Investigating the dosimetric and tumor control consequences of prostate seed loss and migration

Knaup, Courtney; Mavroidis, Panayiotis; Esquivel, Carlos O.; Stathakis, Sotirios; Swanson, Gregory P.; Baltas, Dimos; Papanikolaou, Nikos

doi:10.1118/1.4712227

Cited by 10 publications

(8 citation statements)

References 21 publications

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“…IGRT is important for HDR-BT treatment planning to delineate the prostate and organs at risk because delivery of a high radiation dose to an incorrect volume would be associated with incomplete cancer treatment and toxicity, 50 and for LDR-BT because the movement of just a few seeds could significantly alter dosimetric coverage. 51 Indeed, ultrasonographybased planning of HDR-BT enables the procedure to be completed in 1-5 sessions, minimizing catheter displace ment. Thus, the theoretical benefits of HDR-BT boost therapy that make it an advanced radiotherapy modality when compared with LDR-BT boost or EBRT monotherapy include the use of high doses per fraction, which result in higher tumour cell death and lower radiotoxicity, improved radiophysical parameters without the need for the complex IGRT systems needed for EBRT and patient convenience.…”

Section: Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

Evolution of advanced technologies in prostate cancer radiotherapy

et al. 2013

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Conventional treatment options for clinically localized, low-risk prostate cancer include radical prostatectomy, external-beam radiotherapy (EBRT) and low-dose-rate brachytherapy. Advances in image-guided radiotherapy (IGRT) since the 1980s, the development of intensity-modulated radiotherapy (IMRT) during the 1990s and evidence from radiobiological models--which support the use of high doses per fraction--have developed alongside novel advanced radiotherapy modalities that include high-dose-rate brachytherapy (HDR-BT), stereotactic body radiotherapy (SBRT) and proton beam therapy. The relationship between the outcomes of and toxicities experienced by patients with prostate cancer treated with HDR-BT, SBRT and particle-beam therapy should provide urologists and oncologists an understanding of the continually evolving technology in prostate radiotherapy. On the basis of published evidence, conventionally fractionated EBRT with IMRT is considered the standard of care over conventional 3D conformal radiotherapy, whereas HDR-BT boost is an acceptable treatment option for selected patients with intermediate-risk and high-risk prostate cancer. SBRT and proton therapy should not be used for patients (regardless of disease risk group) outside the setting of a clinical trial. Finally, comparative effectiveness research should be conducted to provide a framework for evaluating advanced radiotherapy technologies by comparing the benefits and harms of available therapeutic options to optimize the risk:benefit ratio and improve cost effectiveness.

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Section: Stereotactic Body Radiotherapy (Sbrt)mentioning

confidence: 99%

Evolution of advanced technologies in prostate cancer radiotherapy

et al. 2013

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“…Again in comparison to LDR, anatomic and, thus, dosimetric changes are kept to a minimum, since issues associated with LDR BRT such as migration of seed/source and deformation of tissue do not occur. [41][42][43] On the other hand, intrafractional anatomic alteration caused by organ motion during EBRT delivery, [44][45][46] as well as setup inaccuracies, is overcomed with HDR due to rectification of theses error during the implantation procedure with interactive online dosimetry or modified prior to dose delivery with real-time anatomy-based treatment planning. 25 This minimization of errors allows for a decrease in the therapeutic margins required beyond the intended target, thus exposing less healthy tissue in unnecessary radiation, transforming HDR BRT to the optimal intraprostatic dose-escalation technique, where needed, especially when combined with EBRT.…”

Section: Rationale For Hdr Brachytherapymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

High‐dose‐rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome

et al. 2021

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Background: High-dose-rate brachytherapy (HDR BRT) has been enjoying rapid acceptance as a treatment modality offered to selected prostate cancer patients devoid of risk group, employed either in monotherapy setting or combined with external beam radiation therapy (EBRT) and is currently one of the most active clinical research areas.Recent findings: This review encompasses all the current evidence to support the use of HDR BRT in various clinical scenario and shines light to the HDR BRT rationale, as an ultimately conformal dose delivery method enabling safe dose escalation to the prostate. Conclusion:Valid long-term data, both in regard to the oncologic outcomes and toxicity profile, support the current clinical indication spectrum of HDR BRT. At the same time, this serves as solid, rigid ground for emerging therapeutic applications, allowing the technique to remain in the spotlight alongside stereotactic radiosurgery.

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“…Knaup et al . reported their studies on five patients’ plans, each of them planned with I-125, Pd-103, and Cs-131 loose seeds [ 6 ]. Their simulation was done by removing 1, 2, or 3 seeds closest to urethra or the exterior prostatic capsule.…”

Section: Purposementioning

confidence: 99%

Original paper Evaluation of the dosimetric impact of loss and displacement of seeds in prostate low-dose-rate brachytherapy

Wang¹,

Nasser²,

Borg³

et al. 2015

jcb

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PurposeTo analyze the seed loss and displacement and their dosimetric impact in prostate low-dose-rate (LDR) brachytherapy while utilizing the combination of loose and stranded seeds.Material and methodsTwo hundred and seventeen prostate cancer patients have been treated with LDR brachytherapy. Loose seeds were implanted in the prostate center and stranded seeds in the periphery of the gland. Patients were imaged with transrectal ultrasound before implant and with computerized tomography/magnetic resonance imaging (CT/MR) one month after implant. The seed loss and displacement had been analyzed. Their impact on prostate dosimetry had been examined. The seed distribution beyond the prostate inferior boundary had been studied.ResultsThe mean number of seeds per patient that were lost to lung, pelvis/abdomen, urine, or unknown destinations was 0.21, 0.13, 0.03, and 0.29, respectively. Overall, 40.1% of patients had seed loss. Seed migration to lung and pelvis/abdomen occurred in 15.5% and 10.5% of the patients, respectively. Documented seed loss to urine was found in 3% of the patients while 20% of patients had seed loss to unknown destinations. Prostate length difference between pre-plan and post-implant images was within 6 mm in more than 98% of cases. The difference in number of seeds inferior to prostate between pre-plan and post-implant dosimetry was within 7 seeds for 93% of patients. At time of implant, 98% of seeds, inferior to prostate, were within 5 mm and 100% within 15 mm, and in one month post-implant 83% within 9 mm and 96.3% within 15 mm. Prostate post-implant V100, D90, and rectal wall RV100 for patients without seed loss were 94.6%, 113.9%, and 0.98 cm3, respectively, as compared to 95.0%, 114.8%, and 0.95 cm3 for the group with seed loss.ConclusionsSeed loss and displacement have been observed to be frequent. No correlation between seed loss and displacement and post-plan dosimetry has been reported.

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Investigating the dosimetric and tumor control consequences of prostate seed loss and migration

Cited by 10 publications

References 21 publications

Evolution of advanced technologies in prostate cancer radiotherapy

Evolution of advanced technologies in prostate cancer radiotherapy

High‐dose‐rate brachytherapy for prostate cancer: Rationale, current applications, and clinical outcome

Original paper Evaluation of the dosimetric impact of loss and displacement of seeds in prostate low-dose-rate brachytherapy

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