The Role of Needle Trauma in the Development of Urinary Toxicity Following Prostate High Dose Rate (HDR) Brachytherapy

Boyea, G.; Antonucci, J. Vito; Wallace, Michelle; Ghilezan, Michel; Gustafson, Gary; Chen, P.Y.; Saputo, K.; Flynn, C.; Martínez, Álvaro

doi:10.1016/j.ijrobp.2007.07.1450

Cited by 5 publications

(3 citation statements)

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“…In practice, a compromise has to be found: it is clear that the more needle insertions there are, the better the dose distribution will be. However, the influence of adding one or more needle insertions may lead to additional toxicity: Vargas et al (2005) and Boyea et al (2007) showed the urinary toxicity following HDR brachytherapy is significantly increased by using more than 14 needle insertions. For those reasons, we believe that an automatic determination of the number of needle insertions requires additional work and we decided to perform the simulations for different number of needle insertions.…”

Section: Discussionmentioning

confidence: 99%

A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

et al. 2017

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MR-guided high-dose-rate (HDR) brachytherapy has gained increasing interest as a treatment for patients with localized prostate cancer because of the superior value of MRI for tumor and surrounding tissues localization. To enable needle insertion into the prostate with the patient in the MR bore, a single needle MR-compatible robotic system involving needle-by-needle dose delivery has been developed at our institution. Throughout the intervention, dose delivery may be impaired by: (1) sub-optimal needle positioning caused by e.g. needle bending, (2) intra-operative internal organ motion such as prostate rotations or swelling, or intra-procedural rectum or bladder filling. This may result in failure to reach clinical constraints. To assess the first aforementioned challenge, a recent study from our research group demonstrated that the deposited dose may be greatly improved by real-time adaptive planning with feedback on the actual needle positioning. However, the needle insertion sequence is left to the doctor and therefore, this may result in sub-optimal dose delivery. In this manuscript, a new method is proposed to determine and update automatically the needle insertion sequence. This strategy is based on the determination of the most sensitive needle track. The sensitivity of a needle track is defined as its impact on the dose distribution in case of sub-optimal positioning. A stochastic criterion is thus presented to determine each needle track sensitivity based on needle insertion simulations. To assess the proposed sequencing strategy, HDR prostate brachytherapy was simulated on 11 patients with varying number of needle insertions. Sub-optimal needle positioning was simulated at each insertion (modeled by typical random angulation errors). In 91% of the scenarios, the dose distribution improved when the needle was inserted into the most compared to the least sensitive needle track. The computation time for sequencing was less than 6 s per needle track. The proposed needle insertion sequencing can therefore assist in delivering an optimal dose in HDR prostate brachytherapy.

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Section: Discussionmentioning

confidence: 99%

A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

et al. 2017

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“…In practice, a compromise has to be found: it is clear that the more needle insertions there are, the better the dose distribution will be. However, the influence of adding one or more needle insertions may lead to additional toxicity: Vargas et al (2005) and Boyea et al (2007) showed the urinary toxicity following HDR brachytherapy is significantly increased by using more than 14 needle insertions. For those reasons, we think that an automatic determination of the number of needle insertions requires additional works and we decided to perform the simulations for different numbers of needle insertions (from 4 to 12).…”

Section: Discussionmentioning

confidence: 99%

Adaptive planning strategy for high dose rate prostate brachytherapy—a simulation study on needle positioning errors

et al. 2016

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The development of magnetic resonance (MR) guided high dose rate (HDR) brachytherapy for prostate cancer has gained increasing interest for delivering a high tumor dose safely in a single fraction. To support needle placement in the limited workspace inside the closed-bore MRI, a single-needle MR-compatible robot is currently under development at the University Medical Center Utrecht (UMCU). This robotic device taps the needle in a divergent way from a single rotation point into the prostate. With this setup, it is warranted to deliver the irradiation dose by successive insertions of the needle. Although robot-assisted needle placement is expected to be more accurate than manual template-guided insertion, needle positioning errors may occur and are likely to modify the pre-planned dose distribution.In this paper, we propose a dose plan adaptation strategy for HDR prostate brachytherapy with feedback on the needle position: a dose plan is made at the beginning of the interventional procedure and updated after each needle insertion in order to compensate for possible needle positioning errors. The introduced procedure can be used with the single needle MR-compatible robot developed at the UMCU. The proposed feedback strategy was tested by simulating complete HDR procedures with and without feedback on eight patients with different numbers of needle insertions (varying from 4 to 12). In of the cases tested, the number of clinically acceptable plans obtained at the end of the procedure was larger with feedback compared to the situation without feedback. Furthermore, the computation time of the feedback between each insertion was below 100 s which makes it eligible for intra-operative use.

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“…On one hand, a sufficient number of needle catheters have to be inserted to achieve adequate dose coverage of the tumor while sparing adjacent normal organs. On the other hand, it is highly desired to use as a minimal number of needle catheters as possible to minimize trauma (Eapen et al 2004, Boyea et al 2007. The current clinical practice relies on physician's intuition to select needle catheter positions.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous needle catheter selection and dwell time optimization for preplanning of high-dose-rate brachytherapy of prostate cancer

et al. 2021

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Purpose. Needle catheter positions critically affect the quality of treatment plans in prostate cancer high-dose-rate (HDR) brachytherapy. The current standard needle positioning approach is based on human intuition, which cannot guarantee a high-quality plan. This study proposed a method to simultaneously select needle catheter positions and determine dwell time for preplanning of HDR brachytherapy of prostate cancer. Methods. We formulated the needle catheter selection problem and inverse dwell time optimization problem in a unified framework. In addition to the dose objectives of the planning target volume (PTV) and organs at risk (OARs), the objective function incorporated a group-sparsity term with a needle-specific adaptive weighting scheme to generate high-quality plans with the minimal number of needle catheters. The optimization problem was solved by a fast-iterative shrinkage-thresholding algorithm. For validation purposes, we tested the proposed algorithm on 10 patient cases previously treated at our institution and compared the resulting plans with plans generated using needle catheters selected manually. Results. Compared to the plan with manually selected needle catheters, when normalizing both plans to the same PTV coverage V 100% = 95%, the plans generated by the proposed algorithm reduced median V 125% from 65% to 64%, but increased median V 150% from 35% to 38%, and V 200% from 14% to 16%. All planning objectives were met. All clinically important dosimetric parameters of OARs were reduced. D 1cc of bladder and rectum were reduced from 8.57 Gy to 8.50 Gy and from 7.24 Gy to 6.80 Gy, respectively. D max of urethra was reduced from 15.85 Gy to 15.77 Gy. The median number of selected needle catheters was reduced by two. The computational time for solving the proposed optimization problem was ∼90 s using MATLAB. Conclusion. The proposed algorithm was able to generate plans for prostate cancer HDR brachytherapy preplanning with increased median conformity index (0.73–0.77) and slightly lower median homogeneity index (0.64–0.62) with the number of selected needles reduced by two compared to the manual needle selection approach.

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The Role of Needle Trauma in the Development of Urinary Toxicity Following Prostate High Dose Rate (HDR) Brachytherapy

Cited by 5 publications

References 0 publications

A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

A novel adaptive needle insertion sequencing for robotic, single needle MR-guided high-dose-rate prostate brachytherapy

Adaptive planning strategy for high dose rate prostate brachytherapy—a simulation study on needle positioning errors

Simultaneous needle catheter selection and dwell time optimization for preplanning of high-dose-rate brachytherapy of prostate cancer

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