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

Peters, Max; Duijzentkunst, Daan A. Smit; Westendorp, R.; Pol, Sandrine M.G. van de; Kattevilder, R.; Schellekens, A.; Zyp, Jochem R.N. van der Voort van; Moerland, Marinus A.; Vulpen, Marco van; Hoekstra, C.J.M.

doi:10.1016/j.brachy.2016.11.018

Cited by 10 publications

(7 citation statements)

References 18 publications

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“…Furthermore, the introduction of the CBCT technique significantly improved treatment outcome. For low‐risk prostate cancer, 7‐year biochemical disease‐free survival (BDFS) improved from 87.2%to 93.5% (log rank: P = 0.04), for intermediate risk from 75.9% to 88.5% ( P < 0.001), and for high risk from 57.1% to 85.0% ( P < 0.001) with the introduction of CBCT‐based adaptive planning …”

Section: Discussionmentioning

confidence: 99%

Cone-beam CT-based adaptive planning improves permanent prostate brachytherapy dosimetry: An analysis of 1266 patients

et al. 2017

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Purpose: To evaluate adaptive planning for permanent prostate brachytherapy and to identify the prostate regions that needed adaptation. Methods and materials: After the implantation of stranded seeds, using real-time intraoperative planning, a transrectal ultrasound (TRUS)-scan was obtained and contoured. The positions of seeds were determined on a C-arm cone-beam computed tomography (CBCT)-scan. The CBCT-scan was registered to the TRUS-scan using fiducial gold markers. If dose coverage on the combined imagedataset was inadequate, an intraoperative adaptation was performed by placing remedial seeds. CBCT-based intraoperative dosimetry was analyzed for the prostate (D 90 , V 100 , and V 150 ) and the urethra (D 30 ). The effects of the adaptive dosimetry procedure for Day 30 were separately assessed. Results: We analyzed 1266 patients. In 17.4% of the procedures, an adaptation was performed. Without the dose contribution of the adaptation Day 30 V 100 would be < 95% for half of this group. On Day 0, the increase due to the adaptation was 11.8 AE 7.2% (1SD) for D 90 and 9.0 AE 6.4% for V 100 . On Day 30, we observed an increase in D 90 of 12.3 AE 6.0% and in V 100 of 4.2 AE 4.3%. For the total group, a D 90 of 119.6 AE 9.1% and V 100 of 97.7 AE 2.5% was achieved. Most remedial seeds were placed anteriorly near the base of the prostate. Conclusion: CBCT-based adaptive planning enables identification of implants needing adaptation and improves prostate dose coverage. Adaptations were predominantly performed near the anterior base of the prostate.

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Section: Discussionmentioning

confidence: 99%

Cone-beam CT-based adaptive planning improves permanent prostate brachytherapy dosimetry: An analysis of 1266 patients

et al. 2017

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“…Since the beginning of the 21st century, cone-beam computed tomography (CBCT) has progressively established as important part of the imaging workflows in several medical fields, [1][2][3][4][5][6][7][8][9] such as dentistry, 1 orthopedics, 2 image-guided radiotherapy, 3,4 and brachytherapy. 5 Due to their often mobile configuration, [6][7][8] corresponding CBCT-scanners are particularly suited and reveal high potential for both intraoperative 6,7 and interventional 8 applications.…”

Section: Introductionmentioning

confidence: 99%

Technical evaluation of the cone‐beam computed tomography imaging performance of a novel, mobile, gantry‐based X‐ray system for brachytherapy

Karius

Karolczak

Strnad

et al. 2021

J Applied Clin Med Phys

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A novel, mobile cone-beam computed tomography (CBCT) system for image-guided adaptive brachytherapy was recently deployed at our hospital as worldwide first site. Prior to the device's clinical operation, a profound characterization of its imaging performance was conducted. This was essential to optimize both the imaging workflow and image quality for achieving the best possible clinical outcomes. We present the results of our investigations. Methods: The novel CBCT-system features a ring gantry with 121 cm clearance as well as a 43.2 × 43.2 cm 2 flat-panel detector, and is controlled via a tabletpersonal computer (PC). For evaluating its imaging performance, the geometric reproducibility as well as imaging fidelity, computed tomography (CT)-number accuracy, uniformity, contrast-noise-ratio (CNR), noise characteristics, and spatial resolution as fundamental image quality parameters were assessed.As dose metric the weighted cone-beam dose index (CBDI w ) was measured.Image quality was evaluated using standard quality assurance (QA) as well as anthropomorphic upper torso and breast phantoms. Both in-house and manufacturer protocols for abdomen, pelvis, and breast imaging were examined. Results: Using the in-house protocols, the QA phantom scans showed altogether a high image quality, with high CT-number accuracy (R 2 > 0.97) and uniformity (<12 Hounsfield Unit (HU) cupping), reasonable noise and imaging fidelity, and good CNR at bone-tissue transitions of up to 28:1. Spatial resolution was strongly limited by geometric instabilities of the device. The breast phantom scans fulfilled clinical requirements, whereas the abdomen and pelvis scans showed severe artifacts, particularly at air/bone-tissue transitions. Conclusion:With the novel CBCT-system, achieving a high image quality appears possible in principle. However, adaptations of the standard protocols, performance enhancements in image reconstruction referring to artifact reductions, as well as the extinction of geometric instabilities are imperative.

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“…The most critical aspect of the treatment plan is the precise implantation of radioactive seeds to protect normal tissues. While CT-guided implantation was used widely in the past,[31][32][33][34] MR has higher spatial and density resolutions and can clearly show lesion shape, size, and anatomic relationship with the surrounding tissues. MR can also reconstruct three-dimensional images by basing on cross-sections, providing more accurate targeting.…”

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confidence: 99%

MR‐guided 125I seed implantation treatment for maxillofacial malignant tumor

Wang

Peng

et al. 2020

J Applied Clin Med Phys

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PurposeThis study assessed the therapeutic efficacy of postoperative magnetic resonance (MR)‐guided interstitial 125I seed implantation for treatment of oral and maxillofacial malignant tumors.Methods and MaterialsA total of 127 patients with oral or maxillofacial malignant tumors were included in this study who received interstitial 125I treatment after the surgery resection. Before implantation, all the patients received MR scans to assess the lesion scope, extent, and nature. 125I implantation target regions were based on the pre‐operative imaging. 125I seeds were delivered to target regions via puncture needles under the real‐time guidance of MR. Computed tomography (CT)or MR was performed immediately after implantation and again every 3 months later.ResultsAfter successful 125I implantation, all patients were also examined regularly to detect tumor recurrence, lymphatic, and distant metastases. To date, CT or MR verification showed that 13/127 patients experienced tumor recurrence or lymphatic metastasis or distant metastasis. No seeds migration was observed, no serious treatment‐related complications affected patient quality of life, and no important organ (such as major cervical vessels, spinal cord, etc.) injuries were observed.ConclusionOur results show that MR‐guided 125I implantation is an effective approach to site‐specific treatment for oral and maxillofacial tumor, which could potentially reduce postoperative complications and tumor recurrence rates, increase patient survival, and improve quality of life.

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

Cited by 10 publications

References 18 publications

Cone-beam CT-based adaptive planning improves permanent prostate brachytherapy dosimetry: An analysis of 1266 patients

Cone-beam CT-based adaptive planning improves permanent prostate brachytherapy dosimetry: An analysis of 1266 patients

Technical evaluation of the cone‐beam computed tomography imaging performance of a novel, mobile, gantry‐based X‐ray system for brachytherapy

MR‐guided 125I seed implantation treatment for maxillofacial malignant tumor

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