR prostate brachytherapy was developed. Coupled to adaptive planning, the selection of the needle with the largest dose coverage impact

  4. Ultrasound and PET-CT image fusion for prostate brachytherapy image guidance

    International Nuclear Information System (INIS)

    Hasford, F.

    2015-01-01

    Fusion of medical images between different cross-sectional modalities is widely used, mostly where functional images are fused with anatomical data. Ultrasound has for some time now been the standard imaging technique used for treatment planning of prostate cancer cases. While this approach is laudable and has yielded some positive results, latest developments have been the integration of images from ultrasound and other modalities such as PET-CT to compliment missing properties of ultrasound images. This study has sought to enhance diagnosis and treatment of prostate cancers by developing MATLAB algorithms to fuse ultrasound and PET-CT images. The fused ultrasound-PET-CT image has shown to contain improved quality of information than the individual input images. The fused image has the property of reduced uncertainty, increased reliability, robust system performance, and compact representation of information. The objective of co-registering the ultrasound and PET-CT images was achieved by conducting performance evaluation of the ultrasound and PET-CT imaging systems, developing image contrast enhancement algorithm, developing MATLAB image fusion algorithm, and assessing accuracy of the fusion algorithm. Performance evaluation of the ultrasound brachytherapy system produced satisfactory results in accordance with set tolerances as recommended by AAPM TG 128. Using an ultrasound brachytherapy quality assurance phantom, average axial distance measurement of 10.11 ± 0.11 mm was estimated. Average lateral distance measurements of 10.08 ± 0.07 mm, 20.01 ± 0.06 mm, 29.89 ± 0.03 mm and 39.84 ± 0.37 mm were estimated for the inter-target distances corresponding to 10 mm, 20 mm, 30 mm and 40 mm respectively. Volume accuracy assessment produced measurements of 3.97 cm 3 , 8.86 cm 3 and 20.11 cm 3 for known standard volumes of 4 cm 3 , 9 cm 3 and 20 cm 3 respectively. Depth of penetration assessment of the ultrasound system produced an estimate of 5.37 ± 0.02 cm

  5. Monte Carlo investigation of I-125 interseed attenuation for standard and thinner seeds in prostate brachytherapy with phantom validation using a MOSFET.

    Science.gov (United States)

    Mason, J; Al-Qaisieh, B; Bownes, P; Henry, A; Thwaites, D

    2013-03-01

    In permanent seed implant prostate brachytherapy the actual dose delivered to the patient may be less than that calculated by TG-43U1 due to interseed attenuation (ISA) and differences between prostate tissue composition and water. In this study the magnitude of the ISA effect is assessed in a phantom and in clinical prostate postimplant cases. Results are compared for seed models 6711 and 9011 with 0.8 and 0.5 mm diameters, respectively. A polymethyl methacrylate (PMMA) phantom was designed to perform ISA measurements in a simple eight-seed arrangement and at the center of an implant of 36 seeds. Monte Carlo (MC) simulation and experimental measurements using a MOSFET dosimeter were used to measure dose rate and the ISA effect. MC simulations of 15 CT-based postimplant prostate treatment plans were performed to compare the clinical impact of ISA on dose to prostate, urethra, rectum, and the volume enclosed by the 100% isodose, for 6711 and 9011 seed models. In the phantom, ISA reduced the dose rate at the MOSFET position by 8.6%-18.3% (6711) and 7.8%-16.7% (9011) depending on the measurement configuration. MOSFET measured dose rates agreed with MC simulation predictions within the MOSFET measurement uncertainty, which ranged from 5.5% to 7.2% depending on the measurement configuration (k = 1, for the mean of four measurements). For 15 clinical implants, the mean ISA effect for 6711 was to reduce prostate D90 by 4.2 Gy (3%), prostate V100 by 0.5 cc (1.4%), urethra D10 by 11.3 Gy (4.4%), rectal D2cc by 5.5 Gy (4.6%), and the 100% isodose volume by 2.3 cc. For the 9011 seed the mean ISA effect reduced prostate D90 by 2.2 Gy (1.6%), prostate V100 by 0.3 cc (0.7%), urethra D10 by 8.0 Gy (3.2%), rectal D2cc by 3.1 Gy (2.7%), and the 100% isodose volume by 1.2 cc. Differences between the MC simulation and TG-43U1 consensus data for the 6711 seed model had a similar impact, reducing mean prostate D90 by 6 Gy (4.2%) and V100 by 0.6 cc (1.8%). ISA causes the delivered dose

  6. Prostate biopsy after ano-rectal resection: value of CT-guided trans-gluteal biopsy

    International Nuclear Information System (INIS)

    Cantwell, Colin P.; Hahn, Peter F.; Gervais, Debra A.; Mueller, Peter R.

    2008-01-01

    We describe our single-institutional experience with computed tomography (CT)-guided percutaneous transgluteal biopsy of the prostate in patients in whom transrectal ultrasound-guided biopsy is precluded by prior ano-rectal resection. Between March 1995 and April 2007, 22 patients had 34 prostate biopsies (mean age 68; mean PSA 29 ng/ml; mean follow-up 6.1 years). The charts of patients who had transgluteal biopsy were reviewed for demographic, complications and pathology. Ninety-five percent (21/22) of primary biopsies were diagnostic. Of the 21 diagnostic biopsies, 11 were positive for prostate cancer and ten were definitive benign samples. Seventy-three percent (8/11) of the patients had progressive PSA elevation that mandated 11 further prostate biopsies. Six patients had a second biopsy, one patient had a third and one patient had a fourth biopsy. Among patients who had serial biopsies, 38% (3/8) had prostate cancer. No complications or death occurred. A malignant biopsy was not significantly associated with core number (P = 0.58) or a high PSA level (P 0.15). CT-guided transgluteal biopsy of the prostate is safe and effective. (orig.)

  7. Image-guided diagnosis of prostate cancer can increase detection of tumors

    Science.gov (United States)

    In the largest prospective study to date of image-guided technology for identifying suspicious regions of the prostate to biopsy, researchers compared the ability of this technology to detect high-risk prostate cancer with that of the current standard of

  8. The using of megavoltage computed tomography in image-guided brachytherapy for cervical cancer: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Tharavichitkul, Ekkasit; Janla-or, Suwapim; Wanwilairat, Somsak; Chakrabandhu, Somvilai; Klunklin, Pitchayaponne; Onchan, Wimrak; Supawongwattana, Bongkot; Chitapanarux, Imjai [Division of Therapeutic Radiology and Oncology, Dept. of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai (Thailand); Galalae, Razvan M. [Faculty of Medicine, Christian-Albrecht University (Campus Kiel), Kiel (Germany)

    2015-06-15

    We present a case of cervical cancer treated by concurrent chemoradiation. In radiation therapy part, the combination of the whole pelvic helical tomotherapy plus image-guided brachytherapy with megavoltage computed tomography of helical tomotherapy was performed. We propose this therapeutic approach could be considered in a curative setting in some problematic situation as our institution.

  9. Prostate preservation by combined external beam and hdr brachytherapy at nodal negative prostate cancer patients - an intermediate analysis after ten years experience

    International Nuclear Information System (INIS)

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

    1996-01-01

    Purpose/Objective: The combined external beam (EBT) and HDR brachytherapy (HBT) boost treatment for localized prostate cancer was established in 1986. The aim of this analysis is to judge the results of this method after 10 years experience. Material and Methods: The treatment and follow-up data of 171 histologically proven, localized (N-staging by imaging) prostate cancer patients were analyzed. Average age of the patients was 68.2 years with a median of 69 years (44-84 years). Tumor stages (using transrectal ultrasound /TRUS/) ranged from A2 (T1b) in two, to B (T2) in 110 and C (T3) in 59 cases. Tumor grading: 27 highly differentiated (G1), 86 moderately differentiated (G2) as well as 57 poorly differentiated (G3) and one undifferentiated (G4) tumor. Follow-up lasted 13-114 months (mean: 53; median: 55 months). Forty-six patients had previous surgery on the bladder neck. Sixty-one patients had transitory androgen deprivation or antiandrogen treatment prior to radiation, which lasted for a max. of 6 months and was finished before radiation with the exception of 13 patients who continued the hormone deprivation after radiotherapy. Initial PSA was known in 126 cases, 86 of them had not received previous androgen deprivation. In 13% values under 4 ng/ml (Hybritech), as well as 46% not above 20 ng/ml and 40 % above 20 ng/ml, respectively. Those cases in which PSA began to rise without having been fallen under a level of 1 ng/ml were considered as PSA progression as well as those cases in which PSA rose to a value twice the PSA nadir we found be essential (2 ng/ml) after it had fallen to a minimum under 1 ng/ml. Ultrasound guided conformal HBT treatment planning was carried out. The 2x 15 Gy HBT boost was integrated into the EBT schedule, total dose was 50 Gy for subclinical disease and 70 Gy for the prostate in 6-7 weeks. Regular follow-up by clinical examination, TRUS + volumetry, PSA, bone scan and after 12 months biopsy. Results: Ten of 171 patients died of

  10. MR-based source localization for MR-guided HDR brachytherapy

    Science.gov (United States)

    Beld, E.; Moerland, M. A.; Zijlstra, F.; Viergever, M. A.; Lagendijk, J. J. W.; Seevinck, P. R.

    2018-04-01

    For the purpose of MR-guided high-dose-rate (HDR) brachytherapy, a method for real-time localization of an HDR brachytherapy source was developed, which requires high spatial and temporal resolutions. MR-based localization of an HDR source serves two main aims. First, it enables real-time treatment verification by determination of the HDR source positions during treatment. Second, when using a dummy source, MR-based source localization provides an automatic detection of the source dwell positions after catheter insertion, allowing elimination of the catheter reconstruction procedure. Localization of the HDR source was conducted by simulation of the MR artifacts, followed by a phase correlation localization algorithm applied to the MR images and the simulated images, to determine the position of the HDR source in the MR images. To increase the temporal resolution of the MR acquisition, the spatial resolution was decreased, and a subpixel localization operation was introduced. Furthermore, parallel imaging (sensitivity encoding) was applied to further decrease the MR scan time. The localization method was validated by a comparison with CT, and the accuracy and precision were investigated. The results demonstrated that the described method could be used to determine the HDR source position with a high accuracy (0.4–0.6 mm) and a high precision (⩽0.1 mm), at high temporal resolutions (0.15–1.2 s per slice). This would enable real-time treatment verification as well as an automatic detection of the source dwell positions.

  11. Magnetic resonance imaging basics for the prostate brachytherapist

    DEFF Research Database (Denmark)

    Wang, Jihong; Tanderup, Kari; Cunha, Adam

    2017-01-01

    . Terminology and MRI system components are reviewed along with typical work flows in prostate high-dose-rate and low-dose-rate brachytherapy. In general, the brachytherapy workflow consists of five key components: diagnosis, implantation, treatment planning (scan + plan), implant verification, and delivery...

  12. Transperineal template-guided prostate saturation biopsies in men with suspicion of prostate cancer: a pilot study from Pakistan.

    Science.gov (United States)

    Mehmood, K; Mubarak, M; Dhar, M; Rafi, M; Kinsella, J

    2017-12-01

    Traditionally, transrectal ultrasound (TRUS)-guided biopsies are done for the diagnosis of prostate cancer (PCa) in Pakistan. The transperineal template-guided saturation biopsy (TTSB) approach has been recently introduced in Pakistan and we share diagnostic yields and pathological findings of specimens taken for PCa diagnosis in men with elevated serum total prostate specific antigen (PSA) and negative TRUS-guided prostate biopsies. In all, 16 patients investigated at the Department of Urology, Sindh Institute of Urology and Transplantation (SIUT), underwent TTSB. The mean age of patients was 67.8 ± 8.8 (range: 55 - 84) years. The median PSA was 9.5 (IQR: 7.9 - 19.8) ng/ ml. The duration of symptoms before biopsy ranged from 1 month to 144 months. The prostate was enlarged with mean weight of 73.5 ± 55.5 g. Histopathology revealed PCa in 5 of 16 (31.2%) cases. The Gleason score was 6 (3+3), 7 (3+4) and 8 (4+4) in 1 case each (6.3%) and 10 (5+5) in 2 cases (12.5%). At least two cores were positive in all positive cases. None of the patients required antibiotics post-procedure. In conclusion, the TTSB technique is a promising option for patients with elevated PSA level and negative transrectal prostate biopsies for the detection of PCa in our setting.

  13. Late rectal bleeding and genitourinary morbidity after high dose rate brachytherapy combined with hypofractionated external beam radiotherapy for localized prostate cancer

    International Nuclear Information System (INIS)

    Ebara, Takeshi; Akimoto, Tetsuo; Kato, Hiroyuki

    2007-01-01

    The purpose of this study was to evaluate late rectal bleeding and genitourinary (GU) morbidity in patients consecutively treated with combined high-dose-rate (HDR) brachytherapy and external beam radiation therapy (EBRT). Data from 80 patients treated consecutively from October 2000 to May 2004 were analyzed. The median age was 69 years old, median follow-up 31 months, ranging from 17-59 months. All patients received endocrine therapy before radiation therapy. The patients were divided into low-, intermediate- and high-risk groups (4/24/52 patients) according to the risk factors defined by T-classification, prostatic specific antigen (PSA) and Gleason score. Fractionation schedules for HDR brachytherapy were prospectively changed, and EBRT was fixed with 3 Gy fractions to 51 Gy. The distribution of fractionation was scheduled as follows; 5 Gy x 5 times in 14 patients, 7 Gy x 3 times in 19 patients, and 9 Gy x 2 times in 47 patients. The rectal bleeding was graded using the toxicity criteria of the Radiation Therapy Oncology Group and European Organization for Research and Treatment of Cancer while the genitourinary morbidities were graded using the toxicity criteria of the Common Terminology Criteria for Adverse Events v.3.0. Grade 2 or worse rectal bleeding developed in 9 patients (11.3%) with the 2-year actuarial probability at 11.2%. Grade 2 and 3 rectal bleeding was recognized in 8 and 1 patients, respectively. Grade 3 morbidity developed in the biopsied sites that were performed in the other hospital. No significant difference was observed in any HDR brachytherapy fractionation schedule. Grade 2 or worse GU morbidities were recognized in 30 patients (37.5%), consisting of 29 Grade 2 patients and 1 Grade 3 patient. Twenty-one patients in Grade 2 morbidity had an increase in the frequency of urination or nocturia, and urethral strictures developed in 3 patients. The 3-year actuarial probability of urethral stricture was 6.0%. One patient experienced Grade 3

  14. Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: a comparison of Australian series.

    Science.gov (United States)

    Wilcox, Shea William; Aherne, Noel J; McLachlan, Craig Steven; McKay, Michael J; Last, Andrew J; Shakespeare, Thomas P

    2015-02-01

    We compare the results of modern external-beam radiotherapy (EBRT), using combined androgen deprivation and dose-escalated intensity-modulated radiotherapy with MRI-CT fusion and daily image guidance with fiducial markers (DE-IG-IMRT), with recently published Australian series of brachytherapy and surgery. Five-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) were calculated for 675 patients treated with DE-IG-IMRT and androgen deprivation therapy (ADT). Patients had intermediate-risk (IR) and high-risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. With a median follow-up of 59 months, our 5-year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5-year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5-year bDFS of 65.5% for HR patients. One LDR series reported 5-year bDFS of 85% for IR patients. Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option. © 2015 The Royal Australian and New Zealand College of Radiologists.

  15. Is modern external beam radiotherapy with androgen deprivation therapy still a viable alternative for prostate cancer in an era of robotic surgery and brachytherapy: a comparison of Australian series

    International Nuclear Information System (INIS)

    Wilcox, Shea W.; Last, Andrew J.; Aherne, Noel J.; McLachlan, Craig S.; McKay, Michael J.; Shakespeare, Thomas P.

    2015-01-01

    We compare the results of modern external-beam radiotherapy (EBRT), using combined androgen deprivation and dose-escalated intensity-modulated radiotherapy with MRI-CT fusion and daily image guidance with fiducial markers (DE-IG-IMRT), with recently published Australian series of brachytherapy and surgery. Five-year actuarial biochemical disease-free survival (bDFS), metastasis-free survival (MFS) and prostate cancer-specific survival (PCaSS) were calculated for 675 patients treated with DE-IG-IMRT and androgen deprivation therapy (ADT). Patients had intermediate-risk (IR) and high-risk (HR) disease. A search was conducted identifying Australian reports from 2005 onwards of IR and HR patients treated with surgery or brachytherapy, reporting actuarial outcomes at 3 years or later. With a median follow-up of 59 months, our 5-year bDFS was 93.3% overall: 95.5% for IR and 91.3% for HR disease. MFS was 96.9% overall (99.0% IR, 94.9% HR), and PCaSS was 98.8% overall (100% IR, 97.7% HR). Prevalence of Grade 2 genitourinary and gastrointestinal toxicity at 5 years was 1.3% and 1.6%, with 0.3% Grade 3 genitourinary toxicity and no Grade 3 gastrointestinal toxicity. Eight reports of brachytherapy and surgery were identified. The HDR brachytherapy series' median 5-year bDFS was 82.5%, MFS 90.0% and PCaSS 97.9%. One surgical series reported 5-year bDFS of 65.5% for HR patients. One LDR series reported 5-year bDFS of 85% for IR patients. Modern EBRT is at least as effective as modern Australian surgical and brachytherapy techniques. All patients considering treatment for localised prostate cancer should be referred to a radiation oncologist to discuss EBRT as an equivalent option.

  16. Diagnostic Accuracy of Multiparametric Magnetic Resonance Imaging and Fusion Guided Targeted Biopsy Evaluated by Transperineal Template Saturation Prostate Biopsy for the Detection and Characterization of Prostate Cancer.

    Science.gov (United States)

    Mortezavi, Ashkan; Märzendorfer, Olivia; Donati, Olivio F; Rizzi, Gianluca; Rupp, Niels J; Wettstein, Marian S; Gross, Oliver; Sulser, Tullio; Hermanns, Thomas; Eberli, Daniel

    2018-02-21

    We evaluated the diagnostic accuracy of multiparametric magnetic resonance imaging and multiparametric magnetic resonance imaging/transrectal ultrasound fusion guided targeted biopsy against that of transperineal template saturation prostate biopsy to detect prostate cancer. We retrospectively analyzed the records of 415 men who consecutively presented for prostate biopsy between November 2014 and September 2016 at our tertiary care center. Multiparametric magnetic resonance imaging was performed using a 3 Tesla device without an endorectal coil, followed by transperineal template saturation prostate biopsy with the BiopSee® fusion system. Additional fusion guided targeted biopsy was done in men with a suspicious lesion on multiparametric magnetic resonance imaging, defined as Likert score 3 to 5. Any Gleason pattern 4 was defined as clinically significant prostate cancer. The detection rates of multiparametric magnetic resonance imaging and fusion guided targeted biopsy were compared with the detection rate of transperineal template saturation prostate biopsy using the McNemar test. We obtained a median of 40 (range 30 to 55) and 3 (range 2 to 4) transperineal template saturation prostate biopsy and fusion guided targeted biopsy cores, respectively. Of the 124 patients (29.9%) without a suspicious lesion on multiparametric magnetic resonance imaging 32 (25.8%) were found to have clinically significant prostate cancer on transperineal template saturation prostate biopsy. Of the 291 patients (70.1%) with a Likert score of 3 to 5 clinically significant prostate cancer was detected in 129 (44.3%) by multiparametric magnetic resonance imaging fusion guided targeted biopsy, in 176 (60.5%) by transperineal template saturation prostate biopsy and in 187 (64.3%) by the combined approach. Overall 58 cases (19.9%) of clinically significant prostate cancer would have been missed if fusion guided targeted biopsy had been performed exclusively. The sensitivity of

  17. Predictors of Toxicity After Image-guided High-dose-rate Interstitial Brachytherapy for Gynecologic Cancer

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Larissa J. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States); Viswanathan, Akila N., E-mail: aviswanathan@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Harvard Medical School, Boston, Massachusetts (United States)

    2012-12-01

    Purpose: To identify predictors of grade 3-4 complications and grade 2-4 rectal toxicity after three-dimensional image-guided high-dose-rate (HDR) interstitial brachytherapy for gynecologic cancer. Methods and Materials: Records were reviewed for 51 women (22 with primary disease and 29 with recurrence) treated with HDR interstitial brachytherapy. A single interstitial insertion was performed with image guidance by computed tomography (n = 43) or magnetic resonance imaging (n = 8). The median delivered dose in equivalent 2-Gy fractions was 72.0 Gy (45 Gy for external-beam radiation therapy and 24 Gy for brachytherapy). Toxicity was reported according to the Common Toxicity Criteria for Adverse Events. Actuarial toxicity estimates were calculated by the Kaplan-Meier method. Results: At diagnosis, the median patient age was 62 years and the median tumor size was 3.8 cm. The median D90 and V100 were 71.4 Gy and 89.5%; the median D2cc for the bladder, rectum, and sigmoid were 64.6 Gy, 61.0 Gy, and 52.7 Gy, respectively. The actuarial rates of all grade 3-4 complications at 2 years were 20% gastrointestinal, 9% vaginal, 6% skin, 3% musculoskeletal, and 2% lymphatic. There were no grade 3-4 genitourinary complications and no grade 5 toxicities. Grade 2-4 rectal toxicity was observed in 10 patients, and grade 3-4 complications in 4; all cases were proctitis with the exception of 1 rectal fistula. D2cc for rectum was higher for patients with grade 2-4 (68 Gy vs 57 Gy for grade 0-1, P=.03) and grade 3-4 (73 Gy vs 58 Gy for grade 0-2, P=.02) rectal toxicity. The estimated dose that resulted in a 10% risk of grade 2-4 rectal toxicity was 61.8 Gy (95% confidence interval, 51.5-72.2 Gy). Discussion: Image-guided HDR interstitial brachytherapy results in acceptable toxicity for women with primary or recurrent gynecologic cancer. D2cc for the rectum is a reliable predictor of late rectal complications. Three-dimensional-based treatment planning should be performed to ensure

  18. Acute bacterial prostatitis after transrectal ultrasound-guided prostate biopsy: epidemiological, bacteria and treatment patterns from a 4-year prospective study.

    Science.gov (United States)

    Campeggi, Alexandre; Ouzaid, Idir; Xylinas, Evanguelos; Lesprit, Philippe; Hoznek, Andras; Vordos, Dimitri; Abbou, Claude-Clément; Salomon, Laurent; de la Taille, Alexandre

    2014-02-01

    To evaluate the incidence, and clinical and bacterial features of iatrogenic prostatitis within 1 month after transrectal ultrasound-guided biopsy for detection of prostate cancer. From January 2006 to December 2009, 3000 patients underwent a 21-core transrectal ultrasound-guided prostate biopsy at Henri Mondor Hospital (Créteil, France) and were prospectively followed. All patients had a fluoroquinolone antimicrobial prophylaxis for 7 days. The primary study end-point was to evaluate the incidence of iatrogenic acute prostatitis within 1 month after the biopsy. The secondary end-point was to analyze the clinical and the bacterial features of the prostatitis. Overall, 20 patients of the entire study population (0.67%) had an acute bacterial prostatitis within 2.90 ± 1.77 days (range 1-7 days) after the transrectal ultrasound-guided biopsy. The groups of patients with (n = 20) and without (n = 2980) infection were similar in terms of age, prostate-specific antigen level and prostate volume. Escherichia coli was the only isolated bacteria. The subsequent tests for antibiotic susceptibility showed a 95% resistance for fluroquinolone and amoxicillin. Resistance to amoxiclav, trimethoprim-sulfamethoxazole, third generation cephalosporin and amikacin was 70%, 70%, 25% and 5% respectively. No resistance to imipenem was reported. They were all admitted for treatment without the need of intensive care unit referral. Complete recovery was achieved after 21.4 ± 7 days of antibiotic treatment. A fluroquinolone-based regimen still represents an appropriate prophylaxis protocol to minimize the risk of acute prostatitis secondary to prostate biopsy. Patients should be provided the appropriate care soon after the onset of the symptoms. An intravenous third generation cephalosporin or imipenem-based therapy seem to provide satisfying results. © 2013 The Japanese Urological Association.

  19. 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

  20. 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.

  1. On-line conformal HDR dose escalation trial in prostate cancer

    International Nuclear Information System (INIS)

    Martinez, Alvaro; Stromberg, Jannifer; Edmundson, Gregory; Gustafson, Gary; Vicini, Frank; Brabbins, Donald

    1996-01-01

    Purpose: To improve treatment results on prostatic adenocarcinoma, 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-four patients with T2b-T3c prostatic adenocarcinoma received 172 transperineal conformal high-dose rate (HDR) boost implants. All patients received concomitant external beam pelvic irradiation. Dose escalation of the three HDR fractions were: 5.5 Gy (18 patients), 6 Gy (15 patients), and 6.5 Gy (21 patients). 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. Results: 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 corrected prior to each HDR treatment. The rectal dose has ranged from 45 to 87%, and the urethral dose from 97 to 112% of the prostate dose. Negative prostatic biopsies at 18 months were seen in (30(32)) patients. Biochemical (PSA <1.5 ng/ml) control at 36 months is is 89%. It is significant that operator dependence has been completely removed because the interactive online planning system uniformly guides the physicians. Conclusions: With ultrasound guidance and the interactive online dosimetry system, organ motion is insignificant because it can be corrected during the procedure. Common pitfalls of brachytherapy, including operator dependence and difficulty with reproducibility, have been

  2. Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy

    International Nuclear Information System (INIS)

    Bittner, Nathan; Merrick, Gregory S.; Galbreath, Robert W.; Butler, Wayne M.; Adamovich, Edward; Wallner, Kent E.

    2010-01-01

    Purpose: Standard prostate biopsy schemes underestimate Gleason score in a significant percentage of cases. Extended biopsy improves diagnostic accuracy and provides more reliable prognostic information. In this study, we tested the hypothesis that greater biopsy core number should result in improved treatment outcome through better tailoring of therapy. Methods and Materials: From April 1995 to May 2006, 1,613 prostate cancer patients were treated with permanent brachytherapy. Patients were divided into five groups stratified by the number of prostate biopsy cores (≤6, 7-9, 10-12, 13-20, and >20 cores). Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were evaluated as a function of core number. Results: The median patient age was 66 years, and the median preimplant prostate-specific antigen was 6.5 ng/mL. The overall 10-year bPFS, CSS, and OS were 95.6%, 98.3%, and 78.6%, respectively. When bPFS was analyzed as a function of core number, the 10-year bPFS for patients with >20, 13-20, 10-12, 7-9 and ≤6 cores was 100%, 100%, 98.3%, 95.8%, and 93.0% (p < 0.001), respectively. When evaluated by treatment era (1995-2000 vs. 2001-2006), the number of biopsy cores remained a statistically significant predictor of bPFS. On multivariate analysis, the number of biopsy cores was predictive of bPFS but did not predict for CSS or OS. Conclusion: Greater biopsy core number was associated with a statistically significant improvement in bPFS. Comprehensive regional sampling of the prostate may enhance diagnostic accuracy compared to a standard biopsy scheme, resulting in better tailoring of therapy.

  3. TU-AB-201-05: Automatic Adaptive Per-Operative Re-Planning for HDR Prostate Brachytherapy - a Simulation Study On Errors in Needle Positioning

    International Nuclear Information System (INIS)

    Borot de Battisti, M; Maenhout, M; Lagendijk, J J W; Van Vulpen, M; Moerland, M A; Senneville, B Denis de; Hautvast, G; Binnekamp, D

    2015-01-01

    Purpose: To develop adaptive planning with feedback for MRI-guided focal HDR prostate brachytherapy with a single divergent needle robotic implant device. After each needle insertion, the dwell positions for that needle are calculated and the positioning of remaining needles and dosimetry are both updated based on MR imaging. Methods: Errors in needle positioning may occur due to inaccurate needle insertion (caused by e.g. the needle’s bending) and unpredictable changes in patient anatomy. Consequently, the dose plan quality might dramatically decrease compared to the preplan. In this study, a procedure was developed to re-optimize, after each needle insertion, the remaining needle angulations, source positions and dwell times in order to obtain an optimal coverage (D95% PTV>19 Gy) without exceeding the constraints of the organs at risk (OAR) (D10% urethra<21 Gy, D1cc bladder<12 Gy and D1cc rectum<12 Gy). Complete HDR procedures with 6 needle insertions were simulated for a patient MR-image set with PTV, prostate, urethra, bladder and rectum delineated. Random angulation errors, modeled by a Gaussian distribution (standard deviation of 3 mm at the needle’s tip), were generated for each needle insertion. We compared the final dose parameters for the situations (I) without re-optimization and (II) with the automatic feedback. Results: The computation time of replanning was below 100 seconds on a current desk computer. For the patient tested, a clinically acceptable dose plan was achieved while applying the automatic feedback (median(range) in Gy, D95% PTV: 19.9(19.3–20.3), D10% urethra: 13.4(11.9–18.0), D1cc rectum: 11.0(10.7–11.6), D1cc bladder: 4.9(3.6–6.8)). This was not the case without re-optimization (median(range) in Gy, D95% PTV: 19.4(14.9–21.3), D10% urethra: 12.6(11.0–15.7), D1cc rectum: 10.9(8.9–14.1), D1cc bladder: 4.8(4.4–5.2)). Conclusion: An automatic guidance strategy for HDR prostate brachytherapy was developed to compensate

  4. 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

  5. Evaluation of rectal bleeding factors associated with prostate brachytherapy

    International Nuclear Information System (INIS)

    Aoki, Manabu; Miki, Kenta; Sasaki, Hiroshi; Kido, Masato; Shirahama, Jun; Takagi, Sayako; Kobayashi, Masao; Honda, Chikara; Kanehira, Chihiro

    2009-01-01

    The purpose of this study was to analyze rectal bleeding prognostic factors associated with prostate brachytherapy (PB) or in combination with external-beam radiation therapy (EBRT) and to examine dosimetric indications associated with rectal bleeding. The study included 296 patients followed up for >36 months (median, 48 months). PB was performed alone in 252 patients and in combination with EBRT in 44 patients. PB combined with EBRT is indicated for patients with a Gleason score >6. The prescribed dose was 144 Gy for monotherapy and 110 Gy for PB+EBRT (44-46 Gy). Although 9.1% who received monotherapy had 2.3% grade 2 rectal bleeding, 36.3% who received combined therapy had 15.9% grade 2 rectal bleeding. Combined therapy was associated with higher incidence of rectal bleeding (P=0.0049) and higher percentage of grade 2 bleeding (P=0.0005). Multivariate analysis revealed that R-150 was the only significant factor for rectal bleeding, and modified Radiation Therapy Oncology Group (RTOG) grade in monotherapy and biologically equivalent dose (BED) were significant for combined therapy. Moreover, grade 2 rectal bleeding increased significantly at D90 >130 Gy. Although R-150 was the significant prognostic factor for rectal bleeding and modified RTOG rectal toxicity grade, BED was the significant prognostic factor for modified RTOG rectal toxicity grade. (author)

  6. Does prostate brachytherapy treat the seminal vesicles? A dose-volume histogram analysis of seminal vesicles in patients undergoing combined PD-103 prostate implantation and external beam irradiation

    International Nuclear Information System (INIS)

    Stock, Richard G.; Lo, Yeh-Chi; Gaildon, Mohamoud; Stone, Nelson N.

    1999-01-01

    Purpose: Combined brachytherapy of the prostate and external beam irradiation (EBRT) of the prostate and seminal vesicles (SV) is becoming a popular treatment for high-risk prostate cancer. Dose-volume histogram (DVH) analysis of the SV in patients undergoing this treatment was performed to determine the dose distribution to the SV and the adequacy of this treatment in patients with potential SV involvement. Methods and Materials: Twenty-five consecutive patients were treated with a Pd-103 implant of the prostate alone and 45 Gy of EBRT to the prostate and SV. Attempts were not made to implant the SV but seeds were routinely placed at the junction of the prostate and SV. All patients underwent CT-based post implant dosimetric analysis 1 month after implantation. As part of this analysis, DVH were generated for the prostate and total SV volume (SVT). In addition, the SV was divided into 6-mm-thick volumes identified as SV1, SV2, SV3, SV4, and SV5 starting from the junction of the prostate and SV and extending distally. DVH were also generated for these structures. Delivered dose was defined as the D90 (dose delivered to 90% of the organ on DVH). Results: The median volumes in cc of the prostate, SVT, SV1, SV2, SV3, SV4, and SV5 were 34.33, 9.75, 2.7, 3.48, 2.92, 3.18, and 1.96 respectively. The SVT contained from 0-9 seeds (median 2). There was little dose delivered to the SVT and SV volumes from the implanted prostate. The median D90 values for the prostate, SVT, SV1, SV2, SV3, SV4, and SV5 were 8615 cGy, 675 cGy, 3100 cGy, 1329 cGy, 553 cGy, 246 cGy, and 67 cGy, respectively. The dose delivered to the prostate covered small percentages of SV. The percents of SV volumes covered by the prostate D90 were 11, 35, 3.3, 0, 0, and 0 for SVT, SV1, SV2, SV3, SV4, and SV5, respectively. Conclusions: DVH analysis of the SV reveals that dose generated from an implanted prostate contributes little to the SV. Those patients at high risk for SV involvement may be under treated

  7. Disinfection of a probe used in ultrasound-guided prostate biopsy.

    Science.gov (United States)

    Rutala, William A; Gergen, Maria F; Weber, David J

    2007-08-01

    Transrectal ultrasound (TRUS)-guided prostate biopsies are among the most common outpatient diagnostic procedures in urology clinics and carry the risk of introducing pathogens that may lead to infection. To investigate the effectiveness of procedures for disinfecting a probe used in ultrasound-guided prostate biopsy. The effectiveness of disinfection was determined by inoculating 10(7) colony forming units (cfu) of Pseudomonas aeruginosa at the following 3 sites on the probe: the interior lumen of the biopsy needle guide, the outside surface of the biopsy needle guide, and the interior lumen of the ultrasound probe where the needle guide passes through the transducer. Each site was investigated separately. After inoculation, the probe was immersed in 2% glutaraldehyde for 20 minutes and then assessed for the level of microbial contamination. The results demonstrated that disinfection (ie, a reduction in bacterial load of greater than 7 log(10) cfu) could be achieved if the needle guide was removed from the probe. However, if the needle guide was left in the probe channel during immersion in 2% glutaraldehyde, disinfection was not achieved (ie, the reduction was approximately 1 log(10) cfu). Recommendations for probe disinfection are provided and include disassembling the device and immersing the probe and the needle guide separately in a high-level disinfectant.

  8. PSA bounce after 125I-brachytherapy for prostate cancer as a favorable prognosticator

    International Nuclear Information System (INIS)

    Engeler, Daniel S.; Schwab, Christoph; Schmid, Hans-Peter; Thoeni, Armin F.; Hochreiter, Werner; Prikler, Ladislav; Suter, Stefan; Stucki, Patrick; Schiefer, Johann; Plasswilm, Ludwig; Putora, Paul Martin

    2015-01-01

    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.) [de

  9. Brachytherapy needle deflection evaluation and correction

    International Nuclear Information System (INIS)

    Wan Gang; Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron

    2005-01-01

    In prostate brachytherapy, an 18-gauge needle is used to implant radioactive seeds. This thin needle can be deflected from the preplanned trajectory in the prostate, potentially resulting in a suboptimum dose pattern and at times requiring repeated needle insertion to achieve optimal dosimetry. In this paper, we report on the evaluation of brachytherapy needle deflection and bending in test phantoms and two approaches to overcome the problem. First we tested the relationship between needle deflection and insertion depth as well as whether needle bending occurred. Targeting accuracy was tested by inserting a brachytherapy needle to target 16 points in chicken tissue phantoms. By implanting dummy seeds into chicken tissue phantoms under 3D ultrasound guidance, the overall accuracy of seed implantation was determined. We evaluated methods to overcome brachytherapy needle deflection with three different insertion methods: constant orientation, constant rotation, and orientation reversal at half of the insertion depth. Our results showed that needle deflection is linear with needle insertion depth, and that no noticeable bending occurs with needle insertion into the tissue and agar phantoms. A 3D principal component analysis was performed to obtain the population distribution of needle tip and seed position relative to the target positions. Our results showed that with the constant orientation insertion method, the mean needle targeting error was 2.8 mm and the mean seed implantation error was 2.9 mm. Using the constant rotation and orientation reversal at half insertion depth methods, the deflection error was reduced. The mean needle targeting errors were 0.8 and 1.2 mm for the constant rotation and orientation reversal methods, respectively, and the seed implantation errors were 0.9 and 1.5 mm for constant rotation insertion and orientation reversal methods, respectively

  10. Endoscope-guided interstitial intensity-modulated brachytherapy and intracavitary brachytherapy as boost radiation for primary early T stage nasopharyngeal carcinoma.

    Directory of Open Access Journals (Sweden)

    Xiang-Bo Wan

    Full Text Available BACKGROUND: Intracavitary brachytherapy (ICBT is usually applied as boost radiotherapy for superficial residual of nasopharyngeal carcinoma (NPC after primary extern-beam radiptherapy (ERT. Here, we evaluated the outcome of endoscope-guided interstitial intensity-modulated brachytherapy (IMBT boost radiation for deep-seated residual NPC. METHODOLOGY/PRINCIPAL FINDINGS: Two hundred and thirteen patients with residual NPC who were salvaged with brachytherapy boost radiation during 2005-2009 were analyzed retrospectively. Among these patients, 171 patients had superficial residual NPC (≤1 cm below the nasopharyngeal epithelium were treated with ICBT boost radiation, and interstitial IMBT boost radiation was delivered to 42 patients with deep-seated residual NPC (>1 cm below the nasopharyngeal epithelium. We found that IMBT boost subgroup had a higher ratio of T2b (81.0% VS 34.5%, P<0.001 and stage II (90.5% VS 61.4%, P = 0.001 than that of ICBT boost subgroup. The dosage of external-beam radiotherapy in the nasopharyngeal (63.0±3.8 VS 62.6±4.3 Gray (Gy, P = 0.67 and regional lymph nodes (55.8±5.0 VS 57.5±5.7 Gy, P = 0.11 was comparable in both groups. For brachytherapy, IMBT subgroup had a lower boost radiation dosage than ICBT subgroup (11.0±2.9 VS 14.8±3.2 Gy, P<0.01. Though the IMBT group had deeper residual tumors and received lower boost radiation dosages, both subgroups had the similar 5-year actuarial overall survival rate (IMBT VS ICBT group: 96.8% VS 93.6%, P = 0.87, progression-free survival rate (92.4% VS 86.5%, P = 0.41 and distant metastasis-free survival rate (94.9% VS 92.7%, P = 0.64. Moreover, IMBT boost radiation subgroup had a similar local (97.4% VS 94.4%, P = 0.57 and regional (95.0% VS 97.2%, P = 0.34 control to ICBT subgroup. The acute and late toxicities rates were comparable between the both subgroups. CONCLUSIONS/SIGNIFICANCE: IMBT boost radiation may be a promising therapeutic

  11. Biological in situ Dose Painting for Image-Guided Radiation Therapy Using Drug-Loaded Implantable Devices

    International Nuclear Information System (INIS)

    Cormack, Robert A.; Sridhar, Srinivas; Suh, W. Warren; D'Amico, Anthony V.; Makrigiorgos, G. Mike

    2010-01-01

    Purpose: Implantable devices routinely used for increasing spatial accuracy in modern image-guided radiation treatments (IGRT), such as fiducials or brachytherapy spacers, encompass the potential for in situ release of biologically active drugs, providing an opportunity to enhance the therapeutic ratio. We model this new approach for two types of treatment. Methods and Materials: Radiopaque fiducials used in IGRT, or prostate brachytherapy spacers ('eluters'), were assumed to be loaded with radiosensitizer for in situ drug slow release. An analytic function describing the concentration of radiosensitizer versus distance from eluters, depending on diffusion-elimination properties of the drug in tissue, was developed. Tumor coverage by the drug was modeled for tumors typical of lung stereotactic body radiation therapy treatments for various eluter dimensions and drug properties. Six prostate 125 I brachytherapy cases were analyzed by assuming implantation of drug-loaded spacers. Radiosensitizer-induced subvolume boost was simulated from which biologically effective doses for typical radiosensitizers were calculated in one example. Results: Drug distributions from three-dimensional arrangements of drug eluters versus eluter size and drug properties were tabulated. Four radiosensitizer-loaded fiducials provide adequate radiosensitization for ∼4-cm-diameter lung tumors, thus potentially boosting biologically equivalent doses in centrally located stereotactic body treated lesions. Similarly, multiple drug-loaded spacers provide prostate brachytherapy with flexible shaping of 'biologically equivalent doses' to fit requirements difficult to meet by using radiation alone, e.g., boosting a high-risk region juxtaposed to the urethra while respecting normal tissue tolerance of both the urethra and the rectum. Conclusions: Drug loading of implantable devices routinely used in IGRT provides new opportunities for therapy modulation via biological in situ dose painting.

  12. High dose rate brachytherapy (HDRB) in prostate cancer - technique description and preliminary results

    International Nuclear Information System (INIS)

    Cordova Junior, Ardo Lotar; Salvajoli, Joao Victor; Pelizzon, Antonio CAssio Assis; Cecilio, Paulo Jose

    1998-01-01

    Describe the technique and preliminary results of high dose rate brachytherapy (HDRB) in localized prostate cancer. Subjects methods: Between March, 1997 and April, 1998, 26 patients were treated with external beam radiotherapy (45 to 50.4 Gy - 1.8 Gy per day) and implants (16 Gy in 2 days - twice a day). Median age was 68 years. The distribution by clinical stage was: 5 T1c, 9 T2a, 10 T2b and 2 T3a. Median initial PSA was 16 ng/ml. Results: With a median follow-up of 4 months, 85% of patients showed normal levels of PSA, with a median of 0.6 ng/ml, 60 to 90 days after treatment. Dysuria grades 1 and 2 and proctitis grade 1 were found in 11,3 and 5 patients, respectively. Conclusion: The method is safe, with acceptable early side effects. Longer follow-up is necessary before drawing any conclusions. (author)

  13. Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation.

    Science.gov (United States)

    Jaberi, Ramin; Siavashpour, Zahra; Aghamiri, Mahmoud Reza; Kirisits, Christian; Ghaderi, Reza

    2017-12-01

    Intra-fractional organs at risk (OARs) deformations can lead to dose variation during image-guided adaptive brachytherapy (IGABT). The aim of this study was to modify the final accepted brachytherapy treatment plan to dosimetrically compensate for these intra-fractional organs-applicators position variations and, at the same time, fulfilling the dosimetric criteria. Thirty patients with locally advanced cervical cancer, after external beam radiotherapy (EBRT) of 45-50 Gy over five to six weeks with concomitant weekly chemotherapy, and qualified for intracavitary high-dose-rate (HDR) brachytherapy with tandem-ovoid applicators were selected for this study. Second computed tomography scan was done for each patient after finishing brachytherapy treatment with applicators in situ. Artificial neural networks (ANNs) based models were used to predict intra-fractional OARs dose-volume histogram parameters variations and propose a new final plan. A model was developed to estimate the intra-fractional organs dose variations during gynaecological intracavitary brachytherapy. Also, ANNs were used to modify the final brachytherapy treatment plan to compensate dosimetrically for changes in 'organs-applicators', while maintaining target dose at the original level. There are semi-automatic and fast responding models that can be used in the routine clinical workflow to reduce individually IGABT uncertainties. These models can be more validated by more patients' plans to be able to serve as a clinical tool.

  14. Artificial neural network based gynaecological image-guided adaptive brachytherapy treatment planning correction of intra-fractional organs at risk dose variation

    Directory of Open Access Journals (Sweden)

    Ramin Jaberi

    2017-12-01

    Full Text Available Purpose : Intra-fractional organs at risk (OARs deformations can lead to dose variation during image-guided adaptive brachytherapy (IGABT. The aim of this study was to modify the final accepted brachytherapy treatment plan to dosimetrically compensate for these intra-fractional organs-applicators position variations and, at the same time, fulfilling the dosimetric criteria. Material and methods : Thirty patients with locally advanced cervical cancer, after external beam radiotherapy (EBRT of 45-50 Gy over five to six weeks with concomitant weekly chemotherapy, and qualified for intracavitary high-dose-rate (HDR brachytherapy with tandem-ovoid applicators were selected for this study. Second computed tomography scan was done for each patient after finishing brachytherapy treatment with applicators in situ. Artificial neural networks (ANNs based models were used to predict intra-fractional OARs dose-volume histogram parameters variations and propose a new final plan. Results : A model was developed to estimate the intra-fractional organs dose variations during gynaecological intracavitary brachytherapy. Also, ANNs were used to modify the final brachytherapy treatment plan to compensate dosimetrically for changes in ‘organs-applicators’, while maintaining target dose at the original level. Conclusions : There are semi-automatic and fast responding models that can be used in the routine clinical workflow to reduce individually IGABT uncertainties. These models can be more validated by more patients’ plans to be able to serve as a clinical tool.

  15. Differentiation of prostatitis and prostate cancer by using diffusion-weighted MR imaging and MR-guided biopsy at 3 T

    NARCIS (Netherlands)

    Nagel, Klaas N.A.; Schouten, Martijn G.; Hambrock, Thomas; Litjens, Geert J.S.; Hoeks, Caroline; ten Haken, Bernard; Barentsz, Jelle O.; Fütterer, Johannes Jacobus; Fütterer, Jurgen J.

    2013-01-01

    Purpose To determine if prostatitis and prostate cancer (PCa) can be distinguished by using apparent diffusion coefficients (ADCs) on magnetic resonance (MR) images, with specimens obtained at MR-guided biopsy as the standard of reference. Materials and Methods The need for institutional review

  16. WE-DE-201-04: Cross Validation of Knowledge-Based Treatment Planning for Prostate LDR Brachytherapy Using Principle Component Analysis

    Energy Technology Data Exchange (ETDEWEB)

    Roper, J; Ghavidel, B; Godette, K; Schreibmann, E [Winship Cancer Institute of Emory University, GA (United States); Chanyavanich, V [Rocky Mountain Cancer Centers, CO (United States)

    2016-06-15

    Purpose: To validate a knowledge-based algorithm for prostate LDR brachytherapy treatment planning. Methods: A dataset of 100 cases was compiled from an active prostate seed implant service. Cases were randomized into 10 subsets. For each subset, the 90 remaining library cases were registered to a common reference frame and then characterized on a point by point basis using principle component analysis (PCA). Each test case was converted to PCA vectors using the same process and compared with each library case using a Mahalanobis distance to evaluate similarity. Rank order PCA scores were used to select the best-matched library case. The seed arrangement was extracted from the best-matched case and used as a starting point for planning the test case. Any subsequent modifications were recorded that required input from a treatment planner to achieve V100>95%, V150<60%, V200<20%. To simulate operating-room planning constraints, seed activity was held constant, and the seed count could not increase. Results: The computational time required to register test-case contours and evaluate PCA similarity across the library was 10s. Preliminary analysis of 2 subsets shows that 9 of 20 test cases did not require any seed modifications to obtain an acceptable plan. Five test cases required fewer than 10 seed modifications or a grid shift. Another 5 test cases required approximately 20 seed modifications. An acceptable plan was not achieved for 1 outlier, which was substantially larger than its best match. Modifications took between 5s and 6min. Conclusion: A knowledge-based treatment planning algorithm for prostate LDR brachytherapy is being cross validated using 100 prior cases. Preliminary results suggest that for this size library, acceptable plans can be achieved without planner input in about half of the cases while varying amounts of planner input are needed in remaining cases. Computational time and planning time are compatible with clinical practice.

  17. Prognostic Significance of 5-Year PSA Value for Predicting Prostate Cancer Recurrence After Brachytherapy Alone and Combined With Hormonal Therapy and/or External Beam Radiotherapy

    International Nuclear Information System (INIS)

    Stock, Richard G.; Klein, Thomas J.; Cesaretti, Jamie A.; Stone, Nelson N.

    2009-01-01

    Purpose: To analyze the prognosis and outcomes of patients who remain free of biochemical failure during the first 5 years after treatment. Methods and Materials: Between 1991 and 2002, 742 patients with prostate cancer were treated with brachytherapy alone (n = 306), brachytherapy and hormonal therapy (n = 212), or combined implantation and external beam radiotherapy (with or without hormonal therapy; n = 224). These patients were free of biochemical failure (American Society for Therapeutic Radiology and Oncology [ASTRO] definition) during the first 5 post-treatment years and had a documented 5-year prostate-specific antigen (PSA) value. The median follow-up was 6.93 years. Results: The actuarial 10-year freedom from PSA failure rate was 97% using the ASTRO definition and 95% using the Phoenix definition. The median 5-year PSA level was 0.03 ng/mL (range, 0-3.6). The 5-year PSA value was ≤0.01 in 47.7%, >0.01-0.10 in 31.1%, >0.10-0.2 in 10.2%, >0.2-0.5 in 7.82%, and >0.5 in 3.10%. The 5-year PSA value had prognostic significance, with a PSA value of ≤0.2 ng/mL (n = 661) corresponding to a 10-year freedom from PSA failure rate of 99% with the ASTRO definition and 98% with the Phoenix definition vs. 86% (ASTRO definition) and 81% (Phoenix definition) for a PSA value ≥0.2 ng/mL (n = 81; p < .0001). The treatment regimen had no effect on biochemical failure. None of the 742 patients in this study developed metastatic disease or died of prostate cancer. Conclusion: The results of this study have shown that the prognosis for patients treated with brachytherapy and who remain biochemically free of disease for ≥5 years is excellent and none developed metastatic disease during the first 10 years after treatment. The 5-year PSA value is prognostic, and patients with a PSA value <0.2 ng/mL are unlikely to develop subsequent biochemical relapse.

  18. Unification of a common biochemical failure definition for prostate cancer treated with brachytherapy or external beam radiotherapy with or without androgen deprivation

    International Nuclear Information System (INIS)

    Fitch, Dwight L.; McGrath, Samuel; Martinez, Alvaro A.; Vicini, Frank A.; Kestin, Larry L.

    2006-01-01

    Purpose: Minimal data are available regarding selection of an optimal biochemical failure (BF) definition for patients treated with brachytherapy, external beam radiotherapy (EBRT), and combinations of these treatments with or without androgen deprivation (AD). We retrospectively analyzed our institution's experience treating localized prostate cancer in an attempt to determine a BF definition that could be applied for these various treatment modalities. Methods and Materials: A total of 2376 patients with clinical stage T1-T3 N0 M0 prostate cancer were treated with conventional dose (median, 66.6 Gy) EBRT (n = 1201), high-dose (median, 75.6 Gy) adaptive radiation therapy (n = 465), EBRT + high-dose-rate brachytherapy boost (n 416), or brachytherapy alone (n = 294) between 1987 and 2003. A total of 496 patients (21%) received neoadjuvant AD with radiation therapy. There were 21924 posttreatment prostate-specific antigen (PSA) measurements. Multiple BF definitions were tested for their sensitivity, specificity, positive predictive value (+PV), and negative PV (-PV) in predicting subsequent clinical failure (CF) (any local failure or distant metastasis), overall survival (OS), and cause-specific survival (CSS). Median follow-up was 4.5 years. The date of BF was the date BF criteria were met (e.g., date of third rise). Results: A total of 290 patients (12%) experienced CF at a median interval of 3.6 years (range, 0.2-15.2 years). The 5- and 10-year CF rates were 12% and 26%, respectively. Three consecutive rises yielded a 46% sensitivity and 84% specificity for predicting CF. The 10-year CF for those 475 patients who experienced three rises (BF) was 37% vs. 17% for those patients who did not meet these criteria (biochemically controlled [BC]). For all patients, the following definitions were superior to three rises for predicting CF for both +PV, and -PV: n + 1 (≥1 ng/mL above nadir), n + 2, n + 3, threshold 2 (any PSA ≥2.0 ng/mL at or after nadir), threshold 3

  19. [Brachytherapy for Prostate Cancer: Potentials and Limitations of Social Health Insurance Data for Benefit Assessment].

    Science.gov (United States)

    Horenkamp-Sonntag, D; Linder, R; Engel, S; Verheyen, F

    2016-05-01

    Due to the insufficient data base the Federal Joint Committee (G-BA) had in 2009 after 7 years of deliberation decided to initiate consultation regarding ambulatory brachytherapy for localised prostate cancer for 10 years from social health insurance (SHI) benefits. The aim is to gain more findings by means of comparative studies. Based on the non-availability of clinical primary data of a methodologically acceptable level, it was analysed to what extent secondary data of the SHI may be used in order to arrive at valid conclusions for benefit aspects. As base approx. 8 million insured of TK with their data of cost reimbursement between 2006 and 2011 were considered. In SHI secondary data no clinical information regarding tumour stage and other prognostic factors are available. Therefore, a novel method with therapy-specific multisectoral inclusion and exclusion criteria, respectively, was developed in order to differentiate between localised and advanced tumours of the prostate. Overall survival, relapse-free survival, event-free survival and side-effects associated to prostate cancer were analysed. Out of 87 822 insured persons with the diagnosis prostate cancer, 795 with PBT, 10 936 with RP and 1 925 with EBRT were investigated in detail. The 4-year event-free survival rate was 73% for RP, 77% for PBT and 71% for EBRT. Many prostate cancer-specific side effects appeared already before intervention. Side effects of the intestinal tract (23.8%) and sexual impairments (26.5%) were more frequent for EBRT than for RP (17.1%/14.8%) and PBT (16.4%/13.2%). By means of SHI secondary data and adequate operationalisation important findings regarding relevant aspects of prostate cancer in healthcare research can be generated. However, these hold methodological limitations and are not suited to draw valid conclusions for benefit assessment. Based solely on SHI routine data valid statements regarding comparative benefit assessment are limited. Limitations could be

  20. MRI-Guided High–Dose-Rate Intracavitary Brachytherapy for Treatment of Cervical Cancer: The University of Pittsburgh Experience

    Energy Technology Data Exchange (ETDEWEB)

    Gill, Beant S.; Kim, Hayeon; Houser, Christopher J. [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Kelley, Joseph L.; Sukumvanich, Paniti; Edwards, Robert P.; Comerci, John T.; Olawaiye, Alexander B.; Huang, Marilyn; Courtney-Brooks, Madeleine [Department of Gynecologic Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Beriwal, Sushil, E-mail: beriwals@upmc.edu [Department of Radiation Oncology, Magee-Womens Hospital of University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)

    2015-03-01

    Purpose: Image-based brachytherapy is increasingly used for gynecologic malignancies. We report early outcomes of magnetic resonance imaging (MRI)-guided brachytherapy. Methods and Materials: Consecutive patient cases with FIGO stage IB1 to IVA cervical cancer treated at a single institution were retrospectively reviewed. All patients received concurrent cisplatin with external beam radiation therapy along with interdigitated high–dose-rate intracavitary brachytherapy. Computed tomography or MRI was completed after each application, the latter acquired for at least 1 fraction. High-risk clinical target volume (HRCTV) and organs at risk were identified by Groupe Européen de Curiethérapie and European SocieTy for Radiotherapy and Oncology guidelines. Doses were converted to equivalent 2-Gy doses (EQD{sub 2}) with planned HRCTV doses of 75 to 85 Gy. Results: From 2007 to 2013, 128 patients, median 52 years of age, were treated. Predominant characteristics included stage IIB disease (58.6%) with a median tumor size of 5 cm, squamous histology (82.8%), and no radiographic nodal involvement (53.1%). Most patients (67.2%) received intensity modulated radiation therapy (IMRT) at a median dose of 45 Gy, followed by a median brachytherapy dose of 27.5 Gy (range, 25-30 Gy) in 5 fractions. At a median follow up of 24.4 months (range, 2.1-77.2 months), estimated 2-year local control, disease-free survival, and cancer-specific survival rates were 91.6%, 81.8%, and 87.6%, respectively. Predictors of local failure included adenocarcinoma histology (P<.01) and clinical response at 3 months (P<.01). Among the adenocarcinoma subset, receiving HRCTV D{sub 90} EQD{sub 2} ≥84 Gy was associated with improved local control (2-year local control rate 100% vs 54.5%, P=.03). Grade 3 or greater gastrointestinal or genitourinary late toxicity occurred at a 2-year actuarial rate of 0.9%. Conclusions: This study constitutes one of the largest reported series of MRI-guided

  1. Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer

    International Nuclear Information System (INIS)

    Morton, Gerard C.; Loblaw, D. Andrew; Chung, Hans; Tsang, Gail; Sankreacha, Raxa; Deabreu, Andrea; Zhang Liying; Mamedov, Alexandre; Cheung, Patrick; Batchelar, Deidre; Danjoux, Cyril; Szumacher, Ewa

    2011-01-01

    Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose

  2. Three-dimensional seed reconstruction from an incomplete data set for prostate brachytherapy

    International Nuclear Information System (INIS)

    Narayanan, Sreeram; Cho, Paul S; MarksII, Robert J

    2004-01-01

    Intra-operative dosimetry in prostate brachytherapy requires 3D coordinates of the implanted, radioactive seeds. Since CT is not readily available during the implant operation, projection x-rays are commonly used for intra-operative seed localization. Three x-ray projections are usually used. The requirement of the current seed reconstruction algorithms is that the seeds must be identified on all three projections. However, in practice this is often difficult to accomplish due to the problem of heavily clustered and overlapping seeds. We have developed an algorithm that permits seed reconstruction from an incomplete data set. Instead of all three projections, the new algorithm requires only one of the three projections to be complete. Furthermore, even if all three projections are incomplete, it can reconstruct 100% of the implanted seeds depending on how the undetected seeds are distributed among the projections. The method utilizes the principles of epipolar imaging geometry and pseudo-matching of the undetected seeds. The algorithm was successfully applied to a large number of clinical cases where seeds imperceptibly overlap in some projections

  3. Differentiation of Prostatitis and Prostate Cancer by Using Diffusion-weighted MR Imaging and MR-guided Biopsy at 3 T

    NARCIS (Netherlands)

    Nagel, K.N.A.; Schouten, M.G.; Hambrock, T.; Litjens, G.J.S.; Hoeks, C.M.A.; Haken, B.T.; Barentsz, J.O.; Futterer, J.J.

    2013-01-01

    Purpose:To determine if prostatitis and prostate cancer (PCa) can be distinguished by using apparent diffusion coefficients (ADCs) on magnetic resonance (MR) images, with specimens obtained at MR-guided biopsy as the standard of reference.Materials and Methods:The need for institutional review board

  4. Ten years experience in organ preservation using HDR brachytherapy boost for nodal negative, locally advanced prostate cancer

    International Nuclear Information System (INIS)

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

    1996-01-01

    Objectives: In 1986 Bertermann and Brix established the combined external beam (EBT) and HDR brachytherapy (BT) boost treatment for localized prostate cancer. The aim of this analysis is to judge the results of this method after 10 years experience. Material and methods: The treatment and follow-up data of 158 histologically proven, localized (N- by imaging) prostate cancer patients were analyzed. Tumor stages (using transrectal ultrasound/TRUS/) ranged from A2 (T1b) in two, to B (T2) in 105 and C (T3) in 51 cases. Tumor grading: 21 highly differentiated (G1), 79 moderately differentiated (G2) as well as 52 poorly differentiated (G3) and one undifferentiated (G4) tumor. Forty-four patients (pts) had previous surgery on the bladder neck. Forty-eight pts had transitory androgen deprivation or antiandrogen treatment prior to radiation, which lasted for a max. of 6 months and was finished before radiation. Initial PSA was known in 126 cases. In 13% values under 4 ng/ml (Hybritech), as well as 46% not above 20 ng/ml and 40 % above 20 ng/ml, respectively. Ultrasound guided conformal BT treatment planning was carried out. The 2x 15 Gy HDR-BT boost was integrated into the EBT schedule, the total dose was 50 Gy for subclinical disease and 70 Gy for the prostate in 6-7 weeks. Regular follow-up by clinical examination, TRUS + volumetry, PSA, bone scan and after 12 months biopsy. Median follow-up 55 months (6-144 months). Results: Eight of 158 pts died of prostate cancer, 15 of intercurrent disease. Clinical progression in 18 cases (12 systemic, 5 local, 1 both syst. + local). All cases of clinical progression with PSA elevation. All pts, whose PSA did not decrease under 1 ng/ml developed progression (p<0.001). Progression developed in 11% of the 107 organ-confined (T1-2 or A2-B) and 7 (14%) of the advanced tumors (T3 or C). The relation between tumor grading and total progression (clinical + PSA) was as follows: four out of 26 G1 tumors, 9 out of 79 G2 tumors and 21 of the 53

  5. Inverse planning anatomy-based dose optimization for HDR-brachytherapy of the prostate using fast simulated annealing algorithm and dedicated objective function

    International Nuclear Information System (INIS)

    Lessard, Etienne; Pouliot, Jean

    2001-01-01

    An anatomy-based dose optimization algorithm is developed to automatically and rapidly produce a highly conformal dose coverage of the target volume while minimizing urethra, bladder, and rectal doses in the delivery of an high dose-rate (HDR) brachytherapy boost for the treatment of prostate cancer. The dwell times are optimized using an inverse planning simulated annealing algorithm (IPSA) governed entirely from the anatomy extracted from a CT and by a dedicated objective function (cost function) reflecting clinical prescription and constraints. With this inverse planning approach, the focus is on the physician's prescription and constraint instead of on the technical limitations. Consequently, the physician's control on the treatment is improved. The capacity of this algorithm to represent the physician's prescription is presented for a clinical prostate case. The computation time (CPU) for IPSA optimization is less than 1 min (41 s for 142 915 iterations) for a typical clinical case, allowing fast and practical dose optimization. The achievement of highly conformal dose coverage to the target volume opens the possibility to deliver a higher dose to the prostate without inducing overdosage of urethra and normal tissues surrounding the prostate. Moreover, using the same concept, it will be possible to deliver a boost dose to a delimited tumor volume within the prostate. Finally, this method can be easily extended to other anatomical sites

  6. 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

  7. In vivo motion and force measurement of surgical needle intervention during prostate brachytherapy

    International Nuclear Information System (INIS)

    Podder, Tarun; Clark, Douglas; Sherman, Jason; Fuller, Dave; Messing, Edward; Rubens, Deborah; Strang, John; Brasacchio, Ralph; Liao, Lydia; Ng, W.-S.; Yu Yan

    2006-01-01

    In this paper, we present needle insertion forces and motion trajectories measured during actual brachytherapy needle insertion while implanting radioactive seeds in the prostate glands of 20 different patients. The needle motion was captured using ultrasound images and a 6 degree-of-freedom electromagnetic-based position sensor. Needle velocity was computed from the position information and the corresponding time stamps. From in vivo data we found the maximum needle insertion forces to be about 15.6 and 8.9 N for 17 gauge (1.47 mm) and 18 gauge (1.27 mm) needles, respectively. Part of this difference in insertion forces is due to the needle size difference (17G and 18G) and the other part is due to the difference in tissue properties that are specific to the individual patient. Some transverse forces were observed, which are attributed to several factors such as tissue heterogeneity, organ movement, human factors in surgery, and the interaction between the template and the needle. However, theses insertion forces are significantly responsible for needle deviation from the desired trajectory and target movement. Therefore, a proper selection of needle and modulated velocity (translational and rotational) may reduce the tissue deformation and target movement by reducing insertion forces and thereby improve the seed delivery accuracy. The knowledge gleaned from this study promises to be useful for not only designing mechanical/robotic systems but also developing a predictive deformation model of the prostate and real-time adaptive controlling of the needle

  8. 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.

  9. Precision grid and hand motion for accurate needle insertion in brachytherapy

    International Nuclear Information System (INIS)

    McGill, Carl S.; Schwartz, Jonathon A.; Moore, Jason Z.; McLaughlin, Patrick W.; Shih, Albert J.

    2011-01-01

    Purpose: In prostate brachytherapy, a grid is used to guide a needle tip toward a preplanned location within the tissue. During insertion, the needle deflects en route resulting in target misplacement. In this paper, 18-gauge needle insertion experiments into phantom were performed to test effects of three parameters, which include the clearance between the grid hole and needle, the thickness of the grid, and the needle insertion speed. Measurement apparatus that consisted of two datum surfaces and digital depth gauge was developed to quantify needle deflections. Methods: The gauge repeatability and reproducibility (GR and R) test was performed on the measurement apparatus, and it proved to be capable of measuring a 2 mm tolerance from the target. Replicated experiments were performed on a 2 3 factorial design (three parameters at two levels) and analysis included averages and standard deviation along with an analysis of variance (ANOVA) to find significant single and two-way interaction factors. Results: Results showed that grid with tight clearance hole and slow needle speed increased precision and accuracy of needle insertion. The tight grid was vital to enhance precision and accuracy of needle insertion for both slow and fast insertion speed; additionally, at slow speed the tight, thick grid improved needle precision and accuracy. Conclusions: In summary, the tight grid is important, regardless of speed. The grid design, which shows the capability to reduce the needle deflection in brachytherapy procedures, can potentially be implemented in the brachytherapy procedure.

  10. High-Risk Prostate Cancer With Gleason Score 8–10 and PSA Level ≤15 ng/ mL Treated With Permanent Interstitial Brachytherapy

    International Nuclear Information System (INIS)

    Fang, L. Christine; Merrick, Gregory S.; Butler, Wayne M.; Galbreath, Robert W.; Murray, Brian C.; Reed, Joshua L.; Adamovich, Edward; Wallner, Kent E.

    2011-01-01

    Purpose: With widespread prostate-specific antigen (PSA) screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by a Gleason score (GS) ≥8 coupled with a relatively low PSA level. The optimal management of these patients has not been defined. Cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) were evaluated in brachytherapy patients with a GS ≥8 and a PSA level ≤15 ng/mL with or without androgen-deprivation therapy (ADT). Methods and Materials: From April 1995 to October 2005, 174 patients with GS ≥8 and a PSA level ≤15 ng/mL underwent permanent interstitial brachytherapy. Of the patients, 159 (91%) received supplemental external beam radiation, and 113 (64.9%) received ADT. The median follow-up was 6.6 years. The median postimplant Day 0 minimum percentage of the dose covering 90% of the target volume was 121.1% of prescription dose. Biochemical control was defined as a PSA level ≤0.40 ng/mL after nadir. Multiple parameters were evaluated for impact on survival. Results: Ten-year outcomes for patients without and with ADT were 95.2% and 92.5%, respectively, for CSS (p = 0.562); 86.5% and 92.6%, respectively, for bPFS (p = 0.204); and 75.2% and 66.0%, respectively, for OS (p = 0.179). The median post-treatment PSA level for biochemically controlled patients was <0.02 ng/mL. Multivariate analysis failed to identify any predictors for CSS, whereas bPFS and OS were most closely related to patient age. Conclusions: Patients with GS ≥8 and PSA level ≤15 ng/mL have excellent bPFS and CSS after brachytherapy with supplemental external beam radiotherapy. The use of ADT did not significantly impact bPFS, CSS, or OS.

  11. Influence of trace elements in human tissue in low-energy photon brachytherapy dosimetry

    International Nuclear Information System (INIS)

    White, Shane A; Landry, Guillaume; Van Gils, Francis; Verhaegen, Frank; Reniers, Brigitte

    2012-01-01

    The aim of this paper is to determine the dosimetric impact of trace elements in human tissues for low-energy photon sources used in brachytherapy. Monte Carlo dose calculations were used to investigate the dosimetric effect of trace elements present in normal or cancerous human tissues. The effect of individual traces (atomic number Z = 11–30) was studied in soft tissue irradiated by low-energy brachytherapy sources. Three other tissue types (prostate, adipose and mammary gland) were also simulated with varying trace concentrations to quantify the contribution of each trace to the dose distribution. The dose differences between cancerous and healthy prostate tissues were calculated in single- and multi-source geometries. The presence of traces in a tissue produces a difference in the dose distribution that is dependent on Z and the concentration of the trace. Low-Z traces (Na) have a negligible effect ( 3%). There is a potentially significant difference in the dose distribution between cancerous and healthy prostate tissues (4%) and even larger if compared to the trace-free composition (15%) in both single- and multi-sourced geometries. Trace elements have a non-negligible (up to 8% in prostate D 90 ) effect on the dose in tissues irradiated with low-energy photon sources. This study underlines the need for further investigation into accurate determination of the trace composition of tissues associated with low-energy brachytherapy. Alternatively, trace elements could be incorporated as a source of uncertainty in dose calculations. (paper)

  12. Directional interstitial brachytherapy from simulation to application

    Science.gov (United States)

    Lin, Liyong

    Organs at risk (OAR) are sometimes adjacent to or embedded in or overlap with the clinical target volume (CTV) to be treated. The purpose of this PhD study is to develop directionally low energy gamma-emitting interstitial brachytherapy sources. These sources can be applied between OAR to selectively reduce hot spots in the OARs and normal tissues. The reduction of dose over undesired regions can expand patient eligibility or reduce toxicities for the treatment by conventional interstitial brachytherapy. This study covers the development of a directional source from design optimization to construction of the first prototype source. The Monte Carlo code MCNP was used to simulate the radiation transport for the designs of directional sources. We have made a special construction kit to assemble radioactive and gold-shield components precisely into D-shaped titanium containers of the first directional source. Directional sources have a similar dose distribution as conventional sources on the treated side but greatly reduced dose on the shielded side, with a sharp dose gradient between them. A three-dimensional dose deposition kernel for the 125I directional source has been calculated. Treatment plans can use both directional and conventional 125I sources at the same source strength for low-dose-rate (LDR) implants to optimize the dose distributions. For prostate tumors, directional 125I LDR brachytherapy can potentially reduce genitourinary and gastrointestinal toxicities and improve potency preservation for low risk patients. The combination of better dose distribution of directional implants and better therapeutic ratio between tumor response and late reactions enables a novel temporary LDR treatment, as opposed to permanent or high-dose-rate (HDR) brachytherapy for the intermediate risk T2b and high risk T2c tumors. Supplemental external-beam treatments can be shortened with a better brachytherapy boost for T3 tumors. In conclusion, we have successfully finished the

  13. GGEMS-Brachy: GPU GEant4-based Monte Carlo simulation for brachytherapy applications

    Science.gov (United States)

    Lemaréchal, Yannick; Bert, Julien; Falconnet, Claire; Després, Philippe; Valeri, Antoine; Schick, Ulrike; Pradier, Olivier; Garcia, Marie-Paule; Boussion, Nicolas; Visvikis, Dimitris

    2015-07-01

    In brachytherapy, plans are routinely calculated using the AAPM TG43 formalism which considers the patient as a simple water object. An accurate modeling of the physical processes considering patient heterogeneity using Monte Carlo simulation (MCS) methods is currently too time-consuming and computationally demanding to be routinely used. In this work we implemented and evaluated an accurate and fast MCS on Graphics Processing Units (GPU) for brachytherapy low dose rate (LDR) applications. A previously proposed Geant4 based MCS framework implemented on GPU (GGEMS) was extended to include a hybrid GPU navigator, allowing navigation within voxelized patient specific images and analytically modeled 125I seeds used in LDR brachytherapy. In addition, dose scoring based on track length estimator including uncertainty calculations was incorporated. The implemented GGEMS-brachy platform was validated using a comparison with Geant4 simulations and reference datasets. Finally, a comparative dosimetry study based on the current clinical standard (TG43) and the proposed platform was performed on twelve prostate cancer patients undergoing LDR brachytherapy. Considering patient 3D CT volumes of 400  × 250  × 65 voxels and an average of 58 implanted seeds, the mean patient dosimetry study run time for a 2% dose uncertainty was 9.35 s (≈500 ms 10-6 simulated particles) and 2.5 s when using one and four GPUs, respectively. The performance of the proposed GGEMS-brachy platform allows envisaging the use of Monte Carlo simulation based dosimetry studies in brachytherapy compatible with clinical practice. Although the proposed platform was evaluated for prostate cancer, it is equally applicable to other LDR brachytherapy clinical applications. Future extensions will allow its application in high dose rate brachytherapy applications.

  14. GGEMS-Brachy: GPU GEant4-based Monte Carlo simulation for brachytherapy applications

    International Nuclear Information System (INIS)

    Lemaréchal, Yannick; Bert, Julien; Schick, Ulrike; Pradier, Olivier; Garcia, Marie-Paule; Boussion, Nicolas; Visvikis, Dimitris; Falconnet, Claire; Després, Philippe; Valeri, Antoine

    2015-01-01

    In brachytherapy, plans are routinely calculated using the AAPM TG43 formalism which considers the patient as a simple water object. An accurate modeling of the physical processes considering patient heterogeneity using Monte Carlo simulation (MCS) methods is currently too time-consuming and computationally demanding to be routinely used. In this work we implemented and evaluated an accurate and fast MCS on Graphics Processing Units (GPU) for brachytherapy low dose rate (LDR) applications. A previously proposed Geant4 based MCS framework implemented on GPU (GGEMS) was extended to include a hybrid GPU navigator, allowing navigation within voxelized patient specific images and analytically modeled 125 I seeds used in LDR brachytherapy. In addition, dose scoring based on track length estimator including uncertainty calculations was incorporated. The implemented GGEMS-brachy platform was validated using a comparison with Geant4 simulations and reference datasets. Finally, a comparative dosimetry study based on the current clinical standard (TG43) and the proposed platform was performed on twelve prostate cancer patients undergoing LDR brachytherapy. Considering patient 3D CT volumes of 400  × 250  × 65 voxels and an average of 58 implanted seeds, the mean patient dosimetry study run time for a 2% dose uncertainty was 9.35 s (≈500 ms 10 −6 simulated particles) and 2.5 s when using one and four GPUs, respectively. The performance of the proposed GGEMS-brachy platform allows envisaging the use of Monte Carlo simulation based dosimetry studies in brachytherapy compatible with clinical practice. Although the proposed platform was evaluated for prostate cancer, it is equally applicable to other LDR brachytherapy clinical applications. Future extensions will allow its application in high dose rate brachytherapy applications. (paper)

  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. Re-distribution of brachytherapy dose using a differential dose prescription adapted to risk of local failure in low-risk prostate cancer patients

    DEFF Research Database (Denmark)

    Rylander, Susanne; Polders, Daniel; Steggerda, Marcel J

    2015-01-01

    BACKGROUND AND PURPOSE: We investigated the application of a differential target- and dose prescription concept for low-dose-rate prostate brachytherapy (LDR-BT), involving a re-distribution of dose according to risk of local failure and treatment-related morbidity. MATERIAL AND METHODS: Our study......- and dose prescription concept of prescribing a lower dose to the whole gland and an escalated dose to the GTV using LDR-BT seed planning was technically feasible and resulted in a significant dose-reduction to urethra and bladder neck....

  17. Prostate segmentation by feature enhancement using domain knowledge and adaptive region based operations

    International Nuclear Information System (INIS)

    Nanayakkara, Nuwan D; Samarabandu, Jagath; Fenster, Aaron

    2006-01-01

    Estimation of prostate location and volume is essential in determining a dose plan for ultrasound-guided brachytherapy, a common prostate cancer treatment. However, manual segmentation is difficult, time consuming and prone to variability. In this paper, we present a semi-automatic discrete dynamic contour (DDC) model based image segmentation algorithm, which effectively combines a multi-resolution model refinement procedure together with the domain knowledge of the image class. The segmentation begins on a low-resolution image by defining a closed DDC model by the user. This contour model is then deformed progressively towards higher resolution images. We use a combination of a domain knowledge based fuzzy inference system (FIS) and a set of adaptive region based operators to enhance the edges of interest and to govern the model refinement using a DDC model. The automatic vertex relocation process, embedded into the algorithm, relocates deviated contour points back onto the actual prostate boundary, eliminating the need of user interaction after initialization. The accuracy of the prostate boundary produced by the proposed algorithm was evaluated by comparing it with a manually outlined contour by an expert observer. We used this algorithm to segment the prostate boundary in 114 2D transrectal ultrasound (TRUS) images of six patients scheduled for brachytherapy. The mean distance between the contours produced by the proposed algorithm and the manual outlines was 2.70 ± 0.51 pixels (0.54 ± 0.10 mm). We also showed that the algorithm is insensitive to variations of the initial model and parameter values, thus increasing the accuracy and reproducibility of the resulting boundaries in the presence of noise and artefacts

  18. 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

  19. Multicentre treatment planning study of MRI-guided brachytherapy for cervical cancer: Comparison between tandem-ovoid applicator users

    International Nuclear Information System (INIS)

    Nomden, Christel N.; Leeuw, Astrid A.C. de; Van Limbergen, Erik; Brabandere, Marisol de; Nulens, An; Nout, Remi A.; Laman, Mirjam; Ketelaars, Martijn; Lutgens, Ludovicus; Reniers, Brigitte; Jürgenliemk-Schulz, Ina Maria

    2013-01-01

    Background and purpose: To compare MRI-guided treatment planning approaches between four centres that use tandem-ovoid applicators. Material and methods: Four centres generated three treatment plans for four patients: standard, optimised intracavitary, and optimised intracavitary/interstitial. Prescribed D90 High-Risk CTV (HR-CTV) was 85 Gy EQD2 (external-beam radiotherapy and brachytherapy), while the D 2cc OAR limit was 90 Gy EQD2 for bladder and 75 Gy EQD2 for rectum, sigmoid, and bowel, respectively. DVH-parameters, source loading patterns and spatial dose distributions of the three treatment plans were compared. Results: The standard plans of the different centres were comparable with respect to the D90 HR-CTV, but differed in OAR doses. MRI-guided intracavitary optimisation resulted in organ sparing and smaller variation in DVH parameters between the centres. Adding interstitial needles led to target dose escalation while respecting the OAR constraints. However, substantial differences in relative weights of the applicator parts resulted in an increased variation in DVH parameters and locations of high dose regions. Conclusions: MRI-guided brachytherapy treatment planning optimisation provides the possibility to increase the dose to the HR-CTV and spare the OARs. Depending on the degree of conformity the centres make different choices in relative weighting of applicator parts, leading to different dose distributions

  20. Intermediate-term results of image-guided brachytherapy and high-technology external beam radiotherapy in cervical cancer: Chiang Mai University experience.

    Science.gov (United States)

    Tharavichitkul, Ekkasit; Chakrabandhu, Somvilai; Wanwilairat, Somsak; Tippanya, Damrongsak; Nobnop, Wannapha; Pukanhaphan, Nantaka; Galalae, Razvan M; Chitapanarux, Imjai

    2013-07-01

    To evaluate the outcomes of image-guided brachytherapy combined with 3D conformal or intensity modulated external beam radiotherapy (3D CRT/IMRT) in cervical cancer at Chiang Mai University. From 2008 to 2011, forty-seven patients with locally advanced cervical cancer were enrolled in this study. All patients received high-technology (3D CRT/IMRT) whole pelvic radiotherapy with a total dose of 45-46 Gy plus image-guided High-Dose-Rate intracavitary brachytherapy 6.5-7 Gy × 4 fractions to a High-Risk Clinical Target Volume (HR-CTV) according to GEC-ESTRO recommendations. The dose parameters of the HR-CTV for bladder, rectum and sigmoid colon were recorded, as well as toxicity profiles. In addition, the endpoints for local control, disease-free, metastasis-free survival and overall survival were calculated. At the median follow-up time of 26 months, the local control, disease-free survival, and overall survival rates were 97.9%, 85.1%, and 93.6%, respectively. The mean dose of HR-CTV, bladder, rectum and sigmoid were 93.1, 88.2, 69.6, and 72 Gy, respectively. In terms of late toxicity, the incidence of grade 3-4 bladder and rectum morbidity was 2.1% and 2.1%, respectively. A combination of image-guided brachytherapy and IMRT/3D CRT showed very promising results of local control, disease-free survival, metastasis-free survival and overall survival rates. It also caused a low incidence of grade 3-4 toxicity in treated study patients. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. 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.)

  2. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer

    International Nuclear Information System (INIS)

    Le Fur, E.; Fournier, G.; Valeri, A.; Universite de Bretagne Occidentale, Brest; Universite Europeenne de Bretagne, Rennes; APHP, Hopital Tenon, Paris; Pradier, O.; Universite de Bretagne Occidentale, Brest; Universite Europeenne de Bretagne, Rennes; CHU Brest

    2012-01-01

    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 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.)

  3. Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study

    International Nuclear Information System (INIS)

    Buron, Catherine; Le Vu, Beatrice; Cosset, Jean-Marc; Pommier, Pascal; Peiffert, Didier; Delannes, Martine; Flam, Thierry; Guerif, Stephane; Salem, Naji; Chauveinc, Laurent; Livartowski, Alain

    2007-01-01

    Purpose: To prospectively compare health-related quality of life (HRQOL), patient-reported treatment-related symptoms, and costs of iodine-125 permanent implant interstitial brachytherapy (IB) with those of radical prostatectomy (RP) during the first 2 years after these treatments for localized prostate cancer. Methods and Materials: A total of 435 men with localized low-risk prostate cancer, from 11 French hospitals, treated with IB (308) or RP (127), were offered to complete the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire QLQ-C30 version 3 (EORTC QLQ-C30) and the prostate cancer specific EORTC QLQ-PR25 module before and at the end of treatment, 2, 6, 12, 18, and 24 months after treatment. Repeated measures analysis of variance and analysis of covariance were conducted on HRQOL changes. Comparative cost analysis covered initial treatment, hospital follow-up, outpatient and production loss costs. Results: Just after treatment, the decrease of global HRQOL was less pronounced in the IB than in the RP group, with a 13.5 points difference (p < 0.0001). A difference slightly in favor of RP was observed 6 months after treatment (-7.5 points, p = 0.0164) and was maintained at 24 months (-8.2 points, p = 0.0379). Impotence and urinary incontinence were more pronounced after RP, whereas urinary frequency, urgency, and urination pain were more frequent after IB. Mean societal costs did not differ between IB ( Euro 8,019 at T24) and RP ( Euro 8,715 at T24, p = 0.0843) regardless of the period. Conclusions: This study suggests a similar cost profile in France for IB and RP but with different HRQOL and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs

  4. Radical prostatectomy vs high-dose-rate brachytherapy for prostate cancer. Health-related quality-of-life effects

    International Nuclear Information System (INIS)

    Jo, Yoshimasa; Fujisawa, Masato

    2004-01-01

    A screening comparison was made of health-related quality-of-life (HRQOL) outcomes between two primary treatment modalities for localized prostate cancer: radical prostatectomy (RP) and iridium-192 (Ir-192) high-dose rate brachytherapy (HDR-BT) followed by external beam radiotherapy (EBRT). The subjects were 182 patients diagnosed with T1c to T3bN0M0 prostate cancer between October 1997 through August 2002 who underwent RP (n=89) or HDR-BT with 36.8 Gy of EBRT (n=93) and follow-up for at least 6 months. A postal survey was sent, in which HRQOL was assessed using the Short Form Health Survey (SF-36), and disease-specific QOL using the University of California Los Angeles Prostate Cancer Index (UCLA-PCI). We obtained responses to questionnaires from 151 out of 182 patients (83.0%; RP, 78.7%, HDR-BT, 87.1%). No significant difference was observed in SF-36 scale scores between RP and HDR-BT. In the UCLA-PCI, the HDR-BT group had better urinary function (UF, p<0.001) and sexual function (SF, p=0.0272), whereas the RP group had better bowel bother (BB, p=0.0425). In patients with at least 2 years of follow-up, UF (p<0.001) and sexual bother (SB, p=0.0286) were better for the HDR-BT group than for the RP group. HDR-BT patients had significantly better UF (p=0.009) and SB (p=0.0134) than even patients with uni-lateral nerve-sparing RP (n=30). When planning treatment, QOL concerns including mental health issues associated with prostate cancer need to be addressed with the patients, as well as the potential side effects. (author)

  5. Five-year follow-up using a prostate stent as fiducial in image-guided radiotherapy of prostate cancer.

    Science.gov (United States)

    Carl, Jesper; Sander, Lotte

    2015-06-01

    To report results from the five-year follow-up on a previously reported study using image-guided radiotherapy (IGRT) of localized or locally advanced prostate cancer (PC) and a removable prostate stent as fiducial. Patients with local or locally advanced PC were treated using five-field 3D conformal radiotherapy (3DRT). The clinical target volumes (CTV) were treated to 78 Gy in 39 fractions using daily on-line image guidance (IG). Late genito-urinary (GU) and gastro-intestinal (GI) toxicities were scored using the radiotherapy oncology group (RTOG) score and the common toxicity score of adverse events (CTC) score. Urinary symptoms were also scored using the international prostate symptom score (IPSS). Median observation time was 5.4 year. Sixty-two of the 90 patients from the original study cohort were eligible for toxicity assessment. Overall survival, cancer-specific survival and biochemical freedom from failure were 85%, 96% and 80%, respectively at five years after radiotherapy. Late toxicity GU and GI RTOG scores≥2 were 5% and 0%. Comparing pre- and post-radiotherapy IPSS scores indicate that development in urinary symptoms after radiotherapy may be complex. Prostate image-guided radiotherapy using a prostate stent demonstrated survival data comparable with recently published data. GU and GI toxicities at five-year follow-up were low and comparable to the lowest toxicity rates reported. These findings support that the precision of the prostate stent technique is at least as good as other techniques. IPSS revealed a complex development in urinary symptoms after radiotherapy.

  6. Complications and risk factors in transrectal ultrasound-guided prostate biopsies

    Directory of Open Access Journals (Sweden)

    Carlos Márcio Nóbrega de Jesus

    Full Text Available CONTEXT AND OBJECTIVE: Prostate biopsy is not a procedure without risk. There is concern about major complications and which antibiotics are best for routine use before these biopsies. The objective was to determine the rate of complications and the possible risk factors in prostate biopsies. DESIGN AND SETTING: Prospective study, Faculdade de Medicina de Botucatu. METHODS: Transrectal ultrasound (TRUS guided prostate biopsies were carried out in 174 patients presenting either abnormality in digital rectal examinations (DRE or levels higher than 4 ng/ml in prostate-specific antigen (PSA tests, or both. RESULTS: Hemorrhagic complications were the most common (75.3%, while infectious complications occurred in 19% of the cases. Hematuria was the most frequent type (56%. Urinary tract infection (UTI occurred in 16 patients (9.2%. Sepsis was observed in three patients (1.7%. The presence of an indwelling catheter was a risk factor for infectious complications (p < 0.05. Higher numbers of biopsies correlated with hematuria, rectal bleeding and infectious complications (p < 0.05. The other conditions investigated did not correlate with post-biopsy complications. CONCLUSIONS: Post-biopsy complications were mostly self-limiting. The rate of major complications was low, thus showing that TRUS guided prostate biopsy was safe and effective. Higher numbers of fragments taken in biopsies correlated with hematuria, rectal bleeding and infectious complications. An indwelling catheter represented a risk factor for infectious complications. The use of aspirin was not an absolute contraindication for TRUS.

  7. Image guided brachytherapy in locally advanced cervical cancer: Improved pelvic control and survival in RetroEMBRACE, a multicenter cohort study

    DEFF Research Database (Denmark)

    Sturdza, Alina; Pötter, Richard; Fokdal, Lars Ulrik

    2016-01-01

    Purpose Image guided brachytherapy (IGBT) for locally advanced cervical cancer allows dose escalation to the high-risk clinical target volume (HRCTV) while sparing organs at risk (OAR). This is the first comprehensive report on clinical outcome in a large multi-institutional cohort. Patients and ...

  8. Piezoelectrically Actuated Robotic System for MRI-Guided Prostate Percutaneous Therapy

    OpenAIRE

    Su, Hao; Shang, Weijian; Cole, Gregory; Li, Gang; Harrington, Kevin; Camilo, Alexander; Tokuda, Junichi; Tempany, Clare M.; Hata, Nobuhiko; Fischer, Gregory S.

    2014-01-01

    This paper presents a fully-actuated robotic system for percutaneous prostate therapy under continuously acquired live magnetic resonance imaging (MRI) guidance. The system is composed of modular hardware and software to support the surgical workflow of intra-operative MRI-guided surgical procedures. We present the development of a 6-degree-of-freedom (DOF) needle placement robot for transperineal prostate interventions. The robot consists of a 3-DOF needle driver module and a 3-DOF Cartesian...

  9. Fiber Bragg gratings-based sensing for real-time needle tracking during MR-guided brachytherapy

    Energy Technology Data Exchange (ETDEWEB)

    Borot de Battisti, Maxence, E-mail: M.E.P.Borot@umcutrecht.nl; Maenhout, Metha; Lagendijk, Jan J. W.; Vulpen, Marco van; Moerland, Marinus A. [Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX (Netherlands); Denis de Senneville, Baudouin [Imaging Division, University Medical Center Utrecht, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands and IMB, UMR 5251 CNRS/University of Bordeaux, Talence 33400 (France); Hautvast, Gilion; Binnekamp, Dirk [Philips Group Innovation Biomedical Systems, Eindhoven 5656 AE (Netherlands)

    2016-10-15

    Purpose: The development of MR-guided high dose rate (HDR) brachytherapy is under investigation due to the excellent tumor and organs at risk visualization of MRI. However, MR-based localization of needles (including catheters or tubes) has inherently a low update rate and the required image interpretation can be hampered by signal voids arising from blood vessels or calcifications limiting the precision of the needle guidance and reconstruction. In this paper, a new needle tracking prototype is investigated using fiber Bragg gratings (FBG)-based sensing: this prototype involves a MR-compatible stylet composed of three optic fibers with nine sets of embedded FBG sensors each. This stylet can be inserted into brachytherapy needles and allows a fast measurement of the needle deflection. This study aims to assess the potential of FBG-based sensing for real-time needle (including catheter or tube) tracking during MR-guided intervention. Methods: First, the MR compatibility of FBG-based sensing and its accuracy was evaluated. Different known needle deflections were measured using FBG-based sensing during simultaneous MR-imaging. Then, a needle tracking procedure using FBG-based sensing was proposed. This procedure involved a MR-based calibration of the FBG-based system performed prior to the interventional procedure. The needle tracking system was assessed in an experiment with a moving phantom during MR imaging. The FBG-based system was quantified by comparing the gold-standard shapes, the shape manually segmented on MRI and the FBG-based measurements. Results: The evaluation of the MR compatibility of FBG-based sensing and its accuracy shows that the needle deflection could be measured with an accuracy of 0.27 mm on average. Besides, the FBG-based measurements were comparable to the uncertainty of MR-based measurements estimated at half the voxel size in the MR image. Finally, the mean(standard deviation) Euclidean distance between MR- and FBG-based needle position

  10. Protocol for the realization of transrectal prostatic biopsy guided by ultrasound

    International Nuclear Information System (INIS)

    Arce Montero, Jairo

    2013-01-01

    A general protocol is proposed for the realization of the ultrasound-guided prostatic biopsy in patients with positive screening. The screening should be performed taking into account risk antecedents, rectal examination and prostate-specific antigen (PSA) levels in the patients. However, patients that have presented without alteration in the PSA and suspect rectal examination, should be considered for biopsy endorectal with ultrasound guidance even more with positive risk factors. The generalities of prostate cancer are described. The general prostatic anatomy and echographic are reviewed. The echographic technique is analyzed in the exploration endorectal. The echographic findings suspects of prostate cancer are characterized. The different biopsy sampling techniques are described; and based on appropriate knowledge of prostatic echographic anatomy, could increase the effectiveness in the early detection of prostate cancer in patients with positive screening. The complications derived from the process are enumerated. The final recommendations are noted on the protocol described [es

  11. Adaptation of a 3D prostate cancer atlas for transrectal ultrasound guided target-specific biopsy

    International Nuclear Information System (INIS)

    Narayanan, R; Suri, J S; Werahera, P N; Barqawi, A; Crawford, E D; Shinohara, K; Simoneau, A R

    2008-01-01

    Due to lack of imaging modalities to identify prostate cancer in vivo, current TRUS guided prostate biopsies are taken randomly. Consequently, many important cancers are missed during initial biopsies. The purpose of this study was to determine the potential clinical utility of a high-speed registration algorithm for a 3D prostate cancer atlas. This 3D prostate cancer atlas provides voxel-level likelihood of cancer and optimized biopsy locations on a template space (Zhan et al 2007). The atlas was constructed from 158 expert annotated, 3D reconstructed radical prostatectomy specimens outlined for cancers (Shen et al 2004). For successful clinical implementation, the prostate atlas needs to be registered to each patient's TRUS image with high registration accuracy in a time-efficient manner. This is implemented in a two-step procedure, the segmentation of the prostate gland from a patient's TRUS image followed by the registration of the prostate atlas. We have developed a fast registration algorithm suitable for clinical applications of this prostate cancer atlas. The registration algorithm was implemented on a graphical processing unit (GPU) to meet the critical processing speed requirements for atlas guided biopsy. A color overlay of the atlas superposed on the TRUS image was presented to help pick statistically likely regions known to harbor cancer. We validated our fast registration algorithm using computer simulations of two optimized 7- and 12-core biopsy protocols to maximize the overall detection rate. Using a GPU, patient's TRUS image segmentation and atlas registration took less than 12 s. The prostate cancer atlas guided 7- and 12-core biopsy protocols had cancer detection rates of 84.81% and 89.87% respectively when validated on the same set of data. Whereas the sextant biopsy approach without the utility of 3D cancer atlas detected only 70.5% of the cancers using the same histology data. We estimate 10-20% increase in prostate cancer detection rates

  12. Bowel morbidity following radiochemotherapy and image-guided adaptive brachytherapy for cervical cancer: Physician- and patient reported outcome from the EMBRACE study

    DEFF Research Database (Denmark)

    Jensen, Nina Boje Kibsgaard; Pötter, Richard; Kirchheiner, Kathrin

    2018-01-01

    BACKGROUND/PURPOSE: This study describes late bowel morbidity prospectively assessed in the multi-institutional EMBRACE study on MRI-guided adaptive brachytherapy in locally advanced cervical cancer (LACC). MATERIALS/METHODS: A total of 1176 patients were analyzed. Physician reported morbidity (C...

  13. Transperineal Injection of Hyaluronic Acid in Anterior Perirectal Fat to Decrease Rectal Toxicity From Radiation Delivered With Intensity Modulated Brachytherapy or EBRT for Prostate Cancer Patients

    International Nuclear Information System (INIS)

    Prada, Pedro J.; Fernandez, Jose; Martinez, Alvaro A.; Rua, Angeles de la; Gonzalez, Jose M.; Fernandez, Jose M.; Juan, German

    2007-01-01

    Purpose: Rectal toxicity remains a serious complication affecting quality of life for prostate cancer patients treated with radiotherapy. We began an investigational trial injecting hyaluronic acid (HA) in the perirectal fat to increase the distance between the prostate and the anterior rectal wall. This is the first report using HA injection in oncology. Methods and Materials: This is a trial of external beam radiation therapy with HDR brachytherapy boosts in prostate cancer. During the two high-dose-rate (HDR) fractions, thermoluminescent dosimeter dosimeters were placed in the urethra and in the rectum. Before the second HDR fraction, 3-7 mL (mean, 6 mL) of HA was injected under transrectal ultrasound guidance in the perirectal fat to systematically create a 1.5-cm space. Urethral and rectal HDR doses were calculated and measured. Computed tomography and magnetic resonance imaging were used to assess the stability of the new space. Results: Twenty-seven patients enrolled in the study. No toxicity was produced from the HA or the injection. In follow-up computed tomography and magnetic resonance imaging, the HA injection did not migrate or change in mass/shape for close to 1 year. The mean distance between rectum and prostate was 2.0 cm along the entire length of the prostate. The median measured rectal dose, when normalized to the median urethral dose, demonstrated a decrease in dose from 47.1% to 39.2% (p < 0.001) with or without injection. For an HDR boost dose of 1150 cGy, the rectum mean Dmax reduction was from 708 cGy to 507 cGy, p < 0.001, and the rectum mean Dmean drop was from 608 to 442 cGy, p < 0.001 post-HA injection. Conclusion: The new 2-cm distance derived from the HA injection significantly decreased rectal dose in HDR brachytherapy. Because of the several-month duration of stability, the same distance was maintained during the course of external beam radiation therapy

  14. 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.

  15. 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)

  16. 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)

  17. Health-related quality of life after radical retropubic prostatectomy and permanent prostate brachytherapy. A 3-year follow-up study

    International Nuclear Information System (INIS)

    Hashine, Katsuyoshi; Yuasa, Akihito; Shinomori, Kensuke; Ninomiya, Iku; Kataoka, Masaaki; Yamashita, Natsumi

    2011-01-01

    The objective of this study was to examine quality of life (QOL) for 3 years after radical retropubic prostatectomy (RRP) or permanent prostate brachytherapy (PPB) and to determine differences between the two procedures. In all 107 patients who underwent RRP and 91 who received PPB between October 2005 and July 2007 were included in this study. QOL surveys were performed using the international prostate symptom score (IPSS), the Medical Outcome Study 8-items short form health survey and the expanded prostate cancer index composite at baseline and 1, 3, 6, 12 and 36 months after treatment. At 3 years, all parameters for general QOL and almost all for disease-specific QOL were similar to those at 12 months. Urinary continence after RRP slightly improved from 12 months to 3 years, but it was still significantly worse than that after PPB. Scores for urinary irritation or obstruction and for bowel function and bother at 3 years were similar between the two groups. Sexual function and bother did not change between 12 months and 3 years in either group. Sexual function at 3 years after RRP was worse than that after PPB. Recovery from urinary incontinence and sexual function after RRP with nerve sparing were similar to those after PPB. Urinary incontinence at 3 years correlated with the treatment method and patients' age, whereas urinary irritation/obstruction and urinary bother correlated with the pre-treatment IPSS. QOL assessment represents an important issue in prostate cancer management. Our findings are likely to be of aid in the development of a treatment plan for prostate cancer patients. (author)

  18. Comparison of biochemical failure rates between permanent prostate brachytherapy and radical retropubic prostatectomy as a function of posttherapy PSA nadir plus ‘X’

    International Nuclear Information System (INIS)

    Ahmed, Kamran A; Davis, Brian J; Mynderse, Lance A; Slezak, Jeffrey M; Bergstralh, Eric J; Wilson, Torrence M; Choo, C Richard

    2014-01-01

    Prostate-specific antigen (PSA) nadir + 2 ng/mL, also known as the Phoenix definition, is the definition most commonly used to establish biochemical failure (BF) after external beam radiotherapy for prostate cancer management. The purpose of this study is to compare BF rates between permanent prostate brachytherapy (PPB) and radical retropubic prostatectomy (RRP) as a function of PSA nadir plus varying values of X and examine the associated implications. We retrospectively searched for patients who underwent PPB or RRP at our institution between 1998 and 2004. Only primary patients not receiving androgen-deprivation therapy were included in the study. Three RRP patients were matched to each PPB patient on the basis of prognostic factors. BF rates were estimated for PSA nadirs + different values of X. A total of 1,164 patients were used for analysis: 873 in the RRP group and 291 in the PPB group. Patients were equally matched by clinical stage, biopsy Gleason sum, primary Gleason grade, and pretherapy PSA value. Median follow-up was 3.1 years for RRP patients and 3.6 years in the PPB group (P = .01). Using PSA nadir + 0.1 ng/mL for the definition of BF, the 5-year BF rate was 16.3% for PPB patients and 13.5% for RRP patients (P = .007), whereas at nadir + 2 ng/mL or greater, the BF rates were less than 3% and were indistinguishable between PPB and RRP patients. In a cohort of well-matched patients who had prostatectomy or brachytherapy, we examined BF as a function of nadir + X, where X was treated as a continuous variable. As X increases from 0.1 to 2.0 ng/mL, the BF curves converge, and above 2.0 ng/mL they are essentially indistinguishable. The data presented are of interest as BF definitions continue to evolve

  19. ALGEBRA: ALgorithm for the heterogeneous dosimetry based on GEANT4 for BRAchytherapy.

    Science.gov (United States)

    Afsharpour, H; Landry, G; D'Amours, M; Enger, S; Reniers, B; Poon, E; Carrier, J-F; Verhaegen, F; Beaulieu, L

    2012-06-07

    Task group 43 (TG43)-based dosimetry algorithms are efficient for brachytherapy dose calculation in water. However, human tissues have chemical compositions and densities different than water. Moreover, the mutual shielding effect of seeds on each other (interseed attenuation) is neglected in the TG43-based dosimetry platforms. The scientific community has expressed the need for an accurate dosimetry platform in brachytherapy. The purpose of this paper is to present ALGEBRA, a Monte Carlo platform for dosimetry in brachytherapy which is sufficiently fast and accurate for clinical and research purposes. ALGEBRA is based on the GEANT4 Monte Carlo code and is capable of handling the DICOM RT standard to recreate a virtual model of the treated site. Here, the performance of ALGEBRA is presented for the special case of LDR brachytherapy in permanent prostate and breast seed implants. However, the algorithm is also capable of handling other treatments such as HDR brachytherapy.

  20. Characterization of ultrasound elevation beamwidth artifacts for prostate brachytherapy needle insertion

    International Nuclear Information System (INIS)

    Peikari, Mohammad; Chen, Thomas Kuriran; Lasso, Anras; Heffter, Tamas; Fichtinger, Gabor; Burdette, Everette C.

    2012-01-01

    Purpose: Ultrasound elevation beamwidth leads to image artifacts and uncertainties in localizing objects (such as a surgical needle) in ultrasound images. The authors examined the clinical significance of errors caused by elevation beamwidth artifacts and imaging parameters in needle insertion procedures. Methods: Beveled prostate brachytherapy needles were inserted through all holes of a grid template under real-time transrectal ultrasound (TRUS) guidance. The needle tip position as indicated by the TRUS image was compared to their observed physical location. A new device was developed to measure the ultrasound elevation beamwidth. Results: Imaging parameters of the TRUS scanner have direct impact on the localization error ranging from 0.5 up to 4 mm. The smallest localization error was observed laterally close to the center of the grid template and axially within the beam's focal zone. Largest localization error occurs laterally around both sides of the grid template and axially within the beam's far field. The authors also found that the localization errors vary with both lateral and elevation offsets. Conclusions: The authors found properly adjusting the TRUS imaging settings to lower the ultrasound gain and power effectively minimized the appearance of elevation beamwidth artifacts and in turn reduced the localization errors of the needle tip.