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

Hathout, Lara; Folkert, Michael R.; Kollmeier, Marisa A.; Yamada, Yoshiya; Cohen, Gilad; Zeléfsky, Michael J.

doi:10.1016/j.ijrobp.2014.06.031

Cited by 81 publications

(59 citation statements)

References 31 publications

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“…These observations are in agreement with results published by Hathout et al that the dose received by the bladder neck had a strong prognostic power for both early and late toxicity [35]. It may be that the region of bladder irradiation plays an important role in predicating toxicity alongside both total dose and volume irradiated.…”

Section: Discussionsupporting

confidence: 92%

Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life

et al. 2017

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BackgroundLow-dose-rate permanent prostate brachytherapy (PPB) is an attractive treatment option for patients with localised prostate cancer with excellent outcomes. As standard CT-based post-implant dosimetry often correlates poorly with late treatment-related toxicity, this exploratory (proof of concept) study was conducted to investigate correlations between radiation − induced DNA damage biomarker levels, and acute and late bowel, urinary, and sexual toxicity.MethodsTwelve patients treated with 125I PPB monotherapy (145Gy) for prostate cancer were included in this prospective study. Post-implant CT based dosimetry assessed the minimum dose encompassing 90% (D90%) of the whole prostate volume (global), sub-regions of the prostate (12 sectors) and the near maximum doses (D0.1cc, D2cc) for the rectum and bladder. Six blood samples were collected from each patient; pre-treatment, 1 h (h), 4 h, 24 h post-implant, at 4 weeks (w) and at 3 months (m). DNA double strand breaks were investigated by staining the blood samples with immunofluorescence antibodies to γH2AX and 53BP1 proteins (γH2AX/53BP1). Patient self-scored quality of life from the Expanded Prostate Cancer Index Composite (EPIC) were obtained at baseline, 1 m, 3 m, 6 m, 9 m, 1 year (y), 2y and 3y post-treatment. Spearman’s correlation coefficients were used to evaluate correlations between temporal changes in γH2AX/53BP1, dose and toxicity.ResultsThe minimum follow up was 2 years. Population mean prostate D90% was 144.6 ± 12.1 Gy and rectal near maximum dose D0.1cc = 153.0 ± 30.8 Gy and D2cc = 62.7 ± 12.1 Gy and for the bladder D0.1cc = 123.1 ± 27.0 Gy and D2cc = 70.9 ± 11.9 Gy. Changes in EPIC scores from baseline showed high positive correlation between acute toxicity and late toxicity for both urinary and bowel symptoms. Increased production of γH2AX/53BP1 at 24 h relative to baseline positively correlated with late bowel symptoms. Overall, no correlations were observed between dose metrics (prostate global or sector doses) and γH2AX/53BP1 foci counts.ConclusionsOur results show that a prompt increase in γH2AX/53BP1foci at 24 h post-implant relative to baseline may be a useful measure to assess elevated risk of late RT − related toxicities for PPB patients. A subsequent investigation recruiting a larger cohort of patients is warranted to verify our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-017-0792-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 92%

Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life

et al. 2017

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“…Briefly, the patients were intubated under general anesthesia, and intravenous dexamethasone (8 mg) was given at the time of induction (17). The patients were positioned in the dorsal lithotomy position using Allen Stirrups.…”

Section: Methodsmentioning

confidence: 99%

“…Interstitial needles were inserted into the peripheral substance of the prostate gland through a perineal template under sagittal and axial transrectal US image guidance. Transurethral aerated gel was applied to maximize urethral visualization, and axial US images of the prostate were subsequently acquired at 5-mm increments from the base of the prostate to the apex and transferred into the brachytherapy treatment planning system (17). Contours of the target volume and organs at risk were drawn on each axial image for computer-based three-dimensional reconstruction.…”

Section: Methodsmentioning

confidence: 99%

“…For patients treated with brachytherapy combined with external beam radiation, 103 Pd seeds were used with a prescription dose of 100 Gy to the prostate (11). Urethral dose was kept below 120% and rectal dose below 80% of prescription dose (17). Radioactive seeds were placed with a Mick applicator (Mick Radio-Nuclear Instruments, Inc, Mount Vernon, NY) under US and fluoroscopic image guidance according to the approved treatment plan.…”

Section: Methodsmentioning

confidence: 99%

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Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy

et al. 2016

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PURPOSE Prostate low-dose-rate (LDR) brachytherapy involves implantation of radioactive seeds permanently into the prostate gland. During receptive anal intercourse, the penis of the partner may come in close proximity to the implanted prostate gland. We estimate the potential intrarectal dose rates and suggest guidance on radiation precautions. METHODS AND MATERIALS One hundred two patients were included in the study. After implantation, with patients under anesthesia in the dorsal lithotomy position, a new set of ultrasound (US) images and a CT scan were obtained. The images were fused, radioactive seeds and US probe locations were determined on the CT, and prostate, bladder, and rectal contours were drawn on the US. Dose rates (cGy/h) were calculated for the portion of the US probe spanning the prostate for several dose-volume histogram parameters. RESULTS Twenty patients were treated with 125I and 82 patients with 103Pd. Average dose rates at Day 0 to the portion of the US probe spanning the prostate were 2.1 ± 1.3 cGy/h and 2.5 ± 0.8 cGy/h for patients treated with 125I and 103Pd, respectively. After 60 days, average calculated probe dose drops to 1.0 ± 0.6 cGy/h and 0.2 ± 0.1 cGy/h for 125I and 103Pd, respectively. CONCLUSIONS During the immediate weeks after prostate seed implant, the estimated intrarectal dose rates are higher in 103Pd compared to 125I. As 103Pd decays faster than 125I, 2 months after the implant, radiation exposure from 103Pd becomes lower than 125I. Receptive anal intercourse time should be kept as low as possible during 2 and 6 months after low-dose-rate brachytherapy of the prostate with 103Pd and 125I, respectively.

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Section: Brachytherapy Techniquementioning

confidence: 99%

Radiation Safety of Receptive Anal Intercourse with Prostate Cancer Patients Treated with Low-Dose-Rate Brachytherapy

et al. 2016

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PURPOSE-Prostate low-dose-rate (LDR) brachytherapy involves implantation of radioactive seeds permanently into the prostate gland. During receptive anal intercourse, the penis of the partner may come in close proximity to the implanted prostate gland. We estimate the potential intrarectal dose rates and suggest guidance on radiation precautions.METHODS AND MATERIALS-One hundred two patients were included in the study. After implantation, with patients under anesthesia in the dorsal lithotomy position, a new set of ultrasound (US) images and a CT scan were obtained. The images were fused, radioactive seeds and US probe locations were determined on the CT, and prostate, bladder, and rectal contours were drawn on the US. Dose rates (cGy/h) were calculated for the portion of the US probe spanning the prostate for several dose-volume histogram parameters.RESULTS-Twenty patients were treated with 125 I and 82 patients with 103 Pd. Average dose rates at Day 0 to the portion of the US probe spanning the prostate were 2.1 ± 1.3 cGy/h and 2.5 ± 0.8 cGy/h for patients treated with 125 I and 103 Pd, respectively. After 60 days, average calculated probe dose drops to 1.0 ± 0.6 cGy/h and 0.2 ± 0.1 cGy/h for 125 I and 103 Pd, respectively. CONCLUSIONS-During the immediate weeks after prostate seed implant, the estimated intrarectal dose rates are higher in 103 Pd compared to 125 I. As 103 Pd decays faster than 125 I, 2 months after the implant, radiation exposure from 103 Pd becomes lower than 125 I. Receptive anal intercourse time should be kept as low as possible during 2 and 6 months after low-dose-rate brachytherapy of the prostate with 103 Pd and 125 I, respectively.

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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

Cited by 81 publications

References 31 publications

Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life

Prostate cancer treated with brachytherapy; an exploratory study of dose-dependent biomarkers and quality of life

Radiation safety of receptive anal intercourse with prostate cancer patients treated with low-dose-rate brachytherapy

Radiation Safety of Receptive Anal Intercourse with Prostate Cancer Patients Treated with Low-Dose-Rate Brachytherapy

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