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

Publications have reported the benefits of using high‐dose‐rate brachytherapy (HDRB) for the treatment of prostate cancer, since it provides similar biochemical control as other treatments while showing lowest long‐term complications to the organs at risk (OAR). With the inclusion of anatomy‐based inverse planning optimizers, HDRB has the advantage of potentially allowing dose escalation. Among the algorithms used, the Inverse Planning Simulated Annealing (IPSA) optimizer is widely employed since it provides adequate dose coverage, minimizing dose to the OAR, but it is known to generate large dwell times in particular positions of the catheter. As an alternative, the Hybrid Inverse treatment Planning Optimization (HIPO) algorithm was recently implemented in Oncentra Brachytherapy V. 4.3. The aim of this work was to compare, with the aid of radiobiological models, plans obtained with IPSA and HIPO to assess their use in our clinical practice. Thirty patients were calculated with IPSA and HIPO to achieve our department's clinical constraints. To evaluate their performance, dosimetric data were collected: Prostate PTV D90(%),V100(%),V150(%), and V200(%), Urethra D10(%), Rectum D2cc(%), and conformity indices. Additionally tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated with the BioSuite software. The HIPO optimization was performed firstly with Prostate PTV (HIPOPTV) and then with Urethra as priority 1 (HIPOurethra). Initial optimization constraints were then modified to see the effects on dosimetric parameters, TCPs, and NTCPs. HIPO optimizations could reduce TCPs up to 10%–20% for all PTVs lower than 74 cm3. For the urethra, IPSA and HIPOurethra provided similar NTCPs for the majority of volume sizes, whereas HIPOPTV resulted in large NTCP values. These findings were in agreement with dosimetric values. By increasing the PTV maximum dose constraints for HIPOurethra plans, TCPs were found to be in agreement with IPSA without affecting the urethral NTCPs.PACS numbers: 87.55.‐x, 87.55.de, 87.55.dh, 87.53.Jw

“…The dosimetric parameters analyzed were the dose‐volume histograms (DVH)‐based values proposed by GEC/ESTRO‐EAU (19) for the Prostate PTV: the dose that covered 90% of the volume

D_{90} (%)

, the percentage of the prostate PTV that received at least 100% of the prescribed dose

V_{100} (%)

, the volume that received 50% and 100% more than the prescribed dose

V_{150} (%), V_{200} (%)

, and for the OARs the dose that covered 10% of the urethra

D_{10} (%)

and the dose that covered 2 cm 3 of the rectum

D_{2 cc} (%)

. According to clinical practice, acceptability of the plan was evaluated according to the values provided in Table 3.…”

Section: Methodsmentioning

confidence: 99%

Comparison of IPSA and HIPO inverse planning optimization algorithms for prostate HDR brachytherapy

Panettieri

Smith

Mason

et al. 2014

“…Some have detailed descriptions indicating how to conduct the various quality control tests. The guidelines promoted in this document are based on the experience of the authors and expert practitioners and are broadly consistent with recommendations from other jurisdictions 6, 7, 8, 9, 10, 11…”

Section: System Descriptionmentioning

confidence: 80%

“…There are several other publications dealing with the performance, specifications, and quality control of low‐dose‐rate (LDR) permanent seed brachytherapy 4, 5, 6, 7, 8, 9, 10, 11. Most of these publications have extensive reference lists.…”

Section: System Descriptionmentioning

confidence: 99%

“…From the physicist's point of view, there is a convergence of many technologies into a single procedure. American Association of Physicists in Medicine (AAPM) Task Groups 43U1,7 64,6 137,10 138,11 186 30 as well as the American Brachytherapy Society 5, 31 and Groupe Européen de Curiethérapie (GEC) and the European Society for Radiotherapy and Oncology (GEC‐ESTRO) guidelines,8 are reference documents for these procedures. The three areas of importance for all implants are: imaging, dosimetry, and radiation protection.…”

Section: System Descriptionmentioning

confidence: 99%

See 1 more Smart Citation

COMP report: CPQR technical quality control guidelines for low‐dose‐rate permanent seed brachytherapy

Beaulieu¹,

Radford

Villarreal-Barajas

2018

The Canadian Organization of Medical Physicists (COMP), in close partnership with the Canadian Partnership for Quality Radiotherapy (CPQR) has developed a series of Technical Quality Control (TQC) guidelines for radiation treatment equipment. These guidelines outline the performance objectives that equipment should meet in order to ensure an acceptable level of radiation treatment quality. The TQC guidelines have been rigorously reviewed and field tested in a variety of Canadian radiation treatment facilities. The development process enables rapid review and update to keep the guidelines current with changes in technology. This article contains detailed performance objectives and safety criteria for low‐dose‐rate (LDR) permanent seed brachytherapy.

“…Modern HDR prostate brachytherapy, utilizing the most advanced imaging and computer technology, is able to provide high levels of local and biochemical control for intermediate‐ to high‐risk prostate cancers 3, 4, 5. There is a consensus today that transrectal ultrasound (TRUS) guided CT‐based HDR brachytherapy is most common approach for prostate HDR brachytherapy 6, 7, 8, 9, 10. However, one of the main challenges of CT‐based HDR brachytherapy is to accurately contour the prostate in CT images due to the poor soft‐tissue contrast 11, 12…”

Section: Introductionmentioning

confidence: 99%

Improved prostate delineation in prostate HDR brachytherapy with TRUS‐CT deformable registration technology: A pilot study with MRI validation

Yang

Rossi

Jani

et al. 2017

Accurate prostate delineation is essential to ensure proper target coverage and normal‐tissue sparing in prostate HDR brachytherapy. We have developed a prostate HDR brachytherapy technology that integrates intraoperative TRUS‐based prostate contour into HDR treatment planning through TRUS‐CT deformable registration (TCDR) to improve prostate contour accuracy. In a perspective study of 16 patients, we investigated the clinical feasibility as well as the performance of this TCDR‐based HDR approach. We compared the performance of the TCDR‐based approach with the conventional CT‐based HDR in terms of prostate contour accuracy using MRI as the gold standard. For all patients, the average Dice prostate volume overlap was 91.1 ± 2.3% between the TCDR‐based and the MRI‐defined prostate volumes. In a subset of eight patients, inter and intro‐observer reliability study was conducted among three experienced physicians (two radiation oncologists and one radiologist) for the TCDR‐based HDR approach. Overall, a 10 to 40% improvement in prostate volume accuracy can be achieved with the TCDR‐based approach as compared with the conventional CT‐based prostate volumes. The TCDR‐based prostate volumes match closely to the MRI‐defined prostate volumes for all 3 observers (mean volume difference: 0.5 ± 7.2%, 1.8 ± 7.2%, and 3.5 ± 5.1%); while CT‐based contours overestimated prostate volumes by 10.9 ± 28.7%, 13.7 ± 20.1%, and 44.7 ± 32.1%. This study has shown that the TCDR‐based HDR brachytherapy is clinically feasible and can significantly improve prostate contour accuracy over the conventional CT‐based prostate contour. We also demonstrated the reliability of the TCDR‐based prostate delineation. This TCDR‐based HDR approach has the potential to enable accurate dose planning and delivery, and potentially enhance prostate HDR treatment outcome.