Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method

Kang, Sung-Jun; Chou, Rachel H.; Dodge, Richard K.; Clough, Robert; Kang, Hi Sung L.; Bowen, Michael; Steffey, Beverly; Das, Shiva K.; Zhou, Shu; Whitehurst, Arthur W.; Buckley, Niall; Kim, Jay H.; Joyner, R.; Sarmina, Ignacio; Montana, Gustavo S.; Ingram, Sally S.; Anscher, Mitchell S.

doi:10.1016/s0360-3016(01)01530-9

Cited by 49 publications

(24 citation statements)

References 23 publications

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“…Uroflowmetry (Urodyn 1000, Dantec, Denmark) was assessed on two separate occasions (each with a voided volume of >150 mL) and the maximum flow rate (Q max ) corrected for a standard reference volume of 300 mL according to the Siroky nomogram [8]. Symptom scores of <7 were classified as mild, [8][9][10][11][12][13][14][15][16][17][18][19] as moderate and ≥ 20 as severe [7].…”

Section: Methodsmentioning

confidence: 99%

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The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer

et al. 2004

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OBJECTIVE To evaluate lower urinary tract symptoms (LUTS) and the symptom‐associated quality of life (QoL) after radical prostatectomy. PATIENTS AND METHODS We carried out a prospective study (January 1999 to March 2001) of 50 consecutive men initially assessed in the nurse‐led prostate assessment clinic for their LUTS and subsequently diagnosed to have localized prostate cancer. They had a radical retropubic prostatectomy and were assessed before, 3 and 6 months after surgery with a self‐administered International Prostate Symptom Score (IPSS) and QoL questionnaires, and measurements of urinary flow rate and postvoid residual urinary (PVR) volumes. Finally, each patient completed a self‐administered continence questionnaire at 6 weeks, 3 and 6 months after surgery. RESULTS In men with moderate to severe LUTS before surgery there were significant improvements in total IPSS, symptom‐associated QoL, mean peak flow rate and PVR (P < 0.05). However, in eight men with mild LUTS, although there was a 33% improvement in the total symptom score, it was not statistically significant. Thirty‐eight patients reported complete continence, nine had infrequent stress leaks only on heavy physical activity, and the remaining three used < 2 pads/day for protection before heavy physical activity at 3 months after surgery. CONCLUSIONS Radical prostatectomy provides major benefits to men with LUTS besides cancer control. These data are important in counselling patients about the treatment options, especially in view of the current enthusiasm for brachytherapy and conformal radiotherapy, which may worsen LUTS.

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Section: Methodsmentioning

confidence: 99%

“…This information is even more important with the current enthusiasm for using brachytherapy for localized prostate cancer. The acute urinary toxicity, which can be mild to moderate, has been reported to be up to 88%, with 14% of patients requiring prolonged catheterization [18].…”

Section: B E N E F I T S a F T E R R A D I C A L P R O S T A T E C T O Mmentioning

confidence: 99%

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer

et al. 2004

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“…Currently, the needle arrangement is implanted manually by physicians; outcomes and sideeffects vary with physician skill and experience. Recent studies confirm that existing procedures can result in acute side-effects such as edema in tissue, incontinence and impotence [2,3,4]. Most of these side-effects are a result of excessive radiation and needle penetration through sensitive structures (urethra, bladder, rectum, penile bulb, cavernous veins, and neurovascular bundles) [5,6,7,4,8] In the clinical procedure for prostate HDR-BT, hollow needles are inserted one at a time into the prostate through the perineum (the region between the testicles and anus).…”

Section: Introductionmentioning

confidence: 95%

“…However, three properties are desired for needle arrangement: (1) it should be able to produce a dose plan that meets all dose objectives, (2) it should use needles economically, and (3) it should not contain needles which penetrate non-prostate organs. Despite the desire to avoid puncturing, sometimes organs such as the penile bulb are punctured in practice.…”

Section: B Skew-line Needle Arrangements Optimizationmentioning

confidence: 99%

Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Garg¹,

Siauw²,

Berenson³

et al. 2012

2012 IEEE International Conference on Automation Science and Engineering (CASE)

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Abstract-One of the goals of automation is to increase the reliability and quality of a given process. This study aims to automate high dose rate brachytherapy (HDR-BT), a radiation therapy that places radioactive sources at the site of the tumor using needles. Although HDR-BT has a high rate of clinical success in curing prostate cancer, it also has several side effects related to needle and dose trauma. A new planning algorithm from previous work optimizes needle arrangements using skewlines (non-parallel, non-intersecting lines). This paper presents initial experiments towards an automated system for implanting skew-line needle arrangements computed from a planning system. We describe the interface, calibration and integration of the robotic hardware with the planning system, and present experiments using our robotic system to implant needles into anatomically-correct tissue phantoms. Results suggest that this system can achieve HDR-BT treatment objectives with reduced trauma to organs and low demands on operator skill, thus making the procedure repeatable at lower cost. We believe that in the future, robotic HDR-BT will result in improved treatment quality with reduced dependence on physician skill.

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“…Brachytherapy is an effective treatment for cancers in the prostate, cervix, breast, and other anatomical sites [2]. We focus on prostate treatment, where current approaches often result in side-effects such as incontinence and impotence [3], [4], [5]. Most side-effects result from needle penetration through sensitive structures (urethra, bladder, rectum, penile bulb, cavernous veins, and neurovascular bundles) [6], [7], [8], [5], [9].…”

Section: Introductionmentioning

confidence: 99%

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

Garg

Siauw

Berenson

et al. 2013

IEEE Trans. Automat. Sci. Eng.

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Abstract-We present a study in human-centered automation that has potential to reduce patient side effects from high dose rate brachytherapy (HDR-BT). To efficiently deliver radiation to the prostate while minimizing trauma to sensitive structures such as the penile bulb, we modified the Acubot-RND 7-axis robot to guide insertion of diamond-tip needles into desired skew-line geometric arrangements. We extend and integrate two algorithms: Needle Planning with Integer Programming (NPIP) and Inverse Planning with Integer Programming (IPIP) to compute skew-line needle and dose plans. We performed three physical experiments with anatomically-correct phantom models to study performance: two with the robot and one control experiment with an expert human physician (co-author Hsu) without the robot. All were able to achieve needle arrangements that meet the RTOG-0321 clinical dose objectives with zero trauma to the penile bulb. We analyze systematic and random errors in needle placement; total RMS error for the robot system operating without feedback ranged from 2.6 mm to 4.3 mm, which is comparable to the RMS error of 2.7 mm obtained in an earlier study for PPI-BT treatment using a robot with 3D ultrasound feedback.Note to Practitioners Brachytherapy treats cancer by delivering radioactive sources proximal to cancer sites via needles. Current methods use standardized fixed mechanical templates that force needles into parallel arrangements that may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs. Skew-line (non-parallel) arrangements of needles can reach targets under the pubic arch and avoid sensitive organs. However these arrangements cannot be achieved with standard templates, motivating the use of automation. We present a human-centered automation system that integrates state-of-the- Left: The current clinical approach to prostate high dose rate brachytherapy (HDR-BT) uses parallel needles guided by a mechanical template. This approach may prevent needles from reaching prostate volumes blocked by the pubic arch and often require needles to puncture sensitive organs (which can produce long-term side-effects). Right: Skew-line needle arrangements facilitated by robot guidance can avoid puncture by reaching under the pubic arch and can minimize trauma to sensitive organs such as the penile bulb which can produce side effects such as incontinence and impotence.art needle and dose planning algorithms with a modified needle insertion robot. Results suggest that the robot can achieve precision and accuracy comparable to that of expert human physician. This approach has applications to brachytherapy treatment for other organs and to other needle procedures such as biopsy and anesthetic injection.

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Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method

Cited by 49 publications

References 23 publications

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer

The benefits of radical prostatectomy beyond cancer control in symptomatic men with prostate cancer

Initial experiments toward automated robotic implantation of skew-line needle arrangements for HDR brachytherapy

Robot-Guided Open-Loop Insertion of Skew-Line Needle Arrangements for High Dose Rate Brachytherapy

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