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1

Influence of Dose on Risk of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy  

SciTech Connect

Purpose: To assess the influence of dose on the risk of acute urinary retention (AUR) after iodine-125 prostate brachytherapy. Methods and Materials: Between January 2005 and December 2008, 714 consecutive patients with localized prostate cancer were treated with iodine-125 prostate brachytherapy at our department. All patients completed four imaging studies: magnetic resonance imaging before and 4 weeks after treatment and intraoperative three-dimensional transrectal ultrasonography before and after implantation. The development of AUR was prospectively recorded. The evaluated treatment and dosimetric parameters included prostate volume, number of needles and seeds used, intra- and postoperative prostate edema, percentage of prostate volume receiving 100%, 150%, and 200% of the prescribed dose to the prostate, minimal dose received by 90% of the prostate volume, and percentage of the urethra receiving 100%, 150%, and 200% of the prescribed dose. Logistic regression analysis was used to examine which factors were associated with AUR. Results: Of the 714 patients, 57 (8.0%) developed AUR. On univariate analysis, the following treatment and dosimetric factors were significantly associated with AUR: International Prostate Symptom Score (odds ratio [OR], 2.07, per 10-point increase), preimplant prostate volume (OR, 1.06), postimplant prostate volume (OR, 1.04), number of needles used (OR, 1.09), and number of seeds used (OR, 1.03). On multivariate analysis, the only independent predictive factors for AUR were pretreatment prostate volume (OR, 1.05) and International Prostate Symptom Score (OR, 1.76, per 10-point increase). Patients with a pretreatment prostate volume >35 cm{sup 3} had a 10.4% risk of developing AUR compared with 5.4% for those with a prostate volume of {<=}35 cm{sup 3}. No association was found between any of the dosimetric parameters and the development of AUR. Conclusion: The radiation dose, within the range studied, did not influence the risk of AUR after iodine-125 prostate brachytherapy. Prostate volume and International Prostate Symptom Score were the most important predictors of AUR.

Roeloffzen, Ellen M.A., E-mail: E.M.A.Roeloffzen@UMCUtrecht.nl [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Battermann, Jan J.; Deursen, Marijke J.H. van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Department of Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Visscher, Mareije I.; Moerland, Marinus A.; Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2011-07-15

2

A Phase III Randomized Trial of the Timing of Meloxicam With Iodine-125 Prostate Brachytherapy  

SciTech Connect

Purpose: Nonsteroidal anti-inflammatory medication is used to reduce prostate edema and urinary symptoms following prostate brachytherapy. We hypothesized that a cyclooxygenase-2 (COX-2) inhibitor regimen started 1 week prior to seed implant might diminish the inflammatory response, thus reducing edema, retention rates, and symptom severity. Methods and Materials: From March 2004 to February 2008, 316 men consented to an institutional review board-approved randomized study of a 4-week course of meloxicam, 7.5 mg orally twice per day, starting either on the day of implant or 1 week prior to implant. Brachytherapy was performed using iodine-125 seeds and was preplanned and performed under transrectal ultrasound (TRUS) and fluoroscopic guidance. Prostate volume obtained by MR imaging at 1 month was compared to baseline prostate volume obtained by TRUS planimetry and expressed as an edema factor. The trial endpoints were prostate edema at 1 month, International Prostate Symptom Score (IPSS) questionnaire results at 1 and 3 months, and any need for catheterization. Results: Results for 300 men were analyzed. Median age was 61 (range, 45-79 years), and median TRUS prostate volume was 35.7 cc (range, 18.1-69.5 cc). Median IPSS at baseline was 5 (range, 0-24) and was 15 at 1 month, 16 at 3 months, and 10 at 6 months. Catheterization was required for 7% of patients (6.2% day 0 arm vs. 7.9% day -7 arm; p = 0.65). The median edema factor at 1 month was 1.02 (range, 0.73-1.7). 1.01 day 0 arm vs. 1.05 day -7 arm. Baseline prostate volume remained the primary predictor of postimplant urinary retention. Conclusions: Starting meloxicam 1 week prior to brachytherapy compared to starting immediately after the procedure did not reduce 1-month edema, improve IPSSs at 1 or 3 months, or reduce the need for catheterization.

Crook, Juanita, E-mail: juanita.crook@rmp.uhn.on.c [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Patil, Nikhilesh [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Wallace, Kris [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Borg, Jette [Department of Radiation Physics, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Zhou, David [Department of Radiation Medicine, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada); Ma, Clement; Pond, Greg [Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, Ontario (Canada)

2010-06-01

3

Prostate-Specific Antigen Bounce After Permanent Iodine-125 Prostate Brachytherapy-An Australian Analysis  

SciTech Connect

Purpose: To report on prostate-specific antigen (PSA) 'bounces' after {sup 125}I prostate brachytherapy to review the relationship to biochemical control and correlate both clinical and dosimetric variables. Methods and Materials: We analyzed 194 hormone-naive patients with a follow-up of {>=}3 years. Four bounce definitions were applied: an increase of {>=}0.2 ng/mL (definition I), {>=}0.4 ng/mL (definition II), {>=}15% (definition III), and {>=}35% (definition IV) of a previous value with spontaneous return to the prebounce level or lower. Results: Using definition I, II, III, and IV, a bounce was detected in 50%, 34%, 11%, and 9% of patients, respectively. The median time to onset was 14-16 months, the duration was 12-21.5 months, and the magnitude of the increase was 0.5-2 ng/mL. A magnitude of >2 ng/mL, fulfilling the criteria for biochemical failure (BF) according to the American Society for Therapeutic Radiology and Oncology Phoenix definition, was detected in 11.3%, 16.9%, 47.6%, and 50% using definitions I, II, III, and IV, respectively; 11 patients (5.7%) had true BF. The PSA bounces occurred earlier than BF (p < 0.001). The prediction of BF remains controversial and is probably unrelated to biochemical control. The only statistically significant factor predictive of a PSA bounce was younger age (definitions I and II). Conclusion: PSA bounces are common after brachytherapy. All definitions resulted in a high number of false-positive calls for BF during the first 2 years. The definition of an increase of {>=}0.2 ng/mL should be preferred because of the lowest number of false-positive results for BF. Patients experiencing a PSA bounce during the first 2 years after brachytherapy should undergo surveillance every 3-6 months. Additional investigations are recommended for elevated postimplant PSA levels that have not corrected by 3 years of follow-up.

Zwahlen, Daniel R.; Smith, Ryan [Department of Radiation Oncology, Alfred Health and Monash University, Melbourne, VIC (Australia); Andrianopoulos, Nick [Department of Epidemiology and Preventive Medicine, Monash University School of Public Health, Melbourne, VIC (Australia); Matheson, Bronwyn [Department of Radiation Oncology, Alfred Health and Monash University, Melbourne, VIC (Australia); Royce, Peter [Department of Urology, Alfred Health and Monash University, Melbourne, VIC (Australia); Millar, Jeremy L., E-mail: jeremy.millar@med.monash.edu.a [Department of Radiation Oncology, Alfred Health and Monash University, Melbourne, VIC (Australia); Department of Epidemiology and Preventive Medicine, Monash University School of Public Health, Melbourne, VIC (Australia)

2011-01-01

4

Iodine-125 prostate seed brachytherapy in renal transplant recipients: an analysis of oncological outcomes and toxicity profile  

PubMed Central

Purpose Prostate cancer is among the most common non-cutaneous neoplasms affecting renal transplant recipients (RTRs). Available treatments including radical prostatectomy and external beam radiotherapy carry a risk of damage to the transplanted kidney, ureters, or bladder. We assessed the safety and efficacy of Iodine-125 (125I) prostate seed brachytherapy as an alternative to surgery and radiotherapy in these individuals. Material and methods We retrospectively reviewed our brachytherapy database to identify patients with a prior history of renal transplantation, who had undergone seed implantation for localized prostate cancer. Long term PSA control and treatment related toxicity, including graft dysfunction, urinary, rectal, and sexual complications, were assessed and compared with published outcomes for surgery and external beam radiotherapy. Results Of 1054 patients treated with permanent seed implantation from 2002-2012, we identified four who had a prior history of renal transplantation. Mean time from renal transplantation to prostate cancer diagnosis was 13 years. Mean follow-up after seed implantation was 44 months (range 12-60 months). All four patients remain free of PSA progression. No peri-operative complications were experienced following seed implantation, and all four patients continued to have normal graft function. Long term urinary and rectal function scores were comparable to reported outcomes for seed brachytherapy in the non-transplant population. Conclusions 125I prostate seed brachytherapy is associated with high rates of biochemical control and minimal toxicity to the renal graft in RTRs. This treatment should be considered as an alternative to surgery in managing RTRs with localized prostate cancer.

Bucci, Joseph; Malouf, David

2014-01-01

5

Prospective multi-center dosimetry study of low-dose Iodine-125 prostate brachytherapy performed after transurethral resection  

PubMed Central

Purpose To evaluate in a multicenter setting the ability of centers to perform pre-implant permanent prostate brachytherapy planning, fulfilling dosimetric goals and constraints based on the Groupe de Curiethérapie-European Society for Radiotherapy and Oncology guidelines in the setting of implantation after prior prostate transurethral resection (TURP). Material and methods A reference transrectal ultrasound image set of the prostate gland from a patient who had undergone TURP was used. Contouring of the prostate, clinical target volume and organs at risk was performed by the coordinating center. Goals and constraints regarding the dosimetry were defined. Results Seventeen of twenty-five centers invited to participate were able to import the Digital Imaging and Communications in Medicine-images into their planning computer and plan the implant using the defined guidelines. All centers were able to plan treatment, and achieve the recommended objectives and constraints. However, sector analysis has shown a risk of under-dosage in the anterior part of the prostate. Conclusions Correct pre-implantation planning with adherence to protocol guidelines and in compliance with defined dosimetric constraints seems feasible in a post-TURP setting, at least on a theoretical basis. A prospective study evaluating the outcome of prostate brachytherapy performed after TURP can therefore be undertaken with an expectation of a correct dosimetry in the multicenter setting.

Salembier, Carl; Rijnders, Alex; Henry, Ann; Niehoff, Peter; Andre Siebert, Frank; Hoskin, Peter

2013-01-01

6

The Impact of Acute Urinary Retention After Iodine-125 Prostate Brachytherapy on Health-Related Quality of Life  

SciTech Connect

Purpose: To evaluate the impact of acute urinary retention (AUR) in patients treated with {sup 125}I prostate brachytherapy on short- and long-term health-related quality of life (HRQOL); and to assess whether pretreatment HRQOL has additional value in the prediction of AUR. Methods and Materials: For 127 patients treated with {sup 125}I brachytherapy for localized prostate cancer between December 2000 and June 2003, toxicity and HRQOL data were prospectively collected. Patients received a HRQOL questionnaire at five time points: before and 1 month, 6 months, 1 year, and 6 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer core questionnaire (EORTC QLQ-C30), the tumor-specific EORTC prostate cancer module (EORTC QLQ-PR25), and the American Urological Association (AUA) symptom index. Results: Of 127 patients, 13 (10.2%) developed AUR. Patients with AUR had a significantly worse urinary QOL at all time points compared with patients without AUR. The mean difference over time (6 years) between both groups for the EORTC QLQ-PR25 urinary symptom score was 13.0 points (p < 0.001) and for the AUA urinary symptom score was 15.7 points (p = 0.001). Global QOL scores (EORTC QLQ-C30) over time for patients who developed AUR were significantly worse compared with patients without AUR (mean difference 6.7 points; p = 0.043). In multivariate logistic regression analysis, pretreatment International Prostate Symptom Score (p = 0.004) and neoadjuvant hormonal treatment (p = 0.034) were predictors of AUR. Quality of life did not have added predictive value. Conclusion: Acute urinary retention after prostate brachytherapy has a significant negative impact on patient's HRQOL up to 6 years after treatment, in terms of both global QOL measures and urinary symptom scores. Furthermore, our results suggest limited value of pretreatment HRQOL measures for the prediction of AUR.

Roeloffzen, Ellen M.A., E-mail: E.M.A.Roeloffzen@UMCUtrecht.n [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Hinnen, Karel A.; Battermann, Jan J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Roermund, Joep G.H. van [Department of Urology, University Medical Center Utrecht, Utrecht (Netherlands); Gellekom, Marion van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Frank, Steven J. [Department of Radiation Oncology, M. D. Anderson Medical Center, Houston, TX (United States); Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2010-08-01

7

Pulmonary embolization of iodine-125 seeds following prostate implantation  

Microsoft Academic Search

The optimal treatment of prostatic carcinoma limited to the gland remains controversial. Treatment has included implantation of Iodine-125 seeds via both a suprapubic approach and, more recently, a transperineal technique utilizing ultrasound guidance. We recently have noted a heretofore unreported complication with this latter technique, namely, embolization of seeds to the lungs. Review of the chest x-ray films of 31

A. D. Steinfeld; B. R. Donahue; L. Plaine

1991-01-01

8

[Pulmonary embolization of permanently implanted radioactive iodine-125 seeds for carcinoma of the prostate].  

PubMed

One year has passed since we started brachytherapy with radioactive iodine-125 seeds for carcinoma of the prostate. During the follow-up of patients, we have relatively frequently found migrated seeds in the lungs. Migrated seeds are reported to reach mainly the pulmonary artery and cause embolization without clinical symptoms. We counted the embolized seeds and determined the proportion of migrating seeds on chest X-ray exam. We found 47 cases of pulmonary embolization in our initial 100 cases. Less than half of the embolization were found in the chest X-ray exam performed on the next day after the implantation. We found more migrated seeds in the lower lung fields than in the upper and middle lung fields. Pulmonary embolization of implanted iodine-125 seeds is not unusual, and cases of prostate brachytherapy are likely to increase in Japan. We will have increased opportunities to observe chest X-ray films with migrated seeds in the future. PMID:15920972

Fukada, Junichi; Yorozu, Atsunori; Toya, Kazuhito; Ohashi, Toshio; Sugawara, Akitomo; Dokiya, Takushi

2005-04-01

9

Technical and dosimetric aspects of iodine-125 seed reimplantation in suboptimal prostate implants  

PubMed Central

Objective: Brachytherapy employing iodine-125 seeds is an established treatment for low-risk prostate cancers. Post-implant dosimetry (PID) is an important tool for identifying suboptimal implants. The aim of this work was to improve suboptimal implants by a subsequent iodine-125 seed top-up (reimplantation), based on the PID results. Methods: Of 255 patients treated between 2009 and 2012, 6 were identified as having received suboptimal implants and were scheduled for seed top-up. Needle configurations and the number of top-up seeds were determined based on post-implant CT images as well as a reimplantation treatment plan. An average of 14 seeds per patient were implanted during each top-up. Dosimetric outcome was assessed via target parameters and doses received by organs at risk. Results: All six patients had a successful top-up, with a 67% increase in the mean dose delivered to 90% of the prostate volume and a 40% increase in the volume that receives 100% of the prescribed dose. However, the final dosimetric assessment was based on the same seed activity, as the planning system does not account for the decay of the initially implanted seeds. Although physical dosimetry is not influenced by different seed activities (doses are calculated to infinity), the radiobiological implications might be slightly different from the situation when optimal implantation is achieved with one treatment only. Conclusion: Seed reimplantation in suboptimal prostate implants is feasible and leads to successful clinical outcomes. Advances in knowledge: Suboptimal prostate implants can occur for various reasons. This work shows that seed reimplantation as salvage therapy can lead to an optimal dosimetric outcome with manageable normal tissue effects.

Lawson, J M

2013-01-01

10

Permanent Iodine-125 Interstitial Planar Seed Brachytherapy for Close or Positive Margins for Thoracic Malignancies  

SciTech Connect

Purpose: To assess toxicity and outcome following permanent iodine-125 seed implant as an adjunct to surgical resection in cases of advanced thoracic malignancy. Methods and Materials: An institutional review board-approved retrospective review was performed. Fifty-nine patients were identified as having undergone thoracic brachytherapy seed implantation between September 1999 and December 2006. Data for patient demographics, tumor details, and morbidity and mortality were recorded. Results: Fifty-nine patients received 64 implants. At a median follow-up of 17 months, 1-year and 2-year Kaplan-Meier rates of estimated overall survival were 94.1% and 82.0%, respectively. The 1-year and 2-year local control rates were 80.1% and 67.4%, respectively. The median time to develop local recurrence was 11 months. Grades 3 and 4 toxicity rates were 12% at 1 year. Conclusions: This review shows relatively low toxicity for interstitial planar seed implantation after thoracic surgical resection. The high local control results suggest that an incomplete oncologic surgery plus a brachytherapy implant for treating advanced thoracic malignancy merit further investigation.

Mutyala, Subhakar, E-mail: smutyala@montefiore.or [Department of Radiation Oncology, Montefiore Medical Center and Albert Einstein College of Medicine in Bronx, New York, New York (United States); Stewart, Alexandra [St. Luke's Cancer Centre, Royal Surrey County Hospital, Guildford (United Kingdom); Khan, Atif J. [Department of Radiation Oncology, Cancer Institute of New Jersey, New Jersey (United States); Cormack, Robert A.; O'Farrell, Desmond [Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (United States); Sugarbaker, David [Department of Thoracic Surgery, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (United States); Devlin, Phillip M. [Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (United States)

2010-03-15

11

Adjuvant Iodine-125 Brachytherapy for Hepatocellular Carcinoma after Complete Hepatectomy: A Randomized Controlled Trial  

PubMed Central

Background Tumor recurrence is a major problem after curative resection of hepatocellular carcinoma (HCC). The current study evaluated the effects of adjuvant iodine-125 (125I) brachytherapy on postoperative recurrence of HCC. Methodology/Principal Findings From July 2000 to June 2004, 68 HCC patients undergoing curative hepatectomy were randomly assigned into a 125I adjuvant brachytherapy group (n?=?34) and a group of best care (n?=?34). Patients in the 125I adjuvant brachytherapy group received 125I seed implantation on the raw surface of resection. Patients in the best care control group received identical treatments except for the 125I seed implantation. Time to recurrence (TTR) and 1-, 3- and 5-year overall survival (OS) were compared between the two groups. The follow-up ended in January 2010, and lasted for 7.7–106.4 months with a median of 47.6 months. TTR was significantly longer in the 125I group (mean of 60.0 months vs. 36.7 months in the control). The 1-, 3- and 5-year recurrence-free rates of the 125I group were 94.12%, 76.42%, and 73.65% vs. 88.24%, 50.00%, and 29.41% compared with the control group, respectively. The 1-, 3- and 5-year OS rates of the 125I group were 94.12%, 73.53%, and 55.88% vs. 88.24%, 52.94%, and 29.41% compared with the control group, respectively. The 125I brachytherapy decreased the risk of recurrence (HR?=?0.310) and the risk of death (HR?=?0.364). Most frequent adverse events in the 125I group included nausea, vomiting, arrhythmia, decreased white blood cell and/or platelet counts, and were generally mild and manageable. Conclusions/Significance Adjuvant 125I brachytherapy significantly prolonged TTR and increased the OS rate after curative resection of HCC. Trial Registration Australian New Zealand Clinical Trials Registry ACTRN12610000081011.

Wang, Hanning; Xiao, Fanglian; Xiang, Guoan; Shen, Feng

2013-01-01

12

Combination of cryosurgery and Iodine-125 seeds brachytherapy for lung cancer  

PubMed Central

It has been proven that radioactive seeds such as Iodine-125 seeds implantation is a highly effective treatment for patients with localized cancer, such as lung cancer. It may increase the effectiveness of cryosurgery for lung cancer with the combination of Iodine-125 seed implantation into edge of the cryoablation zone. Percutaneous cryosurgery and Iodine-125 seed implantation are mutual complementation; both have been proved to be safe and effective modality for unresectable lung cancer, especially for centrally located lung cancer. Well-designed, randomized and control study both in the laboratory and in the clinical about this option are needed before the conclusive evidence submits.

Zhou, Liang; Xu, Kecheng; Mu, Feng

2012-01-01

13

Cryosurgery in combination with brachytherapy of iodine-125 seeds for pancreatic cancer  

PubMed Central

A major limit of cryoablation is incomplete destruction of cells in the border zone of the cryogenic lesion in which the tissue temperature is warmer than –20 °C. The use of iodine-125 seed implantation is likely to be complementary to cryosurgery for treatment of pancreatic cancer. The procedure of cryosurgery and iodine-125 seed implantation is performed with percutaneous approaches under guidance of ultrasound and/or CT. The number of iodine-125 seeds implanted for every patient was 34 in median. Forty-nine patients with locally advanced pancreatic cancer received cryosurgery with combination of iodine-125 seed implantation. During a median follow-up of 18 months, the median of over all survival was 16.2 months. The 6-, 12-, 24- and 36-month overall survival rates were 94.9%, 63.1%, 22.8% and 9.5%, respectively. Compared with patients with cryosurgery alone, combination treatment shows higher the 6- and 12-month survival rates and longer the median survival.

Xu, Kecheng; Mu, Feng; Hu, Yize

2013-01-01

14

Ferromagnetic hyperthermia and iodine 125 brachytherapy in the treatment of choroidal melanoma in a rabbit model  

SciTech Connect

Hyperthermia has been combined with conventional radiation methods to achieve enhanced tumor destruction. We combined iodine 125 seeds with ferromagnetic thermoseeds in a single plaque to simultaneously deliver radiation and heat in a rabbit model of choroidal melanoma. Initially, six ferromagnetic thermoseeds were placed in parallel on a 14-mm episcleral plaque. The plaques were placed on normal rabbit eyes and on eyes containing transvitreally implanted choroidal melanoma. The heating response was assessed in both normal and tumor-containing eyes. Rigid copper-constantan and flexible Baily thermocouples were used to monitor temperature responses. The animals were subjected to an electromagnetic field of 100 kHz, with power of 1100 to 1500 W. The thermoseeds autoregulated at 48.2 degrees C. Scleral temperatures stabilized at 45.8 degrees C +/- 0.4 degrees C (SD), while temperatures at the base of the tumor stabilized at 43.6 degrees C +/- 0.1 degrees C. Ferromagnetic thermoseeds were then combined with iodine 125 seeds. Similar temperature responses were recorded, and autoradiographic findings confirmed a uniform radiation distribution. Varying the amount or type of ferromagnetic material in the thermoseeds allows the delivery of heat at virtually any temperature. Ferromagnetic hyperthermia may provide a more simplified approach over currently available methods of heat delivery.

Mieler, W.F.; Jaffe, G.J.; Steeves, R.A. (Medical College of Wisconsin, Milwaukee (USA))

1989-10-01

15

The effects of intraocular silicone oil placement prior to iodine 125 brachytherapy for uveal melanoma: a clinical case series  

PubMed Central

Purpose To investigate the role of silicone oil as an adjunct to iodine 125 (125I) brachytherapy in attenuating radiation dose and reducing radiation retinopathy. Methods A 16-mm COMS plaque loaded with 125I seeds was simulated in vitro on an eye model containing silicone oil as a vitreous substitute using BrachyDose. The radiation dose ratio of silicone oil vs water to ocular structures was calculated at angles subtended from the centre of the eye. Silicone oil was then used in three choroidal melanoma patients who underwent 23-gauge vitrectomy, silicone oil placement, and 125I brachytherapy. Results Silicone oil reduced the ocular radiation dose in vitro to 65%. Radiation dose ratios on the retina increased from 0.45 to 0.99 when moving from points diametrically opposed to the plaque's central axis. In 10–24 months' follow-up, no patients have developed radiation retinopathy. Each patient required silicone oil removal and experienced cataract progression, and one also developed a retinal detachment. Conclusions This study confirms that silicone oil attenuates radiation dose in vitro, and may protect against radiation retinopathy clinically in patients, however it requires extensive surgical interventions. Further studies in only very selected populations using silicone oil as an adjunct to 125I brachytherapy will best elucidate its role in shielding radiation retinopathy.

Ahuja, Y; Kapoor, K G; Thomson, R M; Furutani, K M; Shultz, R W; Stafford, S L; Dev, S; Abu-Yaghi, N E; Reynolds, D; Pulido, J S

2012-01-01

16

Dose to fingertips of staff preparing stranded iodine-125 seeds for permanent prostate implants.  

PubMed

The aim of this study is to measure radiation dose to the fingertips of occupationally exposed workers handling stranded iodine-125 seeds during prostate implants. The doses were measured by thermoluminescence dosimetry at the nail of the index finger of both hands in three hospitals in the Netherlands. In all hospitals, measurements were carried out during the preparation of stranded IBt seeds, type Intersource(®) 1251L. The fingertip doses per procedure (mean ± SD) to the fingertip for workers from the three hospitals were estimated to be 0.29 ± 0.15 mSv (n = 6), <0.03 ± <0.02 mSv (n = 8) and 0.31 ± 0.16 mSv (n=16), respectively. The lower doses found for the hospital 2 workers are presumably related to the heavier shielding and longer utensils used in that hospital. Even in the case of hundreds of implant procedures per year, dose to the fingertips for occupationally exposed workers preparing stranded seeds is expected to be well below the annual limit for extremities of 500 mSv. PMID:21112885

van Haaren, P M A; van't Riet, A; Moerland, M A; Koedooder, C; Westendorp, H

2011-04-01

17

Ocular Response of Choroidal Melanoma With Monosomy 3 Versus Disomy 3 After Iodine-125 Brachytherapy  

SciTech Connect

Purpose: To report the ocular response of choroidal melanoma with monosomy 3 vs. disomy 3 after {sup 125}I brachytherapy. Methods and Materials: We evaluated patients with ciliochoroidal melanoma managed with fine needle aspiration biopsy immediately before plaque application for {sup 125}I brachytherapy between January 1, 2005 and December 31, 2008. Patients with (1) cytopathologic diagnosis of melanoma, (2) melanoma chromosome 3 status identified by fluorescence in situ hybridization, and (3) 6 or more months of follow-up after brachytherapy were sorted by monosomy 3 vs. disomy 3 and compared by Kruskal-Wallis test. Results: Among 40 ciliochoroidal melanomas (40 patients), 15 had monosomy 3 and 25 had disomy 3. Monosomy 3 melanomas had a median greatest basal diameter of 12.00 mm and a median tumor thickness of 6.69 mm before brachytherapy; at a median of 1.75 years after brachytherapy, median thickness was 3.10 mm. Median percentage decrease in tumor thickness was 48.3%. Disomy 3 melanomas had a median greatest basal diameter of 10.00 mm and median tumor thickness of 3.19 mm before brachytherapy; at a median of 2.00 years after brachytherapy, median tumor thickness was 2.37 mm. The median percentage decrease in tumor thickness was 22.7%. Monosomy 3 melanomas were statistically greater in size than disomy 3 melanomas (p < 0.001) and showed a greater decrease in tumor thickness after brachytherapy (p = 0.006). Conclusion: In this study, ciliochoroidal melanomas with monosomy 3 were significantly greater in size than disomy 3 melanoma and showed a significantly greater decrease in thickness at a median of 1.75 years after brachytherapy. The greater decrease in monosomy 3 melanoma thickness after brachytherapy is consistent with other malignancies in which more aggressive pathology has been shown to be associated with a greater initial response to radiotherapy.

Marathe, Omkar S. [David Geffen School of Medicine, University of Los Angeles, Los Angeles, CA (United States); Wu, Jeffrey; Lee, Steve P. [Department of Radiation Oncology, University of Los Angeles, Los Angeles, CA (United States); Yu Fei; Burgess, Barry L. [Department of Ophthalmology, The Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); Leu Min [Department of Radiation Oncology, University of Los Angeles, Los Angeles, CA (United States); Straatsma, Bradley R. [Department of Ophthalmology, The Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); McCannel, Tara A., E-mail: TMcCannel@jsei.ucla.edu [Department of Ophthalmology, Jules Stein Eye Institute, University of Los Angeles, Los Angeles, CA (United States); Jonsson Comprehensive Cancer Center, University of Los Angeles, Los Angeles, CA (United States)

2011-11-15

18

Dosimetric and Late Radiation Toxicity Comparison Between Iodine-125 Brachytherapy and Stereotactic Radiation Therapy for Juxtapapillary Choroidal Melanoma  

SciTech Connect

Purpose: To compare the dose distributions and late radiation toxicities for {sup 125}I brachytherapy (IBT) and stereotactic radiation therapy (SRT) in the treatment of juxtapapillary choroidal melanoma. Methods: Ninety-four consecutive patients with juxtapapillary melanoma were reviewed: 30 have been treated with IBT and 64 with SRT. Iodine-125 brachytherapy cases were modeled with plaque simulator software for dosimetric analysis. The SRT dosimetric data were obtained from the Radionics XKnife RT3 software. Mean doses at predetermined intraocular points were calculated. Kaplan-Meier estimates determined the actuarial rates of late toxicities, and the log–rank test compared the estimates. Results: The median follow-up was 46 months in both cohorts. The 2 cohorts were balanced with respect to pretreatment clinical and tumor characteristics. Comparisons of radiation toxicity rates between the IBT and SRT cohorts yielded actuarial rates at 50 months for cataracts of 62% and 75% (P=.1), for neovascular glaucoma 8% and 47% (P=.002), for radiation retinopathy 59% and 89% (P=.0001), and for radiation papillopathy 39% and 74% (P=.003), respectively. Dosimetric comparisons between the IBT and SRT cohorts yielded mean doses of 12.8 and 14.1 Gy (P=.56) for the lens center, 17.6 and 19.7 Gy (P=.44) for the lens posterior pole, 13.9 and 10.8 Gy (P=.30) for the ciliary body, 61.9 and 69.7 Gy (P=.03) for optic disc center, and 48.9 and 60.1 Gy (P<.0001) for retina at 5-mm distance from tumor margin, respectively. Conclusions: Late radiation-induced toxicities were greater with SRT, which is secondary to the high-dose exposure inherent to the technique as compared with IBT. When technically feasible, IBT is preferred to treat juxtapapillary choroidal melanoma.

Krema, Hatem, E-mail: htmkrm19@yahoo.com [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Heydarian, Mostafa [Department of Radiation Medicine, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Radiation Medicine, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Beiki-Ardakani, Akbar [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Weisbrod, Daniel [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Ocular Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Xu, Wei [Department of Biostatistics, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Biostatistics, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada); Laperriere, Normand J.; Sahgal, Arjun [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)] [Department of Radiation Oncology, Princess Margaret Hospital/University Health Network, University of Toronto, Toronto, Ontario (Canada)

2013-07-01

19

Prostate brachytherapy - discharge  

MedlinePLUS

Implant therapy - prostate cancer - discharge; Radioactive seed placement - discharge ... You had a procedure called brachytherapy to treat prostate cancer. Your treatment lasted 30 minutes or more, ...

20

In Vivo Dosimetry With a Linear MOSFET Array to Evaluate the Urethra Dose During Permanent Implant Brachytherapy Using Iodine-125  

SciTech Connect

Purpose: To develop a technique to monitor the dose rate in the urethra during permanent implant brachytherapy using a linear MOSFET array, with sufficient accuracy and without significantly extending the implantation time. Methods and Materials: Phantom measurements were performed to determine the optimal conditions for clinical measurements. In vivo measurements were performed in 5 patients during the {sup 125}I brachytherapy implant procedure. To evaluate if the urethra dose obtained in the operating room with the ultrasound transducer in the rectum and the patient in treatment position is a reference for the total accumulated dose; additional measurements were performed after the implantation procedure, in the recovery room. Results: In vivo measurements during and after the implantation procedure agree very well, illustrating that the ultrasound transducer in the rectum and patient positioning do not influence the measured dose in the urethra. In vivo dose values obtained during the implantation are therefore representative for the total accumulated dose in the urethra. In 5 patients, the dose rates during and after the implantation were below the maximum dose rate of the urethra, using the planned seed distribution. Conclusion: In vivo dosimetry during the implantation, using a MOSFET array, is a feasible technique to evaluate the dose in the urethra during the implantation of {sup 125}I seeds for prostate brachytherapy.

Bloemen-van Gurp, Esther J., E-mail: esther.bloemen@maastro.n [Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht (Netherlands); Haanstra, Bjoerk K.C.; Murrer, Lars H.P.; Gils, Francis C.J.M. van; Dekker, Andre L.A.J.; Mijnheer, Ben J.; Lambin, Philippe [Department of Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht (Netherlands)

2009-11-15

21

Prostate brachytherapy  

MedlinePLUS

Implant therapy - prostate cancer; Radioactive seed placement; Internal radiation therapy - prostate ... place the seeds that deliver radiation into your prostate. The seeds are placed with needles or special ...

22

In Vivo Dosimetry With a Linear MOSFET Array to Evaluate the Urethra Dose During Permanent Implant Brachytherapy Using Iodine125  

Microsoft Academic Search

Purpose: To develop a technique to monitor the dose rate in the urethra during permanent implant brachytherapy using a linear MOSFET array, with sufficient accuracy and without significantly extending the implantation time. Methods and Materials: Phantom measurements were performed to determine the optimal conditions for clinical measurements. In vivo measurements were performed in 5 patients during the ¹²I brachytherapy implant

Esther J. Bloemen-van Gurp; Bjoerk K. C. Haanstra; Lars H. P. Murrer; Francis C. J. M. van Gils; Andre L. A. J. Dekker; Ben J. Mijnheer; Philippe Lambin

2009-01-01

23

Long-Term Results of Brachytherapy With Temporary Iodine-125 Seeds in Children With Low-Grade Gliomas  

SciTech Connect

Purpose: To retrospectively review the results of temporary I-125 brachytherapy in 94 children and adolescents with low-grade glioma. Methods and Materials: Treatment was performed in progressive tumors roughly spherical in shape with a diameter of up to 5 cm, including 79 astrocytomas, 5 oligodendrogliomas, 4 oligoastrocytomas, 1 ependymoma, and 5 other tumors. Location was suprasellar/chiasmal in 44, thalamic/basal ganglia in 18, hemispheric in 15, midbrain/pineal region in 13, and lower brainstem in 3. Initially, 8% of patients were free of symptoms, 47% were symptomatic but not disabled, and 30% were slightly, 6% moderately, and 3% severely disabled. Results: 5- and 10-year survival was 97% and 92%. The response to I-125 brachytherapy over the long term was estimated after a median observation period of 38.4 (range, 6.4-171.0) months. At that time, 4 patients were in complete, 27 in partial, and 18 in objective remission; 15 showed stable and 30 progressive tumors. Treatment results did not correlate with age, sex, histology, tumor size, location, or demarcation of the tumor. Secondary treatment became necessary in 36 patients, including 19 who underwent repeated I-125 brachytherapy. At final follow-up, the number of symptom-free patients had risen to 21%. Thirty-eight percent showed symptoms without functional impairment, 19% were slightly and 11% moderately disabled, and only 4% were severely disabled. Conclusions: Response rates similar to those of conventional radiotherapy or chemotherapy can be anticipated with I-125 brachytherapy in tumors of the appropriate size and shape. We believe it to be a useful contribution to the treatment of low-grade gliomas in children.

Korinthenberg, Rudolf, E-mail: rudolf.korinthenberg@uniklinik-freiburg.d [Division of Neuropaediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital, Albert-Ludwigs University, Freiburg im Breisgau (Germany); Neuburger, Daniela [Division of Neuropaediatrics and Muscular Disorders, Department of Paediatrics and Adolescent Medicine, University Hospital, Albert-Ludwigs University, Freiburg im Breisgau (Germany); Trippel, Michael; Ostertag, Christoph; Nikkhah, Guido [Department of Stereotactic Neurosurgery, Neurocentre, University Hospital, Albert-Ludwigs University, Freiburg im Breisgau (Germany)

2011-03-15

24

Diffusion pattern of low dose rate brachytherapy for prostate cancer in Japan.  

PubMed

Permanent implant brachytherapy for prostate cancer using iodine-125 seeds was adopted in Japan in 2003. Here, we report on the diffusion pattern of this treatment in Japan since 2003. We examined the annual numbers of prostate cancer patients per hospital in Japan, who were treated with iodine-125 seed implant brachytherapy with or without external beam radiation therapy between 2003 and 2011. The hospitals were excluded from the count if brachytherapy was begun in a hospital within the given year, and thus was only available for part of the year. In 2004, 269 patients were treated by brachytherapy at only two hospitals. However, the numbers increased rapidly. A total of 1412 patients were treated at 23 hospitals in 2005, 2783 patients were treated at 83 hospitals in 2008, and 3793 patients were treated at 109 hospitals in 2011. The mean/median numbers of patients treated per hospital were 61.4/42 in 2005, 33.5/25 in 2008, and 35.0/24 in 2011. The number of hospitals where 24 or fewer patients were treated in a year increased. On the other hand, the number of hospitals with a volume of >48 patients per year was stable. Because a relationship between provider volume and outcomes following oncological procedures was shown, a careful evaluation of the effectiveness of permanent implant brachytherapy for prostate cancer is needed. PMID:23560460

Nakamura, Katsumasa; Ohga, Saiji; Yorozu, Atsunori; Dokiya, Takushi; Saito, Shiro; Yamanaka, Hidetoshi

2013-07-01

25

Dosimetry of a thyroid uptake detected in seed migration survey following a patient's iodine-125 prostate implant and in vitro measurements of intentional seed leakages.  

PubMed

As a quality control procedure, a post-implant seed migration survey has been accomplished on 340 prostate cancer patients since November 2001. Pulmonary seed embolization and intracardiac seed embolization have been detected. A case of thyroid uptake due to leaking iodine-125 (I-125) sources was also seized. In order to determine the dose to the thyroid, a dosimetry method was developed to link in vivo measurements and the cumulated dose to the thyroid. The calculated source leakage half-life in the case was approximately 15 days based on the measurements and the estimated cumulated dose to thyroid was 204 cGy. It is concluded that one seed was leaking. In order to verify the in vivo measurements, intentional in vitro seed leakage tests were performed. A seed was cut open and placed in a sealed glass container filled with a given volume of saline. The I-125 concentration in the saline was subsequently measured over a period of six months. Consistent in vivo and in vitro results were obtained. Recent incidents of seed leaks reported from other centers have drawn practitioners' attention to this problem. In order to make the measurements more useful, the seed leakage tests were expanded to include I-125 seeds from six other vendors. The results show that the leakage half-lives of those seeds varied from nine days to a half-year. Two seed models demonstrated least leakage. Since the measurements lasted for six months, the escape of iodine resulted from oxidation of iodide in the saline was a concern for the measurement accuracy. As a reference, another set of leakage tests were performed by adding sodium thiosulfate salt (Na2S2O3 x 5 H2O) to the saline. Sodium thiosulfate is a reducing agent that prevents the conversion of iodide to iodate so as to minimize I-125 evaporation. As a result, significantly shortened leakage half-lives were observed in this group. Seed agitation was also performed and no significant deviations of the leakage rates were observed. Considering the body fluid is more complex than saline, the in vivo leakage half-life, in case a source leak is encountered, may vary significantly from what is presented in this paper due to chemical reactions. In vivo measurements thus may produce a more accurate estimation of leakage half-life and thyroid uptake dose. PMID:16898440

Chen, Qin-Sheng; Russell, John L; Macklis, Roger R; Weinhous, Martin S; Blair, Henry F

2006-07-01

26

Prostate cancer brachytherapy: guidelines overview  

PubMed Central

Prostate cancer, due to wide availability of PSA tests, is very often diagnosed in early stage, nowadays. This makes management of this disease even harder in every day oncology care. There is a wide range of treatment options including surgery, radiotherapy and active surveillance, but essential question is which treatment patient and oncologist should decide for. Due to recent publication of Prostate Cancer Results Study Group, in which brachytherapy is one of supreme curative options for prostate cancer, we decided to overview most present european and north american recommendations. National Comprehensive Cancer Network, American Society for Radiation Oncology, American Brachytherapy Society, European Association of Urology and Groupe Européen de Curiethérapie of European Society for Therapeutic Radiation Oncology guidelines are overviewed, particularly focusing on HDR and LDR brachytherapy.

Bialas, Brygida

2012-01-01

27

Mature Follow-Up for High-Risk Stage I Non-Small-Cell Lung Carcinoma Treated With Sublobar Resection and Intraoperative Iodine-125 Brachytherapy  

SciTech Connect

Purpose: To update the Allegheny General Hospital experience of high-risk Stage I non-small-cell lung cancer patients treated with sublobar resection and intraoperative {sup 125}I Vicryl mesh brachytherapy. Methods and Materials: Between January 5, 1996 and February 19, 2008, 145 patients with Stage I non-small-cell lung cancer who were not lobectomy candidates because of cardiopulmonary compromise underwent sublobar resection and placement of {sup 125}I seeds along the resection line. The {sup 125}I seeds embedded in Vicryl suture were attached with surgical clips to a sheet of Vicryl mesh, inserted over the target area, and prescribed to a 0.5-cm planar margin. Results: The mean target area, total activity, number of seeds implanted, and prescribed total dose was 33.3 cm{sup 2} (range, 18.0-100.8), 20.2 mCi (range, 11.1-29.7), 46 (range, 30-100), and 117 Gy (range, 80-180), respectively. The median length of the surgical stay was 6 days (range, 1-111), with a perioperative mortality rate of 3.4%. At a median follow-up of 38.3 months (range, 1-133), 6 patients had developed local recurrence (4.1%), 9 had developed regional failure (6.2%), and 25 had distant failure (17.2%). On multivariate analysis, no patient- or tumor-specific factors or surgical or dosimetric factors were predictive of local recurrence. The overall median survival was 30.5 months with a 3- and 5-year overall survival rate of 65% and 35%, respectively. Conclusion: {sup 125}I brachytherapy for high-risk, Stage I non-small-cell lung cancer after sublobar resection is well tolerated and associated with a low local failure rate.

Colonias, Athanasios, E-mail: acolonia@wpahs.or [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States); Betler, James [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Trombetta, Mark [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States); Bigdeli, Ghazaleh [Division of Pulmonary Medicine, Allegheny General Hospital, Pittsburgh, PA (United States); Gayou, Olivier [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States); Keenan, Robert [Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States); Department of Thoracic Surgery, Allegheny General Hospital, Pittsburgh, PA (United States); Werts, E. Day; Parda, David S. [Department of Radiation Oncology, Allegheny General Hospital, Pittsburgh, PA (United States); Drexel University College of Medicine, Allegheny Campus, Pittsburgh, PA (United States)

2011-01-01

28

[Permanent implant prostate cancer brachytherapy: 2013 state-of-the art].  

PubMed

With an experience of more than 25 years for the pioneers (and more than 14 years in France), permanent implant brachytherapy using iodine 125 seeds (essentially) is now recognized as a valuable alternative therapy for localized low-risk prostate cancer patients. The possible extension of the indications of exclusive brachytherapy towards selected patients in the intermediate-risk group has now been confirmed by several studies. Moreover, for the other patients in the intermediate-risk group and for the patients in the high-risk group, brachytherapy, as an addition to external radiotherapy, could represent one of the best ways to escalate the dose. Different permanent implant brachytherapy techniques have been proposed; preplanning or real-time procedure, loose or stranded seeds (or both), manual or automatic injection of the seeds. The main point here is the ability to perfectly master the procedure and to comply with the dosimetric constraints, which have been recently redefined by the international societies, such as the GEC-ESTRO group. Mid- and long-term results, which are now available in the literature, indicate relapse-free survival rates of about 90% at 5-10 years, the best results being obtained with satisfactory dosimetric data. Comparative data have shown that the incontinence and impotence rates after brachytherapy seemed to be significantly inferior to what is currently observed after surgery. However, a risk of about 3 to 5% of urinary retention is usually reported after brachytherapy, as well as an irritative urinary syndrome, which may significantly alter the quality of life of the patients, and last several months. In spite of those drawbacks, with excellent long-term results, low rates of incontinence and impotence, and emerging new indications (focal brachytherapy, salvage brachytherapy after localized failure of an external irradiation), permanent implant prostate brachytherapy can be expected to be proposed to an increasing number of patients in the next future. PMID:23478488

Cosset, J-M; Hannoun-Lévi, J-M; Peiffert, D; Delannes, M; Pommier, P; Pierrat, N; Nickers, P; Thomas, L; Chauveinc, L

2013-04-01

29

Autoradiography for iodine-125 seeds  

SciTech Connect

To study the interior design of model 6702 and 6711 iodine-125 seeds, contact autoradiographs were performed using mammography film. Improved resolution was obtained using a pin-hole camera with a hole of 0.1 mm [times] 0.1 mm. With these techniques, qualitative determination of the relative activity distribution within each seed was possible. The number of the activated resin spheres and the positions of the centers of these spheres can be exactly determined. A model calculation shows that variations in the arrangement of the activated spheres within a seed have a moderate influence on the dose distribution at source distances below 10 mm. Knowing the exact source configuration may be useful when comparing dose calculations with measured data for model 6702 [sup 125]I seeds which are currently employed in ophthalmic plaque and implant therapy of other tumors. 16 refs., 5 figs., 2 tabs.

Alberti, W.; Divoux, S. (Alfried Krupp Krankenhaus, Essen (Germany)); Pothmann, B.; Tabor, P. (Universitaetsklinikum, Essen (Germany)); Hermann, K.P.; Harder, D. (Universitaet Goettingen (Germany))

1993-04-02

30

Experimental Research on a Novel Iodine-125 Seed Strand Connected Using Magnesium Alloy AZ31.  

PubMed

Background and Purpose: Aim of this research is to study the in vivo degradation and biocompatibility in rabb its and the dose distribution of novel iodine-125 seed strands connected using magnesium alloy AZ31. Method: Thirtythree New Zealand rabbits were divided into three Groups (A, B, and C). All rabbits in Groups A and C were implanted with VX2 tumors. For Group A, radioactive iodine-125 seed strands were implanted into the VX2 tumors. For Group B, non-radioactive iodine-125 seed strands were implanted into thigh muscle. Rabbits in Group C were used as controls. Displacement of the seed strands was assessed using X-ray and CT. Blood and urine samples were collected from all groups to measure changes in magnesium ion concentrations. The changing effect of alloy AZ31 tube according to dose distribution of iodine-125 was evaluated using the Monte Carlo method. Results: In Groups A and B, 14 days after implantation, majority of the magnesium alloy tubes were fragmented, and 28 days after implantation, the magnesium alloy tubes were completely degraded. Small differences in dose distribution were observed between bare iodine-125 seeds and iodine-125 seed strands. Conclusions: Our results suggest that these novel iodine-125 seed strands connected using magnesium alloy AZ31 are promising anti-cancer drug for brachytherapy due to the rapid degradation of connective materials and even distribution of seed doses in tumors. Some recent patents are also outlined in this article. PMID:24483348

Li, Chuanxing; Zhang, Yanling; Chen, Dong; Duan, Guangfeng; Liu, Zhenyin; Zhang, Liang; Yang, Guang; Zhang, Tao; Lu, Ming-Jian; Singh, Sristi; Zhang, Weidong; Zhang, Fujun

2014-05-01

31

Pretreatment Nomogram to Predict the Risk of Acute Urinary Retention After I-125 Prostate Brachytherapy  

SciTech Connect

Purpose: Acute urinary retention (AUR) after iodine-125 (I-125) prostate brachytherapy negatively influences long-term quality of life and therefore should be prevented. We aimed to develop a nomogram to preoperatively predict the risk of AUR. Methods: Using the preoperative data of 714 consecutive patients who underwent I-125 prostate brachytherapy between 2005 and 2008 at our department, we modeled the probability of AUR. Multivariate logistic regression analysis was used to assess the predictive ability of a set of pretreatment predictors and the additional value of a new risk factor (the extent of prostate protrusion into the bladder). The performance of the final model was assessed with calibration and discrimination measures. Results: Of the 714 patients, 57 patients (8.0%) developed AUR after implantation. Multivariate analysis showed that the combination of prostate volume, IPSS score, neoadjuvant hormonal treatment and the extent of prostate protrusion contribute to the prediction of AUR. The discriminative value (receiver operator characteristic area, ROC) of the basic model (including prostate volume, International Prostate Symptom Score, and neoadjuvant hormonal treatment) to predict the development of AUR was 0.70. The addition of prostate protrusion significantly increased the discriminative power of the model (ROC 0.82). Calibration of this final model was good. The nomogram showed that among patients with a low sum score (<18 points), the risk of AUR was only 0%-5%. However, in patients with a high sum score (>35 points), the risk of AUR was more than 20%. Conclusion: This nomogram is a useful tool for physicians to predict the risk of AUR after I-125 prostate brachytherapy. The nomogram can aid in individualized treatment decision-making and patient counseling.

Roeloffzen, Ellen M., E-mail: e.m.a.roeloffzen@umcutrecht.nl [Department of Radiation Oncology, University Medical Center Utrecht (Netherlands); Vulpen, Marco van; Battermann, Jan J. [Department of Radiation Oncology, University Medical Center Utrecht (Netherlands); Roermund, Joep G. van [Department of Urology, University Medical Center Utrecht (Netherlands); Saibishkumar, Elantholi P. [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (Netherlands)

2011-11-01

32

Intra-Operative Dosimetry in Prostate Brachytherapy.  

National Technical Information Service (NTIS)

Favorable outcome in prostate brachytherapy critically depends on the accurate placement of radioactive sources in their planned locations. Unfortunately, there is variety of mechanical factors that cause the seeds to divert from their planned locations. ...

A. Jain

2006-01-01

33

Palladium103 brachytherapy for prostate carcinoma  

Microsoft Academic Search

Purpose: A report of biochemical outcomes for patients treated with palladium-103 (Pd-103) brachytherapy over a fixed time interval.Methods and Materials: Two hundred thirty patients with clinical stage T1–T2 prostate cancer were treated with Pd-103 brachytherapy and followed with prostate-specific antigen (PSA) determinations. Kaplan-Meier estimates of biochemical failure on the basis of two consecutive elevations of PSA were utilized. Multivariate risk

John C Blasko; Peter D Grimm; John E Sylvester; Kas Ray Badiozamani; David Hoak; William Cavanagh

2000-01-01

34

Preoperative treatment planning with intraoperative optimization can achieve consistent high-quality implants in prostate brachytherapy  

PubMed Central

Advances in brachytherapy treatment planning systems have allowed the opportunity for brachytherapy to be planned intraoperatively as well as preoperatively. The relative advantages and disadvantages of each approach have been the subject of extensive debate, and some contend that the intraoperative approach is vital to the delivery of optimal therapy. The purpose of this study was to determine whether high-quality permanent prostate implants can be consistently achieved using a preoperative planning approach that allows for, but does not necessitate, intraoperative optimization. To achieve this purpose, we reviewed the records of 100 men with intermediate-risk prostate cancer who had been prospectively treated with brachytherapy monotherapy between 2006 and 2009 at our institution. All patients were treated with iodine-125 stranded seeds; the planned target dose was 145 Gy. Only 8 patients required adjustments to the plan on the basis of intraoperative findings. Consistency and quality were assessed by calculating the correlation coefficient between the planned and implanted amounts of radioactivity and by examining the mean values of the dosimetric parameters obtained on preoperative and 30 days postoperative treatment planning. The amount of radioactivity implanted was essentially identical to that planned (mean planned radioactivity, 41.27 U vs. mean delivered radioactivity, 41.36 U; R2 = 0.99). The mean planned and day 30 prostate V100 values were 99.9% and 98.6%, respectively. The mean planned and day 30 prostate D90 values were 186.3 Gy and 185.1 Gy, respectively. Consistent, high-quality prostate brachytherapy treatment plans can be achieved using a preoperative planning approach, mostly without the need for intraoperative optimization. Good quality assurance measures during simulation, treatment planning, implantation, and postimplant evaluation are paramount for achieving a high level of quality and consistency.

Kudchadker, Rajat J.; Pugh, Thomas J.; Swanson, David A.; Bruno, Teresa L.; Bolukbasi, Yasemin; Frank, Steven J.

2014-01-01

35

Current Status of Brachytherapy for Prostate Cancer  

PubMed Central

Brachytherapy was developed to treat prostate cancer 50 years ago. Current advanced techniques using transrectal ultrasonography were established 25 years ago. Transrectal ultrasound (TRUS) has enabled the prostate to be viewed with improved resolution with the use of modern ultrasound machines. Moreover, the development of software that can provide images captured in real time has improved treatment outcomes. Other new radiologic imaging technologies or a combination of magnetic resonance and TRUS could be applied to brachytherapy in the future. The therapeutic value of brachytherapy for early-stage prostate cancer is comparable to that of radical prostatectomy in long-term follow-up. Nevertheless, widespread application of brachytherapy cannot be achieved for several reasons. The treatment outcome of brachytherapy varies according to the skill of the operator and differences in patient selection. Currently, only three radioactive isotopes are available for use in low dose rate prostate brachytherapy: I-125, Pd-103, and Cs-131; therefore, more isotopes should be developed. High dose rate brachytherapy using Ir-192 combined with external beam radiation, which is needed to verify the long-term effects, has been widely applied in high-risk patient groups. Recently, tumor-selective therapy or focal therapy using brachytherapy, which is not possible by surgical extraction, has been developed to maintain the quality of life in selected cases. However, this new application for prostate cancer treatment should be performed cautiously because we do not know the oncological outcome, and it would be an interim treatment method. This technique might evolve into a hybrid of whole-gland treatment and focal therapy.

2012-01-01

36

Brachytherapy for Prostate Cancer: A Systematic Review  

PubMed Central

Low-dose rate brachytherapy has become a mainstream treatment option for men diagnosed with prostate cancer because of excellent long-term treatment outcomes in low-, intermediate-, and high-risk patients. To a great extend due to patient lead advocacy for minimally invasive treatment options, high-quality prostate implants have become widely available in the US, Europe, and Japan. High-dose-rate (HDR) afterloading brachytherapy in the management of localised prostate cancer has practical, physical, and biological advantages over low-dose-rate seed brachytherapy. There are no free live sources used, no risk of source loss, and since the implant is a temporary procedure following discharge no issues with regard to radioprotection use of existing facilities exist. Patients with localized prostate cancer may benefit from high-dose-rate brachytherapy, which may be used alone in certain circumstances or in combination with external-beam radiotherapy in other settings. The purpose of this paper is to present the essentials of brachytherapies techniques along with the most important studies that support their effectiveness in the treatment of prostate cancer.

Koukourakis, Georgios; Kelekis, Nikolaos; Armonis, Vassilios; Kouloulias, Vassilios

2009-01-01

37

The phylogeny of permanent prostate brachytherapy  

PubMed Central

Permanent prostate brachytherapy has been practiced for more than a century. This review examines the influence of earlier procedures on the modern transperineal ultrasound-directed technique. A literature review was conducted to examine the origin of current clinical practice. The dimensions of the modern brachytherapy seed, the prescription dose, and implant/teletherapy sequencing are vestigial features, which may be suboptimal in the current era of low-energy photon-emitting radionuclides and computerized dose calculations. Although the modern transperineal permanent prostate implant procedure has proven to be safe and effective, it should undergo continuous re-evaluation and evolution to ensure that its potential is maximized.

Aronowitz, Jesse N.

2013-01-01

38

Photoacoustic imaging of prostate brachytherapy seeds in ex vivo prostate  

NASA Astrophysics Data System (ADS)

The localization of brachytherapy seeds in relation to the prostate is a key step in intraoperative treatment planning (ITP) for improving outcomes in prostate cancer patients treated with low dose rate prostate brachytherapy. Transrectal ultrasound (TRUS) has traditionally been the modality of choice to guide the prostate brachytherapy procedure due to its relatively low cost and apparent ease of use. However, TRUS is unable to visualize seeds well, precluding ITP and producing suboptimal results. While other modalities such as X-ray and magnetic resonance imaging have been investigated to localize seeds in relation to the prostate, photoacoustic imaging has become an emerging and promising modality to solve this challenge. Moreover, photoacoustic imaging may be more practical in the clinical setting compared to other methods since it adds little additional equipment to the ultrasound system already adopted in procedure today, reducing cost and simplifying engineering steps. In this paper, we demonstrate the latest efforts of localizing prostate brachytherapy seeds using photoacoustic imaging, including visualization of multiple seeds in actual prostate tissue. Although there are still several challenges to be met before photoacoustic imaging can be used in the operating room, we are pleased to present the current progress in this effort.

Kuo, Nathanael; Kang, Hyun Jae; Dejournett, Travis; Spicer, James; Boctor, Emad

2011-03-01

39

Rectal dosimetric analysis following prostate brachytherapy  

Microsoft Academic Search

Purpose: To retrospectively assess the rectal tolerance dose in transperineal ultrasound-guided prostate brachytherapy using easily measured point doses.Methods and Materials: Forty-five consecutive patients who underwent prostate seed implantation from January 1996 to October 1996, using either 125I or 103Pd as monotherapy or as a boost following 45 Gy of external beam radiotherapy (XRT), were evaluated. For monotherapy using 125I, the

Gregory S Merrick; Wayne M Butler; Anthony T Dorsey; Jonathan H Lief; Holly L Walbert; Heather J Blatt

1999-01-01

40

Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry  

SciTech Connect

Purpose: To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images. Methods and Materials: For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1 year, and 2 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer (EORTC) core questionnaire, the tumor-specific EORTC prostate cancer module, and the American Urological Association symptom index. Postimplant dosimetry was based on registered T1 spin echo transversal, T2 turbo spin echo transversal, and T2 turbo spin echo sagittal MR images and CT images taken 4 weeks after implantation of the iodine-125 seeds. Calculated parameters were prostate volume, prostate volume receiving 100% (V{sub 100}) and 150% (V{sub 150}) dose, dose to 90% of the prostate volume (D{sub 90}), maximum dose in 1-, 2-, and 5-cm{sup 3} rectum volume, distance between prostate and anterior rectum wall, and the maximum dose in 1%, 2%, and 5% urethra volume. Analysis of variance for repeated measures was used for comparison of the means of all variables in the different questionnaires. Linear regression analysis (stepwise) was used to investigate the correlations between QoL parameters and dosimetry parameters. Results: On average, only the QoL at 4 weeks after implant was significantly different from (worse than) the QoL at the other time points. Regression analysis showed a significant correlation between changes in bowel problems and the maximum dose in 2-cm{sup 3} rectum volume, between changes in urinary symptoms and prostate volume, and between changes in urinary problems and the D{sub 90} value of the prostate. Conclusions: The QoL for patients with permanent prostate implants was worse in the first months after treatment but returned to baseline values 1 year after implant. Significant correlations were found between dose distribution and QoL.

Gellekom, Marion van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)]. E-mail: marionvangellekom@yahoo.com; Moerland, Marinus A. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Vulpen, Marco van [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Wijrdeman, Harm K. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands); Battermann, Jan J. [Department of Radiotherapy, University Medical Center Utrecht, Utrecht (Netherlands)

2005-11-01

41

American brachytherapy society (ABS) recommendations for transperineal permanent brachytherapy of prostate cancer  

Microsoft Academic Search

Purpose\\/Objective: To develop and disseminate the American Brachytherapy Society (ABS) recommendations for the clinical quality assurance and guidelines of permanent transperineal prostate brachytherapy with 125I or 103Pd.Methods and Materials: The ABS formed a committee of experts in prostate brachytherapy to develop consensus guidelines through a critical analysis of published data supplemented by their clinical experience. The recommendations of the panels

Subir Nag; David Beyer; Jay Friedland; Peter Grimm; Ravinder Nath

1999-01-01

42

Automated intraoperative calibration for prostate cancer brachytherapy  

SciTech Connect

Purpose: Prostate cancer brachytherapy relies on an accurate spatial registration between the implant needles and the TRUS image, called ''calibration''. The authors propose a new device and a fast, automatic method to calibrate the brachytherapy system in the operating room, with instant error feedback. Methods: A device was CAD-designed and precision-engineered, which mechanically couples a calibration phantom with an exact replica of the standard brachytherapy template. From real-time TRUS images acquired from the calibration device and processed by the calibration system, the coordinate transformation between the brachytherapy template and the TRUS images was computed automatically. The system instantly generated a report of the target reconstruction accuracy based on the current calibration outcome. Results: Four types of validation tests were conducted. First, 50 independent, real-time calibration trials yielded an average of 0.57 {+-} 0.13 mm line reconstruction error (LRE) relative to ground truth. Second, the averaged LRE was 0.37 {+-} 0.25 mm relative to ground truth in tests with six different commercial TRUS scanners operating at similar imaging settings. Furthermore, testing with five different commercial stepper systems yielded an average of 0.29 {+-} 0.16 mm LRE relative to ground truth. Finally, the system achieved an average of 0.56 {+-} 0.27 mm target registration error (TRE) relative to ground truth in needle insertion tests through the template in a water tank. Conclusions: The proposed automatic, intraoperative calibration system for prostate cancer brachytherapy has achieved high accuracy, precision, and robustness.

Kuiran Chen, Thomas; Heffter, Tamas; Lasso, Andras; Pinter, Csaba; Abolmaesumi, Purang; Burdette, E. Clif; Fichtinger, Gabor [Queen's University, Kingston, Ontario K7L 3N6 (Canada); University of British Columbia, Vancouver, British Columbia V6T 1Z4 (Canada); Acoustic MedSystems, Inc., Champaign, Illinois 61820-3979 (United States); Queen's University, Kingston, Ontario K7L 3N6 (Canada) and Johns Hopkins University, Baltimore, Maryland 21218-2682 (United States)

2011-11-15

43

[Prostate brachytherapy: current states and future prospects].  

PubMed

The paper presents the characteristics, the place and the limits of brachytherapy in prostate radiotherapy. While sparing the rectal wall, erectile function as well as urinary continence, I(125) and Pd(103) permanent implants represent interesting approaches for good prognosis tumours in comparison to surgery or conformal external beam radiotherapy with similar cure rates. Overcoming easily the problems of organ motion and patient positioning while allowing doses per fraction as high as 10 Gy, brachytherapy is an excellent boosting method in the treatment of intermediate or unfavourable prognosis tumours of which alpha/beta is 1,5 Gy. Encouraging biological control rates of 80-90% have been published in phase II trials. Compared to external beam radiotherapy, the heterogeneity of irradiation inside the clinical target volume should increase the probability of cure as for a specific dose, a significant part will be overdosed. So far, 120-130% of the prescribed doses are delivered to the peripheral zone at the origin of 70% of tumours. On the opposite, this heterogeneity is inducing an overdosage of the urethral bed at the price of higher toxicity levels in situations of previous obstructive syndrome and urethral stenosis. A better integration of the therapeutic modalities available, brachytherapy included, should increase our curative possibilities in the radiation treatment of prostatic cancer. PMID:12914859

Nickers, P; Deneufbourg, J M

2003-08-01

44

Measurement of prostate rotation during insertion of needles for brachytherapy  

Microsoft Academic Search

Background and purposeThe purpose of this study is to investigate whether prostate rotation due to needle insertion for prostate brachytherapy is predictable and if so, to quantify this rotation, and to see whether locking needles reduce the magnitude of prostate rotation.

Vera Lagerburg; Marinus A. Moerland; Jan J. W. Lagendijk; Jan J. Battermann

2005-01-01

45

A Dynamic Dosimetry System for Prostate Brachytherapy  

PubMed Central

The lack of dynamic dosimetry tools for permanent prostate brachytherapy causes otherwise avoidable problems in prostate cancer patient care. The goal of this work is to satisfy this need in a readily adoptable manner. Using the ubiquitous ultrasound scanner and mobile non-isocentric C-arm, we show that dynamic dosimetry is now possible with only the addition of an arbitrarily configured marker-based fiducial. Not only is the system easily configured from accessible hardware, but it is also simple and convenient, requiring little training from technicians. Furthermore, the proposed system is built upon robust algorithms of seed segmentation, fiducial detection, seed reconstruction, and image registration. All individual steps of the pipeline have been thoroughly tested, and the system as a whole has been validated on a study of 25 patients. The system has shown excellent results of accurately computing dose, and does so with minimal manual intervention, therefore showing promise for widespread adoption of dynamic dosimetry.

Kuo, Nathanael; Dehghan, Ehsan; Deguet, Anton; Song, Danny Y.; Prince, Jerry L.; Lee, Junghoon

2013-01-01

46

Prostate brachytherapy seed migration to the left testicular vein  

Microsoft Academic Search

PurposeProstate brachytherapy seeds may detach from their initial insertion sites and migrate to lungs, heart, coronary artery, liver, kidney, and vertebral venous plexus. The authors present the left testicular vein as additional site of seed embolization.

Ba D. Nguyen; Genevieve L. Egnatios

2010-01-01

47

Cancer control after low-dose-rate prostate brachytherapy performed by a multidisciplinary team with no previous prostate brachytherapy experience  

Microsoft Academic Search

ObjectivesTo describe the biochemical disease-free survival observed in the first cohort men treated by a multidisciplinary team of clinicians with no previous experience in low-dose-rate prostate brachytherapy (LDRPB).

Kevin P. McMullen; Allan F. deGuzman; David L. McCullough; W. Robert Lee

2004-01-01

48

Sexual Function and the Use of Medical Devices or Drugs to Optimize Potency After Prostate Brachytherapy  

SciTech Connect

Purpose: Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. Methods and Materials: Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. Results: At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. Conclusions: Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.

Whaley, J. Taylor; Levy, Lawrence B. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Swanson, David A. [Department of Urology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Pugh, Thomas J. [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Kudchadker, Rajat J.; Bruno, Teresa L. [Department of Radiation Physics, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Frank, Steven J., E-mail: sjfrank@mdnaderson.org [Department of Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, TX (United States)

2012-04-01

49

Permanent interstitial brachytherapy for prostate cancer: a current review  

Microsoft Academic Search

Prostate brachytherapy with permanent radioactive implants is becoming an increasingly popular treatment choice for patients with prostate cancer. This therapy is attractive to patients due to the fact that it is an outpatient procedure and in many cases has been associated with lower long-term risks of urinary incontinence and erectile dysfunction when compared to other curative modalities. This review will

Jeffrey Woolsey; Nicole Miller; Dan Theodorescu

2003-01-01

50

10-year biochemical (prostate-specific antigen) control of prostate cancer with 125I brachytherapy  

Microsoft Academic Search

Purpose: To report 10-year biochemical (prostate-specific antigen [PSA]) outcomes for patients treated with 125I brachytherapy as monotherapy for early-stage prostate cancer.Methods and Materials: One hundred and twenty-five consecutively treated patients, with clinical Stage T1-T2b prostate cancer were treated with 125I brachytherapy as monotherapy, and followed with PSA determinations. Kaplan-Meier estimates of PSA progression-free survival (PFS), on the basis of a

PETER D. GRIMM; JOHN C. BLASKO; JOHN E. SYLVESTER; ROBERT M. MEIER; William Cavanagh

2001-01-01

51

Low-dose rate brachytherapy for patients with low- or intermediate-risk prostate cancer: A systematic review  

PubMed Central

Introduction: We review the current evidence for the role of low-dose rate brachytherapy (PB) in patients with low- or intermediate-risk prostate cancer using a systematic review of the literature. Methods: We searched MEDLINE and EMBASE (from January 1996 to October 2011), the Cochrane Library, relevant guideline web-sites, and websites for meetings specific for genitourinary diseases. Results: Ten systematic reviews and 55 single-study papers met the pre-planned study selection criteria. In the end, 36 articles were abstracted and analyzed for this systematic review. There is no evidence for a difference in efficacy between PB and external beam radiation therapy (EBRT), or between PB and radical prostatectomy (RP). During the 6 months to 3 years after treatment, PB was associated with less urinary incontinence and sexual impotency than RP, and RP was associated with less urinary irritation and rectal morbidity than PB. However, these differences diminished over time. PB conferred less risk of impotency and rectal morbidity in the three years after treatment than EBRT. Iodine-125 and alladium-103 did not differ with respect to biochemical relapse-free survival and patient-reported outcomes. Conclusions: PB alone is a treatment option with equal efficacy to EBRT or RP alone in patients with newly diagnosed low- or intermediate-risk prostate cancer who require or choose active treatment.

Rodrigues, George; Yao, Xiaomei; Loblaw, D. Andrew; Brundage, Michael; Chin, Joseph L.

2013-01-01

52

MRI\\/TRUS data fusion for prostate brachytherapy. Preliminary results  

Microsoft Academic Search

Prostate brachytherapy involves implanting radioactive seeds (I 125 for instance! permanently in the gland for the treatment of localized prostate cancers, e.g., cT1c-T2a N0 M0 with good prognostic factors. Treatment planning and seed implanting are most often based on the intensive use of transrectal ultrasound ~TRUS! imaging. This is not easy because prostate visualization is difficult in this imaging modality

Christophe Reynier; Jocelyne Troccaz; Philippe Fourneret; Andrée Dusserre; Cécile Gay-Jeune; Jean-Luc Descotes; Michel Bolla; Jean-Yves Giraud

2008-01-01

53

Photoacoustic imaging of prostate brachytherapy seeds with transurethral light delivery  

NASA Astrophysics Data System (ADS)

We present a novel approach to photoacoustic imaging of prostate brachytherapy seeds utilizing an existing urinary catheter for transurethral light delivery. Two canine prostates were surgically implanted with brachyther- apy seeds under transrectal ultrasound guidance. One prostate was excised shortly after euthanasia and fixed in gelatin. The second prostate was imaged in the native tissue environment shortly after euthanasia. A urinary catheter was inserted in the urethra of each prostate. A 1-mm core diameter optical fiber coupled to a 1064 nm Nd:YAG laser was inserted into the urinary catheter. Light from the fiber was either directed mostly parallel to the fiber axis (i.e. end-fire fire) or mostly 90° to the fiber axis (i.e. side-fire fiber). An Ultrasonix SonixTouch scanner, transrectal ultrasound probe with curvilinear (BPC8-4) and linear (BPL9-5) arrays, and DAQ unit were utilized for synchronized laser light emission and photoacoustic signal acquisition. The implanted brachytherapy seeds were visualized at radial distances of 6-16 mm from the catheter. Multiple brachytherapy seeds were si- multaneously visualized with each array of the transrectal probe using both delay-and-sum (DAS) and short-lag spatial coherence (SLSC) beamforming. This work is the first to demonstrate the feasibility of photoacoustic imaging of prostate brachytherapy seeds using a transurethral light delivery method.

Lediju Bell, Muyinatu A.; Guo, Xiaoyu; Song, Danny Y.; Boctor, Emad M.

2014-03-01

54

3D TRUS Image Segmentation in Prostate Brachytherapy.  

PubMed

Brachytherapy is a minimally invasive interventional surgery used to treat prostate cancer. It is composed of three steps: dose pre-planning, implantation of radioactive seeds, and dose post-planning. In these procedures, it is crucial to determine the positions of needles and seeds, measure the volume of the prostate gland. Three-dimensional transrectal ultrasound (TRUS) imaging has been demonstrated to be a useful technique to perform such tasks. Compared to CT, MRI or X-ray imaging, US image suffers from low contrast, image speckle and shadows, making it challenging for segmentation of needles, the prostates and seeds in the 3D TRUS images. In this paper, we reviewed 3D TRUS image segmentation methods used in prostate brachytherapy including the segmentations of the needles, the prostate, as well as the seeds. Furthermore, some experimental results with agar phantom, turkey and chicken phantom, as well as the patient data are reported. PMID:17281931

Ding, Mingyue; Gardi, Lori; Wei, Zhouping; Fenster, Aaron

2005-01-01

55

Brachytherapy versus prostatectomy in localized prostate cancer: Results of a French multicenter prospective medico-economic study  

SciTech Connect

Purpose: To prospectively compare health-related quality of life (HRQOL), patient-reported treatment-related symptoms, and costs of iodine-125 permanent implant interstitial brachytherapy (IB) with those of radical prostatectomy (RP) during the first 2 years after these treatments for localized prostate cancer. Methods and Materials: A total of 435 men with localized low-risk prostate cancer, from 11 French hospitals, treated with IB (308) or RP (127), were offered to complete the European Organization for Research and Treatment of Cancer core Quality of Life Questionnaire QLQ-C30 version 3 (EORTC QLQ-C30) and the prostate cancer specific EORTC QLQ-PR25 module before and at the end of treatment, 2, 6, 12, 18, and 24 months after treatment. Repeated measures analysis of variance and analysis of covariance were conducted on HRQOL changes. Comparative cost analysis covered initial treatment, hospital follow-up, outpatient and production loss costs. Results: Just after treatment, the decrease of global HRQOL was less pronounced in the IB than in the RP group, with a 13.5 points difference (p < 0.0001). A difference slightly in favor of RP was observed 6 months after treatment (-7.5 points, p = 0.0164) and was maintained at 24 months (-8.2 points, p = 0.0379). Impotence and urinary incontinence were more pronounced after RP, whereas urinary frequency, urgency, and urination pain were more frequent after IB. Mean societal costs did not differ between IB ( Euro 8,019 at T24) and RP ( Euro 8,715 at T24, p = 0.0843) regardless of the period. Conclusions: This study suggests a similar cost profile in France for IB and RP but with different HRQOL and side effect profiles. Those findings may be used to tailor localized prostate cancer treatments to suit individual patients' needs.

Buron, Catherine [Department of Medical Information, Institut Curie, Paris (France); Le Vu, Beatrice [Department of Medical Information, Institut Curie, Paris (France); Cosset, Jean-Marc [Department of Oncology/Radiotherapy, Institut Curie, Paris (France); Pommier, Pascal [Department of Radiotherapy, Centre Leon Berard, Lyon (France); Peiffert, Didier [Department of Radiotherapy, Centre Alexis Vautrin, Nancy (France); Delannes, Martine [Department of Radiotherapy, Centre Claudius Regaud, Toulouse (France); Flam, Thierry [Department of Urology, Hopital Cochin, Paris (France); Guerif, Stephane [Department of Radiotherapy, Centre Hospitalier Universitaire, Poitiers (France); Salem, Naji [Department of Radiotherapy, Institut Paoli-Calmettes, Marseille (France); Chauveinc, Laurent [Department of Radiotherapy, Clinique Hartmann, Neuilly sur Seine (France); Livartowski, Alain [Department of Medical Information, Institut Curie, Paris (France)]. E-mail: alain.livartowski@curie.net

2007-03-01

56

Treatment technique evolution and dosimetry trends over seven years of low dose rate prostate brachytherapy at an Australian institution.  

PubMed

Low dose rate prostate brachytherapy treatments began at the Royal Adelaide Hospital (RAH), Australia, in September 2004. This paper will focus on the evolution of treatment technique since then showing how procedural improvements have enabled timely diagnosis of under-dose and scheduling of top-up treatments for sub-optimum implants, and how significant time savings have been achieved for staff and patients. In addition, implant dosimetry trends over this period have been investigated and results are presented. Iodine-125 seeds (Oncura model 6711) have been used since LDR prostate treatments began, with an aim to deliver a prostate dose of 145 Gy. Three key changes in implant technique took place during the period Sept 2004 to Sept 2011. The live implant dosimetry trends of the prostate D90, urethra V150, and rectum D0.1cc and D2.0cc, were assessed to see if the change in technique had an impact on the treatment planning and seed deployment. The switch from manual loading of seeds to pre-loaded needles and the change from a two-step pre-planning procedure to live planning have realized the greatest time savings with approximately 1.0 FTE physicist day saved per 2 patient implant day and 2 patient visits saved per treatment. Dosimetric parameters also improved with mean implant D90s rising from 166 Gy to 180 Gy. The average Urethra D10 also increased over the study group, rising from 186 Gy to 199 Gy while the rectum dose remained unchanged. Both rectum and urethra dose remained below GEC-ESTRO guidelines despite the observed rise in urethral dose. PMID:22975428

Rutten, Thomas P; Lawson, John M; Marcu, Loredana G

2013-11-01

57

High dose rate prostate brachytherapy: the California Endocurietherapy (CET) Method  

Microsoft Academic Search

Background and purpose: To describe the rationale, protocol and procedure for the treatment of prostate cancer using high dose rate brachytherapy (HDR-BT) and a non-fixed template technique.Materials and methods: Between July 1991 and December 1998, 491 patients with carcinoma of the prostate were treated using HDR-BT and a non-fixed template technique. AJC stages T1C–T3B, patients with prior transurethral resections of

D. Jeffrey Demanes; Rodney R Rodriguez; Gillian A Altieri

2000-01-01

58

Modern Brachytherapy for Localized Prostate Cancers: The Northwest Hospital (Seattle) Experience  

PubMed Central

Modern ultrasound-guided prostate brachytherapy is rapidly changing the way localized prostate cancer is managed. With routine use of prostate-specific antigen screening, prostate cancer is being diagnosed in younger men, who are understandably concerned about the morbidity of radical treatments that may significantly decrease their quality of life. Numerous studies of prostate brachytherapy have shown the excellent disease control rates achieved while maintaining low levels of urinary and erectile difficulties. This report examines a modern implant method of brachytherapy; describes patient selection for brachytherapy, alone and in combination with external beam therapy; and presents results from a series of men followed for 12 years.

Korb, Leroy J; Brawer, Michael K

2001-01-01

59

Cardiac and hepatic seed implant embolization after prostate brachytherapy  

Microsoft Academic Search

Prostate brachytherapy seed implants occasionally embolize to lungs because of their small size. They may lodge in the right cardiac cavities before reaching the pulmonary arteries and lungs. A rare instance of seed migration to the coronary artery through an existing right-to-left cardiac shunt or patent foramen ovale has also been reported. I present a case of seed implant relocation

Ba D. Nguyen

2006-01-01

60

Racial and socioeconomic disparities in the selection of prostate brachytherapy  

PubMed Central

Purpose To utilize the surveillance, epidemiology, and end results database to analyze whether there are racial or socioeconomic disparities associated with the selection of prostate brachytherapy. Material and methods We selected patients who were diagnosed with localized prostate cancer between 2004-2006 and who underwent treatment with radiation. Data regarding race and estimates of socioeconomic status were also obtained by analyzing the average reported cost of living adjusted income in the SEER county from which the patient was treated, and dividing these results into quartiles. Multivariate logistic regression analysis was used to determine whether there were any disparities associated with brachytherapy use. Results A total of 38 704 patients were included in the analysis. Most patients (57%) received EBRT alone, while the remaining 43% of patients had brachytherapy as a component of their treatment, either alone (30.2%) or in combination with EBRT (12.2%). On multivariate logistic regression, prostate brachytherapy use was less likely in African American patients with an odds ratio of 0.89 (95% CI: 0.84-0.95, p < 0.001), and was more likely to be used in those with higher socioeconomic status. Regarding socioeconomic status, the odds ratio for receiving brachytherapy was 1.65 (95% CI: 1.55-1.75) for the 25-50% quartile, 1.92 (95% CI: 1.81-2.04) for the 50-75% quartile, and 2.05 (95% CI: 1.93-2.18) for the 75-100% quartile, respectively (p < 0.001). Conclusions There do appear to be socioeconomic and racial disparities in the selection of prostate brachytherapy. These findings may have both significant equality of care as well as cost of care implications.

Chen, Shan-Chin; Rineer, Justin; Weiss, Jeffrey; Rotman, Marvin; Schwartz, David

2013-01-01

61

Use of TRUS to predict pubic arch interference of prostate brachytherapy  

Microsoft Academic Search

Purpose: To demonstrate the potential for transrectal ultrasound (TRUS) to predict pubic arch interference of transperineal needle placement for prostate brachytherapy.Methods and Materials: TRUS and pelvic computerized tomography (CT) scans from 22 patients who had transperineal prostate brachytherapy at University of Washington were analyzed for pubic arch visualization and interference. The outer margins of the prostate and the inner margins

Kent Wallner; William Ellis; Kenneth Russell; William Cavanagh; John Blasko

1999-01-01

62

Reality-based Needle Insertion Simulation for Haptic Feedback in Prostate Brachytherapy  

Microsoft Academic Search

There is a strong need to improve the tools clinicians use for training in procedures such as prostate brachytherapy where the success rate is directly related to the clinician's level of experience. Accurate haptic feedback is needed for developing improved surgical simulators and trainers for such procedures. In prostate brachytherapy, accurate needle placement of radioactive seeds in the prostate is

James T. Hing; Ari D. Brooks; Jaydev P. Desai

2006-01-01

63

Is there a role for postimplant dosimetry after real-time dynamic permanent prostate brachytherapy?  

Microsoft Academic Search

Purpose: To evaluate the correlation of real-time dynamic prostate brachytherapy (RTDPB) dosimetry and traditional postimplant dosimetry for permanent prostate brachytherapy. Methods and Materials: A total of 164 patients underwent RTDPB for clinically confined prostate cancer. Of these 164 patients, 45 were implanted with ¹°³Pd and 119 with ¹²⁵I. Additionally, 44 patients underwent combined external beam radiotherapy and brachytherapy and 120

Louis. Potters; Emel Calugaru; Anup Jassal; Joseph Presser

2006-01-01

64

Radiobiological evaluation of low dose-rate prostate brachytherapy implants  

NASA Astrophysics Data System (ADS)

Low dose-rate brachytherapy is a radiation therapy treatment for men with prostate cancer. While this treatment is common, the use of isotopes with varying dosimetric characteristics means that the prescription level and normal organ tolerances vary. Additionally, factors such as prostate edema, seed loss and seed migration may alter the dose distribution within the prostate. The goal of this work is to develop a radiobiological response tool based on spatial dose information which may be used to aid in treatment planning, post-implant evaluation and determination of the effects of prostate edema and seed migration. Aim 1: Evaluation of post-implant prostate edema and its dosimetric and biological effects. Aim 2: Incorporation of biological response to simplify post-implant evaluation. Aim 3: Incorporation of biological response to simplify treatment plan comparison. Aim 4: Radiobiologically based comparison of single and dual-isotope implants. Aim 5: Determine the dosimetric and radiobiological effects of seed disappearance and migration.

Knaup, Courtney James

65

Secondary sarcoma of bone post-prostate brachytherapy: A case report  

PubMed Central

Malignancies associated with brachytherapy for prostate cancer are largely unreported in the literature. We report a case of post-brachytherapy osteogenic sarcoma in the pelvis 6 years after permanent 125I implant for intermediate-risk prostate cancer. The patient was treated with neoadjuvant chemotherapy, limb-sparing surgical resection and postoperative radiation therapy for unexpected positive margins.

Ye, Allison Y.; Conway, Jessica; Peacock, Michael; Clarkson, Paul W.; Lee, Cheng-Han; Simmons, Christine; Weir, Lorna; McKenzie, Michael

2014-01-01

66

Efficacy of sildenafil citrate in prostate brachytherapy patients with erectile dysfunction  

Microsoft Academic Search

Objectives. To ascertain the efficacy of sildenafil citrate (Viagra) in patients with erectile dysfunction (ED) either before or after prostate brachytherapy by an open-label, nonrandomized study.Methods. Sixty-two patients who underwent prostate brachytherapy between March 1995 and July 1998, had ED either before or after brachytherapy, and were interested in treatment with sildenafil comprised the patient population. Clinical and treatment parameters

Gregory S Merrick; Wayne M Butler; Jonathan H Lief; Robin L Stipetich; Laurie J Abel; Anthony T Dorsey

1999-01-01

67

High-dose-rate brachytherapy as monotherapy for prostate cancer: technique, rationale and perspective  

PubMed Central

High-dose-rate (HDR) brachytherapy as monotherapy is a comparatively new brachytherapy procedure for prostate cancer. Although clinical results are not yet mature enough, it is a highly promising approach in terms of potential benefits for both radiation physics and radiobiology. In this article, we describe our technique for monotherapeutic HDR prostate brachytherapy, as well as the rationale and theoretical background, with educational intent.

Suzuki, Osamu; Otani, Yuki; Yoshida, Ken; Nose, Takayuki; Ogawa, Kazuhiko

2014-01-01

68

Technology Insight: combined external-beam radiation therapy and brachytherapy in the management of prostate cancer  

Microsoft Academic Search

External-beam radiation therapy (EBRT) combined with brachytherapy is an attractive treatment option for selected patients with clinically localized prostate cancer. This therapeutic strategy offers dosimetric coverage if local-regional microscopic disease is present and provides a highly conformal boost of radiation to the prostate and immediate surrounding tissues. Either low-dose-rate (LDR) permanent brachytherapy or high-dose-rate (HDR) temporary brachytherapy can be combined

Mark D Hurwitz

2008-01-01

69

Primary Gleason Grade 4 Impact on Biochemical Recurrence After Permanent Interstitial Brachytherapy in Japanese Patients With Low- or Intermediate-Risk Prostate Cancer  

SciTech Connect

Purpose: To reveal a predictive factor for biochemical recurrence (BCR) after permanent prostate brachytherapy (PPB) using iodine-125 seed implantation in patients with localized prostate cancer classified as low or intermediate risk based on National Comprehensive Cancer Network (NCCN) guidelines. Methods and Materials: From January 2004 to December 2009, 414 consecutive Japanese patients with clinically localized prostate cancer classified as low or intermediate risk based on the NCCN guidelines were treated with PPB. The clinical factors including pathological data reviewed by a central pathologist and follow-up data were prospectively collected. Kaplan-Meier and Cox regression analyses were used to assess the factors associated with BCR. Results: Median follow-up was 36.5 months. The 2-, 3-, 4-, and 5-year BCR-free rates using the Phoenix definition were 98.3%, 96.0%, 91.6%, and 87.0%, respectively. On univariate analysis, the Gleason score, especially primary Gleason grade 4 in biopsy specimens, was a strong predicting factor (p < 0.0001), while age, initial prostate-specific antigen (PSA) level, T stage, and minimal dose delivered to 90% of the prostate volume (D90) were insignificant. Multivariate analysis indicated that a primary Gleason grade 4 was the most powerful prognostic factor associated with BCR (hazard ratio = 6.576, 95% confidence interval, 2.597-16.468, p < 0.0001). Conclusions: A primary Gleason grade 4 carried a worse BCR prognosis than the primary grade 3 in patients treated with PPB. Therefore, the indication for PPB in patients with a Gleason sum of 4 + 3 deserves careful and thoughtful consideration.

Uesugi, Tatsuya [Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan); Saika, Takashi, E-mail: saika@cc.okayama-u.ac.jp [Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan); Edamura, Kohei; Nose, Hiroyuki; Kobuke, Makoto; Ebara, Shin; Abarzua, Fernand [Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan); Katayama, Norihisa [Department of Radiology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan); Yanai, Hiroyuki [Department of Pathology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan); Nasu, Yasutomo; Kumon, Hiromi [Department of Urology, Okayama University, Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama (Japan)

2012-02-01

70

Recurrent Prostate Cancer Genomic Alterations Predict Response to Brachytherapy Treatment  

PubMed Central

Background This study aimed to evaluate the association of recurrent molecular alterations in prostate cancer, such as ERG rearrangements and phosphatase and tensin homolog gene (PTEN) deletions, with oncologic outcomes in patients with prostate cancer treated with brachytherapy. Methods Ninety-two men underwent I-125 brachytherapy with a 145 Gy delivered dose between 2000 and 2008. Pretreatment prostate biopsies were analyzed by immunohistochemistry (IHC) and FISH for ERG rearrangement and overexpression, PTEN deletion, and expression loss. Univariable and multivariable Cox-regression analyses evaluated association of ERG and PTEN status with biochemical recurrence (BCR). Results Within a median follow-up of 73 months, 11% of patients experienced BCR. Of 80 samples with both IHC and FISH performed for ERG, 46 (57.8%) demonstrated rearrangement by FISH and 45 (56.3%) by IHC. Of 77 samples with both IHC and FISH for PTEN, 14 (18.2%) had PTEN deletion by FISH and 22 (28.6%) by IHC. No significant associations were found between ERG, PTEN status, and clinicopathologic features. Patients with concurrent ERG rearrangement and PTEN deletion demonstrated significantly worse relapse-free survival rates compared with those with ERG or PTEN wild type (P < 0.01). In multivariable Cox regression analysis adjusted for the effects of standard clinicopathologic features, combined ERG rearranged and PTEN deletion was independently associated with BCR (HR = 2.6; P = 0.02). Conclusions Concurrent ERG rearrangement and PTEN loss was independently associated with time to BCR in patients undergoing brachytherapy. Future studies are needed to validate prostate cancer molecular subtyping for risk stratification. Impact Identifying patients in the ERG-rearranged/PTEN-deleted molecular subclass may improve treatment personalization.

Fontugne, Jacqueline; Lee, Daniel; Cantaloni, Chiara; Barbieri, Christopher E.; Caffo, Orazio; Hanspeter, Esther; Mazzoleni, Guido; Palma, Paolo Dalla; Rubin, Mark A.; Fellin, Giovanni; Mosquera, Juan Miguel; Barbareschi, Mattia; Demichelis, Francesca

2014-01-01

71

Posttreatment biopsy results following interstitial brachytherapy in early-stage prostate cancer  

Microsoft Academic Search

Purpose: To assess pathologic control rates for prostatic carcinoma as determined by postimplant prostate biopsy in a large series of consecutive patients who have received permanent interstitial brachytherapy using a contemporary transrectal ultrasound-directed, transperineal, computer generated, volume technique.Methods and Materials: Four hundred and two patients received permanent 125I or 103Pd interstitial brachytherapy as primary treatment for early stage prostatic carcinoma

Bradley R. Prestidge; David C. Hoak; Peter D. Grimm; Haakon Ragde; William Cavanagh; John C. Blasko

1997-01-01

72

Relative influence of Gleason score and pretreatment PSA in predicting survival following brachytherapy for prostate cancer  

Microsoft Academic Search

Purpose: To evaluate 10-year survival rates after prostate brachytherapy and to assess the relative importance of pretreatment prostate-specific antigen (PSA) and Gleason score in predicting cancer death.Materials and Methods: A retrospective review was performed on all patients treated with permanent brachytherapy for stage T1 or T2 primary prostate cancer at a single institution from December 1988 through June 30, 1998.

David C Beyer; Terry Thomas; Joseph Hilbe; Virginia Swenson

2003-01-01

73

Anisotropy characterization of I-125 seed with attached encapsulated cobalt chloride complex contrast agent markers for MRI-based prostate brachytherapy.  

PubMed

We have developed a novel MRI marker for prostate brachytherapy. The purpose of this study was to evaluate the changes in anisotropy when cobalt chloride complex contrast agent encapsulated contrast agent markers (C4-ECAM) were placed adjacent to an iodine-125 (I-125) titanium seed, and to verify that the C4-ECAMs were visible on magnetic resonance imaging (MRI) after radiation exposure. Two C4-ECAMs were verified to be MRI visible in a phantom before radiation exposure. The C4-ECAMs were then attached to each end of a 12.7-U (10-mCi) I-125 titanium seed in a polymer tube. Anisotropy was measured and analyzed with the seed alone and with attached C4-ECAMs by suspending thermoluminescent dosimeters in a water phantom in 2 circles surrounding the radioactive source with radius of 1 or 2 cm. A T1-weighted MRI evaluation of C4-ECAMs was then performed after exposure to the amount of radiation typically delivered during 1 month of prostate brachytherapy. Measured values of the anisotropy function F(r, ?) for the I-125 seed with and without the C4-ECAMs were mutually statistically indistinguishable (standard error of the mean <4.2%) and agreed well with published TG-43 values for the bare seed. As expected, the anisotropy function ?(an)(r) for the 2 datasets (with and without C4-ECAMs) derived from the measured F(r, ?) did not exhibit statistically measurable difference. Both datasets showed agreement with the published TG-43 ?(an)(r) for the bare seed. The C4-ECAMs were well visualized by MRI after 1 month of radiation exposure. There were no changes in anisotropy when the C4-ECAMs were placed next to an I-125 radioactive seed, and the C4-ECAMs were visualized after radiation exposure. PMID:20537886

Frank, Steven J; Tailor, Ramesh C; Kudchadker, Rajat J; Martirosyan, Karen S; Stafford, R Jason; Elliott, Andrew M; Swanson, David A; Sing, David; Choi, Jonathan; Mourtada, Firas; Ibbott, Geoffrey S

2011-01-01

74

Anisotropy Characterization of I-125 Seed with Attached Encapsulated Cobalt Chloride Complex Contrast Agent Markers for MRI-Based Prostate Brachytherapy  

SciTech Connect

We have developed a novel MRI marker for prostate brachytherapy. The purpose of this study was to evaluate the changes in anisotropy when cobalt chloride complex contrast agent encapsulated contrast agent markers (C4-ECAM) were placed adjacent to an iodine-125 (I-125) titanium seed, and to verify that the C4-ECAMs were visible on magnetic resonance imaging (MRI) after radiation exposure. Two C4-ECAMs were verified to be MRI visible in a phantom before radiation exposure. The C4-ECAMs were then attached to each end of a 12.7-U (10-mCi) I-125 titanium seed in a polymer tube. Anisotropy was measured and analyzed with the seed alone and with attached C4-ECAMs by suspending thermoluminescent dosimeters in a water phantom in 2 circles surrounding the radioactive source with radius of 1 or 2 cm. A T1-weighted MRI evaluation of C4-ECAMs was then performed after exposure to the amount of radiation typically delivered during 1 month of prostate brachytherapy. Measured values of the anisotropy function F(r, {theta}) for the I-125 seed with and without the C4-ECAMs were mutually statistically indistinguishable (standard error of the mean <4.2%) and agreed well with published TG-43 values for the bare seed. As expected, the anisotropy function {phi}{sub an}(r) for the 2 datasets (with and without C4-ECAMs) derived from the measured F(r, {theta}) did not exhibit statistically measurable difference. Both datasets showed agreement with the published TG-43 {phi}{sub an}(r) for the bare seed. The C4-ECAMs were well visualized by MRI after 1 month of radiation exposure. There were no changes in anisotropy when the C4-ECAMs were placed next to an I-125 radioactive seed, and the C4-ECAMs were visualized after radiation exposure.

Frank, Steven J., E-mail: sjfrank@mdanderson.or [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Tailor, Ramesh C.; Kudchadker, Rajat J. [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Martirosyan, Karen S. [Department of Chemical and Biomolecular Engineering, University of Houston, Houston, TX (United States); Stafford, R. Jason; Elliott, Andrew M. [Department of Imaging Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Swanson, David A. [Department of Urology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Sing, David; Choi, Jonathan [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Mourtada, Firas; Ibbott, Geoffrey S. [Department of Radiation Physics, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)

2011-07-01

75

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results.  

PubMed

Prostate brachytherapy involves implanting radioactive seeds (I125 for instance) permanently in the gland for the treatment of localized prostate cancers, e.g., cT1c-T2a N0 M0 with good prognostic factors. Treatment planning and seed implanting are most often based on the intensive use of transrectal ultrasound (TRUS) imaging. This is not easy because prostate visualization is difficult in this imaging modality particularly as regards the apex of the gland and from an intra- and interobserver variability standpoint. Radioactive seeds are implanted inside open interventional MR machines in some centers. Since MRI was shown to be sensitive and specific for prostate imaging whilst open MR is prohibitive for most centers and makes surgical procedures very complex, this work suggests bringing the MR virtually in the operating room with MRI/TRUS data fusion. This involves providing the physician with bi-modality images (TRUS plus MRI) intended to improve treatment planning from the data registration stage. The paper describes the method developed and implemented in the PROCUR system. Results are reported for a phantom and first series of patients. Phantom experiments helped characterize the accuracy of the process. Patient experiments have shown that using MRI data linked with TRUS data improves TRUS image segmentation especially regarding the apex and base of the prostate. This may significantly modify prostate volume definition and have an impact on treatment planning. PMID:15259661

Reynier, Christophe; Troccaz, Jocelyne; Fourneret, Philippe; Dusserre, André; Gay-Jeune, Cécile; Descotes, Jean-Luc; Bolla, Michel; Giraud, Jean-Yves

2004-06-01

76

Perineural invasion on prostate needle biopsy does not predict biochemical failure following brachytherapy for prostate cancer  

SciTech Connect

Purpose: To determine if the presence of perineural invasion (PNI) predicts biochemical recurrence in patients who underwent low-dose-rate brachytherapy for the treatment of localized prostate cancer. Methods and Materials: A retrospective case control matching study was performed. The records of 651 patients treated with brachytherapy between 1996 and 2003 were reviewed. Sixty-three of these patients developed biochemical failure. These sixty-three patients were then matched in a one-to-one ratio to patients without biochemical failure, controlling for biopsy Gleason score, clinical stage, initial prostate-specific antigen, age, and the use of androgen deprivation. The pathology of the entire cohort was then reviewed for evidence of perineural invasion on initial prostate biopsy specimens. The biochemical relapse free survival rates for these two groups were compared. Results: Cases and controls were well matched, and there were no significant differences between the two groups in age, Gleason grade, clinical stage, initial prostate-specific antigen, and the use of androgen deprivation. PNI was found in 19 (17%) patients. There was no significant difference in the rates of PNI between cases and controls, 19.6% and 14.3% respectively (p 0.45). PNI did not correlate with biochemical relapse free survival (p 0.40). Conclusion: Perineural invasion is not a significant predictor of biochemical recurrence in patients undergoing brachytherapy for prostate cancer.

Weight, Christopher J. [Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Ciezki, Jay P. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Zhou Ming [Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Department of Anatomical Pathology, Cleveland Clinic Foundation, Cleveland, OH (United States); Klein, Eric A. [Glickman Urological Institute, Cleveland Clinic Foundation, Cleveland, OH (United States)

2006-06-01

77

Permanent Prostate Brachytherapy in Prostate Glands <20 cm{sup 3}  

SciTech Connect

Purpose: To investigate the dosimetry, treatment-related morbidity, and biochemical outcomes for brachytherapy in patients with prostate glands <20 cm{sup 3}. Methods and Materials: From November 1996 to October 2006, 104 patients with prostate glands <20 cm{sup 3} underwent brachytherapy. Multiple prostate, urethral, and rectal dosimetric parameters were evaluated. Treatment-related urinary and rectal morbidity were assessed from patient questionnaires. Cause-specific survival, biochemical progression-free survival, and overall survival were recorded. Results: The median patient age, follow up, and pre-treatment ultrasound volume was 64 years, 5.0 years and 17.6cm{sup 3}, respectively. Median day 0 dosimetry was significant for the following: V100 98.5%, D90 126.1% and R100 <0.5% of prescription dose. The mean urethral and maximum urethral doses were 119.6% and 133.8% of prescription. The median time to International Prostate Symptom Score resolution was 4 months. There were no RTOG grade III or IV rectal complications. The cause-specific survival, biochemical progression-free survival, and overall survival rates were 100%, 92.5%, and 77.8% at 9 years. For biochemically disease-free patients, the median most recent postbrachytherapy PSA value was 0.02 ng/mL. Conclusion: Our results demonstrate that brachytherapy for small prostate glands is highly effective, with an acceptable morbidity profile, excellent postimplant dosimetry, acceptable treatment-related morbidity, and favorable biochemical outcomes.

Mayadev, Jyoti [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.or [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Reed, Joshua R.; Butler, Wayne M.; Galbreath, Robert W.; Allen, Zachariah A. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Health Care System, Group Health Cooperative, University of Washington, Seattle, WA (United States)

2010-04-15

78

Biological damage in testis by Iodine125 in partially blocked thyroid of rats  

Microsoft Academic Search

Summary Degeneration of testis has been observed after administration of Iodine-125 in potassiumperchlorate treated rats. Histological damage is associated with loss of DNA, RNA, acid phosphatase, total adenosine triphosphatase (ATPase) and Na\\/K dependent ATPase. Iodine-125 induced atrophic testis shows higher content of sodium and lower levels of potassium as compared to control testis. Damage of testis by Iodine-125 has been

G. S. Gupta; V. K. Chopra

1977-01-01

79

Dose enhancement by various nanoparticles in prostate brachytherapy.  

PubMed

The aim of this Monte Carlo study is to calculate dose enhancement in tumours by various nanoparticles in prostate brachytherapy using (125)I interstitial implants. ProstaSeed (125)I brachytherapy source was simulated using MCNPX Monte Carlo code. Dose rate constant, radial dose function and anisotropy function values were calculated and compared with previously published data. Dose enhancement factors (DEFs) were calculated for Fe2O3, Ag, Gd, Pt and Au nanoparticles with concentrations of 7, 18 and 30 mg/ml. Our source simulation was validated by comparing our results with previously published data. Maximum DEF values on the central transverse line, within the tumour, for Fe2O3, Ag, Gd, Pt and Au nanoparticles with 30 mg/ml concentration were 1.27, 1.15, 1.14, 1.32, 1.79, respectively. No general trend in DEF with increasing atomic number, or concentration of nanoparticles was observed. However, DEF was the highest for 30 mg/ml concentration of Au. The 50 % isodose line tightened toward the central point of the spherical tumour and the central 100 % isodose line expanded outward. The presence of nanoparticles in a prostate tumour increases the dose inside tumour and decreases the dose outside it, thus the treatment time and source activity can be decreased due to dose enhancement in the tumour. While more preclinical studies on other aspects are necessary, using nanoparticles can be proposed as a useful tool in prostate brachytherapy. Au nanoparticles with higher concentrations can be more useful for this purpose when compared to other nanoparticles. PMID:24307601

Ghorbani, Mahdi; Bakhshabadi, Mahdi; Golshan, Alireza; Knaup, Courtney

2013-12-01

80

High dose rate brachytherapy in the treatment of prostate cancer.  

PubMed

The optimal treatment of patients with localized prostate cancer remains controversial. Significant clinical data are available, however, demonstrating that patients treated with radiation therapy (RT) have a significantly better outcome as the dose to the gland is increased. What remains debatable, however, is how to best deliver these higher doses of RT without significantly increasing normal tissue toxicities. Conformal high dose rate brachytherapy (C-HDR BT) represents an alternative means of precise dose delivery that offers similar tumoricidal effects as three-dimensional (3D) conformal external beam radiotherapy (EBRT) or permanent interstitial prostate seed implants with potential additional advantages. Since C-HDR BT consists of temporarily placing afterloading needles or catheters directly into the prostate gland under real-time ultrasound guidance, a steep dose gradient between the prostate and adjacent normal tissues can be generated that is minimally affected by organ motion and edema or treatment setup uncertainties. The ability to control the amount of time the single HDR radioactive source "dwells" at each position along the length of each brachytherapy catheter further enhances the conformity of the dose. In addition, recent radiobiological data on prostate cancer treatment suggest that C-HDR BT should produce tumor control and late normal tissue side effects that are at least as good as achieved with conventional fractionation, with the additional possibility that acute side effects might be reduced. Published data from several groups performing C-HDR BT as boosts in patients with locally advanced disease have supported these assumptions. Combined with the physical advantages discussed above, C-HDR BT should provide similar tumor control as 3D conformal EBRT with the added advantages of reduced treatment times, less acute toxicity, and no additional technological requirements to account and correct for treatment setup uncertainties and organ motion. Due to the success of C-HDR BT as boost treatment in locally advanced disease, this form of radiation treatment has recently been applied to low-risk prostate cancer patients as an alternative brachytherapy technique to permanent interstitial seed implantation. Advantages in this setting include an improved ability to define and deliver the prescribed dose, a significantly shortened treatment schedule compared to 3D conformal EBRT, and the fact that patients are not radioactive after implantation. PMID:12905008

Vicini, Frank; Vargas, Carlos; Gustafson, Gary; Edmundson, Gregory; Martinez, Alvaro

2003-09-01

81

Primary Causes of Death After Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate the primary causes of death in low-risk (low-risk), intermediate-risk (intermediate-risk), and high-risk (high-risk) patients undergoing permanent prostate brachytherapy with or without supplemental therapies. Methods and Materials: From April 1995 through November 2004, a total of 1,354 consecutive patients underwent prostate brachytherapy. All patients underwent brachytherapy >3 years before analysis. Of the patients, 532 (39.3%) received androgen deprivation therapy and 703 (51.9%) received supplemental radiation therapy. The median follow-up was 5.4 years. Multiple parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific survival was 97.0% (99.7%, 99.0%, and 90.1% for low-risk, intermediate-risk, and high-risk patients). Overall survival was 76.7% (82.5%, 78.3%, and 67.6% for low-, intermediate-, and high-risk patients, respectively). The cumulative death rate for cardiovascular disease was 11.5% (8.7%, 9.3%, and 19.8% for low-, intermediate-, and high-risk patients). The death rate from second malignancies (nonprostate cancer) was 7.2% and was not substantially different when stratified by risk group. Death from all other causes was 6.5% for the entire cohort but 1.3%, 5.0%, and 10.8% for low-, intermediate-, and high-risk patients. In multivariate analysis, death from prostate cancer was best predicted by Gleason score and risk group, whereas death from cardiovascular disease, nonprostate cancer, and all other causes were most closely related to patient age and tobacco use. Conclusions: Although cardiovascular mortality was the predominant cause of death, prostate cancer was responsible for approximately 10% of all deaths. In particular, overall survival was poorest in the high-risk group. Although high-risk patients were most likely to die of prostate cancer, the divergence in overall survival between high-risk and lower-risk patients primarily resulted from an excess of cardiovascular deaths. Changes in lifestyle to improve cardiovascular health may improve overall survival in patients with clinically localized prostate cancer.

Bittner, Nathan [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Merrick, Gregory S. [Schiffler Cancer Center Wheeling Jesuit University, Wheeling, WV (United States)], E-mail: gmerrick@urologicresearchinstitute.org; Galbreath, Robert W.; Butler, Wayne M. [Schiffler Cancer Center Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Radiation Oncology, Puget Sound Healthcare Corporation, Department of Veterans Affairs, Seattle, WA (United States); Allen, Zachariah A.; Brammer, Sarah G. [Schiffler Cancer Center Wheeling Jesuit University, Wheeling, WV (United States); Moyad, Mark [Department of Urology, University of Michigan Medical Center, Ann Arbor, MI (United States)

2008-10-01

82

Cardiac and hepatic seed implant embolization after prostate brachytherapy.  

PubMed

Prostate brachytherapy seed implants occasionally embolize to lungs because of their small size. They may lodge in the right cardiac cavities before reaching the pulmonary arteries and lungs. A rare instance of seed migration to the coronary artery through an existing right-to-left cardiac shunt or patent foramen ovale has also been reported. I present a case of seed implant relocation to the heart and left hepatic lobe by way of presumed different venous pathways represented by the periprostatic and hemorrhoidal venous plexuses, respectively. PMID:16979711

Nguyen, Ba D

2006-09-01

83

Development of a tapping device: a new needle insertion method for prostate brachytherapy  

Microsoft Academic Search

The purpose of this study is to develop and test a tapping device for needle insertion for prostate brachytherapy. This device will tap the needle into the prostate with a certain, well-defined, amount of momentum, instead of the currently used method of pushing the needle. Because of the high needle insertion velocity, we expect prostate motion and deformation to be

V Lagerburg; M A Moerland; M K Konings; R E van de Vosse; J J W Lagendijk; J J Battermann

2006-01-01

84

In vivo photoacoustic imaging of prostate brachytherapy seeds  

NASA Astrophysics Data System (ADS)

We conducted an approved canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. Brachytherapy seeds coated with black ink were inserted into the canine prostate using methods similar to a human procedure. A transperineal, interstitial, fiber optic light delivery method, coupled to a 1064 nm laser, was utilized to irradiate the prostate and the resulting acoustic waves were detected with a transrectal ultrasound probe. The fiber was inserted into a high dose rate (HDR) brachytherapy needle that acted as a light-diffusing sheath, enabling radial light delivery from the tip of the fiber inside the sheath. The axis of the fiber was located at a distance of 4-9 mm from the long axis of the cylindrical seeds. Ultrasound images acquired with the transrectal probe and post-operative CT images of the implanted seeds were analyzed to confirm seed locations. In vivo limitations with insufficient light delivery within the ANSI laser safety limit (100 mJ/cm2) were overcome by utilizing a short-lag spatial coherence (SLSC) beamformer, which provided average seed contrasts of 20-30 dB for energy densities ranging 8-84 mJ/cm2. The average contrast was improved by up to 20 dB with SLSC beamforming compared to conventional delay-and-sum beamforming. There was excellent agreement between photoacoustic, ultrasound, and CT images. Challenges included visualization of photoacoustic artifacts that corresponded with locations of the optical fiber and hyperechoic tissue structures.

Lediju Bell, Muyinatu A.; Kuo, Nathanael P.; Song, Danny Y.; Kang, Jin; Boctor, Emad M.

2014-03-01

85

Sequential evaluation of prostate edema after permanent seed prostate brachytherapy using CT-MRI fusion  

SciTech Connect

Purpose: To analyze the extent and time course of prostate edema and its effect on dosimetry after permanent seed prostate brachytherapy. Methods and Materials: Twenty patients scheduled for permanent seed {sup 125}I prostate brachytherapy agreed to a prospective study on postimplant edema. Implants were preplanned using transrectal ultrasonography. Postimplant dosimetry was calculated using computed tomography-magnetic resonance imaging (CT-MRI) fusion on the day of the implant (Day 1) and Days 8 and 30. The prostate was contoured on MRI, and the seeds were located on CT. Factors investigated for an influence on edema were the number of seeds and needles, preimplant prostate volume, transitional zone index (transition zone volume divided by prostate volume), age, and prostate-specific antigen level. Prostate dosimetry was evaluated by the percentage of the prostate volume receiving 100% of the prescribed dose (V{sub 100}) and percentage of prescribed dose received by 90% of the prostate volume (D{sub 90}). Results: Prostate edema was maximal on Day 1, with the median prostate volume 31% greater than preimplant transrectal ultrasound volume (range, 0.93-1.72; p < 0.001) and decreased with time. It was 21% greater than baseline at Day 8 (p = 0.013) and 5% greater on Day 30 (p < 0.001). Three patients still had a prostate volume greater than baseline by Day 30. The extent of edema depended on the transition zone volume (p = 0.016) and the preplan prostate volume (p 0.003). The median V{sub 100} on Day 1 was 93.6% (range, 86.0-98.2%) and was 96.3% (range, 85.7-99.5%) on Day 30 (p = 0.079). Patients with a Day 1 V{sub 100} >93% were less affected by edema resolution, showing a median increase in V{sub 100} of 0.67% on Day 30 compared with 2.77% for patients with a V{sub 100} <93 % on Day 1. Conclusion: Despite the extreme range of postimplant edema, the effect on dosimetry was less than expected. Dose coverage of the prostate was good for all patients during Days 1-30. Our data indicate that postimplant dosimetry on the day of implant is sufficient for patients with good dose coverage (Day 1 V{sub 100} >93%)

Taussky, Daniel [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Austen, Lyn [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Toi, Ants [Department of Medical Imaging, Princess Margaret Hospital, Toronto, ON (Canada); Yeung, Ivan [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada); Williams, Theresa [Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON (Canada); Pearson, Shannon [Department of Radiation Medicine, Princess Margaret Hospital, Toronto, ON (Canada); McLean, Michael [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Pond, Gregory [Department of Biostatistics, Princess Margaret Hospital, Toronto, ON (Canada); Crook, Juanita [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada)]. E-mail: juanita.crook@rmp.uhn.on.ca

2005-07-15

86

Report of a consensus meeting on focal low dose rate brachytherapy for prostate cancer.  

PubMed

What's known on the subject? and What does the study add? Whole gland brachytherapy has been used to successfully treat prostate cancer but the protocol for focal therapy has not previously been established. The consensus findings provide guidance on patient selection for focal brachytherapy as well as recommendations for conducting therapy and patient follow-up. Low dose rate prostate brachytherapy is an effective treatment for localized prostate cancer. Recently, it has been considered for use in a focused manner whereby treatment is targeted only to areas of prostate cancer. The objective of focal brachytherapy is to provide effective cancer control for low-risk disease but with reduced genitourinary and rectal side-effects in a cost-effective way. We report on the outputs of a consensus meeting of international experts in brachytherapy and focal therapy convened to consider the feasibility and potential development of focal brachytherapy. A number of factors were considered for focal brachytherapy including optimal patient selection, disease characterization and localization, treatment protocols and outcome measures. The consensus meeting also addressed the design of a clinical trial that would assess the oncological outcomes and side-effect profiles resulting from focal brachytherapy. PMID:22239224

Langley, Stephen; Ahmed, Hashim U; Al-Qaisieh, Bashar; Bostwick, David; Dickinson, Louise; Veiga, Francisco Gomez; Grimm, Peter; Machtens, Stefan; Guedea, Ferran; Emberton, Mark

2012-02-01

87

Dose escalation in permanent brachytherapy for prostate cancer: dosimetric and biological considerations  

Microsoft Academic Search

No prospective dose escalation study for prostate brachytherapy (PB) with permanent implants has been reported. In this work, we have performed a dosimetric and biological analysis to explore the implications of dose escalation in PB using 125I and 103Pd implants. The concept of equivalent uniform dose (EUD), proposed originally for external-beam radiotherapy (EBRT), is applied to low dose rate brachytherapy.

X Allen Li; Jian Z Wang; Robert D Stewart; Steven J DiBiase

2003-01-01

88

Long-Term Outcomes of Alternative Brachytherapy Techniques for Early Prostate Cancer.  

National Technical Information Service (NTIS)

All active, potentially curative treatments for clinically localized prostate cancer damage quality of life. Brachytherapy,or radioactive seed implants, theoretically may increase the target radiation dose and thus improve control of cancer. has been rapi...

J. A. Talcott

2006-01-01

89

Long-Term Outcomes of Alternative Brachytherapy Techniques for Early Prostate Cancer. Addendum.  

National Technical Information Service (NTIS)

All active, potentially curative treatments for clinically localized prostate cancer damage quality of life. Brachytherapy, or radioactive seed implants, theoretically may increase the target radiation dose and thus improve control of cancer. It has been ...

J. A. Talcott

2008-01-01

90

Long-Term Outcomes of Alternative Brachytherapy Techniques for Early Prostate Cancer.  

National Technical Information Service (NTIS)

All active, potentially curative treatments for clinically localized prostate cancer damage quality of life. Brachytherapy, or radioactive seed implants, theoretically may increase the target radiation dose and thus improve control of cancer. It has been ...

J. A. Talcott

2008-01-01

91

Long-Term Outcomes of Alternative Brachytherapy Techniques for Early Prostate Cancer.  

National Technical Information Service (NTIS)

All active, potentially curative treatments for clinically localized prostate cancer damage quality of life. Brachytherapy,or radioactive seed implants, theoretically may increase the target radiation dose and thus improve control of cancer has been rapid...

J. A. Talcott

2007-01-01

92

Iodine125, a tracer in cell biology: physical properties and biological aspects  

Microsoft Academic Search

Some essential physical properties of the transmutation of iodine-125 are discussed and the range of its electrons calculated. Its suitability for autoradiographs is compared with that of tritium. The dose distribution around a point source and the dose absorbed by a cell nucleus labelled with 125I and 3H are calculated. It is suggested that the biological toxicity of iodine-125 is

H H Ertl; L E Feinendegen; H J Heiniger

1970-01-01

93

Quality of life of patients after permanent prostate brachytherapy in relation to dosimetry  

Microsoft Academic Search

Purpose: To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images. Methods and Materials: For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1

Marion P. R. Van Gellekom; Marinus A. Moerland; Marco Van Vulpen; Harm K. Wijrdeman; Jan J. Battermann

2005-01-01

94

Real-time optimized intraoperative dosimetry for prostate brachytherapy: A pilot study  

Microsoft Academic Search

Purpose: To assess the feasibility of real-time intraoperative treatment planning for permanent prostate brachytherapy analyzing the impact on operative time and adequacy of postimplant dosimetry.Methods and Materials: Seventeen consecutive patients undergoing permanent brachytherapy for prostate cancer had real-time intraoperative computer-based and optimized treatment planning. The first 8 patients were implanted using a plan generated before the surgery and served to

David C Beyer; Robert H Shapiro; Fred Puente

2000-01-01

95

A Case of Bladder-Inverted Papilloma after Brachytherapy for Prostate Cancer  

PubMed Central

An 82-year-old male who presented with the chief complaint of gross hematuria and a history of prostate cancer treated with brachytherapy 6 years previously is described. Cystoscopy revealed multiple bladder tumors on the right posterior wall. A transurethral resection of the bladder tumor was performed and a pathological diagnosis of the inverted papilloma was made. To the best of our knowledge, this case is the first report of bladder-inverted papilloma after brachytherapy for prostate cancer.

Ezaki, Taisuke; Kosaka, Takeo; Mikami, Shuji; Kaburaki, Naoto; Mizuno, Ryuichi; Oya, Mototsugu

2014-01-01

96

EARLY QUALITY OF LIFE ASSESSMENT IN MEN TREATED WITH PERMANENT SOURCE INTERSTITIAL BRACHYTHERAPY FOR CLINICALLY LOCALIZED PROSTATE CANCER  

Microsoft Academic Search

PurposeWe prospectively assessed quality of life changes with time using validated instruments in men with clinically localized prostate cancer treated with permanent source interstitial brachytherapy.

W. ROBERT LEE; RICHARD P. McQUELLON; L. DOUG CASE; ALLAN F. deGUZMAN; DAVID L. McCULLOUGH

1999-01-01

97

Characterization of liposomes containing iodine-125-labeled radiographic contrast agents  

SciTech Connect

Multilamellar liposomes were prepared containing either iodine-125-labeled (/sup 125/I) diatrizoate or /sup 125/I labeled iotrol in their aqueous phase. The in vitro permeabilities of liposomes containing both contrast agents were measured in the presence of saline and serum at 37 degrees C. Two different phospholipid compositions were studied: phosphatidylcholine/cholesterol/stearylamine (PC/C/S, 8: 1:1 molar ratio) and distearoylphosphatidylcholine/sphingomyelin (DSPC/SM, 5:2 mole ratio). In saline, similar permeabilities were observed for the four phospholipid-contrast agent combinations. In serum, however, leakage of /sup 125/I activity was 2 to 3 times greater from PC/C/S liposomes than from vesicles composed of DSPC/SM. When PC/C/S liposomes that contained /sup 125/I-diatrizoate were injected into rats, the clearance half-times for /sup 125/I activity from the liver, spleen, and whole body were 4.4 hours, 4.5 hours, and 2.8 hours, respectively. Liposomes composed of DSPC/SM cleared at a significantly slower rate from the liver, spleen, and whole body with half-times of 24.0 hours, 18.4 hours, and 17.2 hours observed from these tissues, respectively.

Zalutsky, M.R.; Noska, M.A.; Seltzer, S.E.

1987-02-01

98

MRI-guided prostate brachytherapy with single needle method—a planning study  

Microsoft Academic Search

Background and purposeMagnetic resonance image (MRI)-guided prostate brachytherapy with a conventional closed MR scanner is hampered by the limited access to the prostate. To handle this problem, we have designed a new implantation method, based on a patient lying in a closed MR scanner, a robotic device to be placed between patient's legs, and one needle with one insertion point.

Marion P. R Van Gellekom; Marinus A Moerland; Jan J Battermann; Jan J. W Lagendijk

2004-01-01

99

Dosimetry and cancer control after low-dose-rate prostate brachytherapy  

Microsoft Academic Search

PurposeTo describe the relationship between two commonly used dosimetric quantifiers (dose received by 90% of the prostate [D90] and volume receiving 100% of dose [V100]) and biochemical disease-free survival (bDFS) in a cohort of men treated with low-dose-rate prostate brachytherapy (LDRPB).

W. Robert Lee; Allan F. deGuzman; Kevin P. McMullen; David L. McCullough

2005-01-01

100

Body Mass Index and Prostate-Specific Antigen Failure Following Brachytherapy for Localized Prostate Cancer  

SciTech Connect

Purpose: Increasing body mass index (BMI) is associated with prostate-specific antigen (PSA) failure after radical prostatectomy and external beam radiation therapy (EBRT). We investigated whether BMI is associated with PSA failure in men treated with brachytherapy for clinically localized prostate cancer. Patients and Methods: Retrospective analyses were conducted on 374 patients undergoing brachytherapy for stage T1c-T2cNXM0 prostate cancer from 1996-2001. Forty-nine patients (13%) received supplemental EBRT and 131 (35%) received androgen deprivation therapy (ADT). Height and weight data were available for 353 (94%). Cox regression analyses were performed to evaluate the relationship between BMI and PSA failure (nadir + 2 ng/ml definition). Covariates included age, race, preimplantation PSA, Gleason score, T category, percent of prescription dose to 90% of the prostate, use of supplemental EBRT, and ADT. Results: Median age, PSA, and BMI were 66 years (range, 42-80 years), 5.7 ng/ml (range, 0.4-22.6 ng/ml), and 27.1 kg/m{sup 2} (range, 18.2-53.6 kg/m{sup 2}), respectively. After a median follow-up of 6.0 years (range, 3.0-10.2 years), there were 76 PSA recurrences. The BMI was not associated with PSA failure. Six-year PSA failure rates were 30.2% for men with BMI less than 25 kg/m{sup 2}, 19.5% for BMI of 25 or greater to less than 30 kg/m{sup 2}, and 14.4% for BMI of 30 kg/m{sup 2} or greater (p = 0.19). Results were similar when BMI was analyzed as a continuous variable, using alternative definitions of PSA failure, and excluding patients treated with EBRT and/or ADT. In multivariate analyses, only baseline PSA was significantly associated with shorter time to PSA failure (adjusted hazard ratio, 1.12; 95% confidence interval, 1.05-1.20; p 0.0006). Conclusions: Unlike after surgery or EBRT, BMI is not associated with PSA failure in men treated with brachytherapy for prostate cancer. This raises the possibility that brachytherapy may be a preferred treatment strategy in obese patients.

Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)], E-mail: jefstathiou@partners.org; Skowronski, Rafi Y.; Coen, John J. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Grocela, Joseph A. [Department of Urology, Massachusetts General Hospital, Boston, MA (United States); Hirsch, Ariel E. [Department of Radiation Oncology, Boston Medical Center, Boston, MA (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

2008-08-01

101

Prostate Specific Antigen Bounce Is Related to Overall Survival in Prostate Brachytherapy  

SciTech Connect

Purpose: To investigate the association between prostate specific antigen (PSA) bounce and disease outcome after prostate brachytherapy. Methods and Materials: We analyzed 975 patients treated with {sup 125}I implantation monotherapy between 1992 and 2006. All patients had tumor Stage {<=}2c, Gleason score {<=}7 prostate cancer, a minimum follow-up of 2 years with at least four PSA measurements, and no biochemical failure in the first 2 years. Median follow-up was 6 years. Bounce was defined as a PSA elevation of +0.2 ng/mL with subsequent decrease to previous nadir. We used the Phoenix +2 ng/mL definition for biochemical failure. Additional endpoints were disease-specific and overall survival. Multivariate Cox regression analysis was performed to adjust for potential confounding factors. Results: Bounce occurred in 32% of patients, with a median time to bounce of 1.6 years. More than 90% of bounces took place in the first 3 years after treatment and had disappeared within 2 years of onset. Ten-year freedom from biochemical failure, disease-specific survival, and overall survival rates were, respectively, 90%, 99%, and 88% for the bounce group and 70%, 93%, and 82% for the no-bounce group. Only 1 patient (0.3%) died of prostate cancer in the bounce group, compared with 40 patients (6.1%) in the no-bounce group. Adjusted for confounding, a 70% biochemical failure risk reduction was observed for patients experiencing a bounce (hazard ratio 0.31; 95% confidence interval 0.20-0.48). Conclusions: A PSA bounce after prostate brachytherapy is strongly related to better outcome in terms of biochemical failure, disease-specific survival, and overall survival.

Hinnen, Karel A., E-mail: KAHinnen@Gmail.com [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht (Netherlands); Battermann, Jan J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Roermund, Joep G.H. van [Department of Urology, University Medical Center Utrecht, Utrecht (Netherlands); Frank, Steven J. [Department of Radiation Oncology, M. D. Anderson Cancer Center, Houston, TX (United States); Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2012-02-01

102

3-D Conformal HDR Brachytherapy asMonotherapy for Localized Prostate Cancer  

Microsoft Academic Search

Purpose: Pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose- rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning. Patients and Methods: Between 05\\/2002 and 05\\/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) = 10 ng\\/ml, Gleason score = 7 and clinical stage = T2a were treated. Median PSA

Thomas Martin; Dimos Baltas; Ralf Kurek; Sandra Röddiger; Marina Kontova; Georgios Anagnostopoulos; Thomas Dannenberg; Thomas Buhleier; Georgies Skazikis; Ulf Tunn; Nikolaos Zamboglou

2004-01-01

103

Kimmel Cancer Center study finds brachytherapy reduced death rates in high-risk prostate cancer patients:  

Cancer.gov

Brachytherapy for high-risk prostate cancers patients has historically been considered a less effective modality, but a new study from radiation oncologists at the Kimmel Cancer Center at Jefferson suggests otherwise. A population-based analysis looking at almost 13,000 cases revealed that men who received brachytherapy alone or in combination with external beam radiation therapy (EBRT) had significantly reduced mortality rates.

104

Long-Term Results of an RTOG Phase II Trial (00-19) of External-Beam Radiation Therapy Combined With Permanent Source Brachytherapy for Intermediate-Risk Clinically Localized Adenocarcinoma of the Prostate  

SciTech Connect

Purpose: External-beam radiation therapy combined with low-doserate permanent brachytherapy are commonly used to treat men with localized prostate cancer. This Phase II trial was performed to document late gastrointestinal or genitourinary toxicity as well as biochemical control for this treatment in a multi-institutional cooperative group setting. This report defines the long-term results of this trial. Methods and Materials: All eligible patients received external-beam radiation (45 Gy in 25 fractions) followed 2-6 weeks later by a permanent iodine 125 implant of 108 Gy. Late toxicity was defined by the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring scheme. Biochemical control was defined by the American Society for Therapeutic Radiology and Oncology (ASTRO) Consensus definition and the ASTRO Phoenix definition. Results: One hundred thirty-eight patients were enrolled from 20 institutions, and 131 were eligible. Median follow-up (living patients) was 8.2 years (range, 2.7-9.3 years). The 8-year estimate of late grade >3 genitourinary and/or gastrointestinal toxicity was 15%. The most common grade >3 toxicities were urinary frequency, dysuria, and proctitis. There were two grade 4 toxicities, both bladder necrosis, and no grade 5 toxicities. In addition, 42% of patients complained of grade 3 impotence (no erections) at 8 years. The 8-year estimate of biochemical failure was 18% and 21% by the Phoenix and ASTRO consensus definitions, respectively. Conclusion: Biochemical control for this treatment seems durable with 8 years of follow-up and is similar to high-dose external beam radiation alone or brachytherapy alone. Late toxicity in this multi-institutional trial is higher than reports from similar cohorts of patients treated with high-dose external-beam radiation alone or permanent low-doserate brachytherapy alone, perhaps suggesting further attention to strategies that limit doses to normal structures or to unimodal radiotherapy techniques.

Lawton, Colleen A., E-mail: clawton@mcw.edu [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Yan, Yan [Radiation Therapy Oncology Group Statistical Center, Philadelphia, PA (United States); Lee, W. Robert [Department of Radiation Oncology, Duke University School of Medicine, Durham, NC (United States); Gillin, Michael [Department of Radiation Oncology, MD Anderson Cancer Center, University of Texas MD Anderson Cancer Center, Houston, TX (United States); Firat, Selim [Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI (United States); Baikadi, Madhava [Department of Radiation Oncology, Northeast Radiation Oncology Center, Scranton, PA (United States); Crook, Juanita [Department of Radiation Oncology, University of British Columbia, Kelowna, BC (Canada); Kuettel, Michael [Department of Radiation Medicine, Roswell Park Cancer Institute, Buffalo, NY (United States); Morton, Gerald [Department of Radiation Oncology, Toronto-Sunnybrook Regional Cancer Center, Toronto, ON (Canada); Sandler, Howard [Department of Radiation Oncology, Cedars-Sinai Medical Center, Los Angeles, CA (United States)

2012-04-01

105

[Usefulness of urethral endoprosthesis in the management of urinary retention after brachytherapy for localized prostate cancer].  

PubMed

Brachytherapy is a possible treatment for localized low risk prostate cancer. Although this option is minimally invasive, some side effects may occur. Acute retention of urine (ARU) has been observed in 5% to 22% of cases and can be prevented in most cases by alpha-blocker treatment. Several alternatives have been reported in the literature for the management of ARU following brachytherapy: prolonged suprapubic catheterization, transurethral resection of the prostate and also intermittent self-catheterization. The authors report an original endoscopic approach, using urethral endoprosthesis, with a satisfactory voiding status. PMID:24560204

Kerkeni, W; Chahwan, C; Lenormand, C; Dubray, B; Benyoucef, A; Pfister, C

2014-03-01

106

Focal low-dose rate brachytherapy for the treatment of prostate cancer  

PubMed Central

Whole-gland low-dose rate (LDR) brachytherapy has been a well-established modality of treating low-risk prostate cancer. Treatment in a focal manner has the advantages of reduced toxicity to surrounding organs. Focal treatment using LDR brachytherapy has been relatively unexplored, but it may offer advantages over other modalities that have established experiences with a focal approach. This is particularly true as prostate cancer is being detected at an earlier and more localized stage with the advent of better detection methods and newer imaging modalities.

Tong, William Y; Cohen, Gilad; Yamada, Yoshiya

2013-01-01

107

Contrast-enhanced ultrasound as support for prostate brachytherapy treatment planning  

PubMed Central

Purpose To investigate the possibility of localization of intraprostatic lesions (IL) with contrast-enhanced ultrasound (CEUS) to support the brachytherapy treatment planning of temporary implants. Material and methods Two brachytherapy treatment plans were generated for 8 patients treated with external beam radiotherapy and pulsed-dose rate brachytherapy boost for prostate cancer. The first and second brachytherapy treatment plan was without and with knowledge of the localization of the ILs, respectively. Pairwise comparison was performed on prostate, rectum, and urethra dose-volume parameters and total reference air kerma (TRAK)-values. Results Coverage of the ILs by the 140% isodose was increased from mean 66.0-67.7% for the standard plan to mean 92.5-95.7% for the adapted plan. The mean D90 of the ILs increased from 1.49-1.57 Gy/pulse to 1.76-1.81 Gy/pulse. Dose-volume parameters for the prostate, rectum, and urethra and the TRAK did not change. Conclusions CEUS technique is a promising method for IL localization to aid in brachytherapy treatment planning. Dose coverage on the IL could be improved without any increase of dose in organs at risk.

Wijkstra, Hessel; van Herk, Marcel; Kuipers, Ruud; Kaljouw, Emmie; de la Rosette, Jean; Koning, Caro

2012-01-01

108

Reduction of radioactive seed embolization to the lung following prostate brachytherapy  

Microsoft Academic Search

Purpose:Ultrasound-guided interstitial implantation of radioactive seeds is a common treatment for early stage prostate cancer.One of the risks associated with this therapy is seed embolization to the lung.This paper reports on the incidence and possible adverse effects of seed migration.Methods and Materials:Two hundred ninety consecutive patients were treated with permanent radioactive seed brachytherapy for prostate cancer between January 1 and

Elizabeth M Tapen; John C Blasko; Peter D Grimm; Haakon Ragde; Ray Luse; Stephanie Clifford; John Sylvester; Thomas W Griffin

1998-01-01

109

Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method  

Microsoft Academic Search

Purpose: To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity.Methods and Materials: One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for

Song K Kang; Rachel H Chou; Richard K Dodge; Robert W Clough; Hi-Sung L Kang; M. Gray Bowen; Beverly A Steffey; Shiva K Das; Su-Min Zhou; Arthur W Whitehurst; Niall J Buckley; Jay H Kim; Raymond E Joyner; Ignacio Sarmina; Gustavo S Montana; Sally S Ingram; Mitchell S Anscher

2001-01-01

110

Long-term outcome of high dose rate brachytherapy in radiotherapy of localised prostate cancer  

Microsoft Academic Search

Background and purposeHigh dose rate brachytherapy (HDR-BT) in prostate cancer (PC) is receiving increasing interest. The steep dose gradient gives a possibility to escalate the dose to the prostate. If the ?\\/? ratio is low for PC, hypofractionation will be of advantage. A retrospective analysis of outcome in patients (pts) consecutively treated with combined HDR-BT and conformal external beam radiotherapy

Lennart Åström; Dorte Pedersen; Claes Mercke; Sten Holmäng; Karl Axel Johansson

2005-01-01

111

A gEUD-based inverse planning technique for HDR prostate brachytherapy: Feasibility study  

SciTech Connect

Purpose: The purpose of this work was to study the feasibility of a new inverse planning technique based on the generalized equivalent uniform dose for image-guided high dose rate (HDR) prostate cancer brachytherapy in comparison to conventional dose-volume based optimization. Methods: The quality of 12 clinical HDR brachytherapy implants for prostate utilizing HIPO (Hybrid Inverse Planning Optimization) is compared with alternative plans, which were produced through inverse planning using the generalized equivalent uniform dose (gEUD). All the common dose-volume indices for the prostate and the organs at risk were considered together with radiobiological measures. The clinical effectiveness of the different dose distributions was investigated by comparing dose volume histogram and gEUD evaluators. Results: Our results demonstrate the feasibility of gEUD-based inverse planning in HDR brachytherapy implants for prostate. A statistically significant decrease in D{sub 10} or/and final gEUD values for the organs at risk (urethra, bladder, and rectum) was found while improving dose homogeneity or dose conformity of the target volume. Conclusions: Following the promising results of gEUD-based optimization in intensity modulated radiation therapy treatment optimization, as reported in the literature, the implementation of a similar model in HDR brachytherapy treatment plan optimization is suggested by this study. The potential of improved sparing of organs at risk was shown for various gEUD-based optimization parameter protocols, which indicates the ability of this method to adapt to the user's preferences.

Giantsoudi, D. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78229 (United States); Department of Radiation Oncology, Francis H. Burr Proton Therapy Center, Boston, Massachusetts 02114 (United States); Baltas, D. [Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach GmbH, 63069 Offenbach (Germany); Nuclear and Particle Physics Section, Physics Department, University of Athens, 15701 Athens (Greece); Karabis, A. [Pi-Medical Ltd., Athens 10676 (Greece); Mavroidis, P. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78299 and Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University, 17176 (Sweden); Zamboglou, N.; Tselis, N. [Strahlenklinik, Klinikum Offenbach GmbH, 63069 Offenbach (Germany); Shi, C. [St. Vincent's Medical Center, 2800 Main Street, Bridgeport, Connecticut 06606 (United States); Papanikolaou, N. [Department of Radiological Sciences, University of Texas Health Sciences Center, San Antonio, Texas 78299 (United States)

2013-04-15

112

Development of a patient-reported questionnaire for collecting toxicity data following prostate brachytherapy  

Microsoft Academic Search

PurposeTo improve a questionnaire used to collect patient-reported outcomes from patients with early stage prostate cancer treated with brachytherapy. A secondary aim was to adapt the Late Effects of Normal Tissue (LENT) subjective toxicity questionnaire for use to collect Common Terminology Criteria for Adverse Events (CTCAE) data, the current preferred platform for assessing radiation toxicity.

Damian J. J. Farnell; Paula Mandall; Carmel Anandadas; Jaqueline Routledge; Meriel P. Burns; John P. Logue; James P. Wylie; Ric Swindell; Jac Livsey; Catharine M. L. West; Susan E. Davidson

2010-01-01

113

Microscopic energy absorption in the colloid of thyroid follicles from Auger electrons of iodine-125.  

PubMed

In this study the microscopic energy absorption from Auger electrons of iodine-125 in colloid of two different thyroid models, which represent the normal and thyrotoxic thyroid glands, was theoretically calculated. These calculations were based on the method recently given by Unak (1987; Nucl. Intrum. Meth. Phys. Res. A255, 274) and the Auger electron spectrum given by Charlton and Booz (1981; Radiat. Res. 87, 10). Subsequently the range of highest energy Auger electrons of iodine-125 in thyroidal colloid was found to be about 72 microns. This range is considerably shorter than the radius of a normal thyroid follicle, about 150 microns, but is considerably longer than the 25 microns radius of a thyrotoxic thyroid follicle. On the other hand, the comparison of dose distributions in two different thyroid models showed that the similar activity of iodine-125 per gram of thyroid tissue is able to produce more radiotoxic effects on the thyrotoxic follicular cells. PMID:1647384

Unak, T; Unak, P

1991-01-01

114

Determination of the prescription dose for biradionuclide permanent prostate brachytherapy  

SciTech Connect

A model based on the linear quadratic model that has been corrected for repopulation, sublethal cell damage repair, and RBE effect has been used to determine the prescription dose for prostate permanent brachytherapy using seeds loaded with a mixture of {sup 103}Pd and {sup 125}I or a mixture of {sup 103}Pd and {sup 131}Cs. The prescription dose was determined by comparing the tumor cell survival fractions between the considered biradionuclide seed implant and one monoradionuclide seed implant chosen from {sup 103}Pd, {sup 125}I, and {sup 131}Cs. Prostate edema is included in the model. The influence of the value of the radiobiological parameters and RBE were also investigated. Two mixtures of radionuclides were considered: {sup 103}Pd{sub 0.75}-{sup 125}I{sub 0.25} and {sup 103}Pd{sub 0.25}-{sup 131}Cs{sub 0.75}, where the subscripts indicate the fractions of total initial internal activity in the biradionuclide seed. These fractions were selected in order to obtain a dose distribution that lies between that of {sup 103}Pd and {sup 125}I/{sup 131}Cs. As expected, the computed prescription dose values are dependent on the model parameters (edema half-life and magnitude, radiobiogical parameters, and RBE). The radionuclide used as a benchmark also has a strong impact on the derived prescribed dose. The large uncertainties in the radiobiological parameters and RBE values produce big errors in the computed prescribed dose. Averaged over the range of all the parameters and depending on the radionuclide used as a benchmark (in subscript), the derived prescription dose for the first mixture (PdI) would be: D{sub Pd}{sup PdI}=142{sub -16}{sup +15} Gy and D{sub I}{sup PdI}=142{sub -8}{sup +6} Gy; and D{sub Pd}{sup PdCs}=128{sub -13}{sup +13} Gy and D{sub Cs}{sup PdCs}=115{sub -7}{sup +6} Gy for the PdCs mixture. The uncertainties could be reduced if the radiobiological parameters and RBE value were known more accurately. However, as edema characteristics are patient dependent and can be obtained only after the treatment, an unpredictable error is unavoidable.

Nuttens, V. E.; Lucas, S. [Laboratoire d'Analyses par Reactions Nucleaires, Physics Department, LARN Lab, University of Namur (FUNDP), Rue de Bruxelles, 61, B-5000 Namur (Belgium)

2008-12-15

115

Updated Results of Magnetic Resonance Imaging Guided Partial Prostate Brachytherapy for Favorable Risk Prostate Cancer: Implications for Focal Therapy  

PubMed Central

Purpose We report updated results of magnetic resonance imaging guided partial prostate brachytherapy and propose a definition of biochemical failure following focal therapy. Materials and Methods From 1997 to 2007, 318 men with cT1c, prostate specific antigen less than 15 ng/ml, Gleason 3 + 4 or less prostate cancer received magnetic resonance imaging guided brachytherapy in which only the peripheral zone was targeted. To exclude benign prostate specific antigen increases due to prostatic hyperplasia, we investigated the usefulness of defining prostate specific antigen failure as nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. Cox regression was used to determine the factors associated with prostate specific antigen failure. Results Median followup was 5.1 years (maximum 12.1). While 36 patients met the nadir +2 criteria, 16 of 17 biopsy proven local recurrences were among the 26 men who also had a prostate specific antigen velocity greater than 0.75 ng/ml per year (16 of 26 vs 1 of 10, p = 0.008). Using the nadir +2 definition, prostate specific antigen failure-free survival for low risk cases at 5 and 8 years was 95.1% (91.0–97.3) and 80.4% (70.7–87.1), respectively. This rate improved to 95.6% (91.6–97.7) and 90.0% (82.6–94.3) using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. For intermediate risk cases survival was 73.0% (55.0–84.8) at 5 years and 66.4% (44.8–81.1) at 8 years (the same values as using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year). Conclusions Requiring a prostate specific antigen velocity greater than 0.75 ng/ml per year in addition to nadir +2 appears to better predict clinical failure after therapies that target less than the whole gland. Further followup will determine whether magnetic resonance imaging guided brachytherapy targeting the peripheral zone produces comparable cancer control to whole gland treatment in men with low risk disease. However, at this time it does not appear adequate for men with even favorable intermediate risk disease.

Nguyen, Paul L.; Chen, Ming-Hui; Zhang, Yuanye; Tempany, Clare M.; Cormack, Robert A.; Beard, Clair J.; Hurwitz, Mark D.; Suh, W. Warren; D'Amico, Anthony V.

2013-01-01

116

A dosimetric comparison of {sup 169}Yb versus {sup 192}Ir for HDR prostate brachytherapy  

SciTech Connect

For the purpose of evaluating the use of {sup 169}Yb for prostate High Dose Rate brachytherapy (HDR), a hypothetical {sup 169}Yb source is assumed with the exact same design of the new microSelectron source replacing the {sup 192}Ir active core by pure {sup 169}Yb metal. Monte Carlo simulation is employed for the full dosimetric characterization of both sources and results are compared following the AAPM TG-43 dosimetric formalism. Monte Carlo calculated dosimetry results are incorporated in a commercially available treatment planning system (SWIFT{sup TM}), which features an inverse treatment planning option based on a multiobjective dose optimization engine. The quality of prostate HDR brachytherapy using the real {sup 192}Ir and hypothetical {sup 169}Yb source is compared in a comprehensive analysis of different prostate implants in terms of the multiobjective dose optimization solutions as well as treatment quality indices such as Dose Volume Histograms (DVH) and the Conformal Index (COIN). Given that scattering overcompensates for absorption in intermediate photon energies and distances in the range of interest to prostate HDR brachytherapy, {sup 169}Yb proves at least equivalent to {sup 192}Ir irrespective of prostate volume. This has to be evaluated in view of the shielding requirements for the {sup 169}Yb energies that are minimal relative to that for {sup 192}Ir.

Lymperopoulou, G.; Papagiannis, P.; Sakelliou, L.; Milickovic, N.; Giannouli, S.; Baltas, D. [Nuclear and Particle Physics Section, Physics Department, University of Athens, Panepistimioupolis, Ilisia, 157 71 Athens (Greece); Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach, 63069 Offenbach (Germany); Pi-Medical Ltd., Research and Development Dept., Gennimata 2 Str., 115 24, Ampelokipoi, Athens (Greece); Department of Medical Physics and Engineering, Strahlenklinik, Klinikum Offenbach, 63069 Offenbach (Germany) and Nuclear and Particle Physics Section, Physics Department, University of Athens, Panepistimioupolis, Ilisia, 157 71 Athens (Greece)

2005-12-15

117

The emerging role of high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer.  

PubMed

High-dose-rate (HDR) brachytherapy as monotherapy is a comparatively new brachytherapy procedure for prostate cancer. In addition to the intrinsic advantages of brachytherapy, including radiation dose concentration to the tumor and rapid dose fall-off at the surrounding normal tissue, HDR brachytherapy can yield a more homogeneous and conformal dose distribution through image-based decisions for source dwell positions and by optimization of individual source dwell times. Indication can be extended even to T3a/b or a part of T4 tumors because the applicators can be positioned at the extracapsular lesion, into the seminal vesicles, and/or into the bladder, without any risk of source migration or dropping out. Unlike external beam radiotherapy, with HDR brachytherapy inter-/intra-fraction organ motion is not problematic. However, HDR monotherapy requires patients to stay in bed for 1-4 days during hospitalization, even though the actual overall treatment time is short. Recent findings that the ?/? value for prostate cancer is less than that for the surrounding late-responding normal tissue has made hypofractionation attractive, and HDR monotherapy can maximize this advantage of hypofractionation. Research on HDR monotherapy is accelerating, with a growing number of publications reporting excellent preliminary clinical results due to the high 'biologically effective dose (BED)' of >200 Gy. Moreover, the findings obtained for HDR monotherapy as an early model of extreme hypofractionation tend to be applied to other radiotherapy techniques such as stereotactic radiotherapy. All these developments point to the emerging role of HDR brachytherapy as monotherapy for prostate cancer. PMID:23543798

Yoshioka, Yasuo; Yoshida, Ken; Yamazaki, Hideya; Nonomura, Norio; Ogawa, Kazuhiko

2013-09-01

118

The Use of a Memokath Prostatic Stent for Obstructive Voiding Symptoms after Brachytherapy  

PubMed Central

Introduction Brachytherapy may be complicated by serious obstructive voiding symptoms (OVS). Only conservative treatment options are available in the first 6 months after brachytherapy. We evaluated safety, efficacy and patient tolerance of the Memokath prostatic stent (MPS). Material and Methods A MPS was placed in 10 patients with OVS after brachytherapy. Evaluation included uroflowmetry, international prostate symptom score (IPSS), prostate volume and urethrocystoscopy before and 3 months after placement of the stent. Results Both the IPSS and uroflowmetry results significantly improved after stent insertion. The mean IPSS decreased from 29/5 to 11/1 and the mean Qmax from the uroflowmetry improved from 4.7 to 11.2 ml/s. The 5 patients who were catheter dependent voided spontaneously with a mean Qmax of 15 ml/s. Two stents migrated towards the bladder, and those patients needed a second stent which was placed without complications. Removal of the stent was easy to perform. Adverse effects were minor with perineal pain and irritative voiding symptoms occurring in 5 patients mainly in the first weeks after insertion. This did not negatively influence quality of life and all patients were more satisfied with the stent than without. Conclusions The MPS provides a safe, effective, and completely reversible treatment for patients with OVS after brachytherapy and was well tolerated.

de Graaf, G.W.; Stijns, P.E.F.; Scheepens, W.A.; van Moorselaar, R.J.A.; Hendrikx, A.J.M.

2013-01-01

119

Does prior transurethral resection of prostate compromise brachytherapy quality: A dosimetric analysis  

SciTech Connect

Purpose: To evaluate, in a retrospective review, prostate brachytherapy dosimetry outcomes relative to the transurethral resection of the prostate (TURP) cavity size to address the theoretical concern that an intraprostatic cavity may hinder adequate radioactive source placement. Methods and materials: A total of 73 patients who underwent prostate brachytherapy as part of their treatment of localized prostate cancer had a history of a prior TURP. Of these 73 patients, 37 underwent {sup 125}I implantation, 19 {sup 103}Pd implantation, and 17 partial {sup 103}Pd implantation. The dose was calculated using the dose to 90% of the prostate gland (D{sub 90}) from the 1-month post-implant dosimetric analysis. The doses were normalized relative to 100% of the prescription dose. Archived transrectal ultrasound images were used to determine the maximal length and width of the visible residual TURP cavities. The prolate spheroid or symmetric egg shape was used to calculate each residual cavity volume. The derived volume of the TURP cavity was divided by the measured ultrasound volume of the prostate at brachytherapy, creating a percentage of volume measurement for each prostate. All p values, unless otherwise specified, were generated by comparing patients without a visible TURP defect with the subgroups of patients with a visible defect using the Student t test. Results: A visible residual TURP defect was noted on the operative transrectal ultrasound images of 55 (75%) of the 73 patients with a history of TURP before brachytherapy. The 18 patients without a visible TURP defect had a median D{sub 90} of 96% and were used for subsequent statistical comparison. Thirty-six patients with a TURP defect <10% of the entire prostate volume had a median D{sub 90} of 109% (p = 0.02). Thirteen patients with a TURP defect between 10% and 20% of the prostate volume had a median D{sub 90} of 112% (p = 0.03). Six patients with a TURP defect >20% of the prostate volume had a D{sub 90} of 89% (p = 0.43). Conclusion: A visible residual TURP cavity that is assumed to have a prolate spheroid shape and occupy {>=}10% of a prostate volume did not appear to be a statistically significant hindrance to proper dosimetric outcome.

Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)]. E-mail: Jamie.Cesaretti@msnyuhealth.org; Stone, Nelson N. [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

2004-10-01

120

Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy  

PubMed Central

Chondrosarcomas are uncommon in the spinal column. En bloc excisions with wide margins are of critical importance but not always feasible in spine. We report the outcome in a case of recurrent lumbar vertebral chondrosarcoma treated with marginal resection and iodine-125 seeds placed in the resected tumor bed.

Ren, Chunpeng; Zeng, Jiancheng; Song, Yueming; Wang, Xiandi

2014-01-01

121

Recurrent primary lumbar vertebra chondrosarcoma: Marginal resection and Iodine-125 seed therapy.  

PubMed

Chondrosarcomas are uncommon in the spinal column. En bloc excisions with wide margins are of critical importance but not always feasible in spine. We report the outcome in a case of recurrent lumbar vertebral chondrosarcoma treated with marginal resection and iodine-125 seeds placed in the resected tumor bed. PMID:24741146

Ren, Chunpeng; Zeng, Jiancheng; Song, Yueming; Wang, Xiandi

2014-03-01

122

A new CT prostate segmentation for CT-based HDR brachytherapy  

NASA Astrophysics Data System (ADS)

High-dose-rate (HDR) brachytherapy has become a popular treatment modality for localized prostate cancer. Prostate HDR treatment involves placing 10 to 20 catheters (needles) into the prostate gland, and then delivering radiation dose to the cancerous regions through these catheters. These catheters are often inserted with transrectal ultrasound (TRUS) guidance and the HDR treatment plan is based on the CT images. The main challenge for CT-based HDR planning is to accurately segment prostate volume in CT images due to the poor soft tissue contrast and additional artifacts introduced by the catheters. To overcome these limitations, we propose a novel approach to segment the prostate in CT images through TRUS-CT deformable registration based on the catheter locations. In this approach, the HDR catheters are reconstructed from the intra-operative TRUS and planning CT images, and then used as landmarks for the TRUS-CT image registration. The prostate contour generated from the TRUS images captured during the ultrasound-guided HDR procedure was used to segment the prostate on the CT images through deformable registration. We conducted two studies. A prostate-phantom study demonstrated a submillimeter accuracy of our method. A pilot study of 5 prostate-cancer patients was conducted to further test its clinical feasibility. All patients had 3 gold markers implanted in the prostate that were used to evaluate the registration accuracy, as well as previous diagnostic MR images that were used as the gold standard to assess the prostate segmentation. For the 5 patients, the mean gold-marker displacement was 1.2 mm; the prostate volume difference between our approach and the MRI was 7.2%, and the Dice volume overlap was over 91%. Our proposed method could improve prostate delineation, enable accurate dose planning and delivery, and potentially enhance prostate HDR treatment outcome.

Yang, Xiaofeng; Rossi, Peter; Ogunleye, Tomi; Jani, Ashesh B.; Curran, Walter J.; Liu, Tian

2014-03-01

123

Recommendations for the treatment of localized prostate cancer by permanent interstitial brachytherapy.  

PubMed

The increasing use of interstitial brachytherapy for the treatment of prostate cancer has made it necessary to discuss and establish guidelines for the application of this treatment modality. A group of experts representing the four professional and scientific societies of urologic surgeons and radiation oncologists in Germany was formed by the German Society of Urology (Deutsche Gesellschaft für Urologie, DGU), the Association of German Urologists (Berufsverband der Deutschen Urologen e.V., BDU), the German Society for Radiation Oncology (Deutsche Gesellschaft für Radioonkologie, DEGRO) and the Association of German Radiotherapists (Berufsverband der Deutschen Strahlentherapeuten, BVDSt). This group has formulated a consensus statement consisting of recommendations and guidelines for the indications, planning, implementation and follow-up of permanent interstitial brachytherapy by seed implantation for the treatment of localized prostate cancer. These recommendations also define the responsibilities of the two medical disciplines involved in the use of this interdisciplinary treatment. PMID:12566809

Hakenberg, O W; Wirth, M P; Hermann, T; Alken, P; Kovacs, G; Müller, R P; Ahlemann, L; Schalkhäuser, K

2003-01-01

124

Development of a Pneumatic Robot for MRI-guided Transperineal Prostate Biopsy and Brachytherapy: New Approaches.  

PubMed

Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in order to enhance the cancer detection and treatment. For the accurate needle positioning, a number of robotic assistants have been developed. However, problems exist due to the strong magnetic field and limited workspace. Pneumatically actuated robots have shown the minimum distraction in the environment but the confined workspace limits optimal robot design and thus controllability is often poor. To overcome the problem, a simple external damping mechanism using timing belts was sought and a 1-DOF mechanism test result indicated sufficient positioning accuracy. Based on the damping mechanism and modular system design approach, a new workspace-optimized 4-DOF parallel robot was developed for the MRI-guided prostate biopsy and brachytherapy. A preliminary evaluation of the robot was conducted using previously developed pneumatic controller and satisfying results were obtained. PMID:21399734

Song, Sang-Eun; Cho, Nathan B; Fischer, Gregory; Hata, Nobuhito; Tempany, Clare; Fichtinger, Gabor; Iordachita, Iulian

2010-07-15

125

Development of a Pneumatic Robot for MRI-guided Transperineal Prostate Biopsy and Brachytherapy: New Approaches  

PubMed Central

Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in order to enhance the cancer detection and treatment. For the accurate needle positioning, a number of robotic assistants have been developed. However, problems exist due to the strong magnetic field and limited workspace. Pneumatically actuated robots have shown the minimum distraction in the environment but the confined workspace limits optimal robot design and thus controllability is often poor. To overcome the problem, a simple external damping mechanism using timing belts was sought and a 1-DOF mechanism test result indicated sufficient positioning accuracy. Based on the damping mechanism and modular system design approach, a new workspace-optimized 4-DOF parallel robot was developed for the MRI-guided prostate biopsy and brachytherapy. A preliminary evaluation of the robot was conducted using previously developed pneumatic controller and satisfying results were obtained.

Song, Sang-Eun; Cho, Nathan B.; Fischer, Gregory; Hata, Nobuhito; Tempany, Clare; Fichtinger, Gabor; Iordachita, Iulian

2011-01-01

126

Seed Implant Retention Score Predicts the Risk of Prolonged Urinary Retention After Prostate Brachytherapy  

SciTech Connect

Purpose: To risk-stratify patients for urinary retention after prostate brachytherapy according to a novel seed implant retention score (SIRS). Patients and Methods: A total of 835 patients underwent transperineal prostate seed implant from March 1993 to January 2007; 197 patients had {sup 125}I and 638 patients had {sup 103}Pd brachytherapy. Four hundred ninety-four patients had supplemental external-beam radiation. The final downsized prostate volume was used for the 424 patients who had neoadjuvant hormone therapy. Retention was defined as reinsertion of a Foley catheter after the implant. Results: Retention developed in 7.4% of patients, with an average duration of 6.7 weeks. On univariate analysis, implant without supplemental external-beam radiation (10% vs. 5.6%; p = 0.02), neoadjuvant hormone therapy (9.4% vs. 5.4%; p = 0.02), baseline alpha-blocker use (12.5% vs. 6.3%; p = 0.008), and increased prostate volume (13.4% vs. 6.9% vs. 2.9%, >45 cm{sup 3}, 25-45 cm{sup 3}, <25 cm{sup 3}; p = 0.0008) were significantly correlated with increased rates of retention. On multivariate analysis, implant without supplemental external-beam radiation, neoadjuvant hormone therapy, baseline alpha-blocker use, and increased prostate volume were correlated with retention. A novel SIRS was modeled as the combined score of these factors, ranging from 0 to 5. There was a significant correlation between the SIRS and retention (p < 0.0001). The rates of retention were 0, 4%, 5.6%, 9%, 20.9%, and 36.4% for SIRS of 0 to 5, respectively. Conclusions: The SIRS may identify patients who are at high risk for prolonged retention after prostate brachytherapy. A prospective validation study of the SIRS is planned.

Lee, Hoon K., E-mail: Dr.Hoon@gmail.co [Regional Radiation Oncology, Staten Island, NY (United States); Department of Radiation Oncology, Richmond University Medical Center, Staten Island, NY (United States); Adams, Marc T. [Regional Radiation Oncology, Staten Island, NY (United States); Department of Radiation Oncology, Richmond University Medical Center, Staten Island, NY (United States); Shi, Qiuhu [Department of Biostatistics, School of Public Health, New York Medical School, Valhalla, NY (United States); Basillote, Jay; LaMonica, Joanne; Miranda, Luis; Motta, Joseph [Department of Urology, Richmond University Medical Center, Staten Island, NY (United States)

2010-04-15

127

A fully actuated robotic assistant for MRI-guided prostate biopsy and brachytherapy  

NASA Astrophysics Data System (ADS)

Intra-operative medical imaging enables incorporation of human experience and intelligence in a controlled, closed-loop fashion. Magnetic resonance imaging (MRI) is an ideal modality for surgical guidance of diagnostic and therapeutic procedures, with its ability to perform high resolution, real-time, high soft tissue contrast imaging without ionizing radiation. However, for most current image-guided approaches only static pre-operative images are accessible for guidance, which are unable to provide updated information during a surgical procedure. The high magnetic field, electrical interference, and limited access of closed-bore MRI render great challenges to developing robotic systems that can perform inside a diagnostic high-field MRI while obtaining interactively updated MR images. To overcome these limitations, we are developing a piezoelectrically actuated robotic assistant for actuated percutaneous prostate interventions under real-time MRI guidance. Utilizing a modular design, the system enables coherent and straight forward workflow for various percutaneous interventions, including prostate biopsy sampling and brachytherapy seed placement, using various needle driver configurations. The unified workflow compromises: 1) system hardware and software initialization, 2) fiducial frame registration, 3) target selection and motion planning, 4) moving to the target and performing the intervention (e.g. taking a biopsy sample) under live imaging, and 5) visualization and verification. Phantom experiments of prostate biopsy and brachytherapy were executed under MRI-guidance to evaluate the feasibility of the workflow. The robot successfully performed fully actuated biopsy sampling and delivery of simulated brachytherapy seeds under live MR imaging, as well as precise delivery of a prostate brachytherapy seed distribution with an RMS accuracy of 0.98mm.

Li, Gang; Su, Hao; Shang, Weijian; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Fischer, Gregory S.

2013-03-01

128

A Fully Actuated Robotic Assistant for MRI-Guided Prostate Biopsy and Brachytherapy  

PubMed Central

Intra-operative medical imaging enables incorporation of human experience and intelligence in a controlled, closed-loop fashion. Magnetic resonance imaging (MRI) is an ideal modality for surgical guidance of diagnostic and therapeutic procedures, with its ability to perform high resolution, real-time, high soft tissue contrast imaging without ionizing radiation. However, for most current image-guided approaches only static pre-operative images are accessible for guidance, which are unable to provide updated information during a surgical procedure. The high magnetic field, electrical interference, and limited access of closed-bore MRI render great challenges to developing robotic systems that can perform inside a diagnostic high-field MRI while obtaining interactively updated MR images. To overcome these limitations, we are developing a piezoelectrically actuated robotic assistant for actuated percutaneous prostate interventions under real-time MRI guidance. Utilizing a modular design, the system enables coherent and straight forward workflow for various percutaneous interventions, including prostate biopsy sampling and brachytherapy seed placement, using various needle driver configurations. The unified workflow compromises: 1) system hardware and software initialization, 2) fiducial frame registration, 3) target selection and motion planning, 4) moving to the target and performing the intervention (e.g. taking a biopsy sample) under live imaging, and 5) visualization and verification. Phantom experiments of prostate biopsy and brachytherapy were executed under MRI-guidance to evaluate the feasibility of the workflow. The robot successfully performed fully actuated biopsy sampling and delivery of simulated brachytherapy seeds under live MR imaging, as well as precise delivery of a prostate brachytherapy seed distribution with an RMS accuracy of 0.98mm.

Li, Gang; Su, Hao; Shang, Weijian; Tokuda, Junichi; Hata, Nobuhiko; Tempany, Clare M.; Fischer, Gregory S.

2014-01-01

129

An iterative sequential mixed-integer approach to automated prostate brachytherapy treatment plan optimization  

Microsoft Academic Search

Conventional treatment planning for interstitial prostate brachytherapy is generally a `trial and error' process in which improved treatment plans are generated by iteratively changing, via expert judgement, the configuration of sources within the target volume in order to achieve a satisfactory dose distribution. We have utilized linear mixed-integer programming (MIP) and the branch-and-bound method, a deterministic search algorithm, to generate

W. D. D'Souza; R. R. Meyer; B. R. Thomadsen; M. C. Ferris

2001-01-01

130

Optimization of Catheter Position and Dwell Time in Prostate HDR Brachytherapy using HIPO and Linear Programming  

Microsoft Academic Search

In this work the problem of determination of the optimal catheter position and source loading in HDR prostate brachytherapy\\u000a is modeled as a Mixed Integer Linear Programming (MILP) problem and solved by ILOG CPLEX. The results are compared to those\\u000a of HIPO, a state of the art inverse treatment plan optimization algorithm. Given that MILP is guaranteed to find the

A. Karabis; P. Belotti; D. Baltas

131

Prostate Brachytherapy Seed Reconstruction With Gaussian Blurring and Optimal Coverage Cost  

Microsoft Academic Search

Intraoperative dosimetry in prostate brachytherapy requires localization of the implanted radioactive seeds. A tomosynthesis-based seed reconstruction method is proposed. A three-dimensional volume is reconstructed from Gaussian-blurred projection images and candidate seed locations are computed from the reconstructed volume. A false positive seed removal process, formulated as an optimal coverage problem, iteratively removes ldquoghostrdquo seeds that are created by tomosynthesis reconstruction.

Junghoon Lee; Xiaofeng Liu; Ameet K. Jain; Danny Y. Song; Everette Clif Burdette; Jerry L. Prince; Gabor Fichtinger

2009-01-01

132

Workflow modeling and analysis of computer guided prostate brachytherapy under MR imaging control.  

PubMed

We demonstrate that classical Business Process Reengineering (BPR) methods can be successfully applied to Computer Aided Surgery while increasing safety and efficiency of the overall procedure through an integrated Workflow Management System. Computer guided Prostate Brachytherapy, as a sophisticated treatment by an interdisciplinary team, is perfectly suited to apply our method. Detailed suggestions for improvement of the whole procedure could be derived by our modified BPR method. PMID:15544246

Dickhaus, Christoph F; Burghart, Catherina; Tempany, Clare; D'Amico, Anthony; Haker, Steven; Kikinis, Ron; Woern, Heinz

2004-01-01

133

Image-based high dose rate (HDR) brachytherapy for prostate cancer  

NASA Astrophysics Data System (ADS)

The passage from conventional radiographic film-based to image-based HDR brachytherapy for prostate cancer has significantly improved our ability to define the targets and organs at risk (OAR). 3D anatomical information are obtained from Computed Tomography (CT) or Magnetic Resonance Imaging (MRI), and cancer areas are validated using functional imaging with magnetic resonance spectroscopy imaging (MRSI). Together with inverse planning optimization, image-based HDR brachytherapy can deliver a highly conformal dose distribution to the target while sparing OAR. However, uncertainties inherent to the use of the new imaging modalities may impact on the dose distribution. In this work, we have selected the major uncertainties and studied their impact within the context of the clinical procedures of ultrasound guided HDR prostate brachytherapy delivered in two fractions. The feasibility of using functional imaging to guide the delivery of higher dose to dominant intra-prostatic lesions (DIL) within the prostate was also investigated. The average cranio-caudal displacement of catheters between fractions was 2.7 mm and 5.4 mm for bony anatomy and gold seed marker measurement, respectively. Either increase or reduction of prostate volume was observed with an average of 7.8% and a maximum of 17% between fractions, resulting in minimal dose changes. The dose uncertainty due to the planning CT slice thickness showed a relative error of 1% on average for current 3 mm planning CT, independent of the transversal region of prostate. A retrospective study taking advantage of MRI/MRSI for the dose escalation of the DIL demonstrated that high dose areas could be redistributed to boost the DIL by 120% without any additional dose delivered to OAR compared to a reference plan. On average, the rigid endorectal probe was shown to rotate the prostate anteriorly by 20°, to expand it in the antero-posterior direction by 1.2 mm, and compress it in lateral direction with 1.5 mm. Finally, MRI scans with and without the probe could be registered with a 2 mm precision using translation only. The use of 3D anatomical and functional information combined with inverse planned HDR brachytherapy is a precise procedure for the treatment of localized prostate cancer with potential for dose escalation.

Kim, Yongbok

134

Fast prostate segmentation for brachytherapy based on joint fusion of images and labels  

NASA Astrophysics Data System (ADS)

Brachytherapy as one of the treatment methods for prostate cancer takes place by implantation of radioactive seeds inside the gland. The standard of care for this treatment procedure is to acquire transrectal ultrasound images of the prostate which are segmented in order to plan the appropriate seed placement. The segmentation process is usually performed either manually or semi-automatically and is associated with subjective errors because the prostate visibility is limited in ultrasound images. The current segmentation process also limits the possibility of intra-operative delineation of the prostate to perform real-time dosimetry. In this paper, we propose a computationally inexpensive and fully automatic segmentation approach that takes advantage of previously segmented images to form a joint space of images and their segmentations. We utilize joint Independent Component Analysis method to generate a model which is further employed to produce a probability map of the target segmentation. We evaluate this approach on the transrectal ultrasound volume images of 60 patients using a leave-one-out cross-validation approach. The results are compared with the manually segmented prostate contours that were used by clinicians to plan brachytherapy procedures. We show that the proposed approach is fast with comparable accuracy and precision to those found in previous studies on TRUS segmentation.

Nouranian, Saman; Ramezani, Mahdi; Mahdavi, S. Sara; Spadinger, Ingrid; Morris, William J.; Salcudean, Septimiu E.; Abolmaesumi, Purang

2014-03-01

135

Vibro-acoustography Imaging of Permanent Prostate Brachytherapy seeds in an excised human prostate -- Preliminary Results and Technical Feasibility  

PubMed Central

Objective The objective in this work is to investigate the feasibility of using a new imaging tool called vibro-acoustography (VA) as a means of permanent prostate brachytherapy (PPB) seed localization to facilitate post-implant dosimetry (PID). Methods and Materials Twelve OncoSeed (standard) and eleven EchoSeed (echogenic) dummy seeds were implanted in a human cadaver prostate. Seventeen seeds remained after radical retropubic prostatectomy. VA imaging was conducted on the prostate that was cast in a gel phantom and placed in a tank of degassed water. 2-D magnitude and phase VA image slices were obtained at different depths within the prostate showing location and orientation of the seeds. Results VA demonstrates that twelve of seventeen (71%) seeds implanted were visible in the VA image, and the remainder were obscured by intra-prostatic calcifications. Moreover, it is shown here that VA is capable of imaging and locating PPB seeds within the prostate independent of seed orientation, and the resulting images are speckle free. Conclusion The results presented in this research show that VA allows seed detection within a human prostate regardless of their orientation, as well as imaging intraprostatic calcifications.

Mitri, F.G.; Davis, B.J.; Urban, M.W.; Alizad, A.; Greenleaf, J.F.; Lischer, G.H.; Wilson, T.M.; Fatemi, M.

2009-01-01

136

Low-dose-rate or high-dose-rate brachytherapy in treatment of prostate cancer - between options  

PubMed Central

Purpose Permanent low-dose-rate (LDR-BT) and temporary high-dose-rate (HDR-BT) brachytherapy are competitive techniques for clinically localized prostate radiotherapy. Although a randomized trial will likely never to be conducted comparing these two forms of brachytherapy, a comparative analysis proves useful in understanding some of their intrinsic differences, several of which could be exploited to improve outcomes. The aim of this paper is to look for possible similarities and differences between both brachytherapy modalities. Indications and contraindications for monotherapy and for brachytherapy as a boost to external beam radiation therapy (EBRT) are presented. It is suggested that each of these techniques has attributes that advocates for one or the other. First, they represent the extreme ends of the spectrum with respect to dose rate and fractionation, and therefore have inherently different radiobiological properties. Low-dose-rate brachytherapy has the great advantage of being practically a one-time procedure, and enjoys a long-term follow-up database supporting its excellent outcomes and low morbidity. Low-dose-rate brachytherapy has been a gold standard for prostate brachytherapy in low risk patients since many years. On the other hand, HDR is a fairly invasive procedure requiring several sessions associated with a brief hospital stay. Although lacking in significant long-term data, it possesses the technical advantage of control over its postimplant dosimetry (by modulating the source dwell time and position), which is absent in LDR brachytherapy. This important difference in dosimetric control allows HDR doses to be escalated safely, a flexibility that does not exist for LDR brachytherapy. Conclusions Radiobiological models support the current clinical evidence for equivalent outcomes in localized prostate cancer with either LDR or HDR brachytherapy, using current dose regimens. At present, all available clinical data regarding these two techniques suggests that they are equally effective, stage for stage, in providing high tumor control rates.

2013-01-01

137

Postimplant analysis of transperineal interstitial permanent prostate brachytherapy: evidence for a learning curve in the first year at a single institution  

Microsoft Academic Search

Purpose: The utilization of transperineal interstitial permanent prostate brachytherapy (TIPPB) is increasing in the United States. Quality assessment of TIPPB is in its infancy, and to date, dosimetric analyses have only been reported from centers with a large experience in prostate brachytherapy. The purpose of this report is to critically analyze the dosimetric coverage achieved following TIPPB in the first

W. Robert Lee; Allan F deGuzman; Rick L Bare; Mark G Marshall; David L McCullough

2000-01-01

138

Feasibility of high-dose-rate brachytherapy salvage for local prostate cancer recurrence after radiotherapy: The University of California–San Francisco experience  

Microsoft Academic Search

Purpose: The aim of this study was to evaluate the feasibility and safety of salvage high-dose-rate (HDR) brachytherapy for locally recurrent prostate cancer after external beam radiotherapy (EBRT). Methods and Materials: We retrospectively analyzed 21 consecutively accrued patients undergoing salvage HDR brachytherapy for locally recurrent prostate cancer after EBRT between November 1998 and December 2005. After pathologic confirmation of locally

Brian Lee; Katsuto Shinohara; Vivian Weinberg; Alexander R. Gottschalk; Jean Pouliot; Mack Roach; I.-Chow. Hsu

2007-01-01

139

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer  

Microsoft Academic Search

Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced

Seth A. Rosenthal; Nathan H. J. Bittner; David C. Beyer; D. Jeffrey Demanes; Brian J. Goldsmith; Eric M. Horwitz; Geoffrey S. Ibbott; W. Robert Lee; Subir Nag; W. Warren Suh; Louis Potters

2011-01-01

140

Acute Urinary Retention After I-125 Prostate Brachytherapy in Relation to Dose in Different Regions of the Prostate  

SciTech Connect

Purpose: To assess the influence of dose in different prostate regions, and the influence of anatomic variation on the risk of acute urinary retention (AUR) after I-125 prostate brachytherapy. Methods and Materials: In this case-control study, dosimetry and anatomy were compared between 50 patients with AUR (cases) and 50 patients without AUR (controls). Cases and controls were randomly selected from our database. The following structures were delineated on magnetic resonance imaging: prostate, urethra, peripheral zone, transitional zone, apex, base, midprostate, lower sphincter, and bladder neck. The dosimetric parameters analyzed were D{sub 10}, D{sub 50}, D{sub 90}, V{sub 100}, V{sub 150}, and V{sub 200}. The anatomic parameters analyzed were prostate protrusion into the bladder, bladder overlap, urethra angle, and urethra-bladder angle. The delineator was blinded to the patient's AUR status. Logistic regression analysis was used to investigate the association of these factors with AUR. Results: The dose delivered to different regions of the prostate was not significantly associated with the risk of AUR. Only dose to the bladder neck was significantly associated with AUR (odds ratio 1.13 per 10 Gy; 95% CI 1.02;1.26; p = 0.023). Mean bladder neck D{sub 90} was 65 Gy in AUR cases vs. 56 Gy in controls (p = 0.016), and mean bladder neck D{sub 10} was 128 Gy vs. 107 Gy, respectively (p = 0.018). Furthermore, on univariate analysis, a larger extent of both bladder overlap and of prostate protrusion were associated with a higher risk of AUR (odds ratio 1.16; 95% CI 1.04-1.28; p = 0.005, and odds ratio 1.83; 95% CI 1.37-2.45; p < 0.001, respectively). The mean extent of prostate protrusion was 3.5 mm in AUR cases vs. 1.0 mm in controls (p < 0.001). Odds ratios did not change substantially after adjustment for potential confounders. On multivariate analysis, the extent of prostate protrusion seemed to be a stronger risk factor for AUR than bladder overlap. Conclusion: The risk of AUR is not associated with dose delivered to different regions of the prostate. However, a higher dose to the bladder neck and a larger extent of prostate protrusion into the bladder are risk factors for the development of AUR after I-125 prostate brachytherapy.

Roeloffzen, Ellen M.A., E-mail: e.m.a.roeloffzen@umcutrecht.n [Department of Radiation Oncology, University Medical Center Utrecht (Netherlands); Monninkhof, Evelyn M. [Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht (Netherlands); Battermann, Jan J. [Department of Radiation Oncology, University Medical Center Utrecht (Netherlands); Roermund, Joep G.H. van [Department of Urology, University Medical Center Utrecht (Netherlands); Moerland, Marinus A.; Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht (Netherlands)

2011-05-01

141

There Is No Correlation Between Erectile Dysfunction and Dose to Penile Bulb and Neurovascular Bundles Following Real-Time Low-Dose-Rate Prostate Brachytherapy  

Microsoft Academic Search

Purpose: We evaluated the relationship between the onset of erectile dysfunction and dose to the penile bulb and neurovascular bundles (NVBs) after real-time ultrasound-guided prostate brachytherapy. Methods and Materials: One hundred forty-seven patients who underwent prostate brachytherapy met the following eligibility criteria: (1) treatment with ¹²I brachytherapy to a prescribed dose of 160 Gy with or without hormones without supplemental

Amy N. Solan; Jamie A. Cesaretti; Nelson N. Stone; Richard G. Stock

2009-01-01

142

Short-lag spatial coherence beamforming of photoacoustic images for enhanced visualization of prostate brachytherapy seeds.  

PubMed

Prostate brachytherapy, administered by implanting tiny radioactive seeds to treat prostate cancer, currently relies on transrectal ultrasound imaging for intraoperative visualization of the metallic seeds. Photoacoustic (PA) imaging has been suggested as a feasible alternative to ultrasound imaging due to its superior sensitivity to metal surrounded by tissue. However, PA images suffer from poor contrast when seeds are distant from the light source. We propose a transperineal light delivery method and investigate the application of a short-lag spatial coherence (SLSC) beamformer to enhance low-contrast photoacoustic signals that are distant from this type of light source. Performance is compared to a conventional delay-and-sum beamformer. A pure gelatin phantom was implanted with black ink-coated brachytherapy seeds and the mean contrast was improved by 3-25 dB with the SLSC beamformer for fiber-seed distances ranging 0.6-6.3 cm, when approximately 10% of the receive aperture elements were included in the short-lag sum. For fiber-seed distances greater than 3-4 cm, the mean contrast-to-noise ratio (CNR) was approximately doubled with the SLSC beamformer, while mean signal-to-noise ratios (SNR) were mostly similar with both beamformers. Lateral resolution was decreased by 2 mm, but improved with larger short-lag values at the expense of poorer CNR and SNR. Similar contrast and CNR improvements were achieved with an uncoated brachytherapy seed implanted in ex vivo tissue. Results indicate that the SLSC beamformer has potential to enhance the visualization of prostate brachytherapy seeds that are distant from the light source. PMID:24156057

Lediju Bell, Muyinatu A; Kuo, Nathanael; Song, Danny Y; Boctor, Emad M

2013-01-01

143

Short-lag spatial coherence beamforming of photoacoustic images for enhanced visualization of prostate brachytherapy seeds  

PubMed Central

Prostate brachytherapy, administered by implanting tiny radioactive seeds to treat prostate cancer, currently relies on transrectal ultrasound imaging for intraoperative visualization of the metallic seeds. Photoacoustic (PA) imaging has been suggested as a feasible alternative to ultrasound imaging due to its superior sensitivity to metal surrounded by tissue. However, PA images suffer from poor contrast when seeds are distant from the light source. We propose a transperineal light delivery method and investigate the application of a short-lag spatial coherence (SLSC) beamformer to enhance low-contrast photoacoustic signals that are distant from this type of light source. Performance is compared to a conventional delay-and-sum beamformer. A pure gelatin phantom was implanted with black ink-coated brachytherapy seeds and the mean contrast was improved by 3–25 dB with the SLSC beamformer for fiber-seed distances ranging 0.6–6.3 cm, when approximately 10% of the receive aperture elements were included in the short-lag sum. For fiber-seed distances greater than 3–4 cm, the mean contrast-to-noise ratio (CNR) was approximately doubled with the SLSC beamformer, while mean signal-to-noise ratios (SNR) were mostly similar with both beamformers. Lateral resolution was decreased by 2 mm, but improved with larger short-lag values at the expense of poorer CNR and SNR. Similar contrast and CNR improvements were achieved with an uncoated brachytherapy seed implanted in ex vivo tissue. Results indicate that the SLSC beamformer has potential to enhance the visualization of prostate brachytherapy seeds that are distant from the light source.

Lediju Bell, Muyinatu A.; Kuo, Nathanael; Song, Danny Y.; Boctor, Emad M.

2013-01-01

144

Interactive, multi-modality image registrations for combined MRI/MRSI-planned HDR prostate brachytherapy  

PubMed Central

Purpose This study presents the steps and criteria involved in the series of image registrations used clinically during the planning and dose delivery of focal high dose-rate (HDR) brachytherapy of the prostate. Material and methods Three imaging modalities – Magnetic Resonance Imaging (MRI), Magnetic Resonance Spectroscopic Imaging (MRSI), and Computed Tomography (CT) – were used at different steps during the process. MRSI is used for identification of dominant intraprosatic lesions (DIL). A series of rigid and nonrigid transformations were applied to the data to correct for endorectal-coil-induced deformations and for alignment with the planning CT. Mutual information was calculated as a morphing metric. An inverse planning optimization algorithm was applied to boost dose to the DIL while providing protection to the urethra, penile bulb, rectum, and bladder. Six prostate cancer patients were treated using this protocol. Results The morphing algorithm successfully modeled the probe-induced prostatic distortion. Mutual information calculated between the morphed images and images acquired without the endorectal probe showed a significant (p = 0.0071) increase to that calculated between the unmorphed images and images acquired without the endorectal probe. Both mutual information and visual inspection serve as effective diagnostics of image morphing. The entire procedure adds less than thirty minutes to the treatment planning. Conclusion This work demonstrates the utility of image transformations and registrations to HDR brachytherapy of prostate cancer.

Reed, Galen; Cunha, J. Adam; Noworolski, Susan; Kurhanewicz, John; Vigneron, Daniel; Hsu, I-Chow; Pouliot, Jean

2012-01-01

145

A comprehensive review of CT-based dosimetry parameters and biochemical control in patients treated with permanent prostate brachytherapy  

Microsoft Academic Search

Purpose: The American Brachytherapy Society recommends that postprostate implant dosimetry be performed on all patients undergoing transperineal interstitial permanent prostate brachytherapy (TIPPB) utilizing CT scan clinical target volume reconstructions. This study was undertaken to assess the recommended dosimetry parameters from a large cohort of patients undergoing TIPPB that would predict for PSA relapse-free survival (PSA-RFS).Methods and Materials: Seven hundred nineteen

Louis Potters; Yijian Cao; Emel Calugaru; Taryn Torre; Paul Fearn; Xiao-Hong Wang

2001-01-01

146

Impact of short course hormonal therapy on overall and cancer specific survival after permanent prostate brachytherapy  

SciTech Connect

Purpose: To review the impact of prior hormonal therapy on 10-year overall and prostate cancer specific survival after primary brachytherapy. Methods and Materials: A retrospective review was performed on the Arizona Oncology Services tumor registry for 2,378 consecutive permanent prostate brachytherapy cases from 1988 through 2001. Hormonal therapy was administered before the implant in 464 patients for downsizing of the prostate or at the discretion of the referring physician. All deceased patients with known clinical recurrence were considered to have died of prostate cancer, irrespective of the immediate cause of death. Risk groups were defined, with 1,135 favorable (prostate-specific antigen [PSA] < 10, Gleason < 7, Stage T1-T2a), 787 intermediate (single adverse feature), and 456 unfavorable (two or more adverse features) patients. Kaplan-Meier actuarial survival curves were generated for both overall and cause-specific survival from the time of treatment. Multivariate analysis was performed to assess the impact of hormonal intervention in comparison with known risk factors of grade, PSA, and age. Results: With follow-up ranging up to 12.6 years and a median of 4.1 year, a total of 474 patients died, with 67 recorded as due to prostate cancer. Overall and cause-specific 10-year survival rates are 43% and 88%, respectively. Overall survival is 44% for the hormone naive patients, compared with 20% for the hormone-treated cohort (p = 0.02). The cancer-specific survival is 89% vs. 81% for the same groups (p = 0.133). Multivariate analysis confirms the significance of age > 70 years (p = 0.0013), Gleason score {>=} 7 (p = 0.0005), and prior hormone use (p = 0.0065) on overall survival. Conclusions: At 10 years, in prostate cancer patients receiving brachytherapy, overall survival is worse in men receiving neoadjuvant hormonal therapy, compared with hormone naive patients. This does not appear to be due to other known risk factors for survival (i.e., stage, grade, PSA, age) on multivariate analysis. The leading causes of death were cardiovascular, prostate cancer, and other cancers with no obvious discrepancy between the two groups. This finding is unexpected and requires confirmation from other centers.

Beyer, David C. [Arizona Oncology Services, Scottsdale, AZ (United States) and Foundation for Cancer Research and Education, Scottsdale, AZ (United States)]. E-mail: dbeyer@azoncology.com; McKeough, Timothy [Arizona Oncology Services, Scottsdale, AZ (United States); Thomas, Theresa [Foundation for Cancer Research and Education, Scottsdale, AZ (United States)

2005-04-01

147

Coherence-based photoacoustic imaging of brachytherapy seeds implanted in a canine prostate  

NASA Astrophysics Data System (ADS)

Visualization of individual brachytherapy seed locations assists with intraoperative updates to brachytherapy treatment plans. Photoacoustic imaging is advantageous when compared to current ultrasound imaging methods, due to its superior sensitivity to metal surrounded by tissue. However, photoacoustic images suffer from poor contrast with insufficient laser fluence. A short-lag spatial coherence (SLSC) beamformer was implemented to enhance these low-contrast photoacoustic signals. Photoacoustic imaging was performed with a transrectal ultrasound probe and an optical fiber surrounded by a light-diffusing sheath, placed at a distance of approximately 4-5 mm from the location of seeds implanted in an in vivo canine prostate. The average energy density through the tip of the sheath was varied from 8 to 167 mJ/cm2. When compared to a fast Fourier transform (FFT)- based reconstruction method, the mean contrast and signal-to-noise ratios were improved by up to 22 dB and a factor of 4, respectively, with the SLSC beamformer (12% of the receive aperture elements were included in the short-lag sum). Image artifacts that were spatially coherent had spatial frequency spectra that were quadrantally symmetric about the origin, while the spatial frequency spectra of the seed signals possessed diagonal symmetry. These differences were utilized to reduce artifacts by 9-14 dB after applying a bandpass filter with diagonal symmetry. Results indicate that advanced methods, such as SLSC beamforming or frequency-based filters, hold promise for intraoperative localization of prostate brachytherapy seeds

Lediju Bell, Muyinatu A.; Song, Danny Y.; Boctor, Emad M.

2014-03-01

148

Interfraction patient motion and implant displacement in prostate high dose rate brachytherapy  

SciTech Connect

Purpose: To quantify movement of prostate cancer patients undergoing treatment, using an in-house developed motion sensor in order to determine a relationship between patient movement and high dose rate (HDR) brachytherapy implant displacement. Methods: An electronic motion sensor was developed based on a three axis accelerometer. HDR brachytherapy treatment for prostate is delivered at this institution in two fractions 24 h apart and 22 patients were monitored for movement over the interval between fractions. The motion sensors functioned as inclinometers, monitoring inclination of both thighs, and the inclination and roll of the abdomen. The implanted HDR brachytherapy catheter set was assessed for displacement relative to fiducial markers in the prostate. Angle measurements and angle differences over a 2 s time base were binned, and the standard deviations of the resulting frequency distributions used as a metric for patient motion in each monitored axis. These parameters were correlated to measured catheter displacement using regression modeling. Results: The mean implant displacement was 12.6 mm in the caudal direction. A mean of 19.95 h data was recorded for the patient cohort. Patients generally moved through a limited range of angles with a mean of the exception of two patients who spent in excess of 2 h lying on their side. When tested for a relationship between movement in any of the four monitored axes and the implant displacement, none was significant. Conclusions: It is not likely that patient movement influences HDR prostate implant displacement. There may be benefits to patient comfort if nursing protocols were relaxed to allow patients greater freedom to move while the implant is in situ.

Fox, C. D.; Kron, T.; Leahy, M.; Duchesne, G.; Williams, S.; Tai, K. H.; Haworth, A.; Herschtal, A.; Foroudi, F. [Department of Physical Sciences, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Nursing Service, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria 3002 (Australia); Department of Physical Sciences, Peter MacCallum Cancer Centre and Royal Melbourne Insititute of Technology, Melbourne, Victoria 3000 (Australia); Department of Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre, Melbourne, Victoria 3002 (Australia); Department of Radiation Oncology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria 3010 (Australia)

2011-11-15

149

Small cell carcinoma of the prostate after high-dose-rate brachytherapy for low-risk prostatic adenocarcinoma  

PubMed Central

In the present study, we describe an 80-year-old patient who developed prostatic small cell carcinoma (SCC) following high-dose-rate brachytherapy (HDR-BT) for low-risk prostatic adenocarcinoma. The patient received one implant of Ir-192 and 7 fractions of 6.5 Gy within 3.5 days, for a total prescribed dose of 45.5 Gy. A total of 27 months after HDR-BT, the patient complained of difficulty in urinating. His serum prostate-specific antigen (PSA) levels were 3.2 ng/ml. Systemic examination revealed an enlargement of the prostate, urethral stenosis, pelvic lymph node swelling and multiple lung and bone lesions. His serum neuron-specific enolase (NSE) levels were elevated to 120 ng/ml. A prostate needle biopsy was performed for pathological examination. Histologically, there were tumor cells with hyperchromatic nuclei and scant cytoplasm showing a solid or trabecular growth pattern. Immunohistochemically, they were positive for AE1/AE3, CD56 and synaptophysin, and negative for PSA, PAP and CD57. These findings are consistent with SCC of the prostate. A review of the prostate needle biopsy specimen prior to HDR-BT did not reveal any tumor cells positive for chromogranin A, nor synaptophysin. The final diagnosis was SCC of the prostate with local progression, with lung, lymph node and bone metastases. Three cycles of etoposide/cisplatin (EP) were administered. A greater than 50% decrease in the serum NSE levels was observed. However, there was no objective response. Due to the deterioration of the patient’s general condition, EP was discontinued. One month later, his serum NSE showed a rapid increase to 210 ng/ml with aggressive local progression and the patient succumbed to the disease 5.5 months after the start of EP therapy.

KOMIYA, AKIRA; YASUDA, KENJI; NOZAKI, TETSUO; FUJIUCHI, YASUYOSHI; HAYASHI, SHIN-ICHI; FUSE, HIDEKI

2013-01-01

150

A comparison of radiation dose to the bulb of the penis in men with and without prostate brachytherapy-induced erectile dysfunction  

Microsoft Academic Search

Purpose: To retrospectively evaluate the relationship between the radiation dose to the bulb of the penis and the development of erectile dysfunction (ED) in patients undergoing permanent prostate brachytherapy without external beam radiation therapy.Methods and Materials: Twenty-three men who developed ED after transperineal ultrasound-guided permanent prostate brachytherapy for clinical T1\\/T2 adenocarcinoma of the prostate gland were paired with 23 similar

Gregory S Merrick; Kent Wallner; Wayne M Butler; Robert W Galbreath; Jonathan H Lief; Mark L Benson

2001-01-01

151

Androgen Deprivation Therapy Does Not Impact Cause-Specific or Overall Survival in High-Risk Prostate Cancer Managed With Brachytherapy and Supplemental External Beam  

Microsoft Academic Search

Purpose: To determine cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in high-risk prostate cancer patients undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and July 2002, 204 patients with high-risk prostate cancer (Gleason score {>=}8 or prostate-specific antigen [PSA] >20 ng\\/mL or clinical stage {>=}T2c) underwent brachytherapy. Median follow-up was 7.0

Gregory S.. Merrick; Wayne M. Butler; Kent E. Wallner; Robert W. Galbreath; Zachariah A. Allen; Edward Adamovich; Jonathan Lief

2007-01-01

152

Bioevaluation of 125I Ocu-Prosta seeds for application in prostate cancer brachytherapy  

PubMed Central

Background & objectives: In recent years, brachytherapy involving permanent radioactive seed implantation has emerged as an effective modality for the management of cancer of prostate. 125I-Ocu-Prosta seeds were indigenously developed and studies were carried out to assess the safety of the indigenously developed 125I-Ocu-Prosta seeds for treatment of prostate cancer. Methods: Animal experiments were performed to assess the likelihood of in vivo release of 125I from radioactive seeds and migration of seeds implanted in the prostate gland of the rabbit. In vivo release of 125I activity was monitored by serial blood sampling from the auricular vein and subsequent measurement of 125I activity. Serial computed tomography (CT) scans were done at regular intervals till 6 months post implant to assess the physical migration of the seeds. Results: The laser welded seeds maintained their hermeticity and prevented the in vivo release of 125I activity into the blood as no radioactivity was detected during follow up blood measurements. Our study showed that the miniature 125I seeds were clearly resolved in CT images. Seeds remained within the prostate gland during the entire study period. Moreover, the seed displacement was minimal even within the prostate gland. Interpretation & conclusions: Our findings have demonstrated that indigenously developed 125I-Ocu-Prosta seeds may be suitable for application in treatment of prostate cancer.

Mukherjee, Archana; Sarma, Haladhar Dev; Saxena, Sanjay; Kumar, Yogendra; Chaudhari, Pradip; Goda, Jayant Sastri; Adurkar, Pranjal; Dash, Ashutosh; Samuel, Grace

2014-01-01

153

Impact of prostate edema on cell survival and tumor control after permanent interstitial brachytherapy for early stage prostate cancers  

PubMed Central

Previous studies have shown that the procedure-induced prostate edema during permanent interstitial brachytherapy (PIB) can cause significant variations in the dose delivered to the prostate gland. Because the clinical impact of edema-induced dose variations depends strongly on the magnitude of the edema, the temporal pattern of its resolution and its interplay with the decay of radioactivity and the underlying biological processes of tumor cells (such as tumor potential doubling time), we investigated the impact of edema-induced dose variations on the tumor cell survival and tumor control probability after PIB with the 131Cs, 125I and 103Pd sources used in current clinical practice. The exponential edema resolution model reported by Waterman et al. (Int. J. Radiat. Oncol. Biol. Phys. 41, 1069–1077–1998) was used to characterize the edema evolutions observed previously during clinical PIB for prostate cancer. The concept of biologically effective dose (BED), taking into account tumor cell proliferation and sublethal damage repair during dose delivery, was used to characterize the effects of prostate edema on cell survival and tumor control probability. Our calculation indicated that prostate edema, if not taken into account appropriately, can increase the cell survival and decrease the probability of local control of PIB. The edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life for radioactive decay and decreasing energy of the photons energy emitted by the source. At the doses currently prescribed for PIB and for prostate cancer cells characterized by nominal radiobiology parameters recommended by AAPM TG-137, PIB using 125I sources was less affected by edema than PIB using 131Cs or 103Pd sources due to the long radioactive decay half-life of 125I. The effect of edema on PIB using 131Cs or 103Pd was similar. The effect of edema on 103Pd PIB was slightly greater, even though the decay half-life of 103Pd (17 days) is longer than that of 131Cs (9.7 days), because the advantage of the longer 103Pd decay half-life was negated by the lower effective energy of the photons it emits (~21 keV compared to ~30.4 keV for 131Cs). In addition, the impact of edema could be reduced or enhanced by differences in the tumor characteristics (e.g. potential tumor doubling time or the ?/? ratio), and the effect of these factors varied for the different radioactive sources. There is a clear need to consider the effects of prostate edema during the planning and evaluation of permanent interstitial brachytherapy treatments for prostate cancer.

Chen, Zhe (Jay); Roberts, Kenneth; Decker, Roy; Pathare, Pradip; Rockwell, Sara; Nath, Ravinder

2011-01-01

154

Effect of Edema on Postimplant Dosimetry in Prostate Brachytherapy Using CT/MRI Fusion  

SciTech Connect

Purpose: To investigate the time course of prostatic edema and the effect on the dose-volume histograms of the prostate for patients treated with brachytherapy. Methods and Materials: A total of 74 patients with prostate cancer were enrolled in this prospective study. A transrectal ultrasound-based preplan was performed 4 weeks before implantation and computed tomography/magnetic resonance imaging fusion-based postimplant dosimetry was performed on the day after implantation (Day 1) and 30 days after implantation (Day 30). The prostate volume, prostate volume covered by 100% of the prescription dose (V{sub 100}), and dose covering 90% of the prostate (D{sub 90}) were evaluated with prostatic edema over time. Results: Prostatic edema was greatest on Day 1, with the mean prostate volume 36% greater than the preplan transrectal ultrasound-based volume; it thereafter decreased over time. It was 9% greater than preplan volume on Day 30. The V{sub 100} increased 5.7% from Day 1 to Day 30, and the D{sub 90} increased 13.1% from Day 1 to Day 30. The edema ratio (postplan/preplan) on Day 1 of low-quality implants with a V{sub 100} of <80% was significantly greater than that of intermediate- to high-quality implants (>80% V{sub 100}; p = 0.0272). The lower V{sub 100} on Day 1 showed a greater increase from Day 1 to Day 30. A V{sub 100} on Day 1 of >92% is unlikely to increase >0% during the interval studied. Conclusion: Low-quality implants on Day 1 were highly associated with edema; however, such a low-quality implant on Day 1, with significant edema, tended to improve by Day 30. If a high-quality implant (V100 >92%) can be obtained on Day 1, a re-examination is no longer necessary.

Tanaka, Osamu [Department of Radiology, Gifu University School of Medicine, Gifu (Japan); Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan)], E-mail: osa-mu@umin.ac.jp; Hayashi, Shinya; Matsuo, Masayuki [Department of Radiology, Gifu University School of Medicine, Gifu (Japan); Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan); Nakano, Masahiro; Uno, Hiromi [Department of Urology, Gifu University School of Medicine, Gifu (Japan); Ohtakara, Kazuhiro [Department of Radiology, Gifu University School of Medicine, Gifu (Japan); Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan); Miyoshi, Toshiharu [Division of Radiation Oncology, Gifu University Hospital, Gifu City (Japan); Deguchi, Takashi [Department of Urology, Gifu University School of Medicine, Gifu (Japan); Hoshi, Hiroaki [Department of Radiology, Gifu University School of Medicine, Gifu (Japan)

2007-10-01

155

Salvage brachytherapy in prostate local recurrence after radiation therapy: predicting factors for control and toxicity  

PubMed Central

Purpose To evaluate efficacy and toxicity after salvage brachytherapy (BT) in prostate local recurrence after radiation therapy. Methods and materials Between 1993 and 2007, we retrospectively analyzed 56 consecutively patients (pts) undergoing salvage brachytherapy. After local biopsy-proven recurrence, pts received 145 Gy LDR-BT (37 pts, 66%) or HDR-BT (19 pts, 34%) in different dose levels according to biological equivalent doses (BED2 Gy). By the time of salvage BT, only 15 pts (27%) received ADT. Univariate and multivariate analyses were performed to identify predictors of biochemical control and toxicities. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities were graded using Common Terminology Criteria for Adverse Events (CTCv3.0). Results Median follow-up after salvage BT was 48 months. The 5-year FFbF was 77%. HDR and LDR late grade 3 GU toxicities were observed in 21% and 24%. Late grade 3 GI toxicities were observed in 2% (HDR) and 2.7% (LDR). On univariate analysis, pre-salvage prostate-specific antigen (PSA)?>?10 ng/ml (p?=?0.004), interval to relapse after initial treatment?Prostate BT is an effective salvage modality in some selected prostate local recurrence patients after radiation therapy. Even, we provide some potential predictors of biochemical control and toxicity for prostate salvage BT, further investigation is recommended.

2014-01-01

156

Dosimetric Impact of Interfraction Catheter Movement in High-Dose Rate Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate the impact of interfraction catheter movement on dosimetry in prostate high-dose-rate (HDR) brachytherapy. Methods and Materials: Fifteen patients were treated with fractionated HDR brachytherapy. Implants were performed on day 1 under transrectal ultrasound guidance. A computed tomography (CT) scan was performed. Inverse planning simulated annealing was used for treatment planning. The first fraction was delivered on day 1. A cone beam CT (CBCT) was performed on day 2 before the second fraction was given. A fusion of the CBCT and CT was performed using intraprostatic gold markers as landmarks. Initial prostate and urethra contours were transferred to the CBCT images. Bladder and rectum contours were drawn, and catheters were digitized on the CBCT. The planned treatment was applied to the CBCT dataset, and dosimetry was analyzed and compared to the initial dose distribution. This process was repeated after a reoptimization was performed, using the same constraints used on day 1. Results: Mean interfraction catheter displacement was 5.1 mm. When we used the initial plan on day 2, the mean prostate V100 (volume receiving 100 Gy or more) decreased from 93.8% to 76.2% (p < 0.01). Rectal V75 went from 0.75 cm{sup 3} to 1.49 cm{sup 3} (p < 0.01). A reoptimization resulted in a mean prostate V100 of 88.1%, closer to the initial plan (p = 0.05). Mean rectal V75 was also improved with a value of 0.59 cm{sup 3}. There was no significant change in bladder and urethra dose on day 2. Conclusions: A mean interfraction catheter displacement of 5.1 mm results in a significant decrease in prostate V100 and an increase in rectum dose. A reoptimization before the second treatment improves dose distribution.

Foster, William, E-mail: fosterw@radonc.ucsf.ed [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States); Cunha, J. Adam M.; Hsu, I.-Chow; Weinberg, Vivan; Krishnamurthy, Devan; Pouliot, Jean [Department of Radiation Oncology, University of California San Francisco, San Francisco, California (United States)

2011-05-01

157

Effect of post-implant edema on prostate brachytherapy treatment margins  

SciTech Connect

Purpose: To determine if postimplant prostate brachytherapy treatment margins calculated on Day 0 differ substantially from those calculated on Day 30. Methods: Thirty patients with 1997 American Joint Commission on Cancer clinical stage T1-T2 prostatic carcinoma underwent prostate brachytherapy with I-125 prescribed to 144 Gy. Treatment planning methods included using loose seeds in a modified peripheral loading pattern and treatment margins (TMs) of 5-8 mm. Postimplant plain radiographs, computed tomography scans, and magnetic resonance scans were obtained 1-4 hours after implantation (Day 0). A second set of imaging studies was obtained at 30 days after implantation (Day 30) and similarly analyzed. Treatment margins were measured as the radial distance in millimeters from the prostate edge to the 100% isodose line. The TMs were measured and tabulated at 90{sup o} intervals around the prostate periphery at 0.6-cm intervals. Each direction was averaged to obtain the mean anterior, posterior, left, and right margins. Results: The mean overall TM increased from 2.6 mm ({+-}2.3) on Day 0 to 3.5 mm ({+-}2.4) on Day 30. The mean anterior margin increased from 1.2 mm on Day 0 to 1.8 mm on Day 30. The posterior margin increased from 1.2 mm on Day 0 to 2.8 mm on Day 30. The lateral treatment margins increased most over time, with mean right treatment margin increasing from 3.9 mm on Day 0 to 4.7 mm on Day 30. Conclusion: Treatment margins appear to be durable in the postimplant period, with a clinically insignificant increase from Day 0 to Day 30.

Reed, Daniel R. [Radiation Oncology, Arizona Oncology Services, Phoenix, AZ (United States); Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Wallner, Kent [Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Radiation Oncology, Group Health Cooperative, Seattle, WA (United States); Ford, Eric [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Mueller, Amy [Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Merrick, Gregory [Schiffler Cancer Center, Wheeling, WV (United States); Maki, Jeffrey [Department of Diagnostic Radiology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Sutlief, Steven [Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Butler, Wayne [Schiffler Cancer Center, Wheeling, WV (United States)

2005-12-01

158

An audit of analgesia requirements for high-dose-rate prostate brachytherapy.  

PubMed

We audited the analgesic, anti-emetic and anti-spasmodic drug usage of patients undergoing high-dose-rate brachytherapy for prostate cancer at the Royal Prince Alfred Hospital. With institutional ethics committee approval, we retrospectively reviewed the records of the first 45 patients undergoing high-dose-rate prostate brachytherapy from January 2003 to July 2005. We collected data regarding the dose of intra- and postoperative analgesics and the anti-emetic and anti-spasmodic drugs administered for the duration of the patients' hospital stay. We converted oral oxycodone doses to parenteral morphine equivalents for the purposes of this study, dividing the oxycodone dose by three. The median age of the patients was 69 (range 55 to 80) years. All had general anaesthesia for the catheter insertion procedure. Twenty-five patients (56%) received intraoperative morphine from 5 to 12 mg (mean 9 mg). Forty-three patients (96%) received regular postoperative paracetamol (1 g qid). Thirty-six patients (80%) required additional postoperative opioid administration with an overall mean (all 45 patients included) of 14.5 mg of parenteral morphine equivalents over the entire postoperative course. Thirty-nine patients received intraoperative hyoscine butylbromide to reduce bladder spasm. Fourteen patients were administered antiemetics. These findings indicate that analgesic requirements during the period in which the prostate brachytherapy catheters remained in place were minimal in most cases. Simple analgesic regimens (regular oral paracetamol, antispasmodics as required for bladder spasm and oral/subcutaneous opioids as required) appear to have been adequate for our patients. PMID:18853591

Doyle, C A; Loadsman, J A; Hruby, G

2008-09-01

159

A new inexpensive customized plaque for choroidal melanoma iodine-125 plaque therapy  

SciTech Connect

The authors have developed a new inexpensive precious metal alloy plaque for use in customized iodine-125 plaque therapy. Each plaque is formed from two flat circular gold/palladium foils which are used in dental crown work. Using a simple manual mechanism, the two forms are stamped over a customized acrylic die shaped to the dimensions of the tumor base plus a 2-mm margin. Completed plaques consist of a back wall, a 2-mm side wall, and a 1.5-mm wide lip with holes for suture placement. Advantages include: simple construction from inexpensive components, customized shape, and iodine seeds that are readily visible on plane radiographs.

Vine, A.K.; Tenhaken, R.K.; Diaz, R.F.; Maxson, B.B.; Lichter, A.S.

1989-04-01

160

Effects of seed migration on post-implant dosimetry of prostate brachytherapy  

SciTech Connect

Brachytherapy using permanent seed implants has been an effective treatment for prostate cancer. However, seeds will migrate after implant, thus making the evaluation of post-implant dosimetry difficult. In this study, we developed a computer program to simulate seed migration and analyzed dosimetric changes due to seed migration at various migration amounts. The study was based on 14 patients treated with Pd-103 at the James Cancer Hospital. Modeling of seed migration, including direction, distance as well as day of migration, was based on clinical observations. Changes of commonly used dosimetric parameters as a function of migration amount (2, 4, 6 mm respectively), prostate size (from 20 to 90 cc), and prostate region (central vs peripheral) were studied. Change of biological outcome (tumor control probability) due to migration was also estimated. Migration reduced prostate D90 to 99{+-}2% of original value in 2 mm migration, and the reduction increased to 94{+-}6% in 6 mm migration. The reduction of prostate dose led to a 14% (40%) drop in the tumor control probability for 2 mm (6 mm) migration, assuming radiosensitive tumors. However, migration has less effect on a prostate implanted with a larger number of seeds. Prostate V100 was less sensitive to migration than D90 since its mean value was still 99% of original value even in 6 mm migration. Migration also showed a different effect in the peripheral region vs the central region of the prostate, where the peripheral mean dose tended to drop more significantly. Therefore, extra activity implanted in the peripheral region during pre-plan can be considered. The detrimental effects of migration were more severe in terms of increasing the dose to normal structures, as rectum V50 may be 70% higher and urethra V100 may be 50% higher in the case of 6 mm migration. Quantitative knowledge of these effects is helpful in treatment planning and post-implant evaluation.

Gao, M.; Wang, J. Z.; Nag, S.; Gupta, N. [Department of Radiation Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University, Columbus, Ohio 43210 (United States) and Department of Radiation Oncology, Stritch School of Medicine, Loyola University Medical Center, Maywood, Illinois (United States); Department of Radiation Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University, Columbus, Ohio 43210 (United States); Department of Radiation Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University, Columbus, Ohio 43210 (United States) and Kaiser Permanente Radiation Oncology, Santa Clara, California (United States); Department of Radiation Medicine, Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Ohio State University, Columbus, Ohio 43210 (United States)

2007-02-15

161

Evaluation of the effect of prostate volume change on tumor control probability in LDR brachytherapy  

PubMed Central

Purpose This study evaluates low dose-rate brachytherapy (LDR) prostate plans to determine the biological effect of dose degradation due to prostate volume changes. Material and methods In this study, 39 patients were evaluated. Pre-implant prostate volume was determined using ultrasound. These images were used with the treatment planning system (Nucletron Spot Pro 3.1®) to create treatment plans using 103Pd seeds. Following the implant, patients were imaged using CT for post-implant dosimetry. From the pre and post-implant DVHs, the biologically equivalent dose and the tumor control probability (TCP) were determined using the biologically effective uniform dose. The model used RBE = 1.75 and ?/? = 2 Gy. Results The prostate volume changed between pre and post implant image sets ranged from –8% to 110%. TCP and the mean dose were reduced up to 21% and 56%, respectively. TCP is observed to decrease as the mean dose decreases to the prostate. The post-implant tumor dose was generally observed to decrease, compared to the planned dose. A critical uniform dose of 130 Gy was established. Below this dose, TCP begins to fall-off. It was also determined that patients with a small prostates were more likely to suffer TCP decrease. Conclusions The biological effect of post operative prostate growth due to operative trauma in LDR was evaluated using the concept. The post-implant dose was lower than the planned dose due to an increase of prostate volume post-implant. A critical uniform dose of 130 Gy was determined, below which TCP begun to decline.

Knaup, Courtney; Mavroidis, Panayiotis; Stathakis, Sotirios; Smith, Mark; Swanson, Gregory

2011-01-01

162

Long-Term Biochemical and Survival Outcome of 921 Patients Treated With I-125 Permanent Prostate Brachytherapy  

Microsoft Academic Search

Purpose: To assess long-term biochemical and survival outcome after permanent prostate brachytherapy (BT). Methods and Materials: Data on 921 patients, treated with permanent interstitial BT monotherapy between 1989 and 2004 for <=T2c Nx\\/0 Mx\\/0 prostate cancer were evaluated. All patients were treated with I-125 seeds (prescription dose 144 Gy). Eighty-five patients with a gland volume >=50cc received 6 months of

Karel A. Hinnen; Jan J. Battermann; Joep G. H. van Roermund; Marinus A. Moerland; Ina M. Juergenliemk-Schulz; Steven J. Frank; Marco van Vulpen

2010-01-01

163

Health-related Quality of Life using SF8 and EPIC Questionnaires after Treatment with Radical Retropubic Prostatectomy and Permanent Prostate Brachytherapy  

Microsoft Academic Search

Objective: The health-related quality of life (HRQOL) after treatment of prostate cancer is examined using a new HRQOL tool. HRQOL, based on the expanded prostate cancer index composite (EPIC) and SF-8 questionnaires, was prospectively compared after either a radical retropubic prostatectomy (RRP) or a permanent prostate brachytherapy (PPB) at a single institute.

Katsuyoshi Hashine; Yoshito Kusuhara; Noriyoshi Miura; Akitomi Shirato; Yoshiteru Sumiyoshi; Masaaki Kataoka

2009-01-01

164

Inverse planning optimization for hybrid prostate permanent-seed implant brachytherapy plans using two source strengths.  

PubMed

The purpose is to demonstrate the ability to generate clinically acceptable prostate permanent seed implant plans using two seed types which are identical except for their activity. The IPSA inverse planning algorithms were modified to include multiple dose matrices for the calculation of dose from different sources, and a selection algorithm was implemented to allow for the swapping of source type at any given source position. Five previously treated patients with a range of prostate volumes from 20-48 cm3 were re-optimized under two hybrid scenarios: (1) using 0.32 and 0.51 mGy m2 / h 125I, and (2) using 0.64 and 0.76 mGy m2 / h 125I. Isodose lines were generated and dosimetric indices , V150Prostate, D90Prostate, V150Urethra, V125Urethra, V120Urethra,V100Urethra, and D10Urethra were calculated. The algorithm allows for the generation of single-isotope, multi-activity hybrid brachytherapy plans. By dealing with only one radionuclide, but of different activity, the biology is unchanged from a standard plan. All V100Prostate were within 2.3 percentage points for every plan and always above the clinically desirable 95%. All V150Urethra were identically zero, and V120Urethra is always below the clinically acceptable value of 1.0 cm3. Clinical optimization times for the hybrid plans are still under one minute, for most cases. It is possible to generate clinically advantageous brachytherapy plans (i.e. obtain the same quality dose distribution as a standard single-activity plan) while incorporating leftover seeds from a previous patient treatment. This method will allow a clinic to continue to provide excellent patient care, but at a reduced cost. Multi-activity hybrid plans were equal in quality (as measured by the standard dosimetric indices) to plans with seeds of a single activity. Despite the expanded search space, optimization times for these studies were still under two minutes on a modern day laptop and can be reduced to below one minute in a clinical setting. With the typical cost of a set of PPI seeds on the order of thousands of dollars, it is possible to reduce the cost of brachytherapy treatments by allowing for easier use of seeds left over from a previous patient or unused due to a cancelled treatment. PMID:20717078

Cunha, J Adam M; Pickett, Barby; Pouliot, Jean

2010-01-01

165

Radioimmunoguided surgery using iodine 125 B72. 3 in patients with colorectal cancer  

SciTech Connect

Preliminary data using B72.3 murine monoclonal antibody labeled with iodine 125 suggested that both clinically apparent as well as occult sites of colorectal cancer could be identified intraoperatively using a hand-held gamma detecting probe. We report the preliminary data of a multicenter trial of this approach in patients with primary or recurrent colorectal cancer. One hundred four patients with primary, suspected, or known recurrent colorectal cancer received an intravenous infusion of 1 mg of B72.3 monoclonal antibody radiolabeled with 7.4 x 10 Bq of iodine 125. Twenty-six patients with primary colorectal cancer and 72 patients with recurrent colorectal cancer were examined. Using the gamma detecting probe, 78% of the patients had localization of the antibody in their tumor; this included 75% of primary tumor sites and 63% of all recurrent tumor sites; 9.2% of all tumor sites identified represented occult sites detected only with the gamma detecting probe. The overall sensitivity was 77% and a predictive value of a positive detection was 78%. A total of 30 occult sites in 26 patients were identified. In patients with recurrent cancer, the antibody study provided unique data that precluded resection in 10 patients, and in another eight patients it extended the potentially curative procedure.

Cohen, A.M.; Martin, E.W. Jr.; Lavery, I.; Daly, J.; Sardi, A.; Aitken, D.; Bland, K.; Mojzisik, C.; Hinkle, G. (Memorial Sloan-Kettering Cancer Center, New York, NY (USA))

1991-03-01

166

Detailed urethral dosimetry in the evaluation of prostate brachytherapy-related urinary morbidity  

SciTech Connect

Purpose: To evaluate the relationship between urinary morbidity after prostate brachytherapy and urethral doses calculated at the base, midprostate, apex, and urogenital diaphragm. Methods and Materials: From February 1998 through July 2002, 186 consecutive patients without a prior history of a transurethral resection underwent monotherapeutic brachytherapy (no supplemental external beam radiation therapy or androgen deprivation therapy) with urethral-sparing techniques (average urethral dose 100%-140% minimum peripheral dose) for clinical T1c-T2b (2002 AJCC) prostate cancer. The median follow-up was 45.5 months. Urinary morbidity was defined by time to International Prostate Symptom Score (IPSS) resolution, maximum increase in IPSS, catheter dependency, and the need for postimplant surgical intervention. An alpha blocker was initiated approximately 2 weeks before implantation and continued at least until the IPSS returned to baseline. Evaluated parameters included overall urethral dose (average and maximum), doses to the base, midprostate, apex, and urogenital diaphragm, patient age, clinical T stage, preimplant IPSS, ultrasound volume, isotope, and D90 and V100/150/200. Results: Of the 186 patients, 176 (94.6%) had the urinary catheter permanently removed on the day of implantation with only 1 patient requiring a urinary catheter >5 days. No patient had a urethral stricture and only 2 patients (1.1%) required a postbrachytherapy transurethral resection of the prostate (TURP). For the entire cohort, IPSS on average peaked 2 weeks after implantation with a mean and median time to IPSS resolution of 14 and 3 weeks, respectively. For the entire cohort, only isotope predicted for IPSS resolution, while neither overall average prostatic urethra nor segmental urethral dose predicted for IPSS resolution. The maximum postimplant IPSS increase was best predicted by preimplant IPSS and the maximum apical urethral dose. Conclusions: With the routine use of prophylactic alpha blockers and strict adherence to urethral-sparing techniques, detailed urethral dosimetry did not substantially improve the ability to predict urinary morbidity. Neither the average dose to the prostatic urethra nor urethral doses stratified into base, midprostate, apex, or urogenital diaphragm segments predicted for IPSS normalization. Radiation doses of 100%-140% minimum peripheral dose are well tolerated by all segments of the prostatic urethra with resultant tumorcidal doses to foci of periurethral cancer.

Allen, Zachariah A. [Schiffler Cancer Center, Wheeling, WV (United States); Merrick, Gregory S. [Schiffler Cancer Center, Wheeling, WV (United States) and Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M. [Schiffler Cancer Center, Wheeling, WV (United States); Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, and University of Washington, Seattle, WA (United States); Kurko, Brian [Schiffler Cancer Center, Wheeling, WV (United States); Anderson, Richard L. [Schiffler Cancer Center, Wheeling, WV (United States); Murray, Brian C. [Schiffler Cancer Center, Wheeling, WV (United States); Galbreath, Robert W. [Schiffler Cancer Center, Wheeling, WV (United States); Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States)

2005-07-15

167

Dynamic dosimetry and edema detection in prostate brachytherapy: a complete system  

NASA Astrophysics Data System (ADS)

Purpose: Brachytherapy (radioactive seed insertion) has emerged as one of the most effective treatment options for patients with prostate cancer, with the added benefit of a convenient outpatient procedure. The main limitation in contemporary brachytherapy is faulty seed placement, predominantly due to the presence of intra-operative edema (tissue expansion). Though currently not available, the capability to intra-operatively monitor the seed distribution, can make a significant improvement in cancer control. We present such a system here. Methods: Intra-operative measurement of edema in prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate. Seeds were reconstructed using a typical non-isocentric C-arm, and exported to a commercial brachytherapy delivery system. Technical obstacles for 3D reconstruction on a non-isocentric C-arm include pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction; and C-arm to TRUS registration. Results: In precision-machined hard phantoms with 40-100 seeds and soft tissue phantoms with 45-87 seeds, we correctly reconstructed the seed implant shape with an average 3D precision of 0.35 mm and 0.24 mm, respectively. In a DoD Phase-1 clinical trial on 6 patients with 48-82 planned seeds, we achieved intra-operative monitoring of seed distribution and dosimetry, correcting for dose inhomogeneities by inserting an average of 4.17 (1-9) additional seeds. Additionally, in each patient, the system automatically detected intra-operative seed migration induced due to edema (mean 3.84 mm, STD 2.13 mm, Max 16.19 mm). Conclusions: The proposed system is the first of a kind that makes intra-operative detection of edema (and subsequent re-optimization) possible on any typical non-isocentric C-arm, at negligible additional cost to the existing clinical installation. It achieves a significantly more homogeneous seed distribution, and has the potential to affect a paradigm shift in clinical practice. Large scale studies and commercialization are currently underway.

Jain, A.; Deguet, A.; Iordachita, I.; Chintalapani, G.; Blevins, J.; Le, Y.; Armour, E.; Burdette, C.; Song, D.; Fichtinger, G.

2008-04-01

168

Evaluation of physician eye lens doses during permanent seed implant brachytherapy for prostate cancer.  

PubMed

Treatment of low grade prostate cancer with permanent implant of radioactive seeds has become one of the most common brachytherapy procedures in use today. The implant procedure is usually performed with fluoroscopy image guidance to ensure that the seeds are deployed in the planned locations. In this situation the physician performing the transperineal implant is required to be close to the fluoroscopy unit and dose to the eye lens may be of concern. In 1991 the International Commission on Radiological Protection (ICRP) provided a recommended dose limit of 150 mSv yr(-1) for occupational exposures to the lens of the eye. With more long term follow-up data, this limit was revised in 2011 to 20 mSv yr(-1). With this revised limit in mind, we have investigated the dose to the lens of the eye received by physicians during prostate brachytherapy seed implantation. By making an approximation of annual workload, we have related the dose received to the annual background dose. Through clinical and phantom measurements with thermoluminescent dosimeters, it was found that the excess dose to the physician's eye lens received for a conservative estimate of annual workload was never greater than 100% of the annual background dose. PMID:22854245

Penfold, S N; Marcu, L; Lawson, J M; Asp, J

2012-09-01

169

CT-guided brachytherapy of prostate cancer: reduction of effective dose from X-ray examination  

NASA Astrophysics Data System (ADS)

Computed tomography (CT) is one of the most effective and informative diagnostic method. Though the number of CT scans among all radiographic procedures in the USA and European countries is 11% and 4% respectively, CT makes the highest contribution to the collective effective dose from all radiographic procedures, it is 67% in the USA and 40% in European countries [1-5]. Therefore it is necessary to understand the significance of dose value from CT imaging to a patient . Though CT dose from multiple scans and potential risk is of great concern in pediatric patients, this applies to adults as well. In this connection it is very important to develop optimal approaches to dose reduction and optimization of CT examination. International Commission on Radiological Protection (ICRP) in its publications recommends radiologists to be aware that often CT image quality is higher than it is necessary for diagnostic confidence[6], and there is a potential to reduce the dose which patient gets from CT examination [7]. In recent years many procedures, such as minimally invasive surgery, biopsy, brachytherapy and different types of ablation are carried out under guidance of computed tomography [6;7], and during a procedures multiple CT scans focusing on a specific anatomic region are performed. At the Clinics of MRRC different types of treatment for patients with prostate cancer are used, incuding conformal CT-guided brachytherapy, implantation of microsources of I into the gland under guidance of spiral CT [8]. So, the purpose of the study is to choose optimal method to reduce radiation dose from CT during CT-guided prostate brachytherapy and to obtain the image of desired quality.

Sanin, Dmitriy B.; Biryukov, Vitaliy A.; Rusetskiy, Sergey S.; Sviridov, Pavel V.; Volodina, Tatiana V.

2014-03-01

170

Rectal toxicity profile after transperineal interstitial permanent prostate brachytherapy: Use of a comprehensive toxicity scoring system and identification of rectal dosimetric toxicity predictors  

Microsoft Academic Search

Purpose: To better understand rectal toxicity after prostate brachytherapy, we employed the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0), a comprehensive system with distinct and separately reported gastrointestinal adverse event items (unlike Radiation Therapy Oncology Group morbidity scoring), to evaluate item-specific postimplant rectal toxicities. Methods and Materials: We analyzed 135 patients treated with brachytherapy {+-}

Jinesh N. Shah; Ronald D.. Ennis

2006-01-01

171

Prostate brachytherapy seed identification on post-implant TRUS images.  

PubMed

TRUS is a conceptually appealing alternative to CT-based dosimetry, offering the substantial practical advantage of being readily available intraoperatively. To test the feasibility and reliability of seed identification on post-implant TRUS using standard two-dimensional images, ten patients treated with I-125 or Pd-103 brachytherapy were studied. A set of transverse images (6 MHz) were taken immediately following completion of the implant procedure. Original thermal images were sent to four physicians and the sources were identified independently by placing marks on a cellophane overlay, with grids to match the axial TRUS images. The number and type of seed implanted were not revealed to the investigators. Instead, they were instructed to mark the positions of what they would consider, with reasonable certainty, to be seeds. The overlays were then manually compared for source identification and agreement between observers regarding each alleged source. The actual number of implanted seeds ranged from 44 to 108 (median: 60). In contrast, the mean number of seeds allegedly identified per patients ranged from 26 to 82 (median: 43). The average percent of the seeds allegedly identified per patient ranged from 51% to 83% (mean: 74%). The four physician investigators--KW, JS, BH, and GM--identified an alleged median of 90%, 44%, 63%, and 91% of the total seeds, respectively. There were five instances in which investigators alleged more seeds than were actually implanted. The consistency of seed identification among the investigators was evaluated by noting how many investigators identified each bright spot on the images. The percent of bright spots identified by all four investigators ranged from 8% to 33% (median: 20%). Despite considerable interest among some of our clinical and commercial colleagues in developing TRUS-based intraoperative post-implant dosimetry, the use of TRUS-based seed identification for post-implant dosimetry should be viewed with skepticism. PMID:12772998

Han, Ben H; Wallner, Kent; Merrick, Gregory; Butler, Wayne; Sutlief, Steven; Sylvester, John

2003-05-01

172

American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) Practice Guideline for the Transperineal Permanent Brachytherapy of Prostate Cancer  

SciTech Connect

Transperineal permanent prostate brachytherapy is a safe and efficacious treatment option for patients with organ-confined prostate cancer. Careful adherence to established brachytherapy standards has been shown to improve the likelihood of procedural success and reduce the incidence of treatment-related morbidity. A collaborative effort of the American College of Radiology (ACR) and American Society for Therapeutic Radiation Oncology (ASTRO) has produced a practice guideline for permanent prostate brachytherapy. The guideline defines the qualifications and responsibilities of all the involved personnel, including the radiation oncologist, physicist and dosimetrist. Factors with respect to patient selection and appropriate use of supplemental treatment modalities such as external beam radiation and androgen suppression therapy are discussed. Logistics with respect to the brachtherapy implant procedure, the importance of dosimetric parameters, and attention to radiation safety procedures and documentation are presented. Adherence to these practice guidelines can be part of ensuring quality and safety in a successful prostate brachytherapy program.

Rosenthal, Seth A., E-mail: rosenthals@radiological.co [Radiation Oncology Centers, Radiological Associates of Sacramento, Sacramento, CA (United States); Bittner, Nathan H.J. [Tacoma/Valley Radiation Oncology Centers, Tacoma, WA (United States); Beyer, David C. [Arizona Oncology Services, Scottsdale, AZ (United States); Demanes, D. Jeffrey [Department of Radiation Oncology, University of California, Los Angeles, CA (United States); Goldsmith, Brian J. [Radiation Oncology Centers, Radiological Associates of Sacramento, Sacramento, CA (United States); Horwitz, Eric M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States); Ibbott, Geoffrey S. [Radiological Physics Center, MD Anderson Cancer Center, Houston, TX (United States); Lee, W. Robert [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Nag, Subir [Department of Radiation Oncology, Kaiser Permanante, Santa Clara, CA (United States); Suh, W. Warren [Department of Radiation Oncology, Cancer Center of Santa Barbara, Santa Barbara, CA (United States); Potters, Louis [Department of Radiation Oncology, Long Island Jewish Medical Center, New Hyde Park, NY (United States)

2011-02-01

173

Robot-assisted 3D-TRUS guided prostate brachytherapy: system integration and validation.  

PubMed

Current transperineal prostate brachytherapy uses transrectal ultrasound (TRUS) guidance and a template at a fixed position to guide needles along parallel trajectories. However, pubic arch interference (PAI) with the implant path obstructs part of the prostate from being targeted by the brachytherapy needles along parallel trajectories. To solve the PAI problem, some investigators have explored other insertion trajectories than parallel, i.e., oblique. However, parallel trajectory constraints in current brachytherapy procedure do not allow oblique insertion. In this paper, we describe a robot-assisted, three-dimensional (3D) TRUS guided approach to solve this problem. Our prototype consists of a commercial robot, and a 3D TRUS imaging system including an ultrasound machine, image acquisition apparatus and 3D TRUS image reconstruction, and display software. In our approach, we use the robot as a movable needle guide, i.e., the robot positions the needle before insertion, but the physician inserts the needle into the patient's prostate. In a later phase of our work, we will include robot insertion. By unifying the robot, ultrasound transducer, and the 3D TRUS image coordinate systems, the position of the template hole can be accurately related to 3D TRUS image coordinate system, allowing accurate and consistent insertion of the needle via the template hole into the targeted position in the prostate. The unification of the various coordinate systems includes two steps, i.e., 3D image calibration and robot calibration. Our testing of the system showed that the needle placement accuracy of the robot system at the "patient's" skin position was 0.15 mm+/-0.06 mm, and the mean needle angulation error was 0.07 degrees. The fiducial localization error (FLE) in localizing the intersections of the nylon strings for image calibration was 0.13 mm, and the FLE in localizing the divots for robot calibration was 0.37 mm. The fiducial registration error for image calibration was 0.12 mm and 0.52 mm for robot calibration. The target registration error for image calibration was 0.23 mm, and 0.68 mm for robot calibration. Evaluation of the complete system showed that needles can be used to target positions in agar phantoms with a mean error of 0.79 mm+/-0.32 mm. PMID:15070252

Wei, Zhouping; Wan, Gang; Gardi, Lori; Mills, Gregory; Downey, Donal; Fenster, Aaron

2004-03-01

174

Dosimetric effects of prone and supine positions on post-implant assessments for prostate brachytherapy  

PubMed Central

Purpose Post-implant dosimetric assessment is essential for optimal care of patients receiving prostate brachytherapy. In most institutions, post-implant computed tomography (CT) is performed in the supine position. This study aimed to assess variability in dosimetric parameters with postural changes during acquisition of post-implant CT scans. Material and methods In total, 85 consecutive patients were enrolled in this study. Fifty-three patients underwent seed implantation alone, and the remaining 32 received a combination of seed implantation and external beam radiotherapy. For post-implant analyses, CT scans were obtained in two patient positions, supine and prone. To evaluate differences in dosimetric parameters associated with postural change, the dosimetric data obtained in the supine position were defined as the standard. Results The median prostate volume was 22.4 ml in the supine and 22.5 ml in the prone position (p = 0.51). The median prostate D90 was 120.1% in the supine and 120.3% in the prone position, not significantly different. The mean prostate V100 was 97.1% in the supine and 97.0% in the prone position, again not significantly different. Median rectal V100 in supine and prone positions were 0.42 ml and 0.33 ml, respectively (p < 0.01). Rectal D2cc was also significantly decreased in the prone as compared with the supine position (median, 59.1% vs. 63.6%; p < 0.01). A larger post-implant prostate volume was associated with decreased rectal doses in the prone position. Conclusions Though there were no significant differences among prostate D90 assessments according to postural changes, our results suggest that post-implant rectal doses decreased in the prone position.

Momma, Tetsuo; Yamashita, Shoji; Kanai, Kunimitsu; Watanabe, Yusuke; Hanada, Takashi; Shigematsu, Naoyuki

2013-01-01

175

High-Dose-Rate Brachytherapy of a Single Implant With Two Fractions Combined With External Beam Radiotherapy for Hormone-Naive Prostate Cancer  

Microsoft Academic Search

Purpose: To evaluate the preliminary outcomes of high-dose-rate (HDR) brachytherapy of a single implant with two fractions and external beam radiotherapy (EBRT) for hormone-naive prostate cancer. Methods and Materials: Between March 2000 and Sept 2003, a total of 53 patients with tumor Stage T1c-T3b N0 M0 prostate cancer were treated with HDR brachytherapy boost doses (7.5 Gy\\/fraction) and 50-Gy EBRT

Morio Sato; Takashi Mori; Shintaro Shirai; Kazushi Kishi; Takeshi Inagaki; Isao Hara

2008-01-01

176

Comparison of Tumor Control and Toxicity Outcomes of High Dose Intensity-Modulated Radiotherapy and Brachytherapy for Patients with Favorable Risk Prostate Cancer  

PubMed Central

Objectives To compare long-term prostate-specific antigen relapse-free survival outcome and incidence of toxicity for low-risk prostate cancer treated with brachytherapy or intensity-modulated radiotherapy. Methods 729 consecutive patients were treated with BRT (n=448; prescription dose, 144 Gy) and intensity-modulated radiotherapy alone (n=281; prescription dose, 81 Gy). Prostate-specific antigen relapse-free survival using nadir +2 definitions, and late toxicity using the National Cancer Institute's Common Terminology Criteria for Adverse Events. Results Seven-year prostate-specific antigen relapse-free survival for brachytherapy and intensity-modulated radiotherapy was 95% and 89% for low-risk patients (p=0.004). Cox regression analysis demonstrated that brachytherapy was associated with improved prostate-specific antigen relapse-free survival even when adjusted for other variables. Incidence of metastatic disease between treatments was low for both treatment groups. Late grade 2 gastrointestinal toxicities were observed in 5.1% and 1.4% of the brachytherapy and intensity-modulated radiotherapy groups, respectively (p=0.02). There were no significant differences between treatment groups for late grade ?3 rectal complications (brachytherapy, 1.1%; intensity-modulated radiotherapy, 0%; p=0.19). Late grade 2 urinary toxicities were more often observed for brachytherapy than intensity-modulated radiotherapy (15.6% and 4.3%, respectively; p<0.0001). There were no significant differences between treatment groups for late grade 3 urinary toxicity (brachytherapy, 2.2%; intensity-modulated radiotherapy, 1.4%; p=0.62). Conclusions Among low risk prostate cancer patients, 7-year biochemical tumor control is superior for intraoperative-planning brachytherapy compared with high-dose intensity-modulated radiotherapy. While significant toxicities were minimal for both groups, modest but significant increases in grade 2 urinary and rectal symptoms were noted for brachytherapy compared with intensity-modulated radiotherapy.

Zelefsky, Michael J.; Yamada, Yoshiya; Pei, Xin; Hunt, Margie; Cohen, Gilad; Zhang, Zhigang; Zaider, Marco

2014-01-01

177

Comparison of Iodine-125 Seed Implantation and Pancreaticoduodenectomy in the Treatment of Pancreatic Cancer  

PubMed Central

Objective: This retrospective study compared the advantages and disadvantages of iodine-125 (125I) seed implantation and pancreaticoduodenectomy (PD) in the treatment of pancreatic cancer. Methods: Patients with diagnosed pancreatic cancer who were treated with 125125I seed implantation (30 patients) or PD (30 patients) in our hospital were evaluated for operative time, bleeding, liver function, time to first bowel movement and normal diet, survival, and medical costs. Results: Compared with patients who underwent PD, those given 125I seed implantation had significantly shorter operative time, less bleeding, higher albumin, shorter periods to bowel movement and normal diet, lower risk of complications, and lower medical costs (P < 0.001, each). The difference of bilirubin level, time to feeding, and median survival were not significant statistically between two treatment grouops. Conclusion: For pancreatic cancer patients for whom PD is not appropriate or who refuse PD, 125I seed implantation is a good option.

Liu, Kai; Ji, Bai; Zhang, Wei; Liu, Songyang; Wang, Yingchao; Liu, Yahui

2014-01-01

178

Evaluation of arterialized vein graft permeability with Evans blue dye and iodine 125-labeled albumin  

SciTech Connect

This study measured endothelial permeability, quantitatively (with iodine 125-labeled albumin) and qualitatively (with Evans blue dye) in arterialized vein grafts in 9 adult dogs. In each dog, the right common carotid artery was ligated and arterial flow was reconstituted with a 5-cm bypass graft of right external jugular vein. Twenty-four hours before the dogs were killed, each dog received both {sup 125}I-labeled albumin (8 microCi/kg) and Evans blue dye (15 mg/kg) intravenously. After the dogs' death, each arterialized vein graft and each left external jugular vein (as control) was harvested and studied. Arterialized vein graft permeability was significantly increased over control at 1, 3, and 6 months (3 dogs at each interval). Scanning electron microscopy revealed confluent endothelium in all specimens. This increased permeability may play a role in vein graft atherosclerosis.

Finck, S.J.; Mashburn, J.P.; Kottke, B.A.; Orszulak, T.A. (Mayo Clinic Jacksonville, FL (USA))

1989-11-01

179

Solid phantom material for the dosimetry of iodine-125 seed ophthalmic plaques  

SciTech Connect

A tissue-equivalent solid phantom material, RE-1, closely simulating the radiological attenuation and scattering properties of the human eye for the iodine-125 photon spectrum and their Compton-scattered secondary photons, was fabricated on a polyethylene base with CaCO[sub 3] and MgO as inorganic additives. A 24 mm diameter spherical phantom was made from 1.1 mm thick sheets of RE-1, and holes were drilled in which 1 mm[sup 3] TLD cubes were placed. The radial dose function g(r), which determines the dose profile on the transverse axis, was measured in a quasi-infinite phantom of RE-1. The values obtained deviate only slightly from those for a quasi-infinite phantom made from water-equivalent material. 18 refs., 3 figs., 2 tabs.

Hermann, K.P.; Harder, D. (Universitaet Goettingen (Germany)); Tabor, P.; Pothmann, B. (Universitaetsklinikum, Essen (Germany)); Alberti, W.; Divoux, S. (Klinik fuer Strahlentherapie und Nuklearmedizin, Essen (Germany))

1993-08-01

180

Distant Metastases Following Permanent Interstitial Brachytherapy for Patients With Clinically Localized Prostate Cancer  

SciTech Connect

Purpose: Recent publications have suggested high-risk patients undergoing radical prostatectomy have a lower risk of distant metastases and improved cause-specific survival (CSS) than patients receiving definitive external beam radiation therapy (XRT). To date, none of these studies has compared distant metastases and CSS in brachytherapy patients. In this study, we evaluate such parameters in a consecutive cohort of brachytherapy patients. Methods and Materials: From April 1995 to June 2007, 1,840 consecutive patients with clinically localized prostate cancer were treated with brachytherapy. Risk groups were stratified according to National Comprehensive Cancer Network ( (www.nccn.org)) guidelines. Subgroups of 658, 893, and 289 patients were assigned to low, intermediate, and high-risk categories. Median follow-up was 7.2 years. Along with brachytherapy implantation, 901 (49.0%) patients received supplemental XRT, and 670 (36.4%) patients received androgen deprivation therapy (median duration, 4 months). The mode of failure (biochemical, local, or distant) was determined for each patient for whom therapy failed. Cause of death was determined for each deceased patient. Multiple parameters were evaluated for impact on outcome. Results: For the entire cohort, metastases-free survival (MFS) and CSS at 12 years were 98.1% and 98.2%, respectively. When rates were stratified by low, intermediate, and high-risk groups, the 12-year MFS was 99.8%, 98.1%, and 93.8% (p < 0.001), respectively. CSS rates were 99.8%, 98.0%, and 95.3% (p < 0.001) for low, intermediate, and high-risk groups, respectively. Biochemical progression-free survival was 98.7%, 95.9% and 90.4% for low, intermediate, and high-risk patients, respectively (p < 0.001). In multivariate Cox-regression analysis, MFS was mostly closely related to Gleason score and year of treatment, whereas CSS was most closely associated with Gleason score. Conclusions: Excellent CSS and MFS rates are achievable with high-quality brachytherapy for low, intermediate, and high-risk patients. These results compare favorably to alternative treatment modalities. In particular, our MFS and CSS rates for high-risk patients appear superior to those of published radical prostatectomy series.

Taira, Al V. [Western Radiation Oncology, Mountain View, California (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.org [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, West Virginia (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, Washington (United States)

2012-02-01

181

Salvage HDR Brachytherapy for Recurrent Prostate Cancer After Previous Definitive Radiation Therapy: 5-Year Outcomes  

SciTech Connect

Purpose: Evaluate efficacy and toxicity of salvage high-dose-rate brachytherapy (HDRB) for locally recurrent prostate cancer after definitive radiation therapy (RT). Methods and Materials: We retrospectively analyzed 52 consecutively accrued patients undergoing salvage HDRB between 1998 and 2009 for locally recurrent prostate cancer after previous definitive RT. After pathologic confirmation of locally recurrent disease, patients received 36 Gy in 6 fractions. Twenty-four patients received neoadjuvant hormonal therapy before salvage, and no patients received adjuvant hormonal therapy. Determination of biochemical failure after salvage HDRB was based on the Phoenix definition. Overall survival (OS) and bF distributions were calculated using the Kaplan-Meier method. Univariate analyses were performed to identify predictors of biochemical control. Acute and late genitourinary (GU) and gastrointestinal (GI) toxicities, based on Common Terminology Criteria for Adverse Events (version 4), were documented. Results: Median follow-up after salvage HDRB was 59.6 months. The 5-year OS estimate was 92% (95% confidence interval [CI]: 80%-97%) with median survival not yet reached. Five-year biochemical control after salvage was 51% (95% CI: 34%-66%). Median PSA nadir postsalvage was 0.1 (range: 0-7.2) reached at a median of 10.2 months after completing HDRB. As for complications, acute and late grade 3 GU toxicities were observed in only 2% and 2%, respectively. No grade 2 or higher acute GI events and 4% grade 2 GI late events were observed. On univariate analysis, disease-free interval after initial definitive RT (P=.07), percent of positive cores at the time of diagnosis (P=.08), interval from first recurrence to salvage HDRB (P=.09), and pre-HDRB prostate-specific antigen (P=.07) were each of borderline significance in predicting biochemical control after salvage HDRB. Conclusions: Prostate HDRB is an effective salvage modality with relatively few long-term toxicities. We provide potential predictors of biochemical control for prostate salvage HDRB.

Chen, Chien Peter [Department of Radiation Oncology, Scripps Clinic, San Diego, California (United States)] [Department of Radiation Oncology, Scripps Clinic, San Diego, California (United States); Weinberg, Vivian [Comprehensive Cancer Center Biostatistics Core, University of California—San Francisco, San Francisco, California (United States)] [Comprehensive Cancer Center Biostatistics Core, University of California—San Francisco, San Francisco, California (United States); Shinohara, Katsuto [Department of Urology, University of California—San Francisco, San Francisco, California (United States)] [Department of Urology, University of California—San Francisco, San Francisco, California (United States); Roach, Mack; Nash, Marc; Gottschalk, Alexander; Chang, Albert J. [Department of Radiation Oncology, University of California—San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California—San Francisco, San Francisco, California (United States); Hsu, I-Chow, E-mail: IHsu@radonc.ucsf.edu [Department of Radiation Oncology, University of California—San Francisco, San Francisco, California (United States)] [Department of Radiation Oncology, University of California—San Francisco, San Francisco, California (United States)

2013-06-01

182

Intraoperative Ultrasound-Fluoroscopy Fusion can Enhance Prostate Brachytherapy Quality  

SciTech Connect

Purpose: To evaluate a transrectal ultrasound (TRUS)-fluoroscopy fusion-based intraoperative dosimetry system. Method and Materials: Twenty-five patients were treated for prostate cancer with Pd-103 implantation. After the execution of the treatment plan, two sets of TRUS images were collected using the longitudinal and axial transducers of a biplanar probe. Then, three fluoroscopic images were acquired at 0, -15 and +15{sup o}. The three-dimensional locations of all implanted seeds were reconstructed from fluoroscopic images. A subset of the implanted seeds was manually identified in TRUS images and used as fiducial markers to perform TRUS-fluoroscopy fusion. To improve the implant quality, additional seeds were placed if adverse isodose patterns were identified during visual inspection. If additional seeds were placed, intraoperative dosimetry was repeated. Day 0 computed tomography-based dosimetry was compared with final intraoperative dosimetry to validate dosimetry achieved in the implant suite. Results: An average of additional 4.0 seeds was implanted in 16 patients after initial intraoperative dose evaluation. Based on TRUS-fluoroscopy fusion-based dosimetry, the V100 improved from 86% to 93% (p = 0.005), whereas D90 increased from 94% to 109% (p = 0.011) with the guided additional seed implantation. No statistical difference was observed in V200 and V300 values. V100 and D90 values were 95 {+-} 4% and 120 {+-} 24%, respectively, based on the final intraoperative dosimetry evaluation, compared with 95 {+-} 4% and 122 {+-} 24%, respectively, based on Day 0 computed tomography-based dosimetry. Conclusions: Implantation of extra seeds based on TRUS-fluoroscopy fusion-based intraoperative dosimetry can improve the final V100 and D90 values with minimal increase in V200 and V300 values.

Orio, Peter F. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Tutar, Ismail B. [Department of Electrical Engineering, University of Washington, Seattle, WA (United States); Narayanan, Sreeram [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Arthurs, Sandra [Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Cho, Paul S. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Kim, Yongmin [Department of Electrical Engineering, University of Washington, Seattle, WA (United States); Department of Bioengineering, University of Washington, Seattle, WA (United States); Merrick, Gregory [Schiffler Cancer Center, Wheeling, WV (United States); Wallner, Kent E. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Radiation Oncology, Group Health Cooperative, Seattle, WA (United States)], E-mail: kent.wallner@med.va.gov

2007-09-01

183

76 FR 11526 - In the Matter of Dr. Gary Kao; Order Prohibiting Involvement In NRC-Licensed Activities  

Federal Register 2010, 2011, 2012, 2013

...brachytherapy iodine-125 used for permanent prostate implants. Dr. Kao was an approved authorized...brachytherapy iodine-125 used for permanent prostate implants under the permit. II On May...NRC that 97 medical events involving prostate brachytherapy occurred at the PVAMC...

2011-03-02

184

Effects of iodine-125 seeds on the methylation of SFRP2 and P16 in colorectal cancer  

PubMed Central

The current study investigated the effects of iodine-125 seeds on the gene methylation of SFRP2 and P16 in colorectal cancer. Mouse models of human colorectal cancer were randomly divided into an experimental group (n=25) and a control group (n=25). The control group was implanted with blank seeds (0 MBq) and the experimental group with iodine-125 seeds (14.8 MBq). At 20 days after implantation, the animals were sacrificed. The methylation levels of SFRP2 and P16 were detected using methylation-specific polymerase chain reactions (MSPs). Following iodine-125 seed irradiation, the level of SFRP2 methylation decreased. The methylation index of the experimental group (0.67±0.05) was significantly lower than that of the control group (0.84±0.07; P<0.05). In the experimental group, 10 samples (40%) displayed methylation in the P16 promoter region compared with 14 (56%) in the control group, which was a significant difference (P<0.05). Iodine-125 seeds induce the downregulation of methylated tumor suppressor gene promoters, thereby inhibiting the proliferation and growth of tumor cells.

LI, XIAOGANG; LU, PING; LI, BO; ZHANG, WANGFU; LUO, KAIYUAN

2013-01-01

185

Prostate brachytherapy seed localization using a mobile C-arm without tracking  

NASA Astrophysics Data System (ADS)

The success of prostate brachytherapy depends on the faithful delivery of a dose plan. In turn, intraoperative localization and visualization of the implanted radioactive brachytherapy seeds enables more proficient and informed adjustments to the executed plan during therapy. Prior work has demonstrated adequate seed reconstructions from uncalibrated mobile c-arms using either external tracking devices or image-based fiducials for c-arm pose determination. These alternatives are either time-consuming or interfere with the clinical flow of the surgery, or both. This paper describes a seed reconstruction approach that avoids both tracking devices and fiducials. Instead, it uses the preoperative dose plan in conjunction with a set of captured images to get initial estimates of the c-arm poses followed by an auto-focus technique using the seeds themselves as fiducials to refine the pose estimates. Intraoperative seed localization is achieved through iteratively solving for poses and seed correspondences across images and reconstructing the 3D implanted seeds. The feasibility of this approach was demonstrated through a series of simulations involving variable noise levels, seed densities, image separability and number of images. Preliminary results indicate mean reconstruction errors within 1.2 mm for noisy plans of 84 seeds or fewer. These are attained for additive noise whose standard deviation of the 3D mean error introduced to the plan to simulate the implant is within 3.2 mm.

Ayad, Maria S.; Lee, Junghoon; Prince, Jerry L.; Fichtinger, Gabor

2009-02-01

186

Comparison Between High and Low Source Activity Seeds for I-125 Permanent Seed Prostate Brachytherapy  

SciTech Connect

Purpose: To compare low (mean 0.44, SD {+-} 0.0163 mCi) with high source activity (0.61 {+-} 0.0178 mCi) in I{sup 125} permanent seed brachytherapy regarding seed loss, dosimetric outcome, and toxicity. Methods and Materials: The study included 199 patients with prostate cancer treated by permanent seed brachytherapy alone: the first 105 with seeds of lower activity (first cohort), the following 94 with higher seed activity (second cohort). The V100, V150, V200, and D90 were analyzed on the CT scan 30 days after implantation (CTD30). The V100, V150, and D2 of the rectum were also calculated on CTD30. Seed loss was determined 30 days after implantation. Urinary toxicity was measured with the International Prostate Symptom Score (IPSS) questionnaire. Results: Lower seed activity was associated with lower V150 and V200 (p = 0.01 and p {<=} 0.001, respectively) on CTD30. More patients had a V100 <90% and D90 <140 Gy in the lower activity cohort (p = 0.098 for D90 and p = 0.029 for V100) on CTD30. There was no difference between cohorts in dose to the rectum (p = 0.325-0.516) or difference in patients' IPSS score from baseline (p = 0.0.117-0.618), although there was a trend toward more urinary toxicity at 4 and 8 months for high activity seeds. Seed loss as a percentage of implanted seeds was not different (p = 0.324). Conclusions: Higher seed activity (I{sup 125} {>=} 0.6 mCi) results in at least equal V100 and D90 on CTD30. However, dose inhomogeneity and a trend toward more urinary toxicity at 4 and 8 months after treatment may lead to a higher long-term urinary complications.

Masucci, Giuseppina Laura; Donath, David; Tetreault-Laflamme, Audrey; Carrier, Jean-Francois; Hervieux, Yannick; Larouche, Renee Xaviere; Bahary, Jean-Paul [Department of Radiation Oncology Centre Hospitalier de l'Universite de Montreal, Montreal (Canada); Taussky, Daniel, E-mail: daniel.taussky.chum@ssss.gouv.qc.c [Department of Radiation Oncology Centre Hospitalier de l'Universite de Montreal, Montreal (Canada)

2010-11-01

187

Assessment of antimicrobial prophylaxis to prevent perioperative infection in patients undergoing prostate brachytherapy: multicenter cohort study.  

PubMed

To propose an appropriate prophylactic antimicrobial therapy for patients undergoing brachytherapy, we evaluated the relationships between various antimicrobial prophylaxis (AMP) protocols and the incidence of postimplant infections in a multicenter cohort study conducted in Japan. The records of 826 patients with localized prostate cancer who underwent a transperineal (125)I brachytherapy procedure between January 2009 and December 2010 were retrospectively reviewed. Perioperative infections, including surgical site and remote infections, were recorded up to postoperative day 30. A total of 6 (0.73%) patients had a perioperative infection following seed implantation, of whom all received AMP for 1 or more days. None of the patients who received a single-dose protocol of AMP using fluoroquinolone p.o. or penicillin with a beta-lactamase inhibitor i.v. developed a perioperative infection. Statistical analysis showed that a single-dose protocol was more significantly related to a lower risk of perioperative infection as compared to the other AMP protocols examined (p = 0.045). Furthermore, our results indicated that bacteriuria and preoperative hair removal were risk factors of perioperative infection with statistical significance (p = 0.007, p = 0.004). Analysis of patient clinical parameters, including age, American Society of Anesthesiologists score, diabetes mellitus, prostate volume, numbers of implanted seeds and needle punctures, operation time, and indwelling duration time of the Foley catheter, did not reveal significant differences in terms of perioperative infection. Our results indicated that a single-dose AMP protocol is sufficient to prevent perioperative infections following seed implantation. On the other hand, AMP is only one of several measures to prevent perioperative infectious complications. It is necessary to know that the patient must have no bacteriuria and that preoperative hair removal should be avoided. PMID:23645185

Taoka, Rikiya; Togo, Yoshikazu; Kubo, Tatsuhiko; Kido, Masahito; Miki, Kenta; Kiyota, Hiroshi; Egawa, Shin; Sugawara, Takashi; Yasuda, Mitsuru; Nakano, Masahiro; Deguchi, Takashi; Nishino, Masashi; Ishikawa, Kiyohito; Shiroki, Ryoichi; Matsumoto, Minori; Shigemura, Katsumi; Tanaka, Kazushi; Arakawa, Soichi; Fujisawa, Masato; Wada, Koichiro; Watanabe, Toyohiko; Kumon, Hiromi; Kobayashi, Kanao; Matsubara, Akio; Sho, Takehiko; Hamasuna, Ryoichi; Matsumoto, Tetsuro; Hayami, Hiroshi; Nakagawa, Masayuki; Yamamoto, Shingo

2013-10-01

188

SU-FF-T-390: In-Vivo Prostate Brachytherapy Absorbed Dose Measurements  

SciTech Connect

Purpose: In-vivo prostate brachytherapy absorbed dosimetrydetector using scintillating fibers. Method and Materials: Five pairs of 85.5 {+-} 0.05 cm long blue shifted scintillating fibers (model BCF-10) with 1 mm{sup 2} cross sectional area were placed in a mixture of gelatin (368.6 {+-} 0.5 grams) and water (3.78 {+-} 0.025 liters) to measured the absorbed dose delivered by a 12 Ci {sup 192}Ir HDR source. The fibers were held by a 7 x 7 cm{sup 2} template grid and optically connected to a 16-channel multianode photomultiplier tube (Hamamatsu, model H6568). Each pair consisted of one fiber 4 mm shorter than the other one to extract the dose by the subtraction method. A dose atlas was used for radiation delivered to the phantom. The plans followed delivered 5 and 7 Gy to a point located 2.0 centimeters away from the central dwelling positions. A total of 32 data points were acquired in a plan to assess the linearity and reproducibility of the measurements.Results: Reproducibility of the data was found to be within 5% and the overall accuracy of the system estimated to be {+-}5.5%. The linearity of the data for all 7 measureddose values (ranging from 0.6 to 7 Gy), gives a slope of 312 counts/Gy with a 1.4% relative deviation. Conclusion: This work indicates the possibility of measuring in real-time the dose effectively delivered to a biological system during prostate brachytherapy treatments. The availability of commercially thin (150 {micro}m) scintillating fibers opens the capability of using such system during clinical treatments (by embedding the fibers within the catheters) with the advantage of performing real-time adjustment of the dose delivery.

Gueye, Paul; Velasco, Carlos; Keppel, Cynthia; Murphy, B.; Sinesi, C.

2009-06-01

189

Implementation of High-Dose-Rate Brachytherapy and Androgen Deprivation in Patients With Prostate Cancer  

SciTech Connect

Purpose: To evaluate outcome (overall survival [OS], the actuarial 5-year cancer-specific survival [CSS], disease-free survival [DFS], biochemical failure-free survival [BFS]), complications and morbidity in patients treated with high-dose-rate brachytherapy (HDR-BT) boost and hormonal treatment with curative aims. Methods: Between 2004 and 2009, 275 prospectively followed pN0/N0M0 patients were included: 19 patients (7%) with T2, Gleason score 7 and prostate-specific antigen (PSA) <10 and 256 patients (93%) with T3 or Gleason score 8-10 or PSA >20 received multimodal treatment with conformal four-field radiotherapy (prostate/vesiculae 2 Gy Multiplication-Sign 25) combined with HDR-BT (iridium 192; prostate 10 Gy Multiplication-Sign 2) with long-term androgen deprivation therapy (ADT). Results: After a median observation time of 44.2 months (range, 10.4-90.5 months) 12 patients had relapsed clinically and/or biochemically and 10 patients were dead, of which 2 patients died from prostate cancer. Five-year estimates of BFS, CSS, DFS, and OS rates were 98.5%, 99.3%, 95.6%, and 96.3%, respectively. None of the patients with either Gleason score <8 or with intermediate risk profile had relapsed. The number of HDR-BT treatments was not related to outcome. Despite of age (median, 65.7 years; range, 45.7-77 years) and considerable pretreatment comorbidity in 39 of 275 patients, Genitourinary treatment-related morbidity was moderate with long-lasting Radiation Therapy Oncology Group Grade 2 voiding problems in 26 patients (9.5%) and occasionally mucous discharge in 20 patients (7%), none with Grade >2 for gastrointestinal at follow-up. Complications during implantations were related to pubic arch interference (4 patients) and lithotomy time, causing 2 patients to develop compartment syndrome. Conclusion: Despite still preliminary observations, our 5-year outcome estimates favor the implementation of high-dose-rate brachytherapy in high-risk patients combined with conformal external radiotherapy and long-term ADT. High-quality implants can be achieved by a trained specialized team at a high-turnover center using transrectal ultrasound-based treatment plans with acceptable morbidity and complication rates.

Lilleby, Wolfgang, E-mail: wolfgang.lilleby@ous-hf.no [Cancer Clinic, Oslo University Hospital, Norwegian Radiumhospital, Department of Radiotherapy and Oncology, Oslo (Norway); Tafjord, Gunnar; Raabe, Nils K. [Cancer Clinic, Oslo University Hospital, Norwegian Radiumhospital, Department of Radiotherapy and Oncology, Oslo (Norway)

2012-07-01

190

The role of high-dose rate brachytherapy in locally advanced prostate cancer.  

PubMed

Although the optimal management of patients with locally advanced prostate cancer remains undefined, sufficient clinical data have emerged showing that patients treated with radiation therapy (RT) have a significantly better outcome as the dose to the gland is escalated. What remains unresolved, however, is how to best deliver these higher tumoricidal doses of RT. Conformal high-dose rate brachytherapy (C-HDR BT) is an alternative means of precise dose escalation that offers similar tumoricidal effects as 3-dimensional (3D) conformal external beam radiotherapy (EBRT) with potential additional advantages. By placing HDR afterloading needles directly into the prostate gland under real-time ultrasound guidance, a steep dose gradient between the prostate and adjacent normal tissues can be generated that is unaffected by organ motion and edema or treatment setup uncertainties. The ability to control the amount of time the single radioactive source dwells at each position along the length of each brachytherapy catheter further enhances the conformity of the dose. In addition, recent radiobiologic data on prostate cancer treatment suggest that the alpha/beta ratio for tumor control is similar to (or possibly even smaller) than that for surrounding late-responding normal tissues. If true, hypofractionation (as practiced with C-HDR BT combined with EBRT) would be expected to produce tumor control and late sequelae that are at least as good as achieved with conventional fractionation, with the additional possibility that early sequelae might be reduced. Recent data from several groups performing C-HDR BT in patients with locally advanced disease have confirmed these assumptions. Combined with the physical advantages discussed earlier, C-HDR BT as a means of dose escalation should provide similar tumor control as 3D conformal EBRT with the added advantages of reduced treatment times, less acute toxicity, and no additional technological requirements to account and correct for treatment setup uncertainties and organ motion. The issues that remain unresolved with this technique (as with other methods of dose escalation) revolve around the amount of additional dose required to provide optimal tumor control, the role of androgen deprivation in the management of patients with locally advanced disease, and whether the regional lymphatics should be irradiated. PMID:12728439

Vicini, Frank A; Vargas, Carlos; Edmundson, Gregory; Kestin, Larry; Martinez, Alvaro

2003-04-01

191

High-dose regions versus likelihood of cure after prostate brachytherapy  

SciTech Connect

Purpose: To analyze the effect of high-dose regions on biochemical cancer control rates after prostate brachytherapy. Methods and Materials: Patients with 1997 American Joint Committee on Cancer clinical Stage T1c-T2a prostate carcinoma (Gleason grade 5-6, prostate-specific antigen level 4-10 ng/mL) were randomized to implantation with {sup 125}I (144 Gy) vs. {sup 103}Pd (125 Gy, National Institute of Standards and Technology 1999). Isotope implantation was performed by standard techniques, using a modified peripheral loading pattern. Of the 313 patients entered in the protocol, 270 were included in this analysis. The {sup 125}I source strength ranged from 0.4 to 0.89 mCi (median, 0.55 mCi), and the {sup 103}Pd source strength ranged from 1.3 to 1.6 mCi (median, 1.5 mCi). CT was performed within 4 h after implantation. The dosimetric parameters analyzed included the percentage of the postimplant prostate volume covered by the 100%, 150%, 200%, and 300% prescription dose (V{sub 100}, V{sub 150}, V{sub 200}, and V{sub 300}, respectively). The median time to the last follow-up for patients without failure was 2.7 years. Freedom from biochemical failure was defined as a serum prostate-specific antigen level of {<=}0.5 ng/mL at last follow-up. Patients were censored at last follow-up if their serum prostate-specific antigen level was still decreasing. Results: The mean V{sub 100}, V{sub 150}, V{sub 200}, and V{sub 300} value was 90% ({+-}8%), 63% ({+-}14), 35% ({+-}13%), and 14% ({+-}7%), respectively. Patients with a V{sub 100} of {>=}90% had a 3-year freedom from biochemical failure rate of 96% vs. 87% for those with a V{sub 100} of <90% (p = 0.0029). Overall, patients with more high-dose regions had a greater chance of biochemical control. However, when only patients with a V{sub 100} of {>=}90% were analyzed, no relationship was found between higher dose regions and the likelihood of cancer control. This lack of effect on biochemical control was apparent for both isotopes. Conclusion: High-dose regions do not appear to affect cancer control rates, as long as >90% of the prostate volume is covered by the prescription dose.

Wallner, Kent [Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States) and Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA (United States) and Group Health Cooperative, Seattle, WA (United States)]. E-mail: kent.wallner@med.va.gov; Merrick, Gregory [Schiffler Cancer Center, Wheeling, WV (United States); Wheeling Jesuit University, Wheeling, WV (United States); Sutlief, Steven [Department of Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States); Department of Radiation Oncology, University of Washington School of Medicine, Seattle, WA (United States); True, Laurence [Department of Pathology, University of Washington School of Medicine, Seattle, WA (United States); Butler, Wayne [Schiffler Cancer Center, Wheeling, WV (United States)

2005-05-01

192

Poor Predictive Value of Intraoperative Real-Time Dosimetry for Prostate Seed Brachytherapy  

SciTech Connect

Purpose: To identify dosimetric parameters predictive of a good prostate seed I{sup 125} quality implant. We analyzed preimplant and postimplant realtime dosimetry in patients treated with intraoperative (IO) inverse planning. Methods and Materials: We analyzed 127 consecutively treated patients with primarily low-risk prostate carcinoma who underwent prostate permanent seed I{sup 125} brachytherapy using an IO planning approach. The implant was done using the three-dimensional transrectal ultrasound (PRE-TRUS)-guided IO interactive inverse preplanning system. The TRUS was repeated in the operating room after the implant procedure was complete (POST-TRUS). The prostate was recontoured and postimplant dosimetry was calculated. Each patient underwent computed tomography scan on Day 28 (CT-D28) to evaluate implant quality. Area under the receiver operating characteristic curves (AUROC) was evaluated for models predictive of a V100 of {>=}90% and a D90 of {>=}140 Gy on the basis of CT-D28 values. Results: On CT-D28, 72.4% of patients had a V100 of {>=}90% and 74.8% had a D90 of {>=}140 Gy. AUROC for a V100 of {>=}90% was 0.665 (p = 0.004) on PRE-TRUS and 0.619 (p = 0.039) on POST-TRUS. AUROC for D90 of {>=}140 Gy was 0.602 (p = 0.086) on PRE-TRUS and 0.614 (p = 0.054) on POST-TRUS. Using PRE-TRUS V100 cutoff of >97% gives sensitivity of 88% and a false-positive rate of 63%. A POST-TRUS D90 cutoff of >170 Gy resulted in a sensitivity of 62% and a false-positive rate of 34%. Conclusions: Because of unacceptably high false-positive rates, IO preimplant and postimplant TRUS-based dosimetry are not accurate tools to predict for postimplant computed tomography-based dosimetry.

Igidbashian, Levon; Donath, David; Carrier, Jean-Francois; Lassalle, Stephanie; Hervieux, Yannick; David, Sandrine; Bahary, Jean-Paul [Departement de Radio-Oncologie, CHUM - Hopital Notre-Dame, Montreal (Canada); Taussky, Daniel [Departement de Radio-Oncologie, CHUM - Hopital Notre-Dame, Montreal (Canada)], E-mail: daniel.taussky.chum@ssss.gouv.qc.ca

2008-10-01

193

Simulation of the artefact of an iodine seed placed at the needle tip in MRI-guided prostate brachytherapy.  

PubMed

The purpose of this research is to study the influence of different needle materials on the artefact of a prostate brachytherapy iodine seed, placed at the needle tip, in MRI (magnetic resonance imaging)-guided prostate brachytherapy. For this research simulations were performed. The simulations showed that with the currently available MRI compatible titanium needles, determination of the exact seed position is difficult, because of the large artefact at the needle tip. This hampers accurate MRI-guided seed delivery. When a plastic needle is used, the image disturbance is caused by the artefact of the iodine seed alone. When a gradient echo sequence is used, the middle of the seed artefact corresponds well with to middle of the real seed position. With the scan parameters we used this deviation was less than 0.4 mm compared to 1.5 mm when a titanium needle is used. PMID:18296753

Lagerburg, V; Moerland, M A; Seppenwoolde, J H; Lagendijk, J J W

2008-03-01

194

Race and Survival Following Brachytherapy-Based Treatment for Men With Localized or Locally Advanced Adenocarcinoma of the Prostate  

SciTech Connect

Purpose: We investigated whether race was associated with risk of death following brachytherapy-based treatment for localized prostate cancer, adjusting for age, cardiovascular comorbidity, treatment, and established prostate cancer prognostic factors. Methods: The study cohort was composed of 5,360 men with clinical stage T1-3N0M0 prostate cancer who underwent brachytherapy-based treatment at 20 centers within the 21st Century Oncology consortium. Cox regression multivariable analysis was used to evaluate the risk of death in African-American and Hispanic men compared to that in Caucasian men, adjusting for age, pretreatment prostate-specific antigen (PSA) level, Gleason score, clinical T stage, year and type of treatment, median income, and cardiovascular comorbidities. Results: After a median follow-up of 3 years, there were 673 deaths. African-American and Hispanic races were significantly associated with an increased risk of all-cause mortality (ACM) (adjusted hazard ratio, 1.77 and 1.79; 95% confidence intervals, 1.3-2.5 and 1.2-2.7; p < 0.001 and p = 0.005, respectively). Other factors significantly associated with an increased risk of death included age (p < 0.001), Gleason score of 8 to 10 (p = 0.04), year of brachytherapy (p < 0.001), and history of myocardial infarction treated with stent or coronary artery bypass graft (p < 0.001). Conclusions: After adjustment for prostate cancer prognostic factors, age, income level, and revascularized cardiovascular comorbidities, African-American and Hispanic races were associated with higher ACM in men with prostate cancer. Additional causative factors need to be identified.

Winkfield, Karen M., E-mail: kwinkfield@partners.org [Harvard Radiation Oncology Program, Harvard Medical School, Boston, Massachusetts (United States); Department of Radiation Oncology, Massachusetts General Hospital, Boston, Massachusetts (United States); Chen Minghui [Department of Statistics, University of Connecticut, Storrs, Connecticut (United States); Dosoretz, Daniel E.; Salenius, Sharon A.; Katin, Michael; Ross, Rudi [21st Century Oncology, Inc., Fort Myers, Florida (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute, Brigham and Women's Hospital, Boston, Massachusetts (United States)

2011-11-15

195

Health-Related Quality of Life 2 Years After Treatment With Radical Prostatectomy, Prostate Brachytherapy, or External Beam Radiotherapy in Patients With Clinically Localized Prostate Cancer  

SciTech Connect

Purpose: To compare treatment impact on health-related quality of life (HRQL) in patients with localized prostate cancer, from before treatment to 2 years after the intervention. Methods and Materials: This was a longitudinal, prospective study of 614 patients with localized prostate cancer treated with radical prostatectomy (134), three-dimensional external conformal radiotherapy (205), and brachytherapy (275). The HRQL questionnaires administered before and after treatment (months 1, 3, 6, 12, and 24) were the Medical Outcomes Study 36-Item Short Form, the Functional Assessment of Cancer Therapy (General and Prostate Specific), the Expanded Prostate Cancer Index Composite (EPIC), and the American Urological Association Symptom Index. Differences between groups were tested by analysis of variance and within-group changes by univariate repeated-measures analysis of variance. Generalized estimating equations (GEE) models were constructed to assess between-group differences in HRQL at 2 years of follow-up after adjusting for clinical variables. Results: In each treatment group, HRQL initially deteriorated after treatment with subsequent partial recovery. However, some dimension scores were still significantly lower after 2 years of treatment. The GEE models showed that, compared with the brachytherapy group, radical prostatectomy patients had worse EPIC sexual summary and urinary incontinence scores (-20.4 and -14.1; p < 0.001), and external radiotherapy patients had worse EPIC bowel, sexual, and hormonal summary scores (-3.55, -5.24, and -1.94; p < 0.05). Prostatectomy patients had significantly better EPIC urinary irritation scores than brachytherapy patients (+4.16; p < 0.001). Conclusions: Relevant differences between treatment groups persisted after 2 years of follow-up. Radical prostatectomy had a considerable negative effect on sexual functioning and urinary continence. Three-dimensional conformal radiotherapy had a moderate negative impact on bowel functioning, and brachytherapy caused moderate urinary irritation. These results provide relevant information for clinical decision making.

Ferrer, Montserrat [Unidad de Investigacion en Servicios Sanitarios, IMIM-Hospital del Mar, Barcelona (Spain); CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona (Spain)], E-mail: mferrer@imim.es; Suarez, Jose Francisco [Servicio de Urologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Spain); Guedea, Ferran [Servicio de Oncologia Radioterapica, Institut Catala d'Oncologia, L'Hospitalet de Llobregat (Spain); Fernandez, Pablo [Servicio de Oncologia Radioterapica, Instituto Oncologico de Guipuzcoa, San Sebastian (Spain); Macias, Victor [Servicio de Oncologia Radioterapica, Capio Hospital General de Catalunya, Sant Cugat del Valles (Spain); Marino, Alfonso [Servicio de Oncologia Radioterapica, Centro Oncologico de Galicia, A Coruna (Spain); Hervas, Asuncion [Servicio de Oncologia Radioterapica, Hospital Ramon y Cajal, Madrid (Spain); Herruzo, Ismael [Servicio de Oncologia Radioterapica, Hospital Regional Carlos Haya, Malaga (Spain); Ortiz, Maria Jose [Servicio de Oncologia Radioterapica, Hospital Virgen del Rocio, Sevilla (Spain); Villavicencio, Humberto [Servicio de Urologia, Fundacion Puigvert, Barcelona (Spain); Craven-Bratle, Jordi [Servicio de Oncologia Radioterapica, Hospital de la Santa Creu i Sant Pau, Barcelona (Spain); Garin, Olatz [Unidad de Investigacion en Servicios Sanitarios, IMIM-Hospital del Mar, Barcelona (Spain); CIBER en Epidemiologia y Salud Publica (CIBERESP), Barcelona (Spain); Aguilo, Ferran [Servicio de Urologia, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat (Spain)

2008-10-01

196

Intraoperative 3D reconstruction of prostate brachytherapy implants with automatic pose correction  

NASA Astrophysics Data System (ADS)

The success of prostate brachytherapy critically depends on delivering adequate dose to the prostate gland, and the capability of intraoperatively localizing implanted seeds provides potential for dose evaluation and optimization during therapy. REDMAPS is a recently reported algorithm that carries out seed localization by detecting, matching and reconstructing seeds in only a few seconds from three acquired x-ray images (Lee et al 2011 IEEE Trans. Med. Imaging 29 38-51). In this paper, we present an automatic pose correction (APC) process that is combined with REDMAPS to allow for both more accurate seed reconstruction and the use of images with relatively large pose errors. APC uses a set of reconstructed seeds as a fiducial and corrects the image pose by minimizing the overall projection error. The seed matching and APC are iteratively computed until a stopping condition is met. Simulations and clinical studies show that APC significantly improves the reconstructions with an overall average matching rate of >=99.4%, reconstruction error of <=0.5 mm, and the matching solution optimality of >=99.8%.

Lee, Junghoon; Kuo, Nathanael; Deguet, Anton; Dehghan, Ehsan; Song, Danny Y.; Burdette, Everette C.; Prince, Jerry L.

2011-08-01

197

Intraoperative 3-D Reconstruction of Prostate Brachytherapy Implants with Automatic Pose Correction  

PubMed Central

The success of prostate brachytherapy critically depends on delivering adequate dose to the prostate gland, and the capability of intraoperatively localizing implanted seeds provides potential for dose evaluation and optimization during therapy. REDMAPS is a recently reported algorithm that carries out seed localization by detecting, matching, and reconstructing seeds in only a few seconds from three acquired x-ray images. In this paper, we present an automatic pose correction (APC) process that is combined with REDMAPS to allow for both more accurate seed reconstruction and the use of images with relatively large pose errors. APC uses a set of reconstructed seeds as a fiducial and corrects the image pose by minimizing the overall projection error. The seed matching and APC are iteratively computed until a stopping condition is met. Simulations and clinical studies show that APC significantly improves the reconstructions with an overall average matching rate of ? 99.4%, reconstruction error of ? 0.5 mm, and the matching solution optimality of ? 99.8%.

Lee, Junghoon; Kuo, Nathanael; Deguet, Anton; Dehghan, Ehsan; Song, Danny Y.; Burdette, Everette C.; Prince, Jerry L.

2011-01-01

198

Characteristic Variation of ?-Fetoprotein DNA Nanometer-Range Irradiated by Iodine-125  

PubMed Central

Abstract To obtain the characteristic variation of structure and functional groups of ?-fetoprotein (AFP) DNA irradiated by iodine-125(125I), the AFP antisense oligonucleotide labeled with various radioactivity dose 125I was mixed with the AFP DNA in a simulated polymerase chain reaction temperature condition. After the mixtures were irradiated by the 125I from 2 to 72 hours, the mutation of the biogenic conformation and functional groups of the irradiated DNA were investigated using laser Raman spectroscopy. The shifted peak and the decreased intensity of the characteristic Raman spectra were found, which demonstrated that the structure of the phosphodiester linkage was broke, the pyridine and purine bases in DNA emerged and damaged. The model of gene conformation changed from form B to form C spectrum after the nanometer-range irradiation with 125I from 2 to 24 hours. The damage of local pyridine and purine bases gradually increased along with the accumulation of irradiation, and the bases and ribosome were finally dissociated and stacked.

Cheng, Mu-hua; Li, Jian-fang; Wu, Zheng-jie; Xie, Liang-jun

2013-01-01

199

Comparison of MRI-based and CT/MRI fusion-based postimplant dosimetric analysis of prostate brachytherapy  

SciTech Connect

Purpose: The aim of this study was to compare the outcomes between magnetic resonance imaging (MRI)-based and computed tomography (CT)/MRI fusion-based postimplant dosimetry methods in permanent prostate brachytherapy. Methods and Materials: Between October 2004 and March 2006, a total of 52 consecutive patients with prostate cancer were treated by brachytherapy, and postimplant dosimetry was performed using CT/MRI fusion. The accuracy and reproducibility were prospectively compared between MRI-based dosimetry and CT/MRI fusion-based dosimetry based on the dose-volume histogram (DVH) related parameters as recommended by the American Brachytherapy Society. Results: The prostate volume was 15.97 {+-} 6.17 cc (mean {+-} SD) in MRI-based dosimetry, and 15.97 {+-} 6.02 cc in CT/MRI fusion-based dosimetry without statistical difference. The prostate V100 was 94.5% and 93.0% in MRI-based and CT/MRI fusion-based dosimetry, respectively, and the difference was statistically significant (p = 0.002). The prostate D90 was 119.4% and 114.4% in MRI-based and CT/MRI fusion-based dosimetry, respectively, and the difference was statistically significant (p = 0.004). Conclusion: Our current results suggested that, as with fusion images, MR images allowed accurate contouring of the organs, but they tended to overestimate the analysis of postimplant dosimetry in comparison to CT/MRI fusion images. Although this MRI-based dosimetric discrepancy was negligible, MRI-based dosimetry was acceptable and reproducible in comparison to CT-based dosimetry, because the difference between MRI-based and CT/MRI fusion-based results was smaller than that between CT-based and CT/MRI fusion-based results as previously reported.

Tanaka, Osamu [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan)]. E-mail: osa-mu@umin.ac.jp; Hayashi, Shinya [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan); Matsuo, Masayuki [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan); Sakurai, Kota [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan); Department of Urology, Gifu University School of Medicine, Gifu City (Japan); Nakano, Masahiro [Department of Urology, Gifu University School of Medicine, Gifu City (Japan); Maeda, Sunaho [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan); Kajita, Kimihiro R.T. [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan); Deguchi, Takashi [Department of Urology, Gifu University School of Medicine, Gifu City (Japan); Hoshi, Hiroaki [Department of Radiology, Gifu University School of Medicine, Gifu City (Japan)

2006-10-01

200

Health-Related Quality of Life up to Six Years After {sup 125}I Brachytherapy for Early-Stage Prostate Cancer  

SciTech Connect

Purpose: Health-related quality of life (HRQOL) after prostate brachytherapy has been extensively described in published reports but hardly any long-term data are available. The aim of the present study was to prospectively assess long-term HRQOL 6 years after {sup 125}I prostate brachytherapy. Methods and Materials: A total of 127 patients treated with {sup 125}I brachytherapy for early-stage prostate cancer between December 2000 and June 2003 completed a HRQOL questionnaire at five time-points: before treatment and 1 month, 6 months, 1 year, and 6 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer core questionnaire (EORTCQLQ-C30), and the tumor-specific EORTC prostate cancer module (EORTC-PR25). A change in a score of >=10 points was considered clinically relevant. Results: Overall, the HRQOL at 6 years after {sup 125}I prostate brachytherapy did not significantly differ from baseline. Although a statistically significant deterioration in HRQOL at 6 years was seen for urinary symptoms, bowel symptoms, pain, physical functioning, and sexual activity (p <.01), most changes were not clinically relevant. A statistically significant improvement at 6 years was seen for mental health, emotional functioning, and insomnia (p <.01). The only clinically relevant changes were seen for emotional functioning and sexual activity. Conclusion: This is the first study presenting prospective HRQOL data up to 6 years after {sup 125}I prostate brachytherapy. HRQOL scores returned to approximately baseline values at 1 year and remained stable up to 6 years after treatment. {sup 125}I prostate brachytherapy did not adversely affect patients' long-term HRQOL.

Roeloffzen, Ellen M.A., E-mail: E.M.A.Roeloffzen@UMCUtrecht.n [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Lips, Irene M.; Gellekom, Marion P.R. van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Roermund, Joep van [Department of Urology, University Medical Center Utrecht, Utrecht (Netherlands); Frank, Steven J. [Department of Radiation Oncology, M. D. Anderson Medical Center, Houston, TX (United States); Battermann, Jan J.; Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2010-03-15

201

Method for the simultaneous preparation of Radon-211, Xenon-125, Xenon-123, Astatine-211, Iodine-125 and Iodine-123  

DOEpatents

A method for simultaneously preparing Radon-211, Astatine-211, Xenon-125, Xenon-123, Iodine-125 and Iodine-123 in a process that includes irradiating a fertile metal material then using a one-step chemical procedure to collect a first mixture of about equal amounts of Radon-211 and Xenon-125, and a separate second mixture of about equal amounts of Iodine-123 and Astatine-211.

Mirzadeh, Saed (East Setauket, NY); Lambrecht, Richard M. (Quogue, NY)

1987-01-01

202

Combined treatment with temporary short-term high dose rate Iridium192 brachytherapy and external beam radiotherapy for irradiation of localized prostatic carcinoma  

Microsoft Academic Search

Purpose: To evaluate the treatment outcome after radical radiotherapy of localized prostate cancer in 50 patients (38 patients with stage T1–2 and 12 patients with stage T3) after a median follow-up time of 45 months (range 18–92 months).Methods: The treatment was given by combination of external beam radiotherapy (50 Gy) and brachytherapy (2 × 10 Gy). The brachytherapy was given

Göran Borghede; Hans Hedelin; Sten Holmäng; Karl Axel Johansson; Frank Aldenborg; Silas Pettersson; Göran Sernbo; Arne Wallgren; Claes Mercke

1997-01-01

203

Mixed integer programming improves comprehensibility and plan quality in inverse optimization of prostate HDR brachytherapy.  

PubMed

Current inverse treatment planning methods that optimize both catheter positions and dwell times in prostate HDR brachytherapy use surrogate linear or quadratic objective functions that have no direct interpretation in terms of dose-volume histogram (DVH) criteria, do not result in an optimum or have long solution times. We decrease the solution time of the existing linear and quadratic dose-based programming models (LP and QP, respectively) to allow optimizing over potential catheter positions using mixed integer programming. An additional average speed-up of 75% can be obtained by stopping the solver at an early stage, without deterioration of the plan quality. For a fixed catheter configuration, the dwell time optimization model LP solves to optimality in less than 15 s, which confirms earlier results. We propose an iterative procedure for QP that allows us to prescribe the target dose as an interval, while retaining independence between the solution time and the number of dose calculation points. This iterative procedure is comparable in speed to the LP model and produces better plans than the non-iterative QP. We formulate a new dose-volume-based model that maximizes V(100%) while satisfying pre-set DVH criteria. This model optimizes both catheter positions and dwell times within a few minutes depending on prostate volume and number of catheters, optimizes dwell times within 35 s and gives better DVH statistics than dose-based models. The solutions suggest that the correlation between the objective value and the clinical plan quality is weak in the existing dose-based models. PMID:23363622

Gorissen, Bram L; den Hertog, Dick; Hoffmann, Aswin L

2013-02-21

204

Topological methods for the comparison of structures using LDR-brachytherapy of the prostate as an example  

NASA Astrophysics Data System (ADS)

The dose coverage of low dose rate (LDR)-brachytherapy for localized prostate cancer is monitored 4-6 weeks after intervention by contouring the prostate on computed tomography and/or magnetic resonance imaging sets. Dose parameters for the prostate (V100, D90 and D80) provide information on the treatment quality. Those depend strongly on the delineation of the prostate contours. We therefore systematically investigated the contouring process for 21 patients with five examiners. The prostate structures were compared with one another using topological procedures based on Boolean algebra. The coincidence number CV measures the agreement between a set of structures. The mutual coincidence C(i, j) measures the agreement between two structures i and j, and the mean coincidence C(i) compares a selected structure i with the remaining structures in a set. All coincidence parameters have a value of 1 for complete coincidence of contouring and 0 for complete absence. The five patients with the lowest CV values were discussed, and rules for contouring the prostate have been formulated. The contouring and assessment were repeated after 3 months for the same five patients. All coincidence parameters have been improved after instruction. This shows objectively that training resulted in more consistent contouring across examiners.

Schiefer, H.; von Toggenburg, F.; Seelentag, W. W.; Plasswilm, L.; Ries, G.; Schmid, H.-P.; Leippold, T.; Krusche, B.; Roth, J.; Engeler, D.

2009-08-01

205

The Impact of Brachytherapy on Prostate Cancer-Specific Mortality for Definitive Radiation Therapy of High-Grade Prostate Cancer: A Population-Based Analysis  

SciTech Connect

Purpose: This population-based analysis compared prostate cancer-specific mortality (PCSM) in a cohort of patients with high-risk prostate cancer after nonsurgical treatment with external beam radiation therapy (EBRT), brachytherapy (BT), or combination (BT + EBRT). Methods and Materials: We identified from the Surveillance, Epidemiology and End Results database patients diagnosed from 1988 through 2002 with T1-T3N0M0 prostate adenocarcinoma of poorly differentiated grade and treated with BT, EBRT, or BT + EBRT. During this time frame, the database defined high grade as prostate cancers with Gleason score 8-10, or Gleason grade 4-5 if the score was not recorded. This corresponds to a cohort primarily with high-risk prostate cancer, although some cases where only Gleason grade was recorded may have included intermediate-risk cancer. We used multivariate models to examine patient and tumor characteristics associated with the likelihood of treatment with each radiation modality and the effect of radiation modality on PCSM. Results: There were 12,745 patients treated with EBRT (73.5%), BT (7.1%), or BT + EBRT (19.4%) included in the analysis. The median follow-up time for all patients was 6.4 years. The use of BT or BT + EBRT increased from 5.1% in 1988-1992 to 31.4% in 1998-2002. Significant predictors of use of BT or BT + EBRT were younger age, later year of diagnosis, urban residence, and earlier T-stage. On multivariate analysis, treatment with either BT (hazard ratio, 0.66; 95% confidence interval, 0.49-0.86) or BT + EBRT (hazard ratio, 0.77; 95% confidence ratio, 0.66-0.90) was associated with significant reduction in PCSM compared with EBRT alone. Conclusion: In patients with high-grade prostate cancer, treatment with brachytherapy is associated with reduced PCSM compared with EBRT alone. Our results suggest that brachytherapy should be investigated as a component of definitive treatment strategies for patients with high-risk prostate cancer.

Shen Xinglei [Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Keith, Scott W. [Division of Biostatistics, Department of Pharmacology and Experimental Therapeutics, Thomas Jefferson University, Philadelphia, PA (United States); Mishra, Mark V.; Dicker, Adam P. [Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States); Showalter, Timothy N., E-mail: timothy.showalter@jeffersonhospital.org [Department of Radiation Oncology, Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA (United States)

2012-07-15

206

Optimization of dose distribution for HDR brachytherapy of the prostate using Attraction-Repulsion Model  

SciTech Connect

Purpose: To optimize dose distribution for high-dose-rate brachytherapy for prostate cancer, we have developed a new algorithm named Attraction-Repulsion Model (ARM). In this study, we compared the ARM with geometric optimization (GO). Methods and Materials: The ARM was used to optimize the dose distribution by finding the best dwell time combination. ARM requires grids inside the clinical target volume (CTV) and critical organs. These grids generate attraction or repulsion based on specific dose constraints. After calculations were performed repeatedly until the attraction and repulsion forces reached equilibrium, the optimal dwell time distribution was established. We compared the ARM with GO for 10 patients using dose-volume histograms. Results: The CTV ranged from 23 to 48 cc, and the CTV V150 ranged from 52% to 79%, and 23% to 44% for GO and ARM, respectively. This indicates that the dose homogeneity indices, as well as the conformal indices, were higher for ARM than for GO. The urethra V150 was 0-99% and 0-1% for GO and ARM, respectively. Conclusion: The ARM proved to be superior to GO in minimizing the dose to normal structures and in improving dose homogeneity for the target while reducing the dose to normal tissues.

Sumida, Iori [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan)]. E-mail: sumida@radonc.med.osaka-u.ac.jp; Shiomi, Hiroya [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Yoshioka, Yasuo [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Inoue, Takehiro [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Lessard, Etienne [Department of Radiation Oncology, University of California San Francisco, San Francisco, CA (United States); Hsu, I.-C.J. [Department of Radiation Oncology, University of California San Francisco, San Francisco, CA (United States); Pouliot, Jean [Department of Radiation Oncology, University of California San Francisco, San Francisco, CA (United States)

2006-02-01

207

An iterative sequential mixed-integer approach to automated prostate brachytherapy treatment plan optimization  

NASA Astrophysics Data System (ADS)

Conventional treatment planning for interstitial prostate brachytherapy is generally a `trial and error' process in which improved treatment plans are generated by iteratively changing, via expert judgement, the configuration of sources within the target volume in order to achieve a satisfactory dose distribution. We have utilized linear mixed-integer programming (MIP) and the branch-and-bound method, a deterministic search algorithm, to generate treatment plans. The rapidity of dose falloff from an interstitial radioactive source requires fine sampling of the space in which dose is calculated. This leads to a large and complex model that is difficult to solve as a single 3D problem. We have therefore implemented an iterative sequential approach that optimizes pseudo-independent 2D slices to achieve a fine-grid 3D solution. Using our approach, treatment plans can be generated in 20-45 min on a 200 MHz processor. A comparison of our approach with the manual `trial and error' approach shows that the optimized plans are generally superior. The dose to the urethra and rectum is usually maintained below harmful levels without sacrificing target coverage. In the event that the dose to the urethra is undesirably high, we present a refined optimization approach that lowers urethra dose without significant loss in target coverage. An analysis of the sensitivity of the optimized plans to seed misplacement during the implantation process is also presented that indicates remarkable stability of the dose distribution in comparison with manual treatment plans.

D'Souza, W. D.; Meyer, R. R.; Thomadsen, B. R.; Ferris, M. C.

2001-02-01

208

An iterative sequential mixed-integer approach to automated prostate brachytherapy treatment plan optimization.  

PubMed

Conventional treatment planning for interstitial prostate brachytherapy is generally a 'trial and error' process in which improved treatment plans are generated by iteratively changing, via expert judgement, the configuration of sources within the target volume in order to achieve a satisfactory dose distribution. We have utilized linear mixed-integer programming (MIP) and the branch-and-bound method, a deterministic search algorithm, to generate treatment plans. The rapidity of dose falloff from an interstitial radioactive source requires fine sampling of the space in which dose is calculated. This leads to a large and complex model that is difficult to solve as a single 3D problem. We have therefore implemented an iterative sequential approach that optimizes pseudo-independent 2D slices to achieve a fine-grid 3D solution. Using our approach, treatment plans can be generated in 20-45 min on a 200 MHz processor. A comparison of our approach with the manual 'trial and error' approach shows that the optimized plans are generally superior. The dose to the urethra and rectum is usually maintained below harmful levels without sacrificing target coverage. In the event that the dose to the urethra is undesirably high, we present a refined optimization approach that lowers urethra dose without significant loss in target coverage. An analysis of the sensitivity of the optimized plans to seed misplacement during the implantation process is also presented that indicates remarkable stability of the dose distribution in comparison with manual treatment plans. PMID:11229716

D'Souza, W D; Meyer, R R; Thomadsen, B R; Ferris, M C

2001-02-01

209

Patient-Reported Quality of Life Following Salvage Brachytherapy For Radio-Recurrent Prostate Cancer: A Prospective Phase II Study  

PubMed Central

Background Patient-reported quality of life following salvage brachytherapy for radiorecurrent prostate cancer has not been well-characterized prospectively. Methods We examined 25 men who recurred after primary radiotherapy for prostate cancer and received MRI-guided salvage brachytherpy as part of a prospective phase II study. These patients prospectively received a validated patient-reported quality of life questionnaire to fill out at baseline, as well as 3, 15, and 27 months after re-irradiation to determine the degree of sexual, bowel, and urinary dysfunction (maximum dysfunction score = 100). Results On average, sexual function continued to decline with time, and patients had significantly worse sexual function scores at 27 months than baseline (p=0.01). However, while bowel and urinary symptoms worsened acutely at 3 or 15 months, they showed on average some improvement by 27 months, and there were no significant differences between baseline and 27 month urinary or bowel scores. An interval to re-irradiation less than 4.5 years and prior brachytherapy were each significantly associated with the largest decrements in bowel function (p=0.035). Conclusion Similar to the patterns seen in the de novo setting, patients who receive salvage brachytherapy report a worsening of bowel and urinary symptoms followed by some improvement by 27 months, while sexual function steadily declines over time. Interval to re-irradiation and type of prior radiation received may be used to counsel and optimize selection of men for salvage brachytherapy with regard to quality-of-life endpoints.

Nguyen, Paul L.; Chen, Ronald C.; Clark, Jack A.; Cormack, Robert A.; Loffredo, Marian; McMahon, Elizabeth; Nguyen, Angela U.; Suh, W. Warren; Tempany, Clare M.; D'Amico, Anthony V.

2014-01-01

210

Reliability of EUCLIDIAN: An autonomous robotic system for image-guided prostate brachytherapy  

PubMed Central

Purpose: Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. Methods: The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane’s model and the Army Material Systems Analysis Activity, i.e., Crow’s model, were applied. The MTBF was used as an important measure for assessing the system’s reliability. Results: During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane’s postulation as well as Crow’s postulation of reliability growth. The Laplace test index was ?3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward improved reliability. The MTBF was 592 seeds, which implied that several prostate seed implantation cases would be possible without encountering any critical failure. The shape parameter for the MTBF was 0.3859 (<1), suggesting a positive reliability growth of this robotic system. At 95% confidence, the reliability for deposition of 65 seeds was more than 90%. Conclusions: Analyses of failure mode strongly indicated a gradual improvement of reliability of this autonomous robotic system. High MTBF implied that several prostate seed implant cases would be possible without encountering any critical failure.

Podder, Tarun K.; Buzurovic, Ivan; Huang, Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan

2011-01-01

211

Reliability of EUCLIDIAN: An autonomous robotic system for image-guided prostate brachytherapy  

SciTech Connect

Purpose: Recently, several robotic systems have been developed to perform accurate and consistent image-guided brachytherapy. Before introducing a new device into clinical operations, it is important to assess the reliability and mean time before failure (MTBF) of the system. In this article, the authors present the preclinical evaluation and analysis of the reliability and MTBF of an autonomous robotic system, which is developed for prostate seed implantation. Methods: The authors have considered three steps that are important in reliability growth analysis. These steps are: Identification and isolation of failures, classification of failures, and trend analysis. For any one-of-a-kind product, the reliability enhancement is accomplished through test-fix-test. The authors have used failure mode and effect analysis for collection and analysis of reliability data by identifying and categorizing the failure modes. Failures were classified according to severity. Failures that occurred during the operation of this robotic system were considered as nonhomogenous Poisson process. The failure occurrence trend was analyzed using Laplace test. For analyzing and predicting reliability growth, commonly used and widely accepted models, Duane's model and the Army Material Systems Analysis Activity, i.e., Crow's model, were applied. The MTBF was used as an important measure for assessing the system's reliability. Results: During preclinical testing, 3196 seeds (in 53 test cases) were deposited autonomously by the robot and 14 critical failures were encountered. The majority of the failures occurred during the first few cases. The distribution of failures followed Duane's postulation as well as Crow's postulation of reliability growth. The Laplace test index was -3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward improved reliability. The MTBF was 592 seeds, which implied that several prostate seed implantation cases would be possible without encountering any critical failure. The shape parameter for the MTBF was 0.3859 (<1), suggesting a positive reliability growth of this robotic system. At 95% confidence, the reliability for deposition of 65 seeds was more than 90%. Conclusions: Analyses of failure mode strongly indicated a gradual improvement of reliability of this autonomous robotic system. High MTBF implied that several prostate seed implant cases would be possible without encountering any critical failure.

Podder, Tarun K.; Buzurovic, Ivan; Huang Ke; Showalter, Timothy; Dicker, Adam P.; Yu, Yan [Department of Radiation Oncology, Kimmel Cancer Center (NCI-designated), Thomas Jefferson University, Philadelphia, Pennsylvania 19107 (United States)

2011-01-15

212

On the need to compensate edema-induced dose reductions in pre-planned 131Cs prostate brachytherapy  

PubMed Central

Purpose Surgical-trauma-induced edema and its protracted resolution can lead to significant dose reduction in pre-planned 131Cs prostate brachytherapy. The purpose of this work was to examine whether these dose reductions should be actively compensated and to estimate the magnitude of additional irradiations needed for dose compensation. Methods and Materials Quantitative edema resolution characteristics observed by Waterman et. el. were used to examine the physical and radiobiological effects of prostate edema in pre-planned 131Cs implants. The need for dose compensation was assessed based on the dose-responses observed in 125I and 103Pd prostate implants. Biologically effective dose calculated with full consideration of edema evolution was used to estimate the additional irradiations needed for dose compensation. Results Edema-induced dose reduction in pre-planned 131Cs implants could easily exceed 10% prescription dose for implants with moderate or large edemas. These dose reductions could lead to more than 10% reduction in biochemical recurrence-free survival for individual patients if the effect of edema was ignored. For a prescribed dose of 120 Gy, the number of 2-Gy external-beam fractions needed to compensate a 5%, 10%, 15%, 20%, or 25% edema-induced dose reduction could be 1, 4, 6, 7, or 9, respectively, for prostate cancers with a median potential doubling time of 42 days. The required additional irradiation increases for tumors that are fast growing and/or are less efficient in sub-lethal damage repair. Conclusions Compensation of edema-induced dose reductions in pre-planned 131Cs prostate brachytherapy should be actively considered for those implants with moderate or large edemas.

Chen, Z. Jay; Deng, Jun; Roberts, Kenneth; Nath, Ravinder

2008-01-01

213

EchoSeed Model 6733 Iodine-125 brachytherapy source: improved dosimetric characterization using the MCNP5 Monte Carlo code.  

PubMed

This study primarily aimed to obtain the dosimetric characteristics of the Model 6733 (125)I seed (EchoSeed) with improved precision and accuracy using a more up-to-date Monte-Carlo code and data (MCNP5) compared to previously published results, including an uncertainty analysis. Its secondary aim was to compare the results obtained using the MCNP5, MCNP4c2, and PTRAN codes for simulation of this low-energy photon-emitting source. The EchoSeed geometry and chemical compositions together with a published (125)I spectrum were used to perform dosimetric characterization of this source as per the updated AAPM TG-43 protocol. These simulations were performed in liquid water material in order to obtain the clinically applicable dosimetric parameters for this source model. Dose rate constants in liquid water, derived from MCNP4c2 and MCNP5 simulations, were found to be 0.993 cGyh(-1)?U(-1) (±1.73%) and 0.965 cGyh(-1)?U(-1) (±1.68%), respectively. Overall, the MCNP5 derived radial dose and 2D anisotropy functions results were generally closer to the measured data (within ±4%) than MCNP4c and the published data for PTRAN code (Version 7.43), while the opposite was seen for dose rate constant. The generally improved MCNP5 Monte Carlo simulation may be attributed to a more recent and accurate cross-section library. However, some of the data points in the results obtained from the above-mentioned Monte Carlo codes showed no statistically significant differences. Derived dosimetric characteristics in liquid water are provided for clinical applications of this source model. PMID:22894389

Mosleh-Shirazi, M A; Hadad, K; Faghihi, R; Baradaran-Ghahfarokhi, M; Naghshnezhad, Z; Meigooni, A S

2012-08-01

214

Comparison of Real-Time Intraoperative Ultrasound-Based Dosimetry With Postoperative Computed Tomography-Based Dosimetry for Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate whether real-time intraoperative ultrasound (US)-based dosimetry can replace conventional postoperative computed tomography (CT)-based dosimetry in prostate brachytherapy. Methods and Materials: Between December 2001 and November 2002, 82 patients underwent {sup 103}Pd prostate brachytherapy. An interplant treatment planning system was used for real-time intraoperative transrectal US-guided treatment planning. The dose distribution was updated according to the estimated seed position to obtain the dose-volume histograms. Postoperative CT-based dosimetry was performed a few hours later using the Theraplan-Plus treatment planning system. The dosimetric parameters obtained from the two imaging modalities were compared. Results: The results of this study revealed correlations between the US- and CT-based dosimetry. However, large variations were found in the implant-quality parameters of the two modalities, including the doses covering 100%, 90%, and 80% of the prostate volume and prostate volumes covered by 100%, 150%, and 200% of the prescription dose. The mean relative difference was 38% and 16% for doses covering 100% and 90% of the prostate volume and 10% and 21% for prostate volumes covered by 100% and 150% of the prescription dose, respectively. The CT-based volume covered by 200% of the prescription dose was about 30% greater than the US-based one. Compared with CT-based dosimetry, US-based dosimetry significantly underestimated the dose to normal organs, especially for the rectum. The average US-based maximal dose and volume covered by 100% of the prescription dose for the rectum was 72 Gy and 0.01 cm{sup 3}, respectively, much lower than the 159 Gy and 0.65 cm{sup 3} obtained using CT-based dosimetry. Conclusion: Although dosimetry using intraoperative US-based planning provides preliminary real-time information, it does not accurately reflect the postoperative CT-based dosimetry. Until studies have determined whether US-based dosimetry or postoperative CT-based dosimetry can better predict patient outcomes, the American Brachytherapy Society recommendation of CT-based postimplant dosimetry should remain the standard of care.

Nag, Subir [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Kaiser Permanente Radiation Oncology, Santa Clara, CA (United States); Shi Peipei [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Department of Statistics, Case Western Reserve University, Cleveland, OH (United States); Liu Bingren [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Department of Radiation Oncology, University of Rochester School of Medicine and Dentistry, Rochester, NY (United States); Gupta, Nilendu [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Bahnson, Robert R. [Department of Urologic Surgery, Ohio State University, Columbus, OH (United States); Wang, Jian Z. [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States)], E-mail: wang.993@osu.edu

2008-01-01

215

Alpha 1-Adrenoceptor Blocker May Improve Not Only Voiding But Also Storage Lower Urinary Tract Symptoms Caused by 125I Brachytherapy for Prostate Cancer  

PubMed Central

Purpose. To assess changes in lower urinary tract symptoms (LUTS) within 1 year after brachytherapy in patients receiving alpha 1-adrenoceptor antagonists. Methods. We retrospectively evaluated 116 patients who underwent 125I prostate brachytherapy in our institute. Seventy-one patients were treated with a combination of external beam radiation therapy and brachytherapy. Alpha 1-adrenoceptor antagonists were prescribed to all patients after brachytherapy. International Prostate Symptom Score (IPSS) forms and postvoid residual urine volume were recorded at all follow-up visits. Results. Forty-nine patients were given tamsulosin hydrochloride, 32 were given silodosin hydrochloride, and 35 were given naftopidil for up to 6 months after seed implantation. Patients given tamsulosin or naftopidil tended to show a higher peak IPSS and slower recovery to baseline values than those given silodosin. The patients given naftopidil showed an insufficient recovery in storage symptoms in naftopidil group in comparison with tamsulosin group at 3 months and with silodosin group at 6 and 9 months. Conclusions. In the management of LUT after brachytherapy, silodosin may provide a more favorable improvement. Silodosin and tamsulosin may have an advantage in improving not only voiding but also storage lower urinary tract symptoms after brachytherapy.

Aoki, Yoshitaka; Ito, Hideaki; Miwa, Yoshiji; Akino, Hironobu; Shioura, Hiroki; Kimura, Hirohiko; Yokoyama, Osamu

2014-01-01

216

PHASE II PROSPECTIVE STUDY OF THE USE OF CONFORMAL HIGH DOSE-RATE BRACHYTHERAPY AS MONOTHERAPY FOR THE TREATMENT OF FAVORABLE STAGE PROSTATE CANCER: A FEASIBILITY REPORT  

Microsoft Academic Search

Purpose: To evaluate the technical feasibility and tolerance of image-guided transperineal conformal high-dose- rate (C-HDR) brachytherapy as the sole treatment modality for favorable, localized cancer of the prostate, and to analyze possible intrafraction and interfraction volume changes in the prostate gland which may affect dosimetric quality. Methods and Materials: Patients were eligible for this prospective Phase II trial if they

ALVARO A. MARTINEZ; ISTVAN PATAKI; GREGORY EDMUNDSON; EVELYN SEBASTIAN; DONALD BRABBINS; GARY GUSTAFSON

2001-01-01

217

Efficacy and Safety of High-Dose-Rate Brachytherapy of Single Implant with Two Fractions Combined with External Beam Radiotherapy for Hormone-Na?ve Localized Prostate Cancer  

PubMed Central

The purpose of this study was to evaluate the efficacy and safety of high-dose-rate (HDR) brachytherapy of a single implant with two fractions plus external beam radiotherapy (EBRT) for hormone-naïve prostate cancer in comparison with radical prostatectomy. Of 150 patients with localized prostate cancer (T1c–T2c), 59 underwent HDR brachytherapy plus EBRT, and 91 received radical prostatectomy. The median follow-up of patients was 62 months for HDR brachytherapy plus EBRT, and 64 months for radical prostatectomy. In patient backgrounds between the two cohorts, the frequency of T2b plus T2c was greater in HDR brachytherapy cohort than in prostatectomy cohort (27% versus 12%, p = 0.029). Patients in HDR brachytherapy cohort first underwent 3D conformal RT with four beams to the prostate to an isocentric dose of 50 Gy in 25 fractions and then, a total of 15–18 Gy in two fractions at least 5 hours apart. We prescribed 9 Gy/fraction for target (prostate gland plus 3 mm lateral outside margin and seminal vesicle) using CT image method for radiation planning. The total biochemical failure-free control rates (BF-FCR) at 3 and 5 years for the HDR brachytherapy cohort, and for the prostatectomy cohort were 92% and 85%, and 72% and 72%, respectively (significant difference, p = 0.0012). The 3-and 5-year BF-FCR in the HDR brachytherapy cohort and in the prostatectomy cohort by risk group was 100 and 100%, and 80 and 80%, respectively, for the low-risk group (p = 0.1418); 92 and 92%, 73 and 73%, respectively, for the intermediate-risk group (p = 0.0492); and 94 and 72%, 45 and 45%, respectively, for the high-risk group (p = 0.0073). After HDR brachytherapy plus EBRT, no patient experienced Grade 2 or greater genitourinay toxicity. The rate of late Grade 1 and 2 GI toxicity was 6% (n = 4). No patient experienced Grade 3 GI toxicity. HDR brachytherapy plus EBRT is useful for treating patients with hormone-naïve localized prostate cancer, and has low GU and GI toxicities.

Noda, Yasutaka; Sato, Morio; Shirai, Shintaro; Kishi, Kazushi; Inagaki, Takeshi; Mori, Takeshi; Hara, Isao

2011-01-01

218

Decline of dose coverage between intraoperative planning and post implant dosimetry for I-125 permanent prostate brachytherapy: Comparison between loose and stranded seed implants  

Microsoft Academic Search

Background and purposeIn permanent prostate brachytherapy the dose distributions 4 weeks post implant differ from the intraoperative dose distributions. The purpose of this study is to compare intraoperative planning and post implant dosimetry for loose and stranded seed implants.

Marinus A. Moerland; Marijke J. H. van Deursen; Sjoerd G. Elias; Marco van Vulpen; Ina M. Jürgenliemk-Schulz; Jan J. Battermann

2009-01-01

219

Prospective evaluation of quality of life after interstitial brachytherapy for localized prostate cancer  

SciTech Connect

Purpose: Permanent interstitial brachytherapy (IB) has become an increasingly appealing therapeutic option for localized prostate cancer (LPC) among physicians and patients because it involves short hospitalization and treatment and its postulated low degree of toxicity may reduce its impact on the patients' quality of life (QoL). The aim of this prospective study was to assess the impact of IB on the QoL of patients with LPC. Methods and Materials: A validated self-completed questionnaire was administered to the patients before and after IB and then at yearly intervals. The items allowed the identification of seven subscales exploring physical well-being (PHY), physical autonomy (POW), psychological well-being (PSY), relational life (REL), urinary function (URI), rectal function (REC), and sexual function (SEX). Results: The assessment of the QoL of 147 patients treated between May 2000 and February 2005 revealed no relevant differences in the PHY scale scores 1 month after IB or later, and the same was true of the POW, PSY, and REL scales. Urinary function significantly worsened after IB and returned to pretreatment levels only after 3 years; the impact of the treatment on the URI scale was greater in the patients with good baseline urinary function than in those presenting more urinary symptoms before IB. Rectal and sexual functions were significantly worse only at the post-IB evaluation. Conclusions: The results of the present study confirm that the impact of IB on the patients' QoL is low despite its transient negative effects on some function, and extend existing knowledge concerning QoL after IB.

Caffo, Orazio [Department of Medical Oncology, Santa Chiara Hospital, Trento (Italy)]. E-mail: orazio.caffo@apss.tn.it; Fellin, Gianni [Department of Radiotherapy, Santa Chiara Hospital, Trento (Italy); Bolner, Andrea [Department of Radiotherapy, Santa Chiara Hospital, Trento (Italy); Coccarelli, Franco [Department of Urology, Santa Chiara Hospital, Trento (Italy); Divan, Claudio [Department of Urology, Santa Chiara Hospital, Trento (Italy); Frisinghelli, Michela [Department of Medical Oncology, Santa Chiara Hospital, Trento (Italy); Mussari, Salvatore [Department of Radiotherapy, Santa Chiara Hospital, Trento (Italy); Ziglio, Franco [Department of Health Physics, Santa Chiara Hospital, Trento (Italy); Malossini, Gianni [Department of Urology, Santa Chiara Hospital, Trento (Italy); Tomio, Luigi [Department of Radiotherapy, Santa Chiara Hospital, Trento (Italy); Galligioni, Enzo [Department of Medical Oncology, Santa Chiara Hospital, Trento (Italy)

2006-09-01

220

Pulmonary Metastases After Low-Dose-Rate Brachytherapy for Localized Prostate Cancer  

PubMed Central

Purpose To analyze unusual events and focus discussion on pulmonary metastasis in particular after low-dose-rate brachytherapy (LDR-BT) for prostate cancer (PCa). Materials and Methods A total of 616 consecutive patients who had undergone LDR-BT for clinically localized PCa at Jikei University Hospital between October 2003 and April 2010 were enrolled in this study. Follow-up information was summarized, and patterns of biochemical recurrence and clinical outcome were investigated. Results Disease risk was stratified as low-risk in 231 patients, intermediate-risk in 365, and high-risk in 20, respectively. Of these patients, 269 (43.7%) had received hormonal therapy (HT) in combination with LDR-BT, and 80 (13.0%) had received external beam radiotherapy (EBRT). Average dosimetric parameter values with and without EBRT were 95.3% and 94.2% for V100, 132.8 Gy and 164.2 Gy for D90, and 180.6 Gy2 and 173.7 Gy2 for the biologically effective dose. Biochemical recurrence was noted in 14 patients (6.1%) in the low-risk group, 25 patients (6.8%) in the intermediate-risk group, and 6 patients (30.0%) in the high-risk group, respectively. In these cases of biochemical recurrence, 9 (64.3%), 13 (52.0%), and 4 patients (66.7%) in each respective risk group showed signs of clinical recurrence. Five patients (19.2%) with clinical recurrence developed pulmonary metastases, of which 4 were isolated lesions. All tumors responded favorably to subsequent HT. Conclusions LDR-BT for biologically aggressive PCa may be linked to possible pulmonary metastasis owing to tumor dissemination during seed implantation. This information is important in planning adequate treatment for these patients.

Kido, Masahito; Sasaki, Hiroshi; Miki, Kenta; Aoki, Manabu; Kimura, Takahiro; Takahash, Hiroyuki; Kanehira, Chihiro; Egawa, Shin

2014-01-01

221

Multi-objective optimization in radiotherapy: applications to stereotactic radiosurgery and prostate brachytherapy.  

PubMed

Treatment planning for radiation therapy is a multi-objective optimization process. Here we present a machine intelligent scheme for treatment planning based on multi-objective decision analysis (MODA) and genetic algorithm (GA) optimization. Multi-objective ranking strategies are represented in the L(p) metric under the displaced ideal model. Goal setting, protocol satisficing and fuzzy ranking of objective importance can be incorporated into the decision scheme to assimilate clinical decision making. For distance measures in the L(p) metric, a dynamic gauge function is defined based on the state energy of the decision system, which is assumed to undergo thermodynamic cooling with iteration time. The MODA scheme interacts with a robust GA engine, which adaptively evolves in the multi-modal landscape that defines the treatment plan quality. A conventionally challenging case of stereotactic radiosurgery of a brain lesion was selected for GA optimization. The resulting dose distributions are compared to human-developed plans, which are commonly regarded as clinically relevant and empirically optimal. The GA-optimized plans achieve substantially better sparing of critical normal neuroanatomy surrounding the brain lesion while respecting the preset constraints on tumor dose uniformity. In addition, machine optimization tends to produce novel treatment strategies which complements expert knowledge. The run time for producing an optimal plan is considerably shorter than the typical planning time for human experts, thus GA can also be used to aid the human treatment planning process. In prostate brachytherapy, MODA-GA was specifically applied to non-ideal conditions in which typical surgical uncertainties in seed implant positioning occur, where noisy objectives were introduced into the optimization scheme. The noisy system is found to be manageable by MODA-GA at uncertainty levels corresponding to reasonably proficient surgery teams. In contrast, noisy objectives would be very difficult to explore by human expert planners. Potential use of noisy optimization with time series analysis is being explored for error-corrective computer guidance in the operating room for prostate seed implantation. In conclusion, the combination of MODA and GA optimization offers both a solution to practical treatment planning tasks and the potential for real time applications in radiotherapy. PMID:10767615

Yu, Y; Zhang, J B; Cheng, G; Schell, M C; Okunieff, P

2000-05-01

222

Minimal percentage of dose received by 90% of the urethra (%UD90) is the most significant predictor of PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer  

PubMed Central

Background To clarify the significant clinicopathological and postdosimetric parameters to predict PSA bounce in patients who underwent low-dose-rate brachytherapy (LDR-brachytherapy) for prostate cancer. Methods We studied 200 consecutive patients who received LDR-brachytherapy between July 2004 and November 2008. Of them, 137 patients did not receive neoadjuvant or adjuvant androgen deprivation therapy. One hundred and forty-two patients were treated with LDR-brachytherapy alone, and 58 were treated with LDR-brachytherapy in combination with external beam radiation therapy. The cut-off value of PSA bounce was 0.1?ng/mL. The incidence, time, height, and duration of PSA bounce were investigated. Clinicopathological and postdosimetric parameters were evaluated to elucidate independent factors to predict PSA bounce in hormone-naïve patients who underwent LDR-brachytherapy alone. Results Fifty patients (25%) showed PSA bounce and 10 patients (5%) showed PSA failure. The median time, height, and duration of PSA bounce were 17?months, 0.29?ng/mL, and 7.0?months, respectively. In 103 hormone-naïve patients treated with LDR-brachytherapy alone, and univariate Cox proportional regression hazard model indicated that age and minimal percentage of the dose received by 30% and 90% of the urethra were independent predictors of PSA bounce. With a multivariate Cox proportional regression hazard model, minimal percentage of the dose received by 90% of the urethra was the most significant parameter of PSA bounce. Conclusions Minimal percentage of the dose received by 90% of the urethra was the most significant predictor of PSA bounce in hormone-naïve patients treated with LDR-brachytherapy alone.

2012-01-01

223

The biochemical recurrence-free rate in patients who underwent prostate low-dose-rate brachytherapy, using two different definitions  

PubMed Central

Background To assess the biochemical recurrence (BCR)-free rate in patients who underwent prostate low-dose-rate brachytherapy (LDR-brachytherapy), using two different definitions (Phoenix definition and PSA???0.2 ng/mL). Methods Two hundreds and three patients who were clinically diagnosed with localized prostate cancer (cT1c-2cN0M0) and underwent LDR-brachytherapy between July 2004 and September 2008 were enrolled. The median follow-up period was 72 months. We evaluated the BCR-free rate using the Phoenix definition and the PSA cut-off value of 0.2 ng/mL, as in the definition for radical prostatectomy. To evaluate an independent variable that can predict BCR, Cox’s proportional hazard regression analysis was carried out. Results The BCR-free rate in patients using the Phoenix definition was acceptable (5-year: 92.8%). The 5- year BCR-free rate using the strict definition (PSA???0.2 ng/mL) was 74.1%. Cox’s proportional hazard regression analysis showed that a higher biological effective dose (BED) of ?180 Gy2 was the only independent variable that could predict BCR (HR: 0.570, 95% C.I.: 0.327-0.994, p?=?0.048). Patients with a higher BED (?180 Gy2) had a significantly higher BCR-free rate than those with a lower BED (<180 Gy2) (5-year BCR-free rate: 80.5% vs. 67.4%). Conclusions A higher BED ?180 Gy2 promises a favorable BCR-free rate, even if the strict definition is adopted.

2014-01-01

224

Role of Novel Risk Classification Method, Prostate Cancer Risk Index (PRIX) for Clinically Localized Prostate Cancer After High-dose-rate Interstitial Brachytherapy as Monotherapy.  

PubMed

Aim: To examine the role of the new grading system Prostate Cancer Risk Index (PRIX) with existing risk-grouping after high-dose-rate interstitial brachytherapy (HDR-ISBT) as monotherapy for localized prostate cancer. Patients and Methods: We analyzed outcome in 100 patients treated by HDR-ISBT as monotherapy using PRIX and compared this with D'Amico, the National Comprehensive Cancer Network (NCCN), and Seattle classifications. The median follow-up was 74 (range=48-109) months. Results: Five-year prostate-specific antigen control and overall survival rates were 94% and 98%, respectively. PRIX separated the risks statistically significantly (p=0.004), while D'Amico (p=0.319), NCCN 2002 (p=0.126), NCCN 2012 (p=0.052) and Seattle (p=0.112) classifications failed to show a statistically significant separation. Conclusion: PRIX is a more useful risk classification system in high-risk patient selection than existing risk classification system in clinically localized prostate cancer after HDR-ISBT as monotherapy. PMID:24922676

Yoshida, Ken; Yamazaki, Hideya; Nakamura, Satoaki; Masui, Koji; Kotsuma, Tadayuki; Akiyama, Hironori; Tanaka, Eiichi; Yoshioka, Yasuo

2014-06-01

225

Catheter-based ultrasound hyperthermia with HDR brachytherapy for treatment of locally advanced cancer of the prostate and cervix  

PubMed Central

A clinical treatment delivery platform has been developed and is being evaluated in a clinical pilot study for providing 3D controlled hyperthermia with catheter-based ultrasound applicators in conjunction with high dose rate (HDR) brachytherapy. Catheter-based ultrasound applicators are capable of 3D spatial control of heating in both angle and length of the devices, with enhanced radial penetration of heating compared to other hyperthermia technologies. Interstitial and endocavity ultrasound devices have been developed specifically for applying hyperthermia within HDR brachytherapy implants during radiation therapy in the treatment of cervix and prostate. A pilot study of the combination of catheter based ultrasound with HDR brachytherapy for locally advanced prostate and cervical cancer has been initiated, and preliminary results of the performance and heating distributions are reported herein. The treatment delivery platform consists of a 32 channel RF amplifier and a 48 channel thermocouple monitoring system. Controlling software can monitor and regulate frequency and power to each transducer section as required during the procedure. Interstitial applicators consist of multiple transducer sections of 2–4 cm length × 180 deg and 3–4 cm × 360 deg. heating patterns to be inserted in specific placed 13g implant catheters. The endocavity device, designed to be inserted within a 6 mm OD plastic tandem catheter within the cervix, consists of 2–3 transducers × dual 180 or 360 deg sectors. 3D temperature based treatment planning and optimization is dovetailed to the HDR optimization based planning to best configure and position the applicators within the catheters, and to determine optimal base power levels to each transducer section. To date we have treated eight cervix implants and six prostate implants. 100 % of treatments achieved a goal of >60 min duration, with therapeutic temperatures achieved in all cases. Thermal dosimetry within the hyperthermia target volume (HTV) and clinical target volume (CTV) are reported. Catheter-based ultrasound hyperthermia with HDR appears feasible with therapeutic temperature coverage of the target volume within the prostate or cervix while sparing surrounding more sensitive regions. (NIHR01CA122276).

Diederich, Chris J.; Wootton, Jeff; Prakash, Punit; Salgaonkar, Vasant; Juang, Titania; Scott, Serena; Chen, Xin; Cunha, Adam; Pouliot, Jean; Hsu, I.C.

2014-01-01

226

Interobserver variation in postimplant computed tomography contouring affects quality assessment of prostate brachytherapy  

Microsoft Academic Search

Purpose: Permanent seed implants are accepted treatment of early stage prostate cancer. Implant quality is assessed by post implant CT-based dosimetry but prostate contours on CT images are obscured by metallic seed artefact and edema. Outcome depends on implant quality, but perceived implant quality depends on accurate prostate contouring. This study documents inter observer variation in prostate contouring on post

Juanita Crook; Michael Milosevic; Pamela Catton; Ivan Yeung; Tara Haycocks; Thao Tran; Charles Catton; Michael Mclean; Tony Panzarella; Masoom A Haider

2002-01-01

227

Ruthenium-106 brachytherapy.  

PubMed

Brachytherapy is the most common method for treating uveal melanoma, and currently the ruthenium-106 (Ru-106) and iodine-125 (I-125) applicators are the most frequently used. Ru-106 applicators were introduced by Prof. Peter Lommatzsch in the 1960s, and since then have been used widely by many ocular oncologists, mainly in Europe. The Ru-106 isotope is a beta ray (electron) emitter, and as such it has a limited depth of penetration. This is the reason why many experts use Ru-106 applicators for tumors with a maximal thickness of up to 7.0 mm, although others use it successfully for thicker tumors. The Ru-106 applicators are manufactured commercially and have a half-life of about 1 year. Ru-106 brachytherapy for uveal melanoma provides excellent local control rates and eye preservation with a relatively low recurrence rate. The main advantage of Ru-106 over other isotopes is the better preservation of vision in the treated eye, and less damage to the healthy parts of the eye due to its limited range of radiation. This can also be achieved by positioning the Ru-106 plaque eccentrically, away from the macula and optic nerve head. Ru-106 brachytherapy can be used in combination with other methods of treatment of uveal melanoma, such as local resection or transpupillary thermotherapy, and is sporadically combined with other isotopes, such as gamma-emitting cobalt-60 and I-125. PMID:22042011

Pe'er, Jacob

2012-01-01

228

MRI characterization of cobalt dichloride-N-acetyl cysteine (C4) contrast agent marker for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

Brachytherapy, a radiotherapy technique for treating prostate cancer, involves the implantation of numerous radioactive seeds into the prostate. While the implanted seeds can be easily identified on a computed tomography image, distinguishing the prostate and surrounding soft tissues is not as straightforward. Magnetic resonance imaging (MRI) offers superior anatomical delineation, but the seeds appear as dark voids and are difficult to identify, thus creating a conundrum. Cobalt dichloride-N-acetyl-cysteine (C4) has previously been shown to be promising as an encapsulated contrast agent marker. We performed spin–lattice relaxation time (T1) and spin–spin relaxation time (T2) measurements of C4 solutions with varying cobalt dichloride concentrations to determine the corresponding relaxivities, r1 and r2. These relaxation parameters were investigated at different field strengths, temperatures and orientations. T1 measurements obtained at 1.5 and 3.0 T, as well as at room and body temperature, showed that r1 is field-independent and temperature-independent. Conversely, the T2 values at 3.0 T were shorter than at 1.5 T, while the T2 values at body temperature were slightly higher than at room temperature. By examining the relaxivities with the C4 vials aligned in three different planes, we found no orientation-dependence. With these relaxation characteristics, we aim to develop pulse sequences that will enhance the C4 signal against prostatic stroma. Ultimately, the use of C4 as a positive contrast agent marker will encourage the use of MRI to obtain an accurate representation of the radiation dose delivered to the prostate and surrounding normal anatomical structures.

Lim, Tze Yee; Stafford, R. Jason; Kudchadker, Rajat J.; Sankaranarayanapillai, Madhuri; Ibbott, Geoffrey; Rao, Arvind; Martirosyan, Karen S.; Frank, Steven J.

2014-05-01

229

Greater Biopsy Core Number Is Associated With Improved Biochemical Control in Patients Treated With Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: Standard prostate biopsy schemes underestimate Gleason score in a significant percentage of cases. Extended biopsy improves diagnostic accuracy and provides more reliable prognostic information. In this study, we tested the hypothesis that greater biopsy core number should result in improved treatment outcome through better tailoring of therapy. Methods and Materials: From April 1995 to May 2006, 1,613 prostate cancer patients were treated with permanent brachytherapy. Patients were divided into five groups stratified by the number of prostate biopsy cores ({<=}6, 7-9, 10-12, 13-20, and >20 cores). Biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were evaluated as a function of core number. Results: The median patient age was 66 years, and the median preimplant prostate-specific antigen was 6.5 ng/mL. The overall 10-year bPFS, CSS, and OS were 95.6%, 98.3%, and 78.6%, respectively. When bPFS was analyzed as a function of core number, the 10-year bPFS for patients with >20, 13-20, 10-12, 7-9 and {<=}6 cores was 100%, 100%, 98.3%, 95.8%, and 93.0% (p < 0.001), respectively. When evaluated by treatment era (1995-2000 vs. 2001-2006), the number of biopsy cores remained a statistically significant predictor of bPFS. On multivariate analysis, the number of biopsy cores was predictive of bPFS but did not predict for CSS or OS. Conclusion: Greater biopsy core number was associated with a statistically significant improvement in bPFS. Comprehensive regional sampling of the prostate may enhance diagnostic accuracy compared to a standard biopsy scheme, resulting in better tailoring of therapy.

Bittner, Nathan [Tacoma/Valley Radiation Oncology Centers, Tacoma, WA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.or [Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert W.; Butler, Wayne M. [Schiffler Cancer Center/Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States); Wallner, Kent E. [Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, WA (United States)

2010-11-15

230

Localization of linked {sup 125}I seeds in postimplant TRUS images for prostate brachytherapy dosimetry  

SciTech Connect

Purpose: To demonstrate that {sup 125}I seeds can be localized in transrectal ultrasound (TRUS) images obtained with a high-resolution probe when the implant is performed with linked seeds and spacers. Adequate seed localization is essential to the implementation of TRUS-based intraoperative dosimetry for prostate brachytherapy. Methods and Materials: Thirteen preplanned peripherally loaded prostate implants were performed using {sup 125}I seeds and spacers linked together in linear arrays that prevent seed migration and maintain precise seed spacing. A set of two-dimensional transverse images spaced at 0.50-cm intervals were obtained with a high-resolution TRUS probe at the conclusion of the procedure with the patient still under anesthesia. The image set extended from 1.0 cm superior to the base to 1.0 cm inferior to the apex. The visible echoes along each needle track were first localized and then compared with the known construction of the implanted array. The first step was to define the distal and proximal ends of each array. The visible echoes were then identified as seeds or spacers from the known sequence of the array. The locations of the seeds that did not produce a visible echo were interpolated from their known position in the array. A CT scan was obtained after implantation for comparison with the TRUS images. Results: On average, 93% (range, 86-99%) of the seeds were visible in the TRUS images. However, it was possible to localize 100% of the seeds in each case, because the locations of the missing seeds could be determined from the known construction of the arrays. Two factors complicated the interpretation of the TRUS images. One was that the spacers also produced echoes. Although weak and diffuse, these echoes could be mistaken for seeds. The other was that the number of echoes along a needle track sometimes exceeded the number of seeds and spacers implanted. This was attributed to the overall length of the array, which was approximately 0.5 cm longer than the center-to-center distance between the first and last seed owing to the finite length of the seeds at the ends of the array. When this occurred, it was necessary to disregard either the most distal or most proximal echo, which produced a 0.5-cm uncertainty in the location of the array in the axial direction. For these reasons, simply localizing the visible echoes in the TRUS images did not guarantee the reliable identification of the seeds. Conclusion: Our results have demonstrated that a high percentage (>85%) of the implanted {sup 125}I seeds can be directly visualized in postimplant TRUS images when the seeds and spacers are linked to preclude seed migration and rotation and when the images are obtained with a high-resolution TRUS probe. Moreover, it is possible to localize 100% of the seeds with the mechanism of linked seeds because the locations of the missing seeds can be determined from the known construction of the arrays.

Xue Jinyu [Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States)]. E-mail: Jinyu.Xue@mail.tju.edu; Waterman, Frank [Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States); Handler, Jay [Department of Urology, Frankford Hospital, Philadelphia, PA (United States); Gressen, Eric [Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA (United States)

2005-07-01

231

Quality of Life in Patients with Low-Risk Prostate Cancer. A Comparative Retrospective Study: Brachytherapy Versus Robot-Assisted Laparoscopic Prostatectomy Versus Active Surveillance  

PubMed Central

Abstract Purpose: To investigate the quality of life (QoL) after different treatment modalities for low-risk prostate cancer, including brachytherapy, robot-assisted laparoscopic prostatectomy (RALP), and active surveillance (AS) with validated questionnaires. Materials and Methods: From a prospective database, we selected a total of 144 men with low-grade localized prostate cancer including 65 (45.1%) patients with RALP, 29 (20.2%) with brachytherapy, and 50 (34.7%) whose cancer was managed with AS. QoL was routinely evaluated with validated questionnaires: The European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core 30 (EORTC-QLQ-C30), EORTC-QLQ-Prostate Module (PR)25, International Index of Erectile Function (IIEF)-15, International Consultation on Incontinence Questionnaire Short Form (ICIQ-SF) with a minimum follow-up of 1 year. Results: In comparison with baseline scores, the brachytherapy group showed a significant decrease of QoL domain scores of voiding complaints (P=0.010), use of incontinence aids (P=0.011), sexual functioning domain (P=0.011), and erectile function (P?0.001). In the RALP group, sexual function (P?0.001), incontinence (P?0.001), and erectile function were significantly affected. A decrease in sexual function was observed in 71% of men after RALP and 59% after brachytherapy. In 30% of men under AS, a decrease of erectile function score during follow-up was reported. Overall, no significant decrease in general QoL was observed neither for men under AS nor for men treated by brachytherapy or RALP. Clinical factors such as age, prostate size, prostate-specific antigen level, and nerve preservation during RALP were nonpredictive of overall QoL after treatment for the individual patient (P=0.676). Conclusion: Patients with low-risk prostate cancer who are treated with brachytherapy or RALP report deterioration of QoL of specific domains such as voiding, continence, and sexual functioning in comparison with AS patients. A decrease of erectile function was also observed during AS. Overall QoL was similar for all three treatments options.

Schoffelmeer, Cecile C.; Tillier, Corin; de Blok, Willem; van Muilekom, Erik; van der Poel, Henk G.

2014-01-01

232

Incidence of Secondary Cancer Development After High-Dose Intensity-Modulated Radiotherapy and Image-Guided Brachytherapy for the Treatment of Localized Prostate Cancer  

SciTech Connect

Purpose: To report the incidence and excess risk of second malignancy (SM) development compared with the general population after external beam radiotherapy (EBRT) and brachytherapy to treat prostate cancer. Methods and Materials: Between 1998 and 2001, 1,310 patients with localized prostate cancer were treated with EBRT (n = 897) or brachytherapy (n = 413). We compared the incidence of SMs in our patients with that of the general population extracted from the National Cancer Institute's Surveillance, Epidemiology, and End Results data set combined with the 2000 census data. Results: The 10-year likelihood of SM development was 25% after EBRT and 15% after brachytherapy (p = .02). The corresponding 10-year likelihood for in-field SM development in these groups was 4.9% and 1.6% (p = .24). Multivariate analysis showed that EBRT vs. brachytherapy and older age were the only significant predictors for the development of all SMs (p = .037 and p = .030), with a trend for older patients to develop a SM. The increased incidence of SM for EBRT patients was explained by the greater incidence of skin cancer outside the radiation field compared with that after brachytherapy (10.6% and 3.3%, respectively, p = .004). For the EBRT group, the 5- and 10-year mortality rate was 1.96% and 5.1% from out-of field cancer, respectively; for in-field SM, the corresponding mortality rates were 0.1% and 0.7%. Among the brachytherapy group, the 5- and 10-year mortality rate related to out-of field SM was 0.8% and 2.7%, respectively. Our observed SM rates after prostate RT were not significantly different from the cancer incidence rates in the general population. Conclusions: Using modern sophisticated treatment techniques, we report low rates of in-field bladder and rectal SM risks after prostate cancer RT. Furthermore, the likelihood of mortality secondary to a SM was unusual. The greater rate of SM observed with EBRT vs. brachytherapy was related to a small, but significantly increased, number of skin cancers in the EBRT patients compared with that of the general population.

Zelefsky, Michael J., E-mail: Zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Housman, Douglas M.; Pei Xin; Alicikus, Zumre; Magsanoc, Juan Martin [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Dauer, Lawrence T.; St Germain, Jean [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Yamada, Yoshiya; Kollmeier, Marisa; Cox, Brett [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zhang Zhigang [Department of Epidemiology and Biostatistics, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

2012-07-01

233

Prostate volume changes during permanent seed brachytherapy: an analysis of intra-operative variations, predictive factors and clinical implication  

PubMed Central

Background To determine prostate volume (Pvol) changes at 3 different time points during the course of I125 permanent seed brachytherapy (PB). To assess the impact of these changes on acute urinary retention (AUR) and dosimetric outcome. Methods We analyzed 149 hormone-naïve patients. Measurements of the prostate volume were done using three-dimensional transrectal ultrasound (3D-TRUS) in the operating room before insertion of any needle (V1), after the insertion of 2 fixation needles with a harpoon (V2) and upon completion of the implant (V3). The quality of the implant was analyzed with the D90 (minimum dose in Grays received by 90% of the prostate volume) at day 30. Results Mean baseline prostate volume (V1) was 37.4?±?9.6 cc. A volume increase of >5% was seen in 51% between V1-V2 (mean?=?2.5 cc, p?prostate swelling had an influence on D90. An increase of 10% in prostate volume between V1 and V2 results in an increase of D90 at Day 30 by 11.7%. Baseline Pvol (V1) was the only predictor of the duration of urinary retention in both univariate and multivariate (p?=?0.04) regression analysis. Conclusions A large part of intraoperative swelling occurs already after the insertion of the fixation needles. This early prostate swelling predicts for D90 but not for AUR.

2013-01-01

234

Benefits of a dual sagittal crystal transducer for ultrasound imaging during I-125 seed implantation for permanent prostate brachytherapy  

PubMed Central

Purpose To investigate whether a longer sagittal view and less movement using a dual sagittal crystal probe (DSCP) for trans rectal ultra sound (TRUS) allow for more accurate online-planning in I-125 permanent implant brachytherapy of the prostate, compared to a single sagittal crystal probe (SSCP). Material and methods Between March 2008 and March 2010, 50 patients with prostate cancer were consecutively included in the study. The first 25 of these patients had both their pre- and online-planning based on a single sagittal crystal probe (SSCP). The treatment-plans of the other 25 patients were based on a DSCP TRUS. Three weeks after implantation a post-planning was made based on CT. TRUS online and CT post-plan dose-volume histogram (DVH) parameters, D90 and V100, were compared for both groups. Also, the post-plan DVH parameters of SSCP were compared to DSCP. The possible factors that might influence the post-plan D90 and V100 were analysed using Analysis of Variance (ANOVA). Results SSCP and DSCP online mean D90 and V100 were significantly larger than post-plan mean D90 and V100 (P < 0.01). The post-plan mean D90 and mean V100 were both non-significantly larger for SSCP based post-plans compared to DSCP based post plans (P = 0.76 and P = 0.68). ANOVA showed significant impact of prostate volume on the post-plan D90 and V100. Conclusions The advantages of the dual sagittal crystal probe did not lead to more accurate online planning by investigating DVH-parameters. The only factor found to have influence on the DVH-parameters was the prostate volume.

Pieters, Bradley; Koedooder, Kees; Lucas, Cees; Koning, Caro

2012-01-01

235

A comparative study of seed localization and dose calculation on pre- and post-implantation ultrasound and CT images for low-dose-rate prostate brachytherapy  

NASA Astrophysics Data System (ADS)

This work investigates variation in the volume of the prostate measured at different stages through the prostate brachytherapy procedure for 30 patients treated with I-125 radioactive seeds. The implanted seeds were localized on post-implantation ultrasound (US) images and the effect of prostate enlargement due to edema on dose coverage for 15 patients was studied. The volume of the prostate was measured at four stages as follows: (a) 2-3 weeks prior to implantation using US imaging, (b) then at the start of the intra-operative prostate brachytherapy procedure on the day of the implant, (c) immediately post-implantation using US imaging in the operating room and (d) finally by CT imaging at nearly 4 weeks post-implantation. Comparative prostate volume studies were performed using US imaging stepper and twister modes. For the purpose of this study, the implanted seeds were localized successfully on post-implant ultrasound twister images, retrospectively. The plans using post-implant US imaging were compared with intra-operative plans on US and plans created on CT images. The prostate volume increases about 10 cm3 on average due to edema induced by needle insertion and seed loading during implantation. The visibility of the implanted seeds on US twister images acquired post-implantation is as good as those on CT images and can be localized and used for dose calculation. The dose coverage represented by parameters such as D90 (dose covering 90% of the volume) and V100 (volume covered by 100% dose) is poorer on plans performed on post-implantation twister US studies than on the intra-operative live plan or the CT scan performed 4 weeks post-operatively. For example, the mean D90 difference on post-implantation US is lower by more than 15% than that on pre-implantation US. The volume enlargement of the prostate due to edema induced by needle insertion and seed placement has a significant effect on the quality of dosimetric coverage in brachytherapy prostate seed implants. Here, we introduced a new approach based on the use of post-implant US twister images to correct for prostate enlargement intra-operatively. Besides the ability to localize the seeds and superior soft tissue visibility, the twister US images include effects of the enlargement of the prostate gland and seed migration during the implantation procedure.

Ali, Imad; Algan, Ozer; Thompson, Spencer; Sindhwani, Puneet; Herman, Terence; Cheng, Chih-Yao; Ahmad, Salahuddin

2009-09-01

236

Failure-free survival following brachytherapy alone or external beam irradiation alone for T1–2 prostate tumors in 2222 patients: results from a single practice  

Microsoft Academic Search

Purpose: To evaluate failure-free survival (FFS) for brachytherapy (BT) alone compared to external beam radiotherapy (EBRT) alone for Stage T1–2 Nx-No Mo patients over the same time period by a single community-based practice in the prostate-specific antigen (PSA) era.Materials and Methods: The database of Arizona Oncology Services (a multiphysician radiation oncology practice in the Phoenix metropolitan area) was reviewed for

David G Brachman; Theresa Thomas; Joseph Hilbe; David C Beyer

2000-01-01

237

Mixed Integer Programming Approaches to Treatment Planning for Brachytherapy - Application to Permanent Prostate Implants  

Microsoft Academic Search

Mixed integer programming models and computational strategies developed for treatment plan- ning optimization in brachytherapy are described. The problem involves the designation of optimal place- ment of radioactive sources (seeds) inside a tumor site. Two MIP models are described. The resulting MIP instances are difficult to solve, due in large part to dense constraint matrices with large disparities in the

Eva K. Lee; Marco Zaider

2003-01-01

238

High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer in Patients at Moderate or High Risk of Biochemical Recurrence  

SciTech Connect

Purpose: To evaluate genitourinary (GU) and gastrointestinal (GI) morbidity and biochemical control of disease in patients with localized prostate adenocarcinoma treated with escalating doses per fraction of high-dose rate brachytherapy alone. Methods and Materials: A total of 197 patients were treated with 34 Gy in four fractions, 36 Gy in four fractions, 31.5 Gy in three fractions, or 26 Gy in two fractions. Median follow-up times were 60, 54, 36, and 6 months, respectively. Results: Incidence of early Grade {>=} 3 GU morbidity was 3% to 7%, and Grade 4 was 0% to 4%. During the first 12 weeks, the highest mean International Prostate Symptom Score (IPSS) value was 14, and between 6 months and 5 years it was 8. Grade 3 or 4 early GI morbidity was not observed. The 3-year actuarial rate of Grade 3 GU was 3% to 16%, and was 3% to 7% for strictures requiring surgery (4-year rate). An incidence of 1% Grade 3 GI events was seen at 3 years. Late Grade 4 GU or GI events were not observed. At 3 years, 99% of patients with intermediate-risk and 91% with high-risk disease were free of biochemical relapse (log-rank p = 0.02). Conclusions: There was no significant difference in urinary and rectal morbidity between schedules. Biochemical control of disease in patients with intermediate and high risk of relapse was good.

Hoskin, Peter [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Rojas, Ana, E-mail: arc03@btconnect.com [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom); Lowe, Gerry; Bryant, Linda; Ostler, Peter; Hughes, Rob; Milner, Jessica; Cladd, Helen [Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom)

2012-03-15

239

A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: A radiobiological modeling study  

PubMed Central

A course of one to three large fractions of high dose rate (HDR) interstitial brachytherapy is an attractive alternative to intensity modulated radiation therapy (IMRT) for delivering boost doses to the prostate in combination with additional external beam irradiation for intermediate risk disease. The purpose of this work is to quantitatively compare single-fraction HDR boosts to biologically equivalent fractionated IMRT boosts, assuming idealized image guided delivery (igIMRT) and conventional delivery (cIMRT). For nine prostate patients, both seven-field IMRT and HDR boosts were planned. The linear-quadratic model was used to compute biologically equivalent dose prescriptions. The cIMRT plan was evaluated as a static plan and with simulated random and setup errors. The authors conclude that HDR delivery produces a therapeutic ratio which is significantly better than the conventional IMRT and comparable to or better than the igIMRT delivery. For the HDR, the rectal gBEUD analysis is strongly influenced by high dose DVH tails. A saturation BED, beyond which no further injury can occur, must be assumed. Modeling of organ motion uncertainties yields mean outcomes similar to static plan outcomes.

Fatyga, M.; Williamson, J. F.; Dogan, N.; Todor, D.; Siebers, J. V.; George, R.; Barani, I.; Hagan, M.

2009-01-01

240

Long-Term Biochemical and Survival Outcome of 921 Patients Treated With I-125 Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To assess long-term biochemical and survival outcome after permanent prostate brachytherapy (BT). Methods and Materials: Data on 921 patients, treated with permanent interstitial BT monotherapy between 1989 and 2004 for <=T2c Nx/0 Mx/0 prostate cancer were evaluated. All patients were treated with I-125 seeds (prescription dose 144 Gy). Eighty-five patients with a gland volume >=50cc received 6 months of antiandrogen therapy before treatment. Patients were classified into risk groups with 232 defined as low-, 369 intermediate-, and 320 high-risk disease. The median follow-up was 69 months (range, 4-186 months); mean age was 67 years. Results: Average 5- and 10-year biochemical no evidence of disease (bNED) rates were 79% and 57%. Average 10-year bNED rates by risk group were 88% for low-risk, 61% for intermediate-risk, and 30% for high-risk disease. The average 10-year overall and disease-specific survival rates were 59% and 82%. Ten-year overall and disease-specific survival rates by risk group were, respectively, 68% and 96% for low-risk, and 64% 87% for intermediate-risk, and 49% and 69% for high-risk disease. In multivariate Cox regression analysis, both risk group and treatment era were independent predictors of bNED and survival. Conclusions: These data on long-term survival continue to support the use of I-125 monotherapy for prostate cancer in low-risk patients and, in particular, demonstrate its efficacy in intermediate-risk patients.

Hinnen, Karel A., E-mail: K.A.Hinnen@UMCUtrecht.n [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Battermann, Jan J. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Roermund, Joep G.H. van [Department of Urology, University Medical Center Utrecht, Utrecht (Netherlands); Moerland, Marinus A.; Juergenliemk-Schulz, Ina M. [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands); Frank, Steven J. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX (United States); Vulpen, Marco van [Department of Radiation Oncology, University Medical Center Utrecht, Utrecht (Netherlands)

2010-04-15

241

High-Dose-Rate Interstitial Brachytherapy as Monotherapy for Clinically Localized Prostate Cancer: Treatment Evolution and Mature Results  

SciTech Connect

Purpose: To report the clinical outcome of high-dose-rate (HDR) interstitial (IRT) brachytherapy (BRT) as sole treatment (monotherapy) for clinically localized prostate cancer. Methods and Materials: Between January 2002 and December 2009, 718 consecutive patients with clinically localized prostate cancer were treated with transrectal ultrasound (TRUS)-guided HDR monotherapy. Three treatment protocols were applied; 141 patients received 38.0 Gy using one implant in 4 fractions of 9.5 Gy with computed tomography-based treatment planning; 351 patients received 38.0 Gy in 4 fractions of 9.5 Gy, using 2 implants (2 weeks apart) and intraoperative TRUS real-time treatment planning; and 226 patients received 34.5 Gy, using 3 single-fraction implants of 11.5 Gy (3 weeks apart) and intraoperative TRUS real-time treatment planning. Biochemical failure was defined according to the Phoenix consensus, and toxicity was evaluated using Common Toxicity Criteria for Adverse Events version 3. Results: The median follow-up time was 52.8 months. The 36-, 60-, and 96-month biochemical control and metastasis-free survival rates for the entire cohort were 97%, 94%, and 90% and 99%, 98%, and 97%, respectively. Toxicity was scored per event, with 5.4% acute grade 3 genitourinary and 0.2% acute grade 3 gastrointestinal toxicity. Late grade 3 genitourinary and gastrointestinal toxicities were 3.5% and 1.6%, respectively. Two patients developed grade 4 incontinence. No other instance of grade 4 or greater acute or late toxicity was reported. Conclusion: Our results confirm IRT-HDR-BRT is safe and effective as monotherapy for clinically localized prostate cancer.

Zamboglou, Nikolaos [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany)] [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany); Tselis, Nikolaos, E-mail: ntselis@hotmail.com [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany)] [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany); Baltas, Dimos [Department of Medical Physics and Engineering, Klinikum Offenbach, Offenbach (Germany)] [Department of Medical Physics and Engineering, Klinikum Offenbach, Offenbach (Germany); Buhleier, Thomas [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany)] [Department of Radiation Oncology, Klinikum Offenbach, Offenbach (Germany); Martin, Thomas [Department of Radiation Oncology, Klinikum Bremen-Mitte, Bremen (Germany)] [Department of Radiation Oncology, Klinikum Bremen-Mitte, Bremen (Germany); Milickovic, Natasa; Papaioannou, Sokratis [Department of Medical Physics and Engineering, Klinikum Offenbach, Offenbach (Germany)] [Department of Medical Physics and Engineering, Klinikum Offenbach, Offenbach (Germany); Ackermann, Hanns [Institute of Biostatistics, J.W. Goethe University of Frankfurt, Frankfurt (Germany)] [Institute of Biostatistics, J.W. Goethe University of Frankfurt, Frankfurt (Germany); Tunn, Ulf W. [Department of Urology, Klinikum Offenbach, Offenbach (Germany)] [Department of Urology, Klinikum Offenbach, Offenbach (Germany)

2013-03-01

242

Relation of immediate and delayed thallium-201 distribution to localization of iodine-125 antimyosin antibody in acute experimental myocardial infarction  

SciTech Connect

Thallium-201 (TI-201) distribution in acute experimental myocardial infarction (MI) (n . 18) was compared with cardiac-specific antimyosin Fab (AM-Fab) uptake, a specific marker for myocardial necrosis. When antimyosin was injected 4 hours after ligation with TI-201 administered 23 hours 55 minutes later and measurement of myocardial distribution determined 5 minutes after intravenous administration of TI-201, (1) TI-201 distribution closely correlated with microsphere regional blood flow, and (2) an inverse exponential relation to iodine-125 (I-125) AM-Fab uptake was apparent. In another group of 4 animals, TI-201 and AM-Fab were administered intravenously 4 hours after MI, and 36 hours later myocardial distribution was measured. This delayed TI-201 distribution had a close inverse linear correlation with I-125 AM-Fab uptake. This inverse linear relation also was apparent in 28-hour-old MIs in dogs (n . 4) where collateral circulation had been established. TI-201 was administered intravenously at 27 hours after MI, and TI-201 distribution was determined 1 hour later. The present study demonstrated that whereas immediate TI-201 distribution is flow-limited, delayed TI-201 distribution is a marker of cell viability which, due to prolonged circulation time and redistribution, is not flow-limited.

Khaw, B.A.; Strauss, H.W.; Pohost, G.M.; Fallon, J.T.; Katus, H.A.; Haber, E.

1983-05-01

243

High Dose Rate Brachytherapy as Prostate Cancer Monotherapy Reduces Toxicity Compared to Low Dose Rate Palladium Seeds  

Microsoft Academic Search

PurposeWe evaluated the potential for differing acute and chronic toxicities between 2 monotherapy methods of image guided conformal brachytherapy, high dose rate (HDR) brachytherapy alone and low dose rate (LDR) permanent palladium seeds.

INGA S. GRILLS; ALVARO A. MARTINEZ; MITCHELL HOLLANDER; RAYWIN HUANG; KENNETH GOLDMAN; PETER Y. CHEN; GARY S. GUSTAFSON

2004-01-01

244

Biological effective dose for comparison and combination of external beam and low-dose rate interstitial brachytherapy prostate cancer treatment plans  

SciTech Connect

We report a methodology for comparing and combining dose information from external beam radiotherapy (EBRT) and interstitial brachytherapy (IB) components of prostate cancer treatment using the biological effective dose (BED). On a prototype early-stage prostate cancer patient treated with EBRT and low-dose rate I-125 brachytherapy, a 3-dimensional dose distribution was calculated for each of the EBRT and IB portions of treatment. For each component of treatment, the BED was calculated on a point-by-point basis to produce a BED distribution. These individual BED distributions could then be summed for combined therapies. BED dose-volume histograms (DVHs) of the prostate, urethra, rectum, and bladder were produced and compared for various combinations of EBRT and IB. Transformation to BED enabled computation of the relative contribution of each modality to the prostate dose, as the relative weighting of EBRT and IB was varied. The BED-DVHs of the prostate and urethra demonstrated dramatically increased inhomogeneity with the introduction of even a small component of IB. However, increasing the IB portion relative to the EBRT component resulted in lower dose to the surrounding normal structures, as evidenced by the BED-DVHs of the bladder and rectum. Conformal EBRT and low-dose rate IB conventional dose distributions were successfully transformed to the common 'language' of BED distributions for comparison and for merging prostate cancer radiation treatment plans. The results of this analysis can assist physicians in quantitatively determining the best combination and weighting of radiation treatment modalities for individual patients.

Jani, Ashesh B.; Hand, Christopher M.; Lujan, Anthony E.; Roeske, John C.; Zagaja, Gregory P.; Vijayakumar, Srinivasan; Pelizzari, Charles A

2004-03-31

245

Whole-Pelvis Radiotherapy in Combination With Interstitial Brachytherapy: Does Coverage of the Pelvic Lymph Nodes Improve Treatment Outcome in High-Risk Prostate Cancer?  

SciTech Connect

Purpose: To compare biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) rates among high-risk prostate cancer patients treated with brachytherapy and supplemental external beam radiation (EBRT) using either a mini-pelvis (MP) or a whole-pelvis (WP) field. Methods and Materials: From May 1995 to October 2005, 186 high-risk prostate cancer patients were treated with brachytherapy and EBRT with or without androgen-deprivation therapy (ADT). High-risk prostate cancer was defined as a Gleason score of >=8 and/or a prostate-specific antigen (PSA) concentration of >=20 ng/ml. Results: With a median follow-up of 6.7 years, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 91.7% vs. 84.4% (p = 0.126), 95.5% vs. 92.6% (p = 0.515), and 79.5% vs. 67.1% (p = 0.721), respectively. Among those patients who received ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 93.6% vs. 90.1% (p = 0.413), 94.2% vs. 96.0% (p = 0.927), and 73.7% vs. 70.2% (p = 0.030), respectively. Among those patients who did not receive ADT, the 10-year bPFS, CSS, and OS rates for the WP vs. the MP arms were 82.4% vs. 75.0% (p = 0.639), 100% vs. 88% (p = 0.198), and 87.5% vs. 58.8% (p = 0.030), respectively. Based on multivariate analysis, none of the evaluated parameters predicted for CSS, while bPFS was best predicted by ADT and percent positive biopsy results. OS was best predicted by age and percent positive biopsy results. Conclusions: For high-risk prostate cancer patients receiving brachytherapy, there is a nonsignificant trend toward improved bPFS, CSS, and OS rates when brachytherapy is given with WPRT. This trend is most apparent among ADT-naive patients, for whom a significant improvement in OS was observed.

Bittner, Nathan [Tacoma/Valley Radiation Oncology Centers, Tacoma, Washington (United States); Merrick, Gregory S., E-mail: gmerrick@UrologicResearchInstitute.or [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, West Virginia (United States); Wallner, Kent E. [Radiation Oncology, Puget Sound Health Care System, Department of Veterans Affairs, Seattle, Washington (United States); Butler, Wayne M.; Galbreath, Robert [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, West Virginia (United States); Adamovich, Edward [Wheeling Hospital, Department of Pathology, Wheeling, West Virginia (United States)

2010-03-15

246

Mouse model of brachytherapy in consort with enucleation for treatment of malignant intraocular melanoma  

SciTech Connect

The efficacy of brachytherapy in the treatment and prevention of metastasis of intraocular melanoma was investigated in a mouse model. A highly metastatic subline of B16 melanoma was transplanted into the anterior segment of C57BL/6 mice and allowed to grow. Brachytherapy was delivered by means of miniature iodine 125 seeds implanted in shallow subcutaneous pockets of the upper eyelid margin of these mice, and 25 Gy of radiation was delivered between days 12 and 14. This brachytherapy reduced both the tumor volume and the number of mitotic figures per high-power field compared with irradiated controls. In a second experiment, 25 Gy of brachytherapy was delivered before enucleation, straddling enucleation, and after enucleation; there was a significant reduction in metastasis when radiation was delivered prior to enucleation. This model may be useful in conducting further studies involving brachytherapy with 125I plaque implants.

Niederkorn, J.; Sanborn, G.E.; Scarbrough, E.E. (Univ. of Texas Southwestern Medical Center, Dallas (USA))

1990-06-01

247

Outcomes of Gleason Score <=8 among High Risk Prostate Cancer Treated with 125I Low Dose Rate Brachytherapy Based Multimodal Therapy  

PubMed Central

Purpose To investigate the role of low dose rate (LDR) brachytherapy-based multimodal therapy in high-risk prostate cancer (PCa) and analyze its optimal indications. Materials and Methods We reviewed the records of 50 high-risk PCa patients [clinical stage ?T2c, prostate-specific antigen (PSA) >20 ng/mL, or biopsy Gleason score ?8] who had undergone 125I LDR brachytherapy since April 2007. We excluded those with a follow-up period <3 years. Biochemical recurrence (BCR) followed the Phoenix definition. BCR-free survival rates were compared between the patients with Gleason score ?9 and Gleason score ?8. Results The mean initial PSA was 22.1 ng/mL, and mean D90 was 244.3 Gy. During a median follow-up of 39.2 months, biochemical control was obtained in 72% (36/50) of the total patients; The estimated 3-year BCR-free survival was 92% for the patients with biopsy Gleason scores ?8, and 40% for those with Gleason scores ?9 (p<0.001). In Cox multivariate analysis, only Gleason score ?9 was observed to be significantly associated with BCR (p=0.021). Acute and late grade ?3 toxicities were observed in 20% (10/50) and 36% (18/50) patients, respectively. Conclusion Our results showed that 125I LDR brachytherapy-based multimodal therapy in high-risk PCa produced encouraging relatively long-term results among the Asian population, especially in patients with Gleason score ?8. Despite small number of subjects, biopsy Gleason score ?9 was a significant predictor of BCR among high risk PCa patients after brachytherapy.

Park, Dong Soo; Gong, In Hyuck; Choi, Don Kyung; Hwang, Jin Ho; Shin, Hyun Soo

2013-01-01

248

Toward adaptive stereotactic robotic brachytherapy for prostate cancer: Demonstration of an adaptive workflow incorporating inverse planning and an MR stealth robot  

PubMed Central

To translate any robot into a clinical environment, it is critical that the robot can seamlessly integrate with all the technology of a modern clinic. MRBot, an MR-stealth brachytherapy delivery device, was used in a closed-bore 3T MRI and a clinical brachytherapy cone beam CT suite. Targets included ceramic dummy seeds, MR-Spectroscopy-sensitive metabolite, and a prostate phantom. Acquired DICOM images were exported to planning software to register the robot coordinates in the imager’s frame, contour and verify target locations, create dose plans, and export needle and seed positions to the robot. The coordination of each system element (imaging device, brachytherapy planning system, robot control, robot) was validated with a seed delivery accuracy of within 2 mm in both a phantom and soft tissue. An adaptive workflow was demonstrated by acquiring images after needle insertion and prior to seed deposition. This allows for adjustment if the needle is in the wrong position. Inverse planning (IPSA) was used to generate a seed placement plan and coordinates for ten needles and 29 seeds were transferred to the robot. After every two needles placed, an image was acquired. The placed seeds were identified and validated prior to placing the seeds in the next two needles. The ability to robotically deliver seeds to locations determined by IPSA and the ability of the system to incorporate novel needle patterns were demonstrated. Shown here is the ability to overcome this critical step. An adaptive brachytherapy workflow is demonstrated which integrates a clinical anatomy-based seed location optimization engine and a robotic brachytherapy device. Demonstration of this workflow is a key element of a successful translation to the clinic of the MRI stealth robotic delivery system, MRBot.

CUNHA, J. ADAM; HSU, I-CHOW; POULIOT, JEAN; ROACH, MACK; SHINOHARA, KATSUTO; KURHANEWICZ, JOHN; REED, GALEN; STOIANOVICI, DAN

2011-01-01

249

A detailed radiobiological and dosimetric analysis of biochemical outcomes in a case-control study of permanent prostate brachytherapy patients  

SciTech Connect

The purpose of this study is to determine dosimetric and radiobiological predictors of biochemical control after recalculation of prostate implant dosimetry using updated AAPM Task Group 43 (TG-43) parameters and the radiobiological parameters recommended by TG-137. All biochemical failures among patients implanted with {sup 125}I or {sup 103}Pd sources between 1994 and March 2006 were matched 2:1 with nonfailure controls. The individual matching was by risk group, radionuclide, prescribed dose, and time of implant (one match before and one after the failed patient) resulting in a median follow-up of 10.9 years. Complete dose volume histogram (DVH) data were recalculated for all 55 cases and 110 controls after updating the original source strength by the retrospectively determined ratios of TG-43. Differential DVH data were acquired in 179 increments of prostate volume versus percentage prescribed dose. At each incremental dose level i, the biologically equivalent dose BED{sub i}, equivalent uniform dose EUD{sub i}, and tumor control probability TCP{sub i} were calculated from the implant dose plus any external beam delivered to the patient. Total BED, EUD, and TCP were then derived from the incremental values for comparison with single point dosimetric quality parameters and DVH-based averages. There was no significant difference between failures and controls in terms of total BED (143 vs 142 Gy), EUD (95 vs 94 Gy), or TCP (0.87 vs 0.89). Conditional logistic regression analysis factored out the matching variables and stratified the cohort into each case and its controls, but no radiobiological parameter was predictive of biochemical failure. However, there was a significant difference between radiobiological parameters of {sup 125}I and {sup 103}Pd due to less complete coverage of the target volume by the former isotope. The implant BED and TCP were highly correlated with the D{sub 90} and natural prescription doses and a series of mean DVH-based doses such as the harmonic mean and expressions of the generalized EUD. In this case-control study of prostate brachytherapy biochemical failures and nonfailures, there were no radiobiological parameters derived from detailed DVH-based analysis that predicted for biochemical control. This may indicate that in our approach, implant dosimetry is at or near the limits of clinically effective dose escalation.

Butler, Wayne M.; Stewart, Renee R.; Merrick, Gregory S. [Schiffler Cancer Center, Wheeling Hospital, 1 Medical Park, Wheeling, West Virginia 26003-6300 and Wheeling Jesuit University, 316 Washington Avenue, Wheeling, West Virginia 26003 (United States)

2009-03-15

250

Biologically effective dose for permanent prostate brachytherapy taking into account postimplant edema  

Microsoft Academic Search

Purpose: To study the influence of radiobiologic and physical parameters and parameters related to edema on the biologically effective dose (BED) for permanent prostate implants and to determine the optimal timing of seed reconstruction for BED calculation.Methods and Materials: On the basis of the linear-quadratic model, an expression for the BED was derived, including the edema parameters. A set of

Marion P. R. Van Gellekom; Marinus A. Moerland; Henk B. Kal; Jan J. Battermann

2002-01-01

251

Early reduction in the aneuploidy at chromosomes 7 and 8 are significantly correlated with clinical effect in high-dose rate brachytherapy with external beam radiotherapy in localized prostate cancer.  

PubMed

Although reduction in the serum prostate specific antigen (PSA) correlates with clinical outcome for high dose rate Iridium-192 (HDR Ir-192) brachytherapy, it takes a long latency period. We investigated numerical chromosome changes of prostatic cancer during the pre- and post-treatment periods of HDR Ir-192 brachytherapy (and external beam radiotherapy), using fluorescence in situ hybridization (FISH) to clear the effect of treatment in early phase. Transitional changes in the frequency of aneuploidy for chromosomes 7, 8, 10, 12, 16, X, and Y in prostate cancer during the pre- and post-treatment periods were observed. Gains of chromosomes 7, 8 and 12 were noted in the pre-treatment samples (4 out of 12 cases in chromosomes 7 and 8; 1 out of 12 cases in chromosome 12), while a notable reduction in the number of cells with extra copies of these chromosomes was observed in post-treatment specimens. This change appears earlier than the reduction in the value of prostate specific antigen (PSA) and strongly reflects the effect of HDR brachytherapy with external beam radiotherapy in localized prostate cancer. Decrease in the number of cells with high ploidies of chromosomes 7, 8 and 12 at 12 weeks after treatment may predict clinical effects of radiation therapy, which may explain the radiation dependency of localized prostate cancer cells. PMID:11712084

Kasahara, K; Taguchi, T; Inoue, K; Shuin, T; Kariya, S; Yoshida, S; Furihata, M

2001-12-01

252

Clinical implementation of a digital tomosynthesis-based seed reconstruction algorithm for intraoperative postimplant dose evaluation in low dose rate prostate brachytherapy  

SciTech Connect

Purpose: The low dose rate brachytherapy procedure would benefit from an intraoperative postimplant dosimetry verification technique to identify possible suboptimal dose coverage and suggest a potential reimplantation. The main objective of this project is to develop an efficient, operator-free, intraoperative seed detection technique using the imaging modalities available in a low dose rate brachytherapy treatment room. Methods: This intraoperative detection allows a complete dosimetry calculation that can be performed right after an I-125 prostate seed implantation, while the patient is still under anesthesia. To accomplish this, a digital tomosynthesis-based algorithm was developed. This automatic filtered reconstruction of the 3D volume requires seven projections acquired over a total angle of 60 deg. with an isocentric imaging system. Results: A phantom study was performed to validate the technique that was used in a retrospective clinical study involving 23 patients. In the patient study, the automatic tomosynthesis-based reconstruction yielded seed detection rates of 96.7% and 2.6% false positives. The seed localization error obtained with a phantom study is 0.4{+-}0.4 mm. The average time needed for reconstruction is below 1 min. The reconstruction algorithm also provides the seed orientation with an uncertainty of 10 deg. {+-}8 deg. The seed detection algorithm presented here is reliable and was efficiently used in the clinic. Conclusions: When combined with an appropriate coregistration technique to identify the organs in the seed coordinate system, this algorithm will offer new possibilities for a next generation of clinical brachytherapy systems.

Brunet-Benkhoucha, Malik; Verhaegen, Frank; Lassalle, Stephanie; Beliveau-Nadeau, Dominic; Reniers, Brigitte; Donath, David; Taussky, Daniel; Carrier, Jean-Francois [Medical Physics Unit, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4 (Canada) and Departement de Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, 1560 rue Sherbrooke Est, Quebec, Montreal, Quebec H2L 4M1 (Canada); Medical Physics Unit, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4 (Canada) and Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht (Netherlands); Departement de Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, 1560 rue Sherbrooke Est, Quebec, Montreal, Quebec H2L 4M1 (Canada); Medical Physics Unit, McGill University, Montreal General Hospital, 1650 Cedar Avenue, Montreal, Quebec H3G 1A4 (Canada) and Department of Radiation Oncology (MAASTRO), GROW Research Institute, University Medical Centre Maastricht, Maastricht (Netherlands); Departement de Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, 1560 rue Sherbrooke Est, Quebec, Montreal, Quebec H2L 4M1 (Canada); Departement de Radio-Oncologie, Centre Hospitalier de l'Universite de Montreal, 1560 rue Sherbrooke Est, Quebec, Montreal, Quebec H2L 4M1 (Canada) and CRCHUM, Centre Hospitalier de l'Universite de Montreal, 1560 rue Sherbrooke Est, Quebec, Montreal, Quebec H2L 4M1 (Canada)

2009-11-15

253

Combination external beam radiation and brachytherapy boost with androgen deprivation for treatment of intermediate-risk prostate cancer: long-term results of CALGB 99809  

PubMed Central

Background Combined transperineal prostate brachytherapy (TPPB) and external beam radiation (EBRT) is widely used for treatment of prostate cancer. Long-term efficacy and toxicity results of a multicenter Phase II trial assessing combination of EBRT and TPPB boost with androgen deprivation therapy (ADT) for intermediate-risk prostate cancer are presented. Methods Intermediate-risk patients per MSKCC/NCCN criteria received six months of ADT, 45 Gy EBRT to the prostate and seminal vesicles, followed by TPPB with I125(100 Gy) or Pd103(90 Gy). Toxicity was graded using NCI CTC version 2 and RTOG late radiation morbidity scoring systems. Disease free survival (DFS) was defined as time from enrollment to progression (biochemical, local, distant or prostate cancer death). In addition to the protocol definition of biochemical failure (3 consecutive PSA rises >1.0ng/ml after 18 months from treatment start), the 1997 ASTRO consensus and Phoenix definitions were also assessed in defining DFS. The Kaplan-Meier method was used to estimate DFS and overall survival. Results 61/63 enrolled patients were eligible. Median follow-up was 73 months. Late grade 2 and 3 toxicity, excluding sexual dysfunction, occurred in 20% and 3% of patients. Six year DFS applying the protocol definition, 1997 ASTRO consensus, and Phoenix definitions was 87.1%, 75.1%, and 84.9%. 6 deaths occurred, only one was attributed to prostate cancer. 6 year overall survival was 96.1%. Conclusions In a cooperative setting, combination of EBRT and TPPB boost plus ADT resulted in excellent DFS with acceptable late toxicity for patients with intermediate-risk prostate cancer.

Hurwitz, Mark D.; Halabi, Susan; Archer, Laura; McGinnis, Lamar S.; Kuettel, Michael R.; DiBiase, Steven J.; Small, Eric J.

2011-01-01

254

Late toxicity and five year outcomes after high-dose-rate brachytherapy as a monotherapy for localized prostate cancer  

PubMed Central

Background To determine the 5-year outcome after high-dose-rate brachytherapy (HDR-BT) as a monotherapy. Methods Between 10/2003 and 06/2006, 36 patients with low (28) and intermediate (8) risk prostate cancer were treated by HDR-BT monotherapy. All patients received one implant and 4 fractions of 9.5 Gy within 48 hours for a total prescribed dose (PD) of 38 Gy. Five patients received concomitant androgen deprivation therapy (ADT). Toxicity was scored according to the common terminology criteria for adverse events from the National Cancer Institute (CTCAE) version 3.0. Biochemical recurrence was defined according to the Phoenix criteria and analyzed using the Kaplan Meier method. Predictors for late grade 3 GU toxicity were analyzed using univariate and multivariate Cox regression analyses. Results The median follow-up was 6.9 years (range, 1.5-8.0 years). Late grade 2 and 3 genitourinary (GU) toxicity was observed in 10 (28%) and 7 (19%) patients, respectively. The actuarial proportion of patients with late grade 3 GU toxicity at 5 years was 17.7%. Late grade 2 and 3 gastrointestinal (GI) toxicities were not observed. The crude erectile function preservation rate in patients without ADT was 75%. The 5 year biochemical recurrence-free survival (bRFS) rate was 97%. Late grade 3 GU toxicity was associated with the urethral volume (p?=?0.001) and the urethral V120 (urethral volume receiving ?120% of the PD; p?=?0.0005) after multivariate Cox regression. Conclusions After HDR-BT monotherapy late grade 3 GU was observed relatively frequently and was associated with the urethral V120. GI toxicity was negligible, the erectile function preservation rate and the bRFS rate was excellent.

2014-01-01

255

There Is No Correlation Between Erectile Dysfunction and Dose to Penile Bulb and Neurovascular Bundles Following Real-Time Low-Dose-Rate Prostate Brachytherapy  

SciTech Connect

Purpose: We evaluated the relationship between the onset of erectile dysfunction and dose to the penile bulb and neurovascular bundles (NVBs) after real-time ultrasound-guided prostate brachytherapy. Methods and Materials: One hundred forty-seven patients who underwent prostate brachytherapy met the following eligibility criteria: (1) treatment with {sup 125}I brachytherapy to a prescribed dose of 160 Gy with or without hormones without supplemental external beam radiation therapy, (2) identification as potent before the time of implantation based on a score of 2 or higher on the physician-assigned Mount Sinai Erectile Function Score and a score of 16 or higher on the abbreviated International Index of Erectile Function patient assessment, and (3) minimum follow-up of 12 months. Median follow-up was 25.7 months (range, 12-47 months). Results: The 3-year actuarial rate of impotence was 23% (34 of 147 patients). An additional 43% of potent patients (49 of 113 patients) were using a potency aid at last follow-up. The penile bulb volume receiving 100% of the prescription dose (V{sub 100}) ranged from 0-0.05 cc (median, 0 cc), with a dose to the hottest 5% (D{sub 5}) range of 12.5-97.9 Gy (median, 40.8 Gy). There was no correlation between penile bulb D{sub 5} or V{sub 100} and postimplantation impotency on actuarial analysis. For the combined right and left NVB structures, V{sub 100} range was 0.3-5.1 cc (median, 1.8 cc), and V{sub 150} range was 0-1.5 cc (median, 0.31 cc). There was no association between NVB V{sub 100} or V{sub 150} and postimplantation impotency on actuarial analysis. Conclusion: Penile bulb doses are low after real-time ultrasound-guided prostate brachytherapy. We found no correlation between dose to either the penile bulb or NVBs and the development of postimplantation impotency.

Solan, Amy N. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)], E-mail: amy.solan@mountsinai.org; Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Stone, Nelson N. [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

2009-04-01

256

Rectal toxicity profile after transperineal interstitial permanent prostate brachytherapy: Use of a comprehensive toxicity scoring system and identification of rectal dosimetric toxicity predictors  

SciTech Connect

Purpose: To better understand rectal toxicity after prostate brachytherapy, we employed the National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE version 3.0), a comprehensive system with distinct and separately reported gastrointestinal adverse event items (unlike Radiation Therapy Oncology Group morbidity scoring), to evaluate item-specific postimplant rectal toxicities. Methods and Materials: We analyzed 135 patients treated with brachytherapy {+-} hormonal therapy, using CTCAE v3.0 to score acute/late rectal toxicities (median follow-up, 41 months). Dosimetric parameters were evaluated for ability to predict toxicities. Results: Use of CTCAE yielded a novel rectal toxicity profile consisting of diarrhea, incontinence, urgency, proctitis, pain, spasms, and hemorrhage event rates. No item had a <5% Grade 1-2 acute toxicity rate (except spasms). Rectal dosimetry predicted late toxicities: for diarrhea, 5% Grade 1 toxicity rate for %V{sub 25} (percent of rectal volume receiving 25% of prescribed prostate dose) {<=} 25% vs. 60% for %V{sub 25} > 25% (p < 0.001); for maximum toxicity, 10% Grade 1 toxicity rate for %V{sub 1} {<=} 40% vs. 44% for %V{sub 1} > 40% (p = 0.007). Conclusions: A comprehensive understanding of item-specific postimplant rectal toxicities was obtained using CTCAE. Rectal %V{sub 25} > 25% and %V{sub 1} > 40% predicted worse late diarrhea and maximum toxicity, respectively.

Shah, Jinesh N. [Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, NY (United States); Ennis, Ronald D. [Department of Radiation Oncology, College of Physicians and Surgeons, Columbia University, New York, NY (United States)]. E-mail: rennis@chpnet.org

2006-03-01

257

Phase II Trial of Combined High Dose Rate Brachytherapy and External Beam Radiotherapy for Adenocarcinoma of the Prostate: Preliminary Results of RTOG 0321  

PubMed Central

Purpose To estimate the rate of late grade 3 or greater genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) following treatment with external beam radiation therapy and prostate high dose rate (HDR) brachytherapy. Methods and Materials Each participating institution submitted CT based HDR brachytherapy dosimetry data electronically for credentialing and for each study patient. Patients with locally confined T1c-T3b prostate cancer were eligible for this study. All patients were treated with 45 Gy in 25 fractions from external beam radiotherapy and one HDR implant delivering 19 Gy in 2 fractions. All AEs were graded according to CTCAEv3.0. Late GU/ GI AEs were defined as those occurring more than nine months from the start of the protocol treatment, in patients with at least 18 months of potential follow-up. Results A total of 129 patients from 14 institutions were enrolled in this study. 125 patients were eligible and AE data was available for 112 patients. The pretreatment characteristics of the patients were as follows: T1c-T2c 91%, T3a-T3b 9%, PSA ? 10 70%, PSA >10-?20 30%, GS 2-6 10%, GS 7 72%, and GS 8-10 18%. At a median follow-up time of 29.6 months, 3 acute and 4 late grade 3 GU/GI AEs were reported. The estimated rate of late grade 3-5 GU and GI AE at 18 months was 2.56%. Conclusion This is the first prospective, multi-institutional trial of CT based HDR brachytherapy and external beam radiotherapy. The technique and doses used in this study resulted in acceptable levels of adverse events.

Hsu, I-Chow; Bae, Kyounghwa; Shinohara, Katsuto; Pouliot, Jean; Purdy, James; Ibbott, Geoffrey; Speight, Joycelyn; Vigneault, Eric; Ivker, Robert; Sandler, Howard

2010-01-01

258

Oblique needle segmentation and tracking for 3D TRUS guided prostate brachytherapy  

SciTech Connect

An algorithm was developed in order to segment and track brachytherapy needles inserted along oblique trajectories. Three-dimensional (3D) transrectal ultrasound (TRUS) images of the rigid rod simulating the needle inserted into the tissue-mimicking agar and chicken breast phantoms were obtained to test the accuracy of the algorithm under ideal conditions. Because the robot possesses high positioning and angulation accuracies, we used the robot as a ''gold standard,'' and compared the results of algorithm segmentation to the values measured by the robot. Our testing results showed that the accuracy of the needle segmentation algorithm depends on the needle insertion distance into the 3D TRUS image and the angulations with respect to the TRUS transducer, e.g., at a 10 deg. insertion anglulation in agar phantoms, the error of the algorithm in determining the needle tip position was less than 1 mm when the insertion distance was greater than 15 mm. Near real-time needle tracking was achieved by scanning a small volume containing the needle. Our tests also showed that, the segmentation time was less than 60 ms, and the scanning time was less than 1.2 s, when the insertion distance into the 3D TRUS image was less than 55 mm. In our needle tracking tests in chicken breast phantoms, the errors in determining the needle orientation were less than 2 deg. in robot yaw and 0.7 deg. in robot pitch orientations, for up to 20 deg. needle insertion angles with the TRUS transducer in the horizontal plane when the needle insertion distance was greater than 15 mm.

Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron [Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada) and Biomedical Engineering Program, University of Western Ontario, London, Ontario N6A 5B9 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada) and Department of Radiology and Nuclear Medicine, University of Western Ontario, London, Ontario N6A 5A5 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, Ontario N6A 5K8 (Canada); Biomedical Engineering Program, University of Western Ontario, London, Ontario N6A 5B9 (Canada) and Department of Radiology and Nuclear Medicine, University of Western Ontario, London, Ontario N6A 5A5 (Canada)

2005-09-15

259

BrachyView: Proof-of-principle of a novel in-body gamma camera for low dose-rate prostate brachytherapy  

SciTech Connect

Purpose: The conformity of the achieved dose distribution to the treatment plan strongly correlates with the accuracy of seed implantation in a prostate brachytherapy treatment procedure. Incorrect seed placement leads to both short and long term complications, including urethral and rectal toxicity. The authors present BrachyView, a novel concept of a fast intraoperative treatment planning system, to provide real-time seed placement information based on in-body gamma camera data. BrachyView combines the high spatial resolution of a pixellated silicon detector (Medipix2) with the volumetric information acquired by a transrectal ultrasound (TRUS). The two systems will be embedded in the same probe so as to provide anatomically correct seed positions for intraoperative planning and postimplant dosimetry. Dosimetric calculations are based on the TG-43 method using the real position of the seeds. The purpose of this paper is to demonstrate the feasibility of BrachyView using the Medipix2 pixel detector and a pinhole collimator to reconstruct the real-time 3D position of low dose-rate brachytherapy seeds in a phantom. Methods: BrachyView incorporates three Medipix2 detectors coupled to a multipinhole collimator. Three-dimensionally triangulated seed positions from multiple planar images are used to determine the seed placement in a PMMA prostate phantom in real time. MATLAB codes were used to test the reconstruction method and to optimize the device geometry. Results: The results presented in this paper show a 3D position reconstruction accuracy of the seed in the range of 0.5-3 mm for a 10-60 mm seed-to-detector distance interval (Z direction), respectively. The BrachyView system also demonstrates a spatial resolution of 0.25 mm in the XY plane for sources at 10 mm distance from Medipix2 detector plane, comparable to the theoretical value calculated for an equivalent gamma camera arrangement. The authors successfully demonstrated the capability of BrachyView for real-time imaging (using a 3 s data acquisition time) of different brachytherapy seed configurations (with an activity of 0.05 U) throughout a 60 Multiplication-Sign 60 Multiplication-Sign 60 mm{sup 3} Perspex prostate phantom. Conclusions: The newly developed miniature gamma camera component of BrachyView, with its high spatial resolution and real time capability, allows accurate 3D localization of seeds in a prostate phantom. Combination of the gamma camera with TRUS in a single probe will complete the BrachyView system.

Petasecca, M.; Loo, K. J.; Safavi-Naeini, M.; Han, Z.; Metcalfe, P. E.; Lerch, M. L. F.; Qi, Y.; Rosenfeld, A. B. [Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Meikle, S. [Brain and Mind Research Institute, University of Sydney, NSW 2006, Australia and Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Pospisil, S.; Jakubek, J. [Institute of Experimental and Applied Physics, Czech Technical University of Prague, Prague (Czech Republic); Bucci, J. A. [St George Cancer Care Centre, St George Hospital, Kogarah, NSW 2217 (Australia); Zaider, M. [Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10021 (United States)

2013-04-15

260

Monte Carlo investigation of I-125 interseed attenuation for standard and thinner seeds in prostate brachytherapy with phantom validation using a MOSFET  

SciTech Connect

Purpose: In permanent seed implant prostate brachytherapy the actual dose delivered to the patient may be less than that calculated by TG-43U1 due to interseed attenuation (ISA) and differences between prostate tissue composition and water. In this study the magnitude of the ISA effect is assessed in a phantom and in clinical prostate postimplant cases. Results are compared for seed models 6711 and 9011 with 0.8 and 0.5 mm diameters, respectively. Methods: A polymethyl methacrylate (PMMA) phantom was designed to perform ISA measurements in a simple eight-seed arrangement and at the center of an implant of 36 seeds. Monte Carlo (MC) simulation and experimental measurements using a MOSFET dosimeter were used to measure dose rate and the ISA effect. MC simulations of 15 CT-based postimplant prostate treatment plans were performed to compare the clinical impact of ISA on dose to prostate, urethra, rectum, and the volume enclosed by the 100% isodose, for 6711 and 9011 seed models. Results: In the phantom, ISA reduced the dose rate at the MOSFET position by 8.6%-18.3% (6711) and 7.8%-16.7% (9011) depending on the measurement configuration. MOSFET measured dose rates agreed with MC simulation predictions within the MOSFET measurement uncertainty, which ranged from 5.5% to 7.2% depending on the measurement configuration (k= 1, for the mean of four measurements). For 15 clinical implants, the mean ISA effect for 6711 was to reduce prostate D90 by 4.2 Gy (3%), prostate V100 by 0.5 cc (1.4%), urethra D10 by 11.3 Gy (4.4%), rectal D2cc by 5.5 Gy (4.6%), and the 100% isodose volume by 2.3 cc. For the 9011 seed the mean ISA effect reduced prostate D90 by 2.2 Gy (1.6%), prostate V100 by 0.3 cc (0.7%), urethra D10 by 8.0 Gy (3.2%), rectal D2cc by 3.1 Gy (2.7%), and the 100% isodose volume by 1.2 cc. Differences between the MC simulation and TG-43U1 consensus data for the 6711 seed model had a similar impact, reducing mean prostate D90 by 6 Gy (4.2%) and V100 by 0.6 cc (1.8%). Conclusions: ISA causes the delivered dose in prostate seed implant brachytherapy to be lower than the dose calculated by TG-43U1. MC simulation of phantom seed arrangements show that dose at a point can be reduced by up to 18% and this has been validated using a MOSFET dosimeter. Clinical simulations show that ISA reduces DVH parameter values, but the reduction is less for thinner seeds.

Mason, J.; Al-Qaisieh, B.; Bownes, P. [Department of Medical Physics and Engineering, St. James's Institute of Oncology, St. James's University Hospital, Leeds, LS9 7TF (United Kingdom); Henry, A. [Clinical Oncology, St. James's Institute of Oncology, St. James's University Hospital, Leeds, LS9 7TF (United Kingdom); Thwaites, D. [Institute of Medical Physics, School of Physics, University of Sydney, NSW 2006, Australia and Academic Unit of Medical Physics, University of Leeds, LS2 9JT (United Kingdom)

2013-03-15

261

Evaluation of hybrid inverse planning and optimization (HIPO) algorithm for optimization in real-time, high-dose-rate (HDR) brachytherapy for prostate.  

PubMed

The purpose of this study is to investigate the effectiveness of the HIPO planning and optimization algorithm for real-time prostate HDR brachytherapy. This study consists of 20 patients who underwent ultrasound-based real-time HDR brachytherapy of the prostate using the treatment planning system called Oncentra Prostate (SWIFT version 3.0). The treatment plans for all patients were optimized using inverse dose-volume histogram-based optimization followed by graphical optimization (GRO) in real time. The GRO is manual manipulation of isodose lines slice by slice. The quality of the plan heavily depends on planner expertise and experience. The data for all patients were retrieved later, and treatment plans were created and optimized using HIPO algorithm with the same set of dose constraints, number of catheters, and set of contours as in the real-time optimization algorithm. The HIPO algorithm is a hybrid because it combines both stochastic and deterministic algorithms. The stochastic algorithm, called simulated annealing, searches the optimal catheter distributions for a given set of dose objectives. The deterministic algorithm, called dose-volume histogram-based optimization (DVHO), optimizes three-dimensional dose distribution quickly by moving straight downhill once it is in the advantageous region of the search space given by the stochastic algorithm. The PTV receiving 100% of the prescription dose (V100) was 97.56% and 95.38% with GRO and HIPO, respectively. The mean dose (D(mean)) and minimum dose to 10% volume (D10) for the urethra, rectum, and bladder were all statistically lower with HIPO compared to GRO using the student pair t-test at 5% significance level. HIPO can provide treatment plans with comparable target coverage to that of GRO with a reduction in dose to the critical structures. PMID:23835384

Pokharel, Shyam; Rana, Suresh; Blikenstaff, Joseph; Sadeghi, Amir; Prestidge, Bradley

2013-01-01

262

Transperineal Injection of Hyaluronic Acid in Anterior Perirectal Fat to Decrease Rectal Toxicity From Radiation Delivered With Intensity Modulated Brachytherapy or EBRT for Prostate Cancer Patients  

SciTech Connect

Purpose: Rectal toxicity remains a serious complication affecting quality of life for prostate cancer patients treated with radiotherapy. We began an investigational trial injecting hyaluronic acid (HA) in the perirectal fat to increase the distance between the prostate and the anterior rectal wall. This is the first report using HA injection in oncology. Methods and Materials: This is a trial of external beam radiation therapy with HDR brachytherapy boosts in prostate cancer. During the two high-dose-rate (HDR) fractions, thermoluminescent dosimeter dosimeters were placed in the urethra and in the rectum. Before the second HDR fraction, 3-7 mL (mean, 6 mL) of HA was injected under transrectal ultrasound guidance in the perirectal fat to systematically create a 1.5-cm space. Urethral and rectal HDR doses were calculated and measured. Computed tomography and magnetic resonance imaging were used to assess the stability of the new space. Results: Twenty-seven patients enrolled in the study. No toxicity was produced from the HA or the injection. In follow-up computed tomography and magnetic resonance imaging, the HA injection did not migrate or change in mass/shape for close to 1 year. The mean distance between rectum and prostate was 2.0 cm along the entire length of the prostate. The median measured rectal dose, when normalized to the median urethral dose, demonstrated a decrease in dose from 47.1% to 39.2% (p < 0.001) with or without injection. For an HDR boost dose of 1150 cGy, the rectum mean Dmax reduction was from 708 cGy to 507 cGy, p < 0.001, and the rectum mean Dmean drop was from 608 to 442 cGy, p < 0.001 post-HA injection. Conclusion: The new 2-cm distance derived from the HA injection significantly decreased rectal dose in HDR brachytherapy. Because of the several-month duration of stability, the same distance was maintained during the course of external beam radiation therapy.

Prada, Pedro J. [Department of Radiation Oncology, Hospital Central de Asturias, Oviedo (Spain)], E-mail: pprada@telecable.es; Fernandez, Jose [Department of Radiation Oncology, Hospital Central de Asturias, Oviedo (Spain); Martinez, Alvaro A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Rua, Angeles de la; Gonzalez, Jose M. [Department of Radiation Oncology, Hospital Central de Asturias, Oviedo (Spain); Fernandez, Jose M. [Department of Radiology, Hospital Central de Asturias, Oviedo (Spain); Juan, German [Department of Radiation Oncology, Hospital Central de Asturias, Oviedo (Spain)

2007-09-01

263

Prognostic Significance of 5-Year PSA Value for Predicting Prostate Cancer Recurrence After Brachytherapy Alone and Combined With Hormonal Therapy and/or External Beam Radiotherapy  

SciTech Connect

Purpose: To analyze the prognosis and outcomes of patients who remain free of biochemical failure during the first 5 years after treatment. Methods and Materials: Between 1991 and 2002, 742 patients with prostate cancer were treated with brachytherapy alone (n = 306), brachytherapy and hormonal therapy (n = 212), or combined implantation and external beam radiotherapy (with or without hormonal therapy; n = 224). These patients were free of biochemical failure (American Society for Therapeutic Radiology and Oncology [ASTRO] definition) during the first 5 post-treatment years and had a documented 5-year prostate-specific antigen (PSA) value. The median follow-up was 6.93 years. Results: The actuarial 10-year freedom from PSA failure rate was 97% using the ASTRO definition and 95% using the Phoenix definition. The median 5-year PSA level was 0.03 ng/mL (range, 0-3.6). The 5-year PSA value was {<=}0.01 in 47.7%, >0.01-0.10 in 31.1%, >0.10-0.2 in 10.2%, >0.2-0.5 in 7.82%, and >0.5 in 3.10%. The 5-year PSA value had prognostic significance, with a PSA value of {<=}0.2 ng/mL (n = 661) corresponding to a 10-year freedom from PSA failure rate of 99% with the ASTRO definition and 98% with the Phoenix definition vs. 86% (ASTRO definition) and 81% (Phoenix definition) for a PSA value {>=}0.2 ng/mL (n = 81; p < .0001). The treatment regimen had no effect on biochemical failure. None of the 742 patients in this study developed metastatic disease or died of prostate cancer. Conclusion: The results of this study have shown that the prognosis for patients treated with brachytherapy and who remain biochemically free of disease for {>=}5 years is excellent and none developed metastatic disease during the first 10 years after treatment. The 5-year PSA value is prognostic, and patients with a PSA value <0.2 ng/mL are unlikely to develop subsequent biochemical relapse.

Stock, Richard G. [Department of Radiation Oncology, Mount Sinai Hospital, New York, NY (United States)], E-mail: Richard.stock@mountsinai.org; Klein, Thomas J.; Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai Hospital, New York, NY (United States); Stone, Nelson N. [Department of Urology, Mount Sinai Hospital, New York, NY (United States)

2009-07-01

264

Combination External Beam Radiation and Brachytherapy Boost With Androgen Suppression for Treatment of Intermediate-Risk Prostate Cancer: An Initial Report of CALGB 99809  

SciTech Connect

Purpose: Transperineal prostate brachytherapy (TPPB) can be used with external beam radiation therapy (EBRT) to provide a high-dose conformal boost to the prostate. The results of a multicenter Phase II trial assessing safety of combination of EBRT and TPPB boost with androgen suppression (AST) in treatment of intermediate-risk prostate cancer are present here. Materials and Methods: Patients had intermediate-risk prostate cancer. Six months of AST was administered. EBRT to the prostate and seminal vesicles was administered to 45Gy followed by TPPB using either {sup 125}I or {sup 103}Pd to deliver an additional 100Gy or 90Gy. Toxicity was graded using the National Cancer Institute CTC version 2 and the Radiation Therapy Oncology Group late radiation morbidity scoring systems. Results: Sixty-three patients were enrolled. Median follow-up was 38 months. Side effects of AST including sexual dysfunction and vasomotor symptoms were commonly observed. Apart from erectile dysfunction, short-term Grade 2 and 3 toxicity was noted in 21% and 7%, primarily genitourinary related. Long-term Grade 2 and 3 toxicities were noted in 13% and 3%. Two patients had Grade 3 dysuria that resolved with longer follow-up. The most common Grade 2 long-term toxicity was urinary frequency (5%). No biochemical or clinical evidence of progression was noted for the entire cohort. Conclusions: In a cooperative group setting, combination EBRT and TPPB boost with 6 months of AST was generally well tolerated with expected genitourinary and gastrointestinal toxicities. Further follow-up will be required to fully assess long-term toxicity and cancer control.

Hurwitz, Mark D. [Dana-Farber/Brigham and Women's Cancer Center, Boston, MA (United States)], E-mail: mhurwitz@lroc.harvard.edu; Halabi, Susan [Harvard Medical School, Boston, MA (United States); Ou, San-San [CALGB Statistical Center, Duke University Medical Center, Durham, NC (United States); McGinnis, Lamar S. [Southeast Cancer Control Consortium, Winston Salem, NC (United States); Keuttel, Michael R. [Roswell Park Cancer Institute, Buffalo, NY (United States); DiBiase, Steven J. [University of Maryland Medical Center, Baltimore, MD (United States); Small, Eric J. [University of California at San Francisco Comprehensive Cancer Center, San Francisco, CA (United States)

2008-11-01

265

Evaluation of (iodine-125)N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3- propanediamine lung uptake using an isolated-perfused lung model  

Microsoft Academic Search

Lung uptake of N,N,N'-trimethyl-N'-(2-Hydroxy-3-methyl-5-iodobenzyl)-1,3- propanediamine (HIPDM) has been reported, but the mechanism of this process has not yet been established. Thus, single-pass (¹²⁵I)HIPDM accumulation was studied in rat lungs perfused with a Krebs-Ringer bicarbonate buffer containing 4.5% bovine albumin. Iodine-125 HIPDM lung accumulation was monitored by the percent of extraction per gram of lung tissue. Iodine-125 HIPDM lung uptake did

D. O. Slosman; A. B. Brill; B. S. Polla; P. O. Alderson

1987-01-01

266

In vivo dosimetry in the urethra using alanine/ESR during 192Ir HDR brachytherapy of prostate cancer—a phantom study  

NASA Astrophysics Data System (ADS)

A phantom study for dosimetry in the urethra using alanine/ESR during 192Ir HDR brachytherapy of prostate cancer is presented. The measurement method of the secondary standard of the Physikalisch-Technische Bundesanstalt had to be slightly modified in order to be able to measure inside a Foley catheter. The absorbed dose to water response of the alanine dosimetry system to 192Ir was determined with a reproducibility of 1.8% relative to 60Co. The resulting uncertainty for measurements inside the urethra was estimated to be 3.6%, excluding the uncertainty of the dose rate constant ?. The applied dose calculated by a treatment planning system is compared to the measured dose for a small series of 192Ir HDR irradiations in a gel phantom. The differences between the measured and applied dose are well within the limits of uncertainty. Therefore, the method is considered to be suitable for measurements in vivo.

Anton, Mathias; Wagner, Daniela; Selbach, Hans-Joachim; Hackel, Thomas; Hermann, Robert Michael; Hess, Clemens Friedrich; Vorwerk, Hilke

2009-05-01

267

Anatomy-Based Inverse Planning Simulated Annealing Optimization in High-Dose-Rate Prostate Brachytherapy: Significant Dosimetric Advantage Over Other Optimization Techniques  

SciTech Connect

Purpose: To perform an independent validation of an anatomy-based inverse planning simulated annealing (IPSA) algorithm in obtaining superior target coverage and reducing the dose to the organs at risk. Method and Materials: In a recent prostate high-dose-rate brachytherapy protocol study by the Radiation Therapy Oncology Group (0321), our institution treated 20 patients between June 1, 2005 and November 30, 2006. These patients had received a high-dose-rate boost dose of 19 Gy to the prostate, in addition to an external beam radiotherapy dose of 45 Gy with intensity-modulated radiotherapy. Three-dimensional dosimetry was obtained for the following optimization schemes in the Plato Brachytherapy Planning System, version 14.3.2, using the same dose constraints for all the patients treated during this period: anatomy-based IPSA optimization, geometric optimization, and dose point optimization. Dose-volume histograms were generated for the planning target volume and organs at risk for each optimization method, from which the volume receiving at least 75% of the dose (V{sub 75%}) for the rectum and bladder, volume receiving at least 125% of the dose (V{sub 125%}) for the urethra, and total volume receiving the reference dose (V{sub 100%}) and volume receiving 150% of the dose (V{sub 150%}) for the planning target volume were determined. The dose homogeneity index and conformal index for the planning target volume for each optimization technique were compared. Results: Despite suboptimal needle position in some implants, the IPSA algorithm was able to comply with the tight Radiation Therapy Oncology Group dose constraints for 90% of the patients in this study. In contrast, the compliance was only 30% for dose point optimization and only 5% for geometric optimization. Conclusions: Anatomy-based IPSA optimization proved to be the superior technique and also the fastest for reducing the dose to the organs at risk without compromising the target coverage.

Jacob, Dayee [Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE (United States)], E-mail: djacob@christianacare.org; Raben, Adam; Sarkar, Abhirup; Grimm, Jimm; Simpson, Larry [Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE (United States)

2008-11-01

268

Six year experience of external beam radiotherapy, brachytherapy boost with a 1Ci {sup 192}Ir source, and neoadjuvant hormonal manipulation for prostate cancer  

SciTech Connect

Purpose: To present preliminary outcomes of pulsed dose rate brachytherapy (PDR-BT), external beam radiotherapy (EBRT), and hormonal manipulation, for prostate cancer. Patients and Methods: Between December 1999 and January 2005, 165 consecutive patients with Stage T1-T3, N0, M0 prostate cancer were treated. Hormones were used in every patient. Median follow-up was 36 months. Risk groups were low (either Stage {<=}T2a, {+-} Gleason score {<=}6, {+-} Prostate-Specific Antigen [PSA] level {<=}10 ng/mL); intermediate (either Stage T2b,c, {+-} Gleason score 7, {+-} PSA 10-20 ng/mL); and high (either Stage T3, {+-} Gleason score 8-10, {+-} PSA >20 ng/mL). Results: At 3 years, Radiotherapy Oncology Group (RTOG) Grade 3 and 4 genito-urinary toxicity was 4% and 1.4%; RTOG Grade 3 and 4 gastro-intestinal toxicity was 2.6% and 0%, respectively. Erectile preservation was 61%. Overall survival was 93% (154 of 165) and cause-specific survival was 98% (162 of 165). At 3 years, disease free survival (DFS) was 93% (153 of 165). DFS for low-, intermediate-, and high-risk groups was 100%, 97%, and 81%, respectively ({chi}{sup 2} (2) = 16.02, p = 0.0003). The nadir plus 2 ng/mL definition ({chi}{sup 2} (2) = 14.49, p 0.0007) best predicted clinical failure, having the lowest false-positive rate (3 of 165). The nadir plus 2 ng/mL PSA-progression-free survival (PSA-PFS) rate was 100%, 95%, and 87% for the low-, intermediate, and high-risk groups, respectively. Overall ASTRO PSA-PFS rate was 88%. Conclusions: Pulsed dose rate brachytherapy plus EBRT is effective in treating localized prostate cancer, with acceptable toxicity. However, a median 5-year PSA-PFS follow-up is required before providing a solid recommendation. This preliminary information supports continued use.

Izard, Michael A. [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia)]. E-mail: michael.izard@i-med.com.au; Haddad, Richard L. [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia); Fogarty, Gerald B. [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia); Rinks, Adrian [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia); Dobbins, Timothy [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia); Katelaris, Philip [Radiation Oncology Associates, Mater Hospital, North Sydney, NSW (Australia)

2006-09-01

269

76 FR 11529 - Gregory Desobry, Ph.D.; Order Requiring Notification of Involvement in NRC-Licensed Activities  

Federal Register 2010, 2011, 2012, 2013

...brachytherapy iodine-125 used for permanent prostate implants. Mr. Desobry's role included...with the vast majority of the permanent prostate implants under the permit. II On May...NRC that 97 medical events involving prostate brachytherapy occurred at the PVAMC...

2011-03-02

270

75 FR 41553 - Report to Congress on Abnormal Occurrences Fiscal Year 2009; Dissemination of Information  

Federal Register 2010, 2011, 2012, 2013

...with a HDR brachytherapy treatment for prostate cancer containing 185 GBq (5 Ci) of...brachytherapy seed implant procedure to treat prostate cancer. The patient was prescribed to...dose of 144 Gy (14,400 rad) to the prostate using 64 iodine-125 seeds as...

2010-07-16

271

Imaging of implant needles for real-time HDR-brachytherapy prostate treatment using biplane ultrasound transducers.  

PubMed

Ultrasound imaging is becoming increasingly important in prostate brachytherapy. In high-dose-rate (HDR) real-time planning procedures the definition of the implant needles is often performed by transrectal ultrasound. This article describes absolute measurements of the visibility and accuracy of manual detection of implant needle tips and compares measurement results of different biplane ultrasound systems in transversal and longitudinal (i.e., sagittal) ultrasound modes. To obtain a fixed coordinate system and stable conditions the measurements were carried out in a water tank using a dedicated marker system. Needles were manually placed in the phantom until the observer decided by the real-time ultrasound image that the zero position was reached. A comparison of three different ultrasound systems yielded an offset between 0.8 and 3.1 mm for manual detection of the needle tip in ultrasound images by one observer. The direction of the offset was discovered to be in the proximal direction, i.e., the actual needle position was located more distally compared to the ultrasound-based definition. In the second part of the study, the ultrasound anisotropy of trocar implant needles is reported. It was shown that the integrated optical density in a region of interest around the needle tip changes with needle rotation. Three peaks were observed with a phase angle of 120 degrees. Peaks appear not only in transversal but also in longitudinal ultrasound images, with a phase shift of 60 degrees. The third section of this study shows results of observer dependent influences on needle tip detection in sagittal ultrasound images considering needle rotation. These experiments were carried out using the marker system in a water tank. The needle tip was placed exactly at the position z=0 mm. It was found that different users tend to differently interpret the same ultrasound images. The needle tip was manually detected five times in the ultrasound images by three experienced observers at positions (+/- standard deviation) -0.53 +/- 0.16, -0.16 +/- 0.14, and -0.30 +/- 0.16 mm using a gain of 15 dB. The minus sign indicates that the needle tips were detected more proximally than the actual position of the needle tip. When using a gain of -15 dB the mean values of two observers resulted in -0.62 +/- 0.08 and -0.51 +/- 0.12 mm. Additionally an alternative approach to the direct needle tip definition was investigated. Two observers detected the solid part of the needle tip in sagittal images. This solid part, often named as "dead space end," is the distance between the needle tip and the beginning of the hollow part of the implant needle. The dead space end is 6.2 mm for the investigated needle type. Two users found mean values of -6.70 +/- 0.16 and -7.00 +/- 0.06 mm, respectively, for 15 dB gain and -6.90 +/- 0.09 and -7.02 +/- 0.06 mm using the -15 dB gain setting. The results show that ultrasound-based needle tip definition in sagittal viewing mode is accurate. The inter- and intraobserver errors should, however, be taken into account. A lower gain setting of the ultrasound system reduces the intraobserver error. PMID:19746773

Siebert, Frank-André; Hirt, Markus; Niehoff, Peter; Kovács, György

2009-08-01

272

Anatomy-based inverse optimization in high-dose-rate brachytherapy combined with hypofractionated external beam radiotherapy for localized prostate cancer: Comparison of incidence of acute genitourinary toxicity between anatomy-based inverse optimization and geometric optimization  

SciTech Connect

Purpose: To evaluate the advantages of anatomy-based inverse optimization (IO) in planning high-dose-rate (HDR) brachytherapy. Methods and Materials: A total of 114 patients who received HDR brachytherapy (9 Gy in two fractions) combined with hypofractionated external beam radiotherapy (EBRT) were analyzed. The dose distributions of HDR brachytherapy were optimized using geometric optimization (GO) in 70 patients and by anatomy-based IO in the remaining 44 patients. The correlation between the dose-volume histogram parameters, including the urethral dose and the incidence of acute genitourinary (GU) toxicity, was evaluated. Results: The averaged values of the percentage of volume receiving 80-150% of the prescribed minimal peripheral dose (V{sub 8}-V{sub 15}) of the urethra generated by anatomy-based IO were significantly lower than the corresponding values generated by GO. Similarly, the averaged values of the minimal dose received by 5-50% of the target volume (D{sub 5}-D{sub 5}) obtained using anatomy-based IO were significantly lower than those obtained using GO. Regarding acute toxicity, Grade 2 or worse acute GU toxicity developed in 23% of all patients, but was significantly lower in patients for whom anatomy-based IO (16%) was used than in those for whom GO was used (37%), consistent with the reduced urethral dose (p <0.01). Conclusion: The results of this study suggest that anatomy-based IO is superior to GO for dose optimization in HDR brachytherapy for prostate cancer.

Akimoto, Tetsuo [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)]. E-mail: takimoto@showa.gunma-u.ac.jp; Katoh, Hiroyuki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Kitamoto, Yoshizumi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Shirai, Katsuyuki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Shioya, Mariko [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)

2006-04-01

273

Prospective longitudinal comparative study of health-related quality of life and treatment satisfaction in patients treated with hormone therapy, radical retropubic prostatectomy, and high or low dose rate brachytherapy for prostate cancer  

PubMed Central

Purpose: To evaluate the effects of four different prostate cancer treatments on quality of life (QoL) and patient satisfaction. Methods: Ninety-six prostate cancer patients were treated with hormone therapy, radical retropubic prostatectomy, high dose rate brachytherapy, or low dose rate brachytherapy. We assessed general, cancer-specific, and prostate disease-specific QoL. More than one year since commencement of treatment, the patients were asked the following questions: 1) How do you feel about your treatment? 2) Would you undergo the same treatment again? Results: The comparison of baseline and 12-month results showed that general and cancer-specific QoL had changed little in all groups. At baseline, the general and cancer-specific QoL tended to be lower in the hormone therapy patients. In the radical the retropubic prostatectomy patients, all scores on the Medical Outcomes Study 36-Item Short Form were worse than the baseline scores at three months. Scores for the International Index of Erectile Function-5 had also worsened, with no recovery. In the low-dose rate brachytherapy patients, the prostate disease-specific QoL at baseline tended to improve. However, the satisfaction levels for each treatment were reasonably good, and most patients would choose the same treatment again. Conclusions: The results of each of the four treatments differed in assessments of QoL. In the radical retropubic prostatectomy patients, the decrease in the International Index of Erectile Function-5 scores was especially remarkable and did not show recovery. In contrast, both brachy therapy groups had attained superior sexual function. However, regardless of the quality of life evaluations, most patients surveyed were satisfied with their treatments and would choose the same treatment again.

Miwa, Sotaro; Mizokami, Atsushi; Konaka, Hiroyuki; Ueno, Satoru; Kitagawa, Yasuhide; Koh, Eitetsu; Namiki, Mikio

2013-01-01

274

4D analysis of influence of patient movement and anatomy alteration on the quality of 3D U/S-based prostate HDR brachytherapy treatment delivery  

SciTech Connect

Purpose: Modern HDR brachytherapy treatment for prostate cancer based on the 3D ultrasound (U/S) plays increasingly important role. The purpose of this study is to investigate possible patient movement and anatomy alteration between the clinical image set acquisition, made after the needle implantation, and the patient irradiation and their influence on the quality of treatment. Methods: The authors used 3D U/S image sets and the corresponding treatment plans based on a 4D-treatment planning procedure: plans of 25 patients are obtained right after the needle implantation (clinical plan is based on this 3D image set) and just before and after the treatment delivery. The authors notice the slight decrease of treatment quality with increase of time gap between the clinical image set acquisition and the patient irradiation. 4D analysis of dose-volume-histograms (DVHs) for prostate: CTV1 = PTV, and urethra, rectum, and bladder as organs at risk (OARs) and conformity index (COIN) is presented, demonstrating the effect of prostate, OARs, and needles displacement. Results: The authors show that in the case that the patient body movement/anatomy alteration takes place, this results in modification of DVHs and radiobiological parameters, hence the plan quality. The observed average displacement of needles (1 mm) and of prostate (0.57 mm) is quite small as compared with the average displacement noted in several other reports [A. A. Martinez et al., Int. J. Radiat. Oncol., Biol., Phys. 49(1), 61-69 (2001); S. J. Damore et al., Int. J. Radiat. Oncol., Biol., Phys. 46(5), 1205-1211 (2000); P. J. Hoskin et al., Radiotherm. Oncol. 68(3), 285-288 (2003); E. Mullokandov et al., Int. J. Radiat. Oncol., Biol., Phys. 58(4), 1063-1071 (2004)] in the literature. Conclusions: Although the decrease of quality of dosimetric and radiobiological parameters occurs, this does not cause clinically unacceptable changes to the 3D dose distribution, according to our clinical protocol.

Milickovic, Natasa; Mavroidis, Panayiotis; Tselis, Nikolaos; Nikolova, Iliyana; Katsilieri, Zaira; Kefala, Vasiliki; Zamboglou, Nikolaos; Baltas, Dimos [Department of Medical Physics and Engineering, Offenbach Clinic, Starkenburgring 66, 63069 Offenbach am Main (Germany); Department of Medical Radiation Physics, Karolinska Institutet and Stockholm University (Sweden); Department of Radiation Oncology, Offenbach Clinic, Starkenburgring 66, 63069 Offenbach am Main (Germany); Department of Medical Physics and Engineering, Offenbach Clinic, Starkenburgring 66, 63069 Offenbach am Main (Germany); Department of Radiation Oncology, Offenbach Clinic, Starkenburgring 66, 63069 Offenbach am Main (Germany); Department of Medical Physics and Engineering, Offenbach Clinic, Starkenburgring 66, 63069 Offenbach am Main, Germany and Nuclear and Particle Physics Section, Physics Department, University of Athens, 15771 Athens (Greece)

2011-09-15

275

Iodine 125-phenylpentadecanoic acid and its beta-methyl substitute metabolism in cultured mouse embryonal myocytes--iodine-labelled fatty acids as tracers of myocardial high energy phosphate.  

PubMed

Iodine-labelled fatty acids have been proposed as new tracers of cardiac metabolisms. However, it is not clear how these tracers would reflect the intracellular metabolism. Therefore, we measured the uptake and release of iodine 125-labelled phenylpentadecanoic acid (IPPA), its beta-methyl substitute (BMIPP) and 201Tl in cultured myocytes of mouse embryos, and compared these values to intracellular adenosine triphosphate (ATP) content after metabolic inhibitions of oxidative phosphorylation by sodium cyanide (CN), glycolysis by 2-deoxyglucose (2-DG) or fatty acid beta-oxidation by lactate. The uptake and release of BMIPP was not changed by any inhibitors suggesting BMIPP would not be metabolized in the myocytes. The uptake of IPPA was significantly reduced by 2DG and 60-80% of IPPA was metabolized to hydrophilic catabolites. The correlation of BMIPP and IPPA uptake to intracellular ATP content were high (r = 0.89, p < 0.05; r = 0.86, p < 0.1), but there was poor correlation of 201Tl to ATP values (r = 0.53, n.s.). These results suggested that iodine-labelled fatty acids could be used as better tracers of myocardial metabolism than 201Tl. PMID:8450598

Okano, M; Ishida, H; Ohsuzu, F; Sakata, N; Katsushika, S; Aosaki, N; Nakamura, H

1993-02-01

276

Promising Long-Term Health-Related Quality of Life After High-Dose-Rate Brachytherapy Boost for Localized Prostate Cancer  

SciTech Connect

Purpose: To explore the long-term general and disease-specific health-related quality of life (HRQOL) >5 years after combined radiotherapy for localized prostate cancer, including a high-dose-rate brachytherapy boost and hormonal deprivation therapy. Methods and Materials: Of 196 eligible patients with localized prostate cancer (Stage T1-T3a) consecutively treated with curative radiotherapy at our institution between June 1998 and August 2000, 182 (93%) completed the European Organization for Research and Treatment of Cancer Quality of Life questionnaires QLQ-C30 and QLQ-PR25, including specific questions on fecal incontinence >5 years after treatment in September 2005. A comparison with age-matched normative data was done, as well as a longitudinal analysis using HRQOL data from a previous study. Results: The analysis included 158 nonrecurrent patients. Comparisons made with normative data showed that physical and role functioning were significantly better statistically and social functioning was significantly worse. Diarrhea and sleep disturbances were more pronounced and pain less pronounced than in a normal male population. The longitudinal analysis of disease-specific HRQOL showed that urinary urgency and erectile problems persisted 5 years after treatment, and nocturia and hormonally dependent symptoms had declined significantly, with a statistically significant difference. Fecal incontinence was recognized by 25% of patients, of whom 80% considered it a minor problem. Conclusion: More than 5 years after combined radiotherapy, irritative urinary problems and erectile dysfunction remain concerns, although severe bowel disturbance and fecal incontinence seem to be minor problems. Longitudinally, a decline mainly in hormonally dependent symptoms was seen. Minor differences in general HRQOL compared with normative data were observed, possibly including 'response shift' effects.

Wahlgren, Thomas [Department of Oncology-Pathology, Karolinska University Hospital and Institutet, Stockholm (Sweden)], E-mail: thomas.wahlgren@karolinska.se; Nilsson, Sten [Department of Oncology-Pathology, Karolinska University Hospital and Institutet, Stockholm (Sweden); Lennernaes, Bo [Department of Oncology, Sahlgrenska Hospital and Academy, University of Gothenburg, Gothenburg (Sweden); Brandberg, Yvonne [Department of Oncology-Pathology, Karolinska University Hospital and Institutet, Stockholm (Sweden)

2007-11-01

277

Evidence-based guideline recommendations on low-dose rate brachytherapy in patients with low- or intermediate-risk prostate cancer  

PubMed Central

Objective: The Genitourinary Cancer Disease Site Group (GU DSG) and Cancer Care Ontario’s Program in Evidence-Based Care (PEBC) in Ontario, Canada developed a guideline on low-dose rate brachytherapy (LDR-BT) in patients with early-stage low-grade prostate cancer in 2001. The current updated guideline focuses on the research questions regarding the effect of LDR-BT alone, the effect of LDR-BT with external beam radiation therapy (EBRT) and the selection of an isotope. Methods: This guideline was developed by using the methods of the Practice Guidelines Development Cycle and the core methodology was a systematic review. MEDLINE and EMBASE (from January 1996 to October 2011), the Cochrane Library, main guideline websites, and main annual meeting abstract websites specific for genitourinary diseases were searched. Internal and external reviews of the draft guideline were conducted. Results: The draft guideline was developed according to a total of 10 systematic reviews and 55 full text articles that met the pre-planned study selection criteria. The quality of evidence was low to moderate. The final report reflects integration of the feedback obtained through the internal review (two oncologists and a methodologist) and external review (five target reviewers and 48 professional consultation reviewers) process, with final approval given by the GU DSG and the PEBC. Conclusion: The main recommendations are: (1) For patients with newly diagnosed low-risk or intermediate-risk prostate cancer who require or choose active treatment, LDR-BT alone is a treatment option as an alternative to EBRT alone or RP alone; and (2) I-125 and Pd-103 are each reasonable isotope options.

Rodrigues, George; Yao, Xiaomei; Loblaw, D. Andrew; Brundage, Michael; Chin, Joseph L.

2013-01-01

278

Magnetic Resonance Imaging (MRI) Markers for MRI-Guided High-Dose-Rate Brachytherapy: Novel Marker-Flange for Cervical Cancer and Marker Catheters for Prostate Cancer  

SciTech Connect

Purpose: To present a novel marker-flange, addressing source-reconstruction uncertainties due to the artifacts of a titanium intracavitary applicator used for magnetic resonance imaging (MRI)-guided high-dose-rate (HDR) brachytherapy (BT); and to evaluate 7 different MRI marker agents used for interstitial prostate BT and intracavitary gynecologic HDR BT when treatment plans are guided by MRI. Methods and Materials: Seven MRI marker agents were analyzed: saline solution, Conray-60, copper sulfate (CuSO{sub 4}) (1.5 g/L), liquid vitamin E, fish oil, 1% agarose gel (1 g agarose powder per 100 mL distilled water), and a cobalt–chloride complex contrast (C4) (CoCl{sub 2}/glycine = 4:1). A plastic, ring-shaped marker-flange was designed and tested on both titanium and plastic applicators. Three separate phantoms were designed to test the marker-flange, interstitial catheters for prostate BT, and intracavitary catheters for gynecologic HDR BT. T1- and T2-weighted MRI were analyzed for all markers in each phantom and quantified as percentages compared with a 3% agarose gel background. The geometric accuracy of the MR signal for the marker-flange was measured using an MRI-CT fusion. Results: The CuSO{sub 4} and C4 markers on T1-weighted MRI and saline on T2-weighted MRI showed the highest signals. The marker-flange showed hyper-signals of >500% with CuSO{sub 4} and C4 on T1-weighted MRI and of >400% with saline on T2-weighted MRI on titanium applicators. On T1-weighted MRI, the MRI signal inaccuracies of marker-flanges were measured <2 mm, regardless of marker agents, and that of CuSO{sub 4} was 0.42 ± 0.14 mm. Conclusion: The use of interstitial/intracavitary markers for MRI-guided prostate/gynecologic BT was observed to be feasible, providing accurate source pathway reconstruction. The novel marker-flange can produce extremely intense, accurate signals, demonstrating its feasibility for gynecologic HDR BT.

Schindel, Joshua; Muruganandham, Manickam [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)] [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States); Pigge, F. Christopher [Department of Chemistry, University of Iowa, Iowa City, Iowa (United States)] [Department of Chemistry, University of Iowa, Iowa City, Iowa (United States); Anderson, James [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)] [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States); Kim, Yusung, E-mail: yusung-kim@uiowa.edu [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)] [Department of Radiation Oncology, University of Iowa, Iowa City, Iowa (United States)

2013-06-01

279

A conformation number to quantify the degree of conformality in brachytherapy and external beam irradiation: Application to the prostate  

Microsoft Academic Search

Purpose: This article presents a method of quantitative assessment of the degree of conformality and its designation by a single numerical value.Methods and Materials: A conformation number is introduced to evaluate objectively the degree of conformality. A comparison is made between the conformation number as found for external beam treatment plans and ultrasonically guided 125I seed implants for localized prostate

Arie van't Riet; Ad C. A. Mak; Marinus A. Moerland; Leo H. Elders; Wiebe van der Zee

1997-01-01

280

Detection of brachytherapy seeds using 3-D transrectal ultrasound.  

PubMed

Detection of brachytherapy seeds plays a key role in dosimetry for prostate brachytherapy. However, seed localization using B-mode transrectal ultrasound (TRUS) still remains a challenge for prostate brachytherapy, mainly due to the small size of brachytherapy seeds in the relatively low-quality B-mode TRUS images. In this paper, we propose a new solution for brachytherapy seed detection using 3-D ultrasound. A 3-D reflected power image is computed from ultrasound RF signals, instead of conventional B-mode images. Then, implanted seeds are segmented in 3-D local search spaces that are determined by a priori knowledge, e.g., needle entry points and seed placements. Needle insertion tracks are also detected locally by the Hough transform. Experimental results show that the proposed solution works well for seed localization in a prostate phantom implanted according to a realistic treatment plan with 136 seeds from 26 needles. PMID:20595088

Wen, Xu; Salcudean, Septimiu Tim E; Lawrence, Peter D

2010-10-01

281

High-Dose-Rate Brachytherapy as Monotherapy Delivered in Two Fractions Within One Day for Favorable/Intermediate-Risk Prostate Cancer: Preliminary Toxicity Data  

SciTech Connect

Purpose: To report the toxicity profile of high-dose-rate (HDR)-brachytherapy (BT) as monotherapy in a Human Investigation Committee-approved study consisting of a single implant and two fractions (12 Gy Multiplication-Sign 2) for a total dose of 24 Gy, delivered within 1 day. The dose was subsequently increased to 27 Gy (13.5 Gy Multiplication-Sign 2) delivered in 1 day. We report the acute and early chronic genitourinary and gastrointestinal toxicity. Methods and Materials: A total of 173 patients were treated between December 2005 and July 2010. However, only the first 100 were part of the IRB-approved study and out of these, only 94 had a minimal follow-up of 6 months, representing the study population for this preliminary report. All patients had clinical Stage T2b or less (American Joint Committee on Cancer, 5th edition), Gleason score 6-7 (3+4), and prostate-specific antigen level of {<=}12 ng/mL. Ultrasound-guided HDR-BT with real-time dosimetry was used. The prescription dose was 24 Gy for the first 50 patients and 27 Gy thereafter. The dosimetric goals and constraints were the same for the two dose groups. Toxicity was scored using the National Cancer Institute Common Terminology Criteria for Adverse Events, version 3. The highest toxicity scores encountered at any point during follow-up are reported. Results: The median follow-up was 17 months (range, 6-40.5). Most patients had Grade 0-1 acute toxicity. The Grade 2 acute genitourinary toxicity was mainly frequency/urgency (13%), dysuria (5%), hematuria, and dribbling/hesitancy (2%). None of the patients required a Foley catheter at any time; however, 8% of the patients experienced transient Grade 1 diarrhea. No other acute gastrointestinal toxicities were found. The most common chronic toxicity was Grade 2 urinary frequency/urgency in 16% of patients followed by dysuria in 4% of patients; 2 patients had Grade 2 rectal bleeding and 1 had Grade 4, requiring laser treatment. Conclusions: Favorable-risk prostate cancer patients treated with a single implant HDR-BT to 24-27 Gy in two fractions within 1 day have excellent tolerance with minimal acute and chronic toxicity. Longer follow-up is needed to confirm these encouraging early results.

Ghilezan, Michel, E-mail: mghilezan@beaumont.edu [Department of Radiation Oncology, William Beaumont Hospital and Rose Cancer Institute, Royal Oak, Michigan (United States); Martinez, Alvaro; Gustason, Gary; Krauss, Daniel; Antonucci, J. Vito; Chen, Peter; Fontanesi, James; Wallace, Michelle; Ye Hong; Casey, Alyse; Sebastian, Evelyn; Kim, Leonard; Limbacher, Amy [Department of Radiation Oncology, William Beaumont Hospital and Rose Cancer Institute, Royal Oak, Michigan (United States)

2012-07-01

282

Direct 2-Arm Comparison Shows Benefit of High-Dose-Rate Brachytherapy Boost vs External Beam Radiation Therapy Alone for Prostate Cancer  

SciTech Connect

Purpose: To evaluate the outcomes of patients treated for intermediate- and high-risk prostate cancer with a single schedule of either external beam radiation therapy (EBRT) and high-dose-rate brachytherapy (HDRB) boost or EBRT alone. Methods and Materials: From 2001-2006, 344 patients received EBRT with HDRB boost for definitive treatment of intermediate- or high-risk prostate cancer. The prescribed EBRT dose was 46 Gy in 23 fractions, with a HDR boost of 19.5 Gy in 3 fractions. This cohort was compared to a contemporaneously treated cohort who received EBRT to 74 Gy in 37 fractions, using a matched pair analysis. Three-dimensional conformal EBRT was used. Matching was performed using a propensity score matching technique. High-risk patients constituted 41% of the matched cohorts. Five-year clinical and biochemical outcomes were analyzed. Results: Initial significant differences in prognostic indicators between the unmatched treatment cohorts were rendered negligible after matching, providing a total of 688 patients. Median biochemical follow-up was 60.5 months. The 5-year freedom from biochemical failure was 79.8% (95% confidence interval [CI], 74.3%-85.0%) and 70.9% (95% CI, 65.4%-76.0%) for the HDRB and EBRT groups, respectively, equating to a hazard ratio of 0.59 (95% CI, 0.43-0.81, P=.0011). Interaction analyses showed no alteration in HDR efficacy when planned androgen deprivation therapy was administered (P=.95), but a strong trend toward reduced efficacy was shown compared to EBRT in high-risk cases (P=.06). Rates of grade 3 urethral stricture were 0.3% (95% CI, 0%-0.9%) and 11.8% (95% CI, 8.1%-16.5%) for EBRT and HDRB, respectively (P<.0001). No differences in clinical outcomes were observed. Conclusions: This comparison of 2 individual contemporaneously treated HDRB and EBRT approaches showed improved freedom from biochemical progression with the HDR approach. The benefit was more pronounced in intermediate- risk patients but needs to be weighed against an increased risk of urethral toxicity.

Khor, Richard [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia)] [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia); Duchesne, Gillian [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia) [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia); Monash University, Melbourne (Australia); Tai, Keen-Hun; Foroudi, Farshad; Chander, Sarat; Van Dyk, Sylvia; Garth, Margaret [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia)] [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia); Williams, Scott, E-mail: Scott.Williams@petermac.org [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia)] [Division of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, and University of Melbourne, Melbourne (Australia)

2013-03-01

283

Cardiovascular Comorbidity and Mortality in Men With Prostate Cancer Treated With Brachytherapy-Based Radiation With or Without Hormonal Therapy  

SciTech Connect

Purpose: To assess the impact of coronary artery disease (CAD) risk factors and sequelae on the risk of all-cause mortality (ACM) in men treated for prostate cancer (PC). Methods and Materials: The study cohort comprised 5077 men with PC consecutively treated with curative intent between 1997 and 2006 at the Chicago Prostate Cancer Center. Cox and Fine and Gray's competing risks regression multivariable analyses were performed, assessing whether cardiovascular comorbidity impacted the risk of ACM and PC-specific mortality, respectively, adjusting for CAD risk factors (diabetes mellitus, hypercholesterolemia, or hypertension) and sequelae (congestive heart failure or myocardial infarction), age, year and type of treatment, and known PC prognostic factors. Results: When compared with men with no comorbidity there was a significantly increased risk of ACM in men with congestive heart failure or myocardial infarction (adjusted hazard ratio [AHR] 1.96, P<.001) and in men with diabetes mellitus (AHR 1.60, P=.03) and hypertension (AHR 1.25, P=.04). In contrast, men with hypercholesterolemia had a similar risk of ACM (AHR 0.68, P=.17) when compared with men with no comorbidity. Other factors associated with a significantly increased risk of ACM included age (AHR 1.09, P<.001), prostate-specific antigen level (AHR 1.25, P=.008), and Gleason score 8-10 disease (AHR 1.71, P=.003). Cardiovascular comorbidity did not impact the risk of PC-specific mortality. Conclusions: In addition to age and unfavorable PC prognostic factors, select CAD risk factors and sequelae are associated with an increased risk of ACM in men treated for PC. These comorbidity prognostic factors predict time courses of mortality from competing causes, which may be factored into the decision-making process when considering management options for PC in a given individual.

Nanda, Akash, E-mail: akash.nanda@orlandohealth.com [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States)] [Department of Radiation Oncology, MD Anderson Cancer Center Orlando, Orlando, Florida (United States); Chen, Ming-Hui [Department of Statistics, University of Connecticut, Storrs, Connecticut (United States)] [Department of Statistics, University of Connecticut, Storrs, Connecticut (United States); Moran, Brian J.; Braccioforte, Michelle H. [Prostate Cancer Foundation of Chicago, Westmont, Illinois (United States)] [Prostate Cancer Foundation of Chicago, Westmont, Illinois (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States)] [Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

2013-04-01

284

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up  

PubMed Central

The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent 192Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ?6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25–94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach.

Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

2014-01-01

285

High-dose-rate brachytherapy and hypofractionated external beam radiotherapy combined with long-term hormonal therapy for high-risk and very high-risk prostate cancer: outcomes after 5-year follow-up.  

PubMed

The purpose of this study was to report the outcomes of high-dose-rate (HDR) brachytherapy and hypofractionated external beam radiotherapy (EBRT) combined with long-term androgen deprivation therapy (ADT) for National Comprehensive Cancer Network (NCCN) criteria-defined high-risk (HR) and very high-risk (VHR) prostate cancer. Data from 178 HR (n = 96, 54%) and VHR (n = 82, 46%) prostate cancer patients who underwent (192)Ir-HDR brachytherapy and hypofractionated EBRT with long-term ADT between 2003 and 2008 were retrospectively analyzed. The mean dose to 90% of the planning target volume was 6.3 Gy/fraction of HDR brachytherapy. After five fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administered. All patients initially underwent ? 6 months of neoadjuvant ADT, and adjuvant ADT was continued for 36 months after EBRT. The median follow-up was 61 months (range, 25-94 months) from the start of radiotherapy. The 5-year biochemical non-evidence of disease, freedom from clinical failure and overall survival rates were 90.6% (HR, 97.8%; VHR, 81.9%), 95.2% (HR, 97.7%; VHR, 92.1%), and 96.9% (HR, 100%; VHR, 93.3%), respectively. The highest Radiation Therapy Oncology Group-defined late genitourinary toxicities were Grade 2 in 7.3% of patients and Grade 3 in 9.6%. The highest late gastrointestinal toxicities were Grade 2 in 2.8% of patients and Grade 3 in 0%. Although the 5-year outcome of this tri-modality approach seems favorable, further follow-up is necessary to validate clinical and survival advantages of this intensive approach compared with the standard EBRT approach. PMID:24222312

Ishiyama, Hiromichi; Satoh, Takefumi; Kitano, Masashi; Tabata, Ken-ichi; Komori, Shouko; Ikeda, Masaomi; Soda, Itaru; Kurosaka, Shinji; Sekiguchi, Akane; Kimura, Masaki; Kawakami, Shogo; Iwamura, Masatsugu; Hayakawa, Kazushige

2014-05-01

286

76 FR 38214 - Report to Congress on Abnormal Occurrences; Fiscal Year 2010; Dissemination of Information  

Federal Register 2010, 2011, 2012, 2013

...brachytherapy seed implant procedure to treat prostate cancer. The patient was prescribed to...dose of 160 Gy (16,000 rad) to the prostate using 67 iodine-125 seeds. Instead...post-implant dose calculation showed that the prostate received a dose of 15.43 Gy...

2011-06-29

287

77 FR 37446 - Report to Congress on Abnormal Occurrences; Fiscal Year 2011; Dissemination of Information  

Federal Register 2010, 2011, 2012, 2013

...brachytherapy seed implant procedure to treat prostate cancer. The patient was prescribed to...dose of 145 Gy (14,500 rad) to the prostate using 65 iodine-125 seeds. Instead...seeds were implanted in the patient's prostate using real time dosimetry under...

2012-06-21

288

[Brachytherapy training].  

PubMed

Treatment technique training needs theoretical and practical knowledge allowing proposing the right treatment for the right patient, but also allowing performing the technical gesture in the best conditions for an optimal result with a maximal security. The evolution of the brachytherapy techniques needs the set up of specific theoretical and practical training sessions. The present article focuses on the importance of the brachytherapy training as well as the different means currently available for the young radiation oncologist community for perfecting their education. National and international trainings are presented. The role of the simulation principle in the frame of brachytherapy is also discussed. Even if brachytherapy is not always an easy technique, its efficacy and its medico-economical impact need to be passed down to motivated students with the implementation of relevant educational means. PMID:23402877

Hannoun-Lévi, J-M; Marchesi, V; Peiffert, D

2013-04-01

289

AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: Report of Task Group 137  

PubMed Central

During the past decade, permanent radioactive source implantation of the prostate has become the standard of care for selected prostate cancer patients, and the techniques for implantation have evolved in many different forms. Although most implants use 125I or 103Pd sources, clinical use of 131Cs sources has also recently been introduced. These sources produce different dose distributions and irradiate the tumors at different dose rates. Ultrasound was used originally to guide the planning and implantation of sources in the tumor. More recently, CT and?or MR are used routinely in many clinics for dose evaluation and planning. Several investigators reported that the tumor volumes and target volumes delineated from ultrasound, CT, and MR can vary substantially because of the inherent differences in these imaging modalities. It has also been reported that these volumes depend critically on the time of imaging after the implant. Many clinics, in particular those using intraoperative implantation, perform imaging only on the day of the implant. Because the effects of edema caused by surgical trauma can vary from one patient to another and resolve at different rates, the timing of imaging for dosimetry evaluation can have a profound effect on the dose reported (to have been delivered), i.e., for the same implant (same dose delivered), CT at different timing can yield different doses reported. Also, many different loading patterns and margins around the tumor volumes have been used, and these may lead to variations in the dose delivered. In this report, the current literature on these issues is reviewed, and the impact of these issues on the radiobiological response is estimated. The radiobiological models for the biological equivalent dose (BED) are reviewed. Starting with the BED model for acute single doses, the models for fractionated doses, continuous low-dose-rate irradiation, and both homogeneous and inhomogeneous dose distributions, as well as tumor cure probability models, are reviewed. Based on these developments in literature, the AAPM recommends guidelines for dose prescription from a physics perspective for routine patient treatment, clinical trials, and for treatment planning software developers. The authors continue to follow the current recommendations on using D90 and V100 as the primary quantities, with more specific guidelines on the use of the imaging modalities and the timing of the imaging. The AAPM recommends that the postimplant evaluation should be performed at the optimum time for specific radionuclides. In addition, they encourage the use of a radiobiological model with a specific set of parameters to facilitate relative comparisons of treatment plans reported by different institutions using different loading patterns or radionuclides.

Nath, Ravinder; Bice, William S.; Butler, Wayne M.; Chen, Zhe; Meigooni, Ali S.; Narayana, Vrinda; Rivard, Mark J.; Yu, Yan

2009-01-01

290

Analysis of prognostic factors in localized high-risk prostate cancer patients treated with HDR brachytherapy, hypofractionated 3D-CRT and neoadjuvant/adjuvant androgen deprivation therapy (trimodality therapy)  

PubMed Central

Trimodality therapy consisting of high dose rate (HDR) brachytherapy combined with external beam radiation therapy (EBRT), neoadjuvant hormonal therapy (NHT) and adjuvant hormonal therapy (AHT) has been used to treat localized high-risk prostate cancer. In this study, an analysis of patients receiving the trimodality therapy was performed to identify prognostic factors of biochemical relapse-free survival (bRFS). Between May 2005 and November 2008, 123 high-risk prostate cancer patients (D'Amico classification) were treated with NHT prior to HDR brachytherapy combined with hypofractionated EBRT. Among these patients, 121 had completed AHT. The patients were assigned by time to be treated with a low-dose or high-dose arm of HDR brachytherapy with subsequent hypofractionated 3D conformal radiation therapy (3D-CRT). Multivariate analysis was used to determine prognostic factors for bRFS. With a median follow-up of 60 months, the 5-year bRFS for all patients was 84.3% (high-dose arm, 92.9%; low-dose arm, 72.4%, P = 0.047). bRFS in the pre-HDR PSA ? 0.1 ng/ml subgroup was significantly improved compared with that in the pre-HDR PSA > 0.1 ng/ml subgroup (88.3% vs 68.2%, P = 0.034). On multivariate analysis, dose of HDR (P = 0.045, HR = 0.25, 95% CI = 0.038–0.97) and pre-HDR PSA level (P = 0.02 HR = 3.2, 95% CI = 1.18–10.16) were significant prognostic factors predicting bRFS. In high-risk prostate cancer patients treated with the trimodality therapy, the dose of HDR and pre-HDR PSA were significant prognostic factors. The pre-HDR PSA ? 0.1 subgroup had significantly improved bRFS. Further studies are needed to confirm the relevance of pre-HDR PSA in trimodality therapy.

Aoki, Manabu; Miki, Kenta; Kido, Masahito; Sasaki, Hiroshi; Nakamura, Wataru; Kijima, Yoshikazu; Kobayashi, Masao; Egawa, Shin; Kanehira, Chihiro

2014-01-01

291

Analysis of prognostic factors in localized high-risk prostate cancer patients treated with HDR brachytherapy, hypofractionated 3D-CRT and neoadjuvant/adjuvant androgen deprivation therapy (trimodality therapy).  

PubMed

Trimodality therapy consisting of high dose rate (HDR) brachytherapy combined with external beam radiation therapy (EBRT), neoadjuvant hormonal therapy (NHT) and adjuvant hormonal therapy (AHT) has been used to treat localized high-risk prostate cancer. In this study, an analysis of patients receiving the trimodality therapy was performed to identify prognostic factors of biochemical relapse-free survival (bRFS). Between May 2005 and November 2008, 123 high-risk prostate cancer patients (D'Amico classification) were treated with NHT prior to HDR brachytherapy combined with hypofractionated EBRT. Among these patients, 121 had completed AHT. The patients were assigned by time to be treated with a low-dose or high-dose arm of HDR brachytherapy with subsequent hypofractionated 3D conformal radiation therapy (3D-CRT). Multivariate analysis was used to determine prognostic factors for bRFS. With a median follow-up of 60 months, the 5-year bRFS for all patients was 84.3% (high-dose arm, 92.9%; low-dose arm, 72.4%, P = 0.047). bRFS in the pre-HDR PSA ? 0.1 ng/ml subgroup was significantly improved compared with that in the pre-HDR PSA > 0.1 ng/ml subgroup (88.3% vs 68.2%, P = 0.034). On multivariate analysis, dose of HDR (P = 0.045, HR = 0.25, 95% CI = 0.038-0.97) and pre-HDR PSA level (P = 0.02 HR = 3.2, 95% CI = 1.18-10.16) were significant prognostic factors predicting bRFS. In high-risk prostate cancer patients treated with the trimodality therapy, the dose of HDR and pre-HDR PSA were significant prognostic factors. The pre-HDR PSA ? 0.1 subgroup had significantly improved bRFS. Further studies are needed to confirm the relevance of pre-HDR PSA in trimodality therapy. PMID:24351458

Aoki, Manabu; Miki, Kenta; Kido, Masahito; Sasaki, Hiroshi; Nakamura, Wataru; Kijima, Yoshikazu; Kobayashi, Masao; Egawa, Shin; Kanehira, Chihiro

2014-05-01

292

A phase II study of external beam radiotherapy combined with permanent source brachytherapy for intermediate-risk, clinically localized adenocarcinoma of the prostate: Preliminary results of RTOG P-0019  

SciTech Connect

Purpose: To estimate the rate of acute and late Grade 3-5 genitourinary and gastrointestinal toxicity after treatment with external beam radiotherapy and permanent source brachytherapy in a multi-institutional, cooperative group setting. Methods and Materials: All patients were treated with external beam radiotherapy (45 Gy in 25 fractions), followed 2-6 weeks later by an interstitial implant using {sup 125}I to deliver an additional 108 Gy. Late genitourinary toxicity was graded according to the Common Toxicity Criteria Version 2.0, and the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer late radiation morbidity scoring system was used for all other toxicity. Results: A total of 138 patients from 28 institutions were entered on this study. Acute toxicity information was available in 131 patients, and 127 patients were analyzable for late toxicity. Acute Grade 3 toxicity was documented in 10 of 131 patients (7.6%). No Grade 4 or 5 acute toxicity has been observed. The 18-month month estimate of late Grade 3 genitourinary and gastrointestinal toxicity was 3.3% (95% confidence interval, 0.1-6.5). No late Grade 4 or 5 toxicity has been observed. Conclusions: The acute and late morbidity observed in this multi-institutional, cooperative group study is consistent with previous reports from single institutions with significant prostate brachytherapy experience.

Lee, W. Robert [Wake Forest University School of Medicine, Winston-Salem, NC (United States)]. E-mail: wrlee@wfubmc.edu; De Silvio, Michelle [Radiation Therapy Oncology Group, Philadelphia, PA (United States); Lawton, Colleen [Medical College of Wisconsin, Milwaukee, WI (United States); Gillin, Michael [M.D. Anderson Hospital, Houston, TX (United States); Morton, Gerard [Toronto-Sunnybrook Regional Cancer Center, Toronto, ON (Canada); Firat, Selim [Albert Einstein School of Medicine, Philadelphia, PA (United States); Baikadi, Madhava [Albert Einstein School of Medicine, Philadelphia, PA (United States); Kuettel, Michael [Roswell Park Cancer Center, Buffalo, NY (United States); Greven, Kathryn [Wake Forest University School of Medicine, Winston-Salem, NC (United States); Sandler, Howard [University of Michigan, Ann Arbor, MI (United States)

2006-03-01

293

Relationship between percent positive biopsies and biochemical outcome after permanent interstitial brachytherapy for clinically organ-confined carcinoma of the prostate gland  

Microsoft Academic Search

Purpose: Recently, the percentage of positive prostate biopsies has been reported to be statistically significant in predicting the biochemical outcome after either radical prostatectomy or 3-dimensional conformal external beam radiotherapy. In this study, we evaluated the impact of the percentage of positive prostate biopsies in predicting the 5-year biochemical outcome for patients with clinically organ-confined prostate cancer undergoing permanent interstitial

Gregory S Merrick; Wayne M Butler; Robert W Galbreath; Jonathan H Lief; Edward Adamovich

2002-01-01

294

Comparability of CT-based and TRUS-based prostate volumes  

Microsoft Academic Search

Purpose: To compare the prostate volumes defined by transrectal ultrasound (TRUS) versus computed tomographic (CT) scans used for brachytherapy planning.Methods and Materials: Ten unselected patients underwent evaluation for prostate brachytherapy with TRUS and CT imaging. Axial prostate contours were obtained at 5-mm intervals in both studies. The CT images were photographed, scanned into a commercial software program, and reprinted from

KasRay Badiozamani; Kent Wallner; William Cavanagh; John Blasko

1999-01-01

295

Temporal effect of neoadjuvant androgen deprivation therapy on PSA kinetics following permanent prostate brachytherapy with or without supplemental external beam radiation  

Microsoft Academic Search

PurposeTo evaluate the effect of neoadjuvant androgen deprivation therapy on PSA kinetics following brachytherapy with or without supplemental external beam radiation therapy (XRT), to evaluate the magnitude and duration of the peak PSA, and to compare potential differences in PSA response curves between biochemically disease-free and failed patients.

Gregory S. Merrick; Wayne M. Butler; Kent E. Wallner; Robert W. Galbreath; Zachariah Allen; Edward Adamovich

2004-01-01

296

Evaluation of (iodine-125)N,N,N'-trimethyl-N'-(2-hydroxy-3-methyl-5-iodobenzyl)-1,3- propanediamine lung uptake using an isolated-perfused lung model  

SciTech Connect

Lung uptake of N,N,N'-trimethyl-N'-(2-Hydroxy-3-methyl-5-iodobenzyl)-1,3- propanediamine (HIPDM) has been reported, but the mechanism of this process has not yet been established. Thus, single-pass (/sup 125/I)HIPDM accumulation was studied in rat lungs perfused with a Krebs-Ringer bicarbonate buffer containing 4.5% bovine albumin. Iodine-125 HIPDM lung accumulation was monitored by the percent of extraction per gram of lung tissue. Iodine-125 HIPDM lung uptake did not appear to occur by simple diffusion. As the time of perfusion was increased from 2 to 15 min, the rate of uptake of 2 microM (/sup 125/I)HIPDM decreased by 40%. During a 2-min perfusion, 98.6% +/- 6.7 (n = 8) extraction was observed with 2 microM (/sup 125/I)HIPDM, but only 38% +/- 2.0 (n = 3) was extracted when the (/sup 125/I)HIPDM concentration was 1 mM. The addition of 1 mM chlorpromazine, propranolol or imipramine also decreased (/sup 125/I)HIPDM lung uptake to 43.0% +/- 1.5, 51.4% +/- 2.2, and 49.8% +/- 0.8, respectively, (each n = 4 - 6, p less than 0.001). Cold (4 degrees C) had little effect on pulmonary accumulation (77.7% +/- 7.4, n = 5, p less than 0.01), and the addition of ouabain or the use of sodium-free medium had no effect. Thus, pulmonary (/sup 125/I)HIPDM accumulation does not appear to occur by sodium-dependent active transport. Rather, its uptake appears to be similar to the uptake of other basic amines, such as propranolol and imipramine, which are known to bind by physico-chemical interactions to pulmonary endothelial cell membranes and reflect pulmonary vascular surface area.

Slosman, D.O.; Brill, A.B.; Polla, B.S.; Alderson, P.O.

1987-02-01

297

A prospective quality-of-life study in men with clinically localized prostate carcinoma treated with radical prostatectomy, external beam radiotherapy, or interstitial brachytherapy  

Microsoft Academic Search

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after 3 different treatments for clinically localized prostate cancer.Methods and Materials: Ninety men with T1–T2 adenocarcinoma of the prostate were treated with curative intent between May 1998 and June 1999 and completed a quality-of-life Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire before

W. Robert Lee; M. Craig Hall; Richard P McQuellon; L. Douglas Case; David L McCullough

2001-01-01

298

Prostate specific antigen in the diagnosis and treatment of adenocarcinoma of the prostate. III. Radiation treated patients  

SciTech Connect

Serum prostate specific antigen was determined (Yang polyclonal radioimmunoassay) in 183 men after radiation therapy for adenocarcinoma of the prostate. A total of 163 men had received 7,000 rad external beam radiotherapy and 20 had been implanted with iodine-125 seeds. Only 11 per cent of these 183 patients had undetectable prostate specific antigen levels at a mean interval of 5 years since completion of radiotherapy. Prostate specific antigen levels after radiotherapy were directly related to initial clinical stage and Gleason score before treatment. Multiple prostate specific antigen determinations were performed with time in 124 of 183 patients. During year 1 after radiotherapy prostate specific antigen levels were decreasing in 82 per cent of the patients but only 8 per cent continued to decrease beyond year 1. Of 80 patients observed greater than 1 year after completion of radiotherapy 51 per cent had increasing values and 41 per cent had stable values. Increasing prostate specific antigen values after radiotherapy were correlated with progression to metastastic disease and residual cancer on prostate biopsy. Total serum acid phosphatase levels were poorly related to prostate specific antigen levels, were less effective in discriminating patients with metastatic disease and provided no additional information beyond that provided by prostate specific antigen.

Stamey, T.A.; Kabalin, J.N.; Ferrari, M.

1989-05-01

299

Interstitially implanted I125 for prostate cancer using transrectal ultrasound  

SciTech Connect

Prostate cancer is the third leading cause of death from cancer among men in the United States. Traditional treatments for prostate cancer are prostatectomy, external beam irradiation, and interstitial implantation of Iodine125 (I125) via laparotomy. These treatments are associated with significant morbidity and limitations. Based on experience with I125 interstitial implantation by transrectal ultrasound guidance for early-stage prostate cancer, it seems that this newer method of treatment has greater accuracy of placement and distribution of the isotope and has had few reported complications. The need for a surgical incision has been eliminated. Hospitalization time also has been decreased, creating the need for ambulatory and inpatient nurses to understand the importance of their respective roles in providing coordinated quality care for these patients. Nurses in these departments must have knowledge of the procedure, radiation safety, and common side effects related to the implant.

Greenburg, S.; Petersen, J.; Hansen-Peters, I.; Baylinson, W. (Northwest Tumor Institute, Seattle, WA (USA))

1990-11-01

300

Use of Gold Markers for Setup in Image-Guided Fractionated High-Dose-Rate Brachytherapy as a Monotherapy for Prostate Cancer  

Microsoft Academic Search

\\u000a \\u000a Background and Purpose:\\u000a   In order to use a single implant with one treatment plan in fractionated high-dose-rate brachytherapy (HDR-B), applicator\\u000a position shifts must be corrected prior to each fraction. The authors investigated the use of gold markers for X-ray-based\\u000a setup and position control between the single fractions.\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a   Caudad-cephalad movement of the applicators prior to each HDR-B fraction

Pirus Ghadjar; Nicole Gwerder; Axel Madlung; Frank Behrensmeier; George N. Thalmann; Roberto Mini; Daniel M. Aebersold

2009-01-01

301

The relationship between the biochemical control outcomes and the quality of planning of high-dose rate brachytherapy as a boost to external beam radiotherapy for locally and locally advanced prostate cancer using the RTOG-ASTRO Phoenix definition  

PubMed Central

Purpose: To evaluated prognostic factors and impact of the quality of planning of high dose rate brachytherapy (HDR-BT) for patients with local or locally advanced prostate cancer treated with external beam radiotherapy (EBRT) and HDR-BT. Methods and Materials: Between 1997 and 2005, 209 patients with biopsy proven prostate adenocarcinoma were treated with localized EBRT and HDR-BT at the Department of Radiation-Oncology, Hospital A. C. Camargo, Sao Paulo, Brazil. Patient's age, Gleason score (GS), clinical stage (CS), initial PSA (iPSA), risk group for biochemical failure (GR), doses of EBRT and HDR-BT, use of three-dimensional planning for HDR-BT (3DHDR) and the Biological Effective Dose (BED) were evaluated as prognostic factors for biochemical control (bC). Results: Median age and median follow-up time were 68 and 5.3 years, respectively. Median EBRT and HDR-BT doses were 45 Gy and 20 Gy. The crude bC at 3.3 year was 94.2%. For the Low, intermediate and high risk patients the bC rates at 3.3 years were 91.5%, 90.2% and 88.5%, respectively. Overall survival (OS) and disease specific survival rates at 3.3 years were 97.8% and 98.4%, respectively. On univariate analysis the prognostic factors related bC were GR (p= 0.040), GS ? 6 (p= 0.002), total dose of HDR-BT ? 20 Gy (p< 0.001), 3DHDR (p< 0.001), BED-HDR ? 99 Gy1.5 (p<0.001) and BED-TT ? 185 (p<0.001). On multivariate analysis the statistical significant predictive factors related to bC were RG (p< 0.001), HDR-BT ? 20 Gy (p=0.008) and 3DHDR (p<0.001). Conclusions: we observed that the bC rates correlates with the generally accepted risk factors described in the literature. Dose escalation, evaluated through the BED, and the quality of planning of HDR-BT are also important predictive factors when treating prostate cancer.

Pellizzon, Antonio Cassio Assis; Salvajoli, Joao; Novaes, Paulo; Maia, Maria; Fogaroli, Ricardo; Gides, Doglas; Horriot, Rodrigues

2008-01-01

302

[Brachytherapy for penile carcinoma].  

PubMed

Malignant tumours of the penis are a rare entity. They are mostly squamous cell carcinomas and arise from the glands or the coronal sulcus. Glans brachytherapy has been developed to avoid mutilating surgery and allow organ preservation. Indications of brachytherapy are tumours less than 4 cm with no invasion of the uretra or corpora cavernosa. Local control is equivalent after brachytherapy and surgery. This article describes the indications, the technique, outcome and toxicity of penile brachytherapy. PMID:23490170

Blanchard, P; Delannes, M; Haie-Meder, C

2013-04-01

303

A Monte Carlo investigation of lung brachytherapy treatment planning.  

PubMed

Iodine-125 ((125)I) and Caesium-131 ((131)Cs) brachytherapy have been used in conjunction with sublobar resection to reduce the local recurrence of stage I non-small cell lung cancer compared with resection alone. Treatment planning for this procedure is typically performed using only a seed activity nomogram or look-up table to determine seed strand spacing for the implanted mesh. Since the post-implant seed geometry is difficult to predict, the nomogram is calculated using the TG-43 formalism for seeds in a planar geometry. In this work, the EGSnrc user-code BrachyDose is used to recalculate nomograms using a variety of tissue models for (125)I and (131)Cs seeds. Calculated prescription doses are compared to those calculated using TG-43. Additionally, patient CT and contour data are used to generate virtual implants to study the effects that post-implant deformation and patient-specific tissue heterogeneity have on perturbing nomogram-derived dose distributions. Differences of up to 25% in calculated prescription dose are found between TG-43 and Monte Carlo calculations with the TG-43 formalism underestimating prescription doses in general. Differences between the TG-43 formalism and Monte Carlo calculated prescription doses are greater for (125)I than for (131)Cs seeds. Dose distributions are found to change significantly based on implant deformation and tissues surrounding implants for patient-specific virtual implants. Results suggest that accounting for seed grid deformation and the effects of non-water media, at least approximately, are likely required to reliably predict dose distributions in lung brachytherapy patients. PMID:23788118

Sutherland, J G H; Furutani, K M; Thomson, R M

2013-07-21

304

Edema associated with I-125 or Pd103 prostate brachytherapy and its impact on post-implant dosimetry: an analysis based on serial CT acquisition  

Microsoft Academic Search

Purpose: To characterize the magnitude and duration of post-implant edema following the implantation of I-125 or Pd-103 seeds into the prostate and to investigate its effect on the CT-based calculation of the total dose delivered by the implant.Materials and Methods: A pre-implant CT scan and 3 to 5 serial post-implant CT scans were obtained on 10 patients who received either

Frank M. Waterman; Ning Yue; Benjamin W. Corn; Adam P. Dicker

1998-01-01

305

Coregistered photoacoustic-ultrasound imaging applied to brachytherapy  

NASA Astrophysics Data System (ADS)

Brachytherapy is a form of radiation therapy commonly used in the treatment of prostate cancer wherein sustained radiation doses can be precisely targeted to the tumor area by the implantation of small radioactive seeds around the treatment area. Ultrasound is a popular imaging mode for seed implantation, but the seeds are difficult to distinguish from the tissue structure. In this work, we demonstrate the feasibility of photoacoustic imaging for identifying brachytherapy seeds in a tissue phantom, comparing the received intensity to endogenous contrast. We have found that photoacoustic imaging at 1064 nm can identify brachytherapy seeds uniquely at laser penetration depths of 5 cm in biological tissue at the ANSI limit for human exposure with a contrast-to-noise ratio of 26.5 dB. Our realtime combined photoacoustic-ultrasound imaging approach may be suitable for brachytherapy seed placement and post-placement verification, potentially allowing for realtime dosimetry assessment during implantation.

Harrison, Tyler; Zemp, Roger J.

2011-08-01

306

Fractionation and protraction for radiotherapy of prostate carcinoma  

Microsoft Academic Search

Purpose: To investigate whether current fractionation and brachytherapy protraction schemes for the treatment of prostatic cancer with radiation are optimal, or could be improved.Methods and Materials: We analyzed two mature data sets on radiotherapeutic tumor control for prostate cancer, one using EBRT and the other permanent seed implants, to extract the sensitivity to changes in fractionation of prostatic tumors. The

David J Brenner; Eric J Hall

1999-01-01

307

Brachytherapy seed and applicator localization via iterative forward projection matching algorithm using digital X-ray projections  

Microsoft Academic Search

Interstitial and intracavitary brachytherapy plays an essential role in management of several malignancies. However, the achievable accuracy of brachytherapy treatment for prostate and cervical cancer is limited due to the lack of intraoperative planning and adaptive replanning. A major problem in implementing TRUS-based intraoperative planning is an inability of TRUS to accurately localize individual seed poses (positions and orientations) relative

Damodar Pokhrel

2010-01-01

308

Mixed integer programming optimization models for brachytherapy treatment planning.  

PubMed Central

Mixed integer programming is proposed as an approach for generating treatment plans for brachytherapy. Two related but distinct, mixed integer programming models are tested on data from eight prostate cancer patients. The results demonstrate that in some cases, "good" treatment plans can be obtained in less than five CPU minutes.

Gallagher, R. J.; Lee, E. K.

1997-01-01

309

MIP Models and BB Strategies in Brachytherapy Treatment Optimization  

Microsoft Academic Search

Brachytherapy (brachy being derived from a Greek word meaning short) is the treatment by means of radioactive sources that are placed at short distances from the target cells. This form of therapy is becoming common in the treatment of early stage prostate cancer, the most common cancer and the second leading cause of cancer deaths among American males. We consider

Robert R. Meyer; Warren D. D'Souza; Michael C. Ferris; Bruce R. Thomadsen

2003-01-01

310

MIP models and BB strategies in brachytherapy treatment optimization  

Microsoft Academic Search

Abstract. Brachytherapy (brachy being derived from a Greek word meaning short) is the treatment of cancer by means,of radioactive sources that are placed at short distances from the target cells. This form of therapy is becoming com- mon in the treatment of early stage prostate cancer, the most common cancer and the second leading cause of cancer deaths among,American males.

R. R. Meyer; M. C. Ferris; B. R. Thomadsen

2003-01-01

311

Design and optimization of a brachytherapy robot  

NASA Astrophysics Data System (ADS)

Trans-rectal ultrasound guided (TRUS) low dose rate (LDR) interstitial brachytherapy has become a popular procedure for the treatment of prostate cancer, the most common type of non-skin cancer among men. The current TRUS technique of LDR implantation may result in less than ideal coverage of the tumor with increased risk of negative response such as rectal toxicity and urinary retention. This technique is limited by the skill of the physician performing the implant, the accuracy of needle localization, and the inherent weaknesses of the procedure itself. The treatment may require 100 or more sources and 25 needles, compounding the inaccuracy of the needle localization procedure. A robot designed for prostate brachytherapy may increase the accuracy of needle placement while minimizing the effect of physician technique in the TRUS procedure. Furthermore, a robot may improve associated toxicities by utilizing angled insertions and freeing implantations from constraints applied by the 0.5 cm-spaced template used in the TRUS method. Within our group, Lin et al. have designed a new type of LDR source. The "directional" source is a seed designed to be partially shielded. Thus, a directional, or anisotropic, source does not emit radiation in all directions. The source can be oriented to irradiate cancerous tissues while sparing normal ones. This type of source necessitates a new, highly accurate method for localization in 6 degrees of freedom. A robot is the best way to accomplish this task accurately. The following presentation of work describes the invention and optimization of a new prostate brachytherapy robot that fulfills these goals. Furthermore, some research has been dedicated to the use of the robot to perform needle insertion tasks (brachytherapy, biopsy, RF ablation, etc.) in nearly any other soft tissue in the body. This can be accomplished with the robot combined with automatic, magnetic tracking.

Meltsner, Michael A.

312

A new endoscopic ultrasonography image processing method to evaluate the prognosis for pancreatic cancer treated with interstitial brachytherapy  

PubMed Central

AIM: To develop a fuzzy classification method to score the texture features of pancreatic cancer in endoscopic ultrasonography (EUS) images and evaluate its utility in making prognosis judgments for patients with unresectable pancreatic cancer treated by EUS-guided interstitial brachytherapy. METHODS: EUS images from our retrospective database were analyzed. The regions of interest were drawn, and texture features were extracted, selected, and scored with a fuzzy classification method using a C++ program. Then, patients with unresectable pancreatic cancer were enrolled to receive EUS-guided iodine 125 radioactive seed implantation. Their fuzzy classification scores, tumor volumes, and carbohydrate antigen 199 (CA199) levels before and after the brachytherapy were recorded. The association between the changes in these parameters and overall survival was analyzed statistically. RESULTS: EUS images of 153 patients with pancreatic cancer and 63 non-cancer patients were analyzed. A total of 25 consecutive patients were enrolled, and they tolerated the brachytherapy well without any complications. There was a correlation between the change in the fuzzy classification score and overall survival (Spearman test, r = 0.616, P = 0.001), whereas no correlation was found to be significant between the change in tumor volume (P = 0.663), CA199 level (P = 0.659), and overall survival. There were 15 patients with a decrease in their fuzzy classification score after brachytherapy, whereas the fuzzy classification score increased in another 10 patients. There was a significant difference in overall survival between the two groups (67 d vs 151 d, P = 0.001), but not in the change of tumor volume and CA199 level. CONCLUSION: Using the fuzzy classification method to analyze EUS images of pancreatic cancer is feasible, and the method can be used to make prognosis judgments for patients with unresectable pancreatic cancer treated by interstitial brachytherapy.

Xu, Wei; Liu, Yan; Lu, Zheng; Jin, Zhen-Dong; Hu, Yu-Hong; Yu, Jian-Guo; Li, Zhao-Shen

2013-01-01

313

Concurrent versus sequential application of ferromagnetic hyperthermia and 125I brachytherapy of melanoma in an animal model.  

PubMed Central

OBJECTIVE: To determine the efficacy of concurrent versus sequential ferromagnetic hyperthermia (FMH), combined with Iodine-125 (125I) brachytherapy, in the treatment of uveal melanoma in a rabbit model. MATERIALS AND METHODS: A Greene melanoma cell line was implanted in rabbit eyes to establish a tumor model comparable to a uveal melanoma. Seventy-one tumor-containing rabbit eyes were treated with 125I brachytherapy at 20, 25, 35, 45, or 55 Gray (Gy)(38 eyes), and with either concurrent (15 eyes) or sequential (18 eyes) FMH, delivered at 48.2 degrees C for 1 hour. An additional 13 eyes were treated with FMH alone at 48.2 degrees C, either in a single heat application (5 eyes), or in a repetitive mode (8 eyes). The radiation and heat were delivered via an episcleral plaque. All tumors were followed with indirect ophthalmoscopy and echography. RESULTS: Tumors treated with 125I brachytherapy alone exhibited complete tumor regression in 50% of eyes at 42 Gy with none of the tumors responding to less than 35 Gy. FMH alone at 48.2 degrees C applied in one cycle limited tumor growth in 20% of eyes, while all eyes treated with repetitive heating exhibited complete tumor control. With concurrent application of FMH and 125I, the 50% tumor control rate occurred at 9.5 Gy, thus resulting in a thermal enhancement ratio (TER) of 4.4. With sequential treatment, the 50% tumor control rate was at 30 Gy, with a resultant TER of 1.4. No complications related to 125I brachytherapy were noted in any eyes, while transient retinal whitening was seen with the FMH. CONCLUSION: This study documents the enhanced synergistic interaction of concurrent FMH and 125I brachytherapy, compared to sequential treatment, in this rabbit melanoma model.

Mieler, W F

1997-01-01

314

Treatment options for localized prostate cancer  

PubMed Central

Abstract Objective To describe treatment options for clinically localized prostate cancer: radical prostatectomy, prostate brachytherapy, external beam radiation, and active surveillance. Quality of evidence Prostate-specific antigen (PSA) outcomes presented are from non-randomized, cohort, and other comparisons trials (level II evidence). We describe PSA outcomes from Canadian centres when they are available. One small randomized controlled trial (level I evidence) in localized prostate cancer is available to compare radical prostatectomy with brachytherapy. Main message Treatment choice in prostate cancer is based on initial PSA level, clinical stage of disease, and Gleason score, together with baseline urinary function, comorbidities, and patient age. In this article, we describe patients’ eligibility for and the common side effects of all treatment options. Prostate brachytherapy and active surveillance have evolved as new standard treatments of localized prostate cancer. We give a brief overview of the brachytherapy procedure, side effects, and PSA outcomes across Canada, as well as active surveillance guidelines. Conclusion Prostate cancer treatment requires a multidisciplinary approach, with input from both urology and radiation oncology. Input from family physicians is often as important in helping guide patients through the treatment decision process.

Keyes, Mira; Crook, Juanita; Morton, Gerard; Vigneault, Eric; Usmani, Nawaid; Morris, W. James

2013-01-01

315

Acute urinary retention after transperineal template-guided prostate biopsy  

Microsoft Academic Search

PurposeUrinary retention occurs in 5%–36% of patients with prostate cancer after implantation of radioactive seeds for brachytherapy. We used transperineal biopsy as a model to determine the influence of needle trauma on urinary retention.

Steven J Buskirk; David M Pinkstaff; Steven P Petrou; Michael J Wehle; Gregory A Broderick; Paul R Young; Stephen D Weigand; Peter C O'Brien; Todd C Igel

2004-01-01

316

Prostatitis (Prostate Infection)  

MedlinePLUS

... ipsum dolor sit amet, consectetur adipiscing elit. Prostatitis (Prostate Infection) What is prostatitis? Prostatitis is a condition that involves inflammation of the prostate and sometimes the area around it. There are ...

317

³²P-chromic phosphate-Poly(L-Lactide) seeds of sustained release and their brachytherapy for prostate cancer with lymphatic metastasis.  

PubMed

This study aims to develop a new agent, the ³²P-chromic phosphate-poly(l-lactide) (³²P-CP-PLLA) seed and to explore its anticancer effect against prostate cancer (Pca) with local lymphatic metastasis in nude mice. ³²P-CP-PLLA seeds of sustained release and nude mouse models of Pca with lymphatic metastasis were prepared. After 4 weeks, the tumor nude mouse models were randomly assigned into five groups. ³²P-CP-PLLA seeds (3.7, 7.4, 14.8, and 0?MBq) and ³²P-CP (14.8?MBq) were implanted in the tumor tissues of the nude mouse models. The following were discussed in this study: (1) the distributions of ³²P-CP-PLLA, (2) the pathological and morphological changes in the tumor and regional lymph nodes, and (3) the changes in white blood cell (WBC) and platelet counts in peripheral blood for toxic reactions. The homemade ³²P-CP-PLLA seed was a regular green cylinder, with an even distribution of mass and radioactivity. After implantation, single-photon emission computed tomograph (SPECT) showed that ³²P was mainly gathered in the tumor and regional lymph nodes. Morphological examinations revealed that necrosis and hemorrhage were around the tumor and focal lymph nodes. The tumor inhibition rates of the five groups were 70.16% ± 5.48%, 80.18% ± 5.84%, 84.97% ± 4.79%, (-), and 78.81% ± 3.13%, respectively. These values were all positive when compared with the control group. As a new homemade agent of pure ?-ray, local implantation of the agent increased the focal retention of radioactivity at the target. Moreover, effective half-life showed an obvious damage to the tumor and metastatic foci of Pca. PMID:22834706

He, Xingjun; Jia, Ruipeng; Xu, Luwei; Liang, Kai; Wang, Zizheng; Shao, Guoqiang; Huang, Peilin; Li, Wencheng

2012-09-01

318

Afterloading Techniques in Brachytherapy.  

National Technical Information Service (NTIS)

The advantages of applying modern afterloading methods in brachytherapie of malignant diseases are outlined. They include, among other things, a considerable reduction in radiation exposure to staff involved. Furthermore, the radiation protection requirem...

M. Kirsch R. Orban B. Lorenz

1981-01-01

319

Plaque Brachytherapy for Uveal Melanoma: A Vision Prognostication Model  

SciTech Connect

Purpose: To generate a vision prognostication model after plaque brachytherapy for uveal melanoma. Methods and Materials: All patients with primary single ciliary body or choroidal melanoma treated with iodine-125 or ruthenium-106 plaque brachytherapy between January 1, 2005, and June 30, 2010, were included. The primary endpoint was loss of visual acuity. Only patients with initial visual acuity better than or equal to 20/50 were used to evaluate visual acuity worse than 20/50 at the end of the study, and only patients with initial visual acuity better than or equal to 20/200 were used to evaluate visual acuity worse than 20/200 at the end of the study. Factors analyzed were sex, age, cataracts, diabetes, tumor size (basal dimension and apical height), tumor location, and radiation dose to the tumor apex, fovea, and optic disc. Univariate and multivariable Cox proportional hazards were used to determine the influence of baseline patient factors on vision loss. Kaplan-Meier curves (log rank analysis) were used to estimate freedom from vision loss. Results: Of 189 patients, 92% (174) were alive as of February 1, 2011. At presentation, visual acuity was better than or equal to 20/50 and better than or equal to 20/200 in 108 and 173 patients, respectively. Of these patients, 44.4% (48) had post-treatment visual acuity of worse than 20/50 and 25.4% (44) had post-treatment visual acuity worse than 20/200. By multivariable analysis, increased age (hazard ratio [HR] of 1.01 [1.00-1.03], P=.05), increase in tumor height (HR of 1.35 [1.22-1.48], P<.001), and a greater total dose to the fovea (HR of 1.01 [1.00-1.01], P<.001) were predictive of vision loss. This information was used to develop a nomogram predictive of vision loss. Conclusions: By providing a means to predict vision loss at 3 years after treatment, our vision prognostication model can be an important tool for patient selection and treatment counseling.

Khan, Niloufer [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio (United States); Khan, Mohammad K. [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States)] [Department of Radiation Oncology, Emory University School of Medicine, Atlanta, Georgia (United States); Bena, James [Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio (United States); Macklis, Roger [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio (United States)] [Department of Radiation Oncology, Taussig Cancer Center, Cleveland Clinic, Cleveland, Ohio (United States); Singh, Arun D., E-mail: singha@ccf.org [Department of Ophthalmic Oncology, Cole Eye Institute, Cleveland Clinic, Cleveland, Ohio (United States)

2012-11-01

320

Prostate Adenocarcinoma  

MedlinePLUS

What is prostate adenocarcinoma? Prostate adenocarcinoma accounts for 95 percent of all prostate cancers. It starts in the prostate gland and, ... Cancer Society. Who is most likely to have prostate adenocarcinoma? Prostate adenocarcinoma becomes more common in men ...

321

Innovations and advances in brachytherapy.  

PubMed

The treatment of cancer with radioactive sources using topical molds and intracavitary radium showed the efficacy of brachytherapy long before external radiation therapy became common practice. Brachytherapy is progressing in several clinical directions that reflect technological innovation as well as changes in medical care which combine to provide significant advances in the practice of brachytherapy today. A major change in brachytherapy, the development of high intensity sources, promoted clinical and technologic innovations in high dose-rate brachytherapy. Pulse dose-rate brachytherapy is the use of these sources to treat a target by using pulses of radiation for several minutes each hour with the same overall time and total dose as low dose-rate treatment. Recent novel approaches of using radiotherapy for prevention of restenosis in coronary and peripheral vessels has interested laboratory and clinical researchers. Most of the work toward new source material for brachytherapy centers around intravascular applications. Technology to support brachytherapy continues to advance rapidly. The interaction between images from diverse modalities and the various phases of the treatment planning is the basis of enhanced treatment planning procedures. Optimization in brachytherapy entails calculating the source strengths or source dwell times to satisfy a set of dose criteria to achieve the best dose distribution for a brachytherapy implant. Progress in computerization and calculation modeling has promoted this technical advance. Education and training in brachytherapy indications and techniques is mandatory to maintain high standards of brachytherapy practice. PMID:9422265

Stitt, J A; Thomadsen, B R

1997-12-01

322

Prostatitis: Disorders of the Prostate  

MedlinePLUS

... Disorders of the Prostate Prostatitis: Disorders of the Prostate On this page: What is the prostate? What ... be signs of another disease. What is the prostate? The prostate is a walnut-sized gland that ...

323

Effect of brachytherapy on NF-?B and VEGF in gastric carcinoma xenografts.  

PubMed

Iodine-125 (125I) seed irradiation can be used as an important supplementary treatment for unresectable advanced gastric cancer. However, the radiobiological mechanism underlying brachytherapy remains unclear. Therefore, we investigated the influence of continuous and low-energy 125I irradiation on the cell cycle distribution, apoptosis, expression of NF-?B and VEGF and tumor growth in a human gastric cancer xenograft model. To create an animal model of gastric cancer, SGC-7901 cells were surgically implanted into mice. The 60 mice bearing SGC-7901 gastric cancer xenografts were randomly separated into 2 groups. Sham seeds (0 mCi) were implanted into the control group (n=30); 125I seeds (0.6 mCi) were implanted into the treatment group (n=30). At 28 days after irradiation, apoptosis was detected by flow cytometry. fluorescence micrograph detected intense VEGF and NF-?B immunofluorescence in the tumor samples, and changes in NF-?B and VEGF mRNA and protein expression were assessed by real-time PCR and western blot analysis, respectively. The tumor volume and weight were measured 0-28 days after 125I seed implantation. 125I seed irradiation induced significant apoptosis and G2/M phase arrest. Reduction in the intensities of VEGF and NF-?B immunofluorescence in tumor vessels was observed after treatment. NF-?B and VEGF mRNA and protein expression levels were substantially lower in the implantation treatment group than in the control group. Consequently, 125I seed implantation inhibited cancer growth and reduced cancer volume. The present study revealed that 125I seed irradiation significantly induced apoptosis and cell cycle arrest in the human gastric cancer xenografts. 125I-induced changes in NF-?B and VEGF expression are suggested as potential mechanisms underlying effective brachytherapy. PMID:24926530

Zhang, Wan-Fu; Jin, Wen-Di; Li, Bo; Wang, Ming-Chun; Li, Xiao-Gang; Mao, Wen-Yuan; Luo, Kai-Yuan

2014-08-01

324

Patterns of Care, Utilization, and Outcomes of Treatments for Localized Prostate Cancer.  

National Technical Information Service (NTIS)

The purpose of the research is to characterize patterns of care, utilization, and outcomes of treatments for localized prostate cancer such as surgery, external beam radiation, and brachytherapy. In particular, the research characterizes the patterns of c...

J. C. Hu

2010-01-01

325

Patterns of Care, Utilization, and Outcomes of Treatments for Localized Prostate Cancer.  

National Technical Information Service (NTIS)

The purpose of the research is to characterize patterns of care, utilization, and outcomes of treatments for localized prostate cancer such as surgery, external beam radiation, and brachytherapy. In particular, the research characterizes the patterns of c...

J. C. Hu

2013-01-01

326

Patterns of Care, Utilization, and Outcomes of Treatments for Localized Prostate Cancer.  

National Technical Information Service (NTIS)

The purpose of the research is to characterize patterns of care, utilization, and outcomes of treatments for localized prostate cancer such as surgery, external beam radiation, and brachytherapy. In particular, the research characterizes the patterns of c...

J. C. Hu

2011-01-01

327

Machine Learning Techniques for Prostate Ultrasound Image Diagnosis  

Microsoft Academic Search

Estimation of prostate location and volume is essential in determining a dose plan for ultrasound-guided brachytherapy, a\\u000a common prostate cancer treatment. However, manual segmentation is difficult, time consuming and prone to variability. In this\\u000a chapter, we present a machine learning scheme, employing a combination of fuzzy sets, wavelets and rough sets, for analyzing\\u000a prostrate ultrasound images in order diagnose prostate

Aboul Ella Hassanien; Hameed Al-Qaheri; Václav Snásel; James F. Peters

2010-01-01

328

Optimization Treatment Planning for Interstitial Brachytherapy Using the Adjoint Transport Method  

Microsoft Academic Search

Permanent radioactive seed implantation (interstitial brachytherapy) is becoming the preferred method of treating prostate cancers. The main goal of the treatment is to deliver a conformal dose to the tumor while simultaneously minimizing the dose to the normal tissue and sensitive tissue structures. The treatment plan determines the number of seeds, their embedded positions, and the dose delivered to the

S. Yoo; D. L. Henderson; B. R. Thomadsen

2001-01-01

329

Photoacoustic imaging of brachytherapy seeds using a channel-domain ultrasound array system  

Microsoft Academic Search

Brachytherapy is a technique commonly used in the treatment of prostate cancer that relies on the precise placement of small radioactive seeds near the tumor location. The advantage of this technique over traditional radiation therapies is that treatment can be continuous and uniform, resulting in fewer clinic visits and a shorter treatment duration. Two important phases of this treatment are

Tyler Harrison; Roger J. Zemp

2011-01-01

330

An approach to using conventional brachytherapy software for clinical treatment planning of complex, Monte Carlo-based brachytherapy dose distributions  

SciTech Connect

Certain brachytherapy dose distributions, such as those for LDR prostate implants, are readily modeled by treatment planning systems (TPS) that use the superposition principle of individual seed dose distributions to calculate the total dose distribution. However, dose distributions for brachytherapy treatments using high-Z shields or having significant material heterogeneities are not currently well modeled using conventional TPS. The purpose of this study is to establish a new treatment planning technique (Tufts technique) that could be applied in some clinical situations where the conventional approach is not acceptable and dose distributions present cylindrical symmetry. Dose distributions from complex brachytherapy source configurations determined with Monte Carlo methods were used as input data. These source distributions included the 2 and 3 cm diameter Valencia skin applicators from Nucletron, 4-8 cm diameter AccuBoost peripheral breast brachytherapy applicators from Advanced Radiation Therapy, and a 16 mm COMS-based eye plaque using {sup 103}Pd, {sup 125}I, and {sup 131}Cs seeds. Radial dose functions and 2D anisotropy functions were obtained by positioning the coordinate system origin along the dose distribution cylindrical axis of symmetry. Origin:tissue distance and active length were chosen to minimize TPS interpolation errors. Dosimetry parameters were entered into the PINNACLE TPS, and dose distributions were subsequently calculated and compared to the original Monte Carlo-derived dose distributions. The new planning technique was able to reproduce brachytherapy dose distributions for all three applicator types, producing dosimetric agreement typically within 2% when compared with Monte Carlo-derived dose distributions. Agreement between Monte Carlo-derived and planned dose distributions improved as the spatial resolution of the fitted dosimetry parameters improved. For agreement within 5% throughout the clinical volume, spatial resolution of dosimetry parameter data {<=}0.1 cm was required, and the virtual brachytherapy source data set included over 5000 data points. On the other hand, the lack of consideration for applicator heterogeneity effect caused conventional dose overestimates exceeding an order of magnitude in regions of clinical interest. This approach is rationalized by the improved dose estimates. In conclusion, a new technique was developed to incorporate complex Monte Carlo-based brachytherapy dose distributions into conventional TPS. These results are generalizable to other brachytherapy source types and other TPS.

Rivard, Mark J.; Melhus, Christopher S.; Granero, Domingo; Perez-Calatayud, Jose; Ballester, Facundo [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States); Radiation Oncology Department, Physics Section, ''La Fe'' University Hospital, Avenida Campanar 21, E-46009 Valencia (Spain); Department of Atomic, Molecular, and Nuclear Physics, University of Valencia, C/Dr. Moliner 50, E-46100 Burjassot, Spain and IFIC (University of Valencia-CSIC), C/Dr. Moliner 50, E-46100 Burjassot (Spain)

2009-06-15

331

Dosimetric and technical aspects of intraoperative I-125 brachytherapy for stage I non-small cell lung cancer.  

PubMed

Initial treatment outcome data from our institution for stage I non-small cell lung cancer (NSCLC) patients have shown that sublobar resection in combination with iodine-125 (I-125) brachytherapy is associated with recurrence rates of 2.0%, compared to 18.6% with sublobar resection alone. In this work, the technical and dosimetric aspects required to execute this procedure from the radiation oncology perspective as well as an analysis of the dose distributions of patients treated with this technique are presented. In this treatment technique, I-125 seeds in vicryl suture are embedded into vicryl mesh and surgically inserted providing a 2.0 cm margin on each side of the resection staple line. A nomogram is developed to determine the suture spacing in the vicryl mesh, as a function of seed activity in order to deliver 120 Gy at a distance of 0.5 cm above and below the seed array. Post-operative dosimetry consists of a CT-based planning and dose volume analysis. Dose distributions, dose volume histograms and mean dose data for lung are analysed in a group of patients. Dosimetric results show significant lung sparing with only a small volume of lung irradiated for all patients with mean lung dose values ranging from 1.5 Gy to 5.4 Gy. Lung brachytherapy with I-125 at the time of sublobar resection is a highly conformal option of dose delivery for stage I NSCLC patients with compromised physiologic reserve. Patient-related toxicity clinically measured by loss of pulmonary function and radiation-induced pneumonitis have not been linked to this procedure. PMID:17301451

Johnson, Mark; Colonias, Athanasios; Parda, David; Trombetta, Mark; Gayou, Olivier; Reitz, Bodo; Miften, Moyed

2007-03-01

332

Prostate Cancer  

MedlinePLUS

... version of this page please turn Javascript on. Prostate Cancer What is Prostate Cancer? How Tumors Form The body is made ... not cancerous, or malignant, which means cancerous. How Prostate Cancer Occurs Prostate cancer occurs when a tumor ...

333

Prostate Problems  

MedlinePLUS

... there are many things you can do. The Prostate The prostate is a gland about the size ... a combination of medicines, surgery, and lifestyle changes. Prostate Cancer Prostate cancer is common among American men. ...

334

Treatment- and Disease-Related Complications of Prostate Cancer  

PubMed Central

One of the highlights of the 16th International Prostate Cancer Update was a session on treatment- and disease-related complications of prostate disease. It began with presentation of a challenging case of rising prostate-specific antigen levels after radical prostatectomy, followed by an overview of the use of zoledronic acid in prostate cancer, a review of side effects of complementary medicines, an overview of complications of cryotherapy, an assessment of complications of brachytherapy and external beam radiation therapy, and a comparison of laparoscopy versus open prostatectomy.

Simoneau, Anne R

2006-01-01

335

Solid state TL detectors for in vivo dosimetry in brachytherapy.  

PubMed

In vivo dosimetry provides information about the actual dose delivered to the patient treated with radiotherapy and can be adopted within a routinary treatment quality assurance protocol. Aim of this study was to evaluate the feasibility of performing in vivo rectal dosimetry by placing thermoluminescence detectors directly on the transrectal ultrasound probe adopted for on-line treatment planning of high dose rate brachytherapy boosts of prostate cancer patients. A suitable protocol for TLD calibration has been set up. In vivo measurements resulted to be in good agreement with the calculated doses, showing that the proposed method is feasible and returns accurate results. PMID:22920417

Gambarini, G; Borroni, M; Grisotto, S; Maucione, A; Cerrotta, A; Fallai, C; Carrara, M

2012-12-01

336

Stereotactic brachytherapy of low-grade cerebral glioma after tumor resection  

PubMed Central

The purpose of this study was to assess the impact of stereotactic brachytherapy (SBT) on survival time and outcome when applied after resection of low-grade glioma (LGG) of World Health Organization grade II. From January 1982 through December 2006 we treated 1024 patients who had glioma with stereotactic implantation of iodine-125 seeds and SBT in accordance with a prospective protocol. For the present analysis, we selected 95 of 277 patients with LGG, in whom SBT was applied to treat progressive (43 patients) or recurrent (52 patients) tumor after resection. At 24 months after seed implantation, the tumor response rate was 35.9%, and the tumor control rate was 97.3%. The median progression-free-survival (PFS) duration after SBT was 52.7 ± 7.1 months. Five-year and 10-year PFS probabilities were 43.4% and 10.7%, respectively. Malignant tumor transformation, the diagnosis “astrocytoma,” and tumor volume >20 mL were significantly associated with reduced PFS. Tumor progression or relapse after SBT (53 of 95 patients) was treated with tumor resection, a second SBT, chemotherapy, and/or radiotherapy. The median overall survival duration (from the first diagnosis of LGG until the patient's last contact) was 245.0 ± 4.9 months. Patients still under observation after seed implantation had a median follow-up time of 156.4 ± 55.7 months. Perioperative transient morbidity was 1.1%, and the frequency of permanent morbidity caused by SBT was 3.3%. In conclusion, SBT of recurrent or progressive LGG after resection located in functionally critical brain areas has high local efficacy and comparably low morbidity. Referred to individually adopted glioma treatment concepts SBT provides a reasonably long PFS, thus improving overall survival. In selected patients, SBT can lead to delays in the application of chemotherapy and/or radiotherapy.

Suchorska, Bogdana; Ruge, Maximilian; Treuer, Harald; Sturm, Volker; Voges, Jurgen

2011-01-01

337

Advances in small molecule inhibitors of androgen receptor for the treatment of advanced prostate cancer  

Microsoft Academic Search

Objectives  Current treatments for localized prostate cancer include brachytherapy, external beam radiation, surgery, and active surveillance.\\u000a Unfortunately, 20–40% of prostate cancer patients will experience recurrence and require hormonal therapies. These therapies\\u000a involve androgen ablation by chemical or surgical castration and application of antiandrogens. Hormonal therapy is initially\\u000a effective, but will inevitably fail and the disease will progress to lethal castration-resistant prostate

Marianne D. Sadar

338

Factors influencing risk of acute urinary retention after TRUS-guided permanent prostate seed implantation  

Microsoft Academic Search

Purpose: To look for factors predictive of acute urinary retention (AUR) after permanent seed prostate brachytherapy.Methods and Materials: From March 1999 to February 2001, 150 permanent seed prostate implants were performed at Princess Margaret Hospital (Stage T1c, n = 113; T2a, n = 37; mean prostate-specific antigen level 5.9 ng\\/mL, prescription dose 145 Gy per Task Group No. 43). ?-Blockers

Juanita Crook; Michael McLean; Charles Catton; Ivan Yeung; John Tsihlias; Melania Pintilie

2002-01-01

339

Development of an adjoint sensitivity field-based treatment-planning technique for the use of newly designed directional LDR sources in brachytherapy  

NASA Astrophysics Data System (ADS)

The development and application of an automated 3D greedy heuristic (GH) optimization algorithm utilizing the adjoint sensitivity fields for treatment planning to assess the advantage of directional interstitial prostate brachytherapy is presented. Directional and isotropic dose kernels generated using Monte Carlo simulations based on Best Industries model 2301 I-125 source are utilized for treatment planning. The newly developed GH algorithm is employed for optimization of the treatment plans for seven interstitial prostate brachytherapy cases using mixed sources (directional brachytherapy) and using only isotropic sources (conventional brachytherapy). All treatment plans resulted in V100 > 98% and D90 > 45 Gy for the target prostate region. For the urethra region, the D10Ur, D90Ur and V150Ur and for the rectum region the V100cc, D2cc, D90Re and V90Re all are reduced significantly when mixed sources brachytherapy is used employing directional sources. The simulations demonstrated that the use of directional sources in the low dose-rate (LDR) brachytherapy of the prostate clearly benefits in sparing the urethra and the rectum sensitive structures from overdose. The time taken for a conventional treatment plan is less than three seconds, while the time taken for a mixed source treatment plan is less than nine seconds, as tested on an Intel Core2 Duo 2.2 GHz processor with 1GB RAM. The new 3D GH algorithm is successful in generating a feasible LDR brachytherapy treatment planning solution with an extra degree of freedom, i.e. directionality in very little time.

Chaswal, V.; Thomadsen, B. R.; Henderson, D. L.

2012-02-01

340

Prostate-Specific Antigen Bounce Following Stereotactic Body Radiation Therapy for Prostate Cancer  

PubMed Central

Introduction: Prostate-specific antigen (PSA) bounce after brachytherapy has been well-documented. This phenomenon has also been identified in patients undergoing stereotactic body radiation therapy (SBRT). While the parameters that predict PSA bounce have been extensively studied in prostate brachytherapy patients, this study is the first to analyze the clinical and pathologic predictors of PSA bounce in prostate SBRT patients. Materials and Methods: Our institution has maintained a prospective database of patients undergoing SBRT for prostate cancer since 2006. Our study population includes patients between May 2006 and November 2011 who have at least 18?months of follow-up. All patients were treated using the CyberKnife treatment system. The prescription dose was 35–36.25?Gy in five fractions. Results: One hundred twenty patients were included in our study. Median PSA follow-up was 24?months (range 18–78?months). Thirty-four (28%) patients had a PSA bounce. The median time to PSA bounce was 9?months, and the median bounce size was 0.50?ng/mL. On univariate analysis, only younger age (p?=?0.011) was shown to be associated with an increased incidence of PSA bounce. Other patient factors, including race, prostate size, prior treatment by hormones, and family history of prostate cancer, did not predict PSA bounces. None of the tumor characteristics studied, including Gleason score, pre-treatment PSA, T-stage, or risk classification by NCCN guidelines, were associated with increased incidence of PSA bounces. Younger age was the only statistically significant predictor of PSA bounce on multivariate analysis (OR?=?0.937, p?=?0.009). Conclusion: PSA bounce, which has been reported after prostate brachytherapy, is also seen in a significant percentage of patients after CyberKnife SBRT. Close observation rather than biopsy can be considered for these patients. Younger age was the only factor that predicted PSA bounce.

Vu, Charles C.; Haas, Jonathan A.; Katz, Aaron E.; Witten, Matthew R.

2014-01-01

341

Prostate Enlargement: Benign Prostatic Hyperplasia (BPH)  

MedlinePLUS

... Topics and Titles : Prostate Enlargement: Benign Prostatic Hyperplasia Prostate Enlargement: Benign Prostatic Hyperplasia On this page: The ... Needed? Hope through Research Additional Reading Glossary The Prostate Gland The prostate is a walnut-sized gland ...

342

Optimization Treatment Planning for Interstitial Brachytherapy Using the Adjoint Transport Method  

SciTech Connect

Permanent radioactive seed implantation (interstitial brachytherapy) is becoming the preferred method of treating prostate cancers. The main goal of the treatment is to deliver a conformal dose to the tumor while simultaneously minimizing the dose to the normal tissue and sensitive tissue structures. The treatment plan determines the number of seeds, their embedded positions, and the dose delivered to the tissue by photons emitted from the seeds. This study adopts the adjoint method to calculate dose and mixed integer programming (MIP) to optimize the dose to regions of interest for the permanent implantation of {sup 125}I radioactive source seeds for prostate cancers.

Yoo, S.; Henderson, D.L.; Thomadsen, B.R.

2001-06-17

343

Enlarged prostate  

MedlinePLUS

BPH; Benign prostatic hyperplasia (hypertrophy); Prostate - enlarged ... The actual cause of prostate enlargement is unknown. Factors linked to aging and changes in the cells of the testicles may have a role in ...

344

Prostate Cancer  

MedlinePLUS

The prostate is the gland below a man's bladder that produces fluid for semen. Prostate cancer is common among older men. It is ... men younger than 40. Risk factors for developing prostate cancer include being over 65 years of age, ...

345

Prostate: Benign Prostatic Hyperplasia (BPH)  

MedlinePLUS

... prostatic hyperplasia (BPH)? As a man ages, his prostate gland commonly becomes enlarged. This condition is known ... especially at night. This condition develops as the prostate enlarges and presses against the urethra, causing it ...

346

Learning about Prostate Cancer  

MedlinePLUS

... Hereditary Form of Prostate Cancer 2002 Learning About Prostate Cancer What is prostate cancer? What is the ... Resources of Information on Prostate Cancer What is prostate cancer? Prostate cancer is the most common cancer ...

347

Ultrasonic Detection and Imaging of Brachytherapy Seeds Based on Singular Spectrum Analysis  

NASA Astrophysics Data System (ADS)

A commonly used, effective method of treating localized prostate cancer is implantation of small radioactive seeds. The standard imaging modality for treatment-planning dosimetry and for guiding and monitoring seed implantation is transrectal ultrasound (TRUS). However, movement of the prostate during seed insertion can cause seed misplacement, hemorrhage, and clutter from calcifications and other hyperechogenic scattering objects, and the specularity of seeds themselves make detecting seeds and verifying proper dosimetry difficult in an intraoperative time frame. Radiation oncologists would find a real-time imaging system that is capable of providing accurate, post-insertion, seed-location information to be very valuable because the information would enable timely feedback for intraoperatively correcting deficiencies in the radiation dose. Therefore, a remaining challenge for TRUS-guided brachytherapy of prostate cancer is accurate detection and localization of the seeds upon their insertion.

Mamou, J.; Feleppa, E. J.

348

Influence of trace elements in human tissue in low-energy photon brachytherapy dosimetry  

NASA Astrophysics Data System (ADS)

The aim of this paper is to determine the dosimetric impact of trace elements in human tissues for low-energy photon sources used in brachytherapy. Monte Carlo dose calculations were used to investigate the dosimetric effect of trace elements present in normal or cancerous human tissues. The effect of individual traces (atomic number Z = 11-30) was studied in soft tissue irradiated by low-energy brachytherapy sources. Three other tissue types (prostate, adipose and mammary gland) were also simulated with varying trace concentrations to quantify the contribution of each trace to the dose distribution. The dose differences between cancerous and healthy prostate tissues were calculated in single- and multi-source geometries. The presence of traces in a tissue produces a difference in the dose distribution that is dependent on Z and the concentration of the trace. Low-Z traces (Na) have a negligible effect (<0.3%) in all tissues, while higher Z (K) had a larger effect (>3%). There is a potentially significant difference in the dose distribution between cancerous and healthy prostate tissues (4%) and even larger if compared to the trace-free composition (15%) in both single- and multi-sourced geometries. Trace elements have a non-negligible (up to 8% in prostate D90) effect on the dose in tissues irradiated with low-energy photon sources. This study underlines the need for further investigation into accurate determination of the trace composition of tissues associated with low-energy brachytherapy. Alternatively, trace elements could be incorporated as a source of uncertainty in dose calculations. This work was part of an invited presentation at the ‘International Workshop on Recent Advances in Monte Carlo Techniques for Radiation Therapy’, held in Montreal, June 8-10, 2011.

White, Shane A.; Landry, Guillaume; van Gils, Francis; Verhaegen, Frank; Reniers, Brigitte

2012-06-01

349

A new robotic needle insertion method to minimise attendant prostate motion  

Microsoft Academic Search

Background and purposeThe purpose of this study is to investigate the efficacy of a new needle insertion method (tapping instead of pushing) in reducing attendant tissue motion. This can be useful in applications where tissue motion due to needle insertion is problematic such as e.g. MRI-guided prostate brachytherapy and breast biopsies. In this study we will focus on prostate motion

Vera Lagerburg; Marinus A. Moerland; Marco van Vulpen; Jan J. W. Lagendijk

2006-01-01

350

Duke researchers develop potential new technique for anticancer radiotherapy could provide alternative to brachytherapy  

Cancer.gov

A promising new approach to treating solid tumors with radiation was highly efficacious and minimally toxic to healthy tissue in a mouse model of cancer, according to data published in Cancer Research, a journal of the American Association for Cancer Research. Some patients with solid tumors, including prostate cancer, are treated using a clinical technique called brachytherapy. Brachytherapy involves the surgical implantation of radioactive "seeds" within a patient's tumor to expose the tumor cells to high levels of radiation while minimizing the negative side effects of radiation on the rest of the body. Researchers at Duke University (home to the Duke Cancer Institute) generated an injectable substance, called a polymer, attached to a source of radioactivity that spontaneously assembled into a radioactive seed after being injected into a tumor.

351

Prostate Problems  

MedlinePLUS

AgePage National Institute on Aging Prostate Problems Stan just found out that a friend has prostate cancer. A lot of men he knows have some kind of problem with their prostate. He’s worried that this might happen to him. ...

352

Prostate Diseases  

MedlinePLUS

The prostate is a gland in men. It helps make semen, the fluid that contains sperm. The prostate surrounds the tube that carries urine away from ... and out of the body. A young man's prostate is about the size of a walnut. It ...

353

The Effects of Metallic Implants on Electroporation Therapies: Feasibility of Irreversible Electroporation for Brachytherapy Salvage  

SciTech Connect

Purpose: Electroporation-based therapies deliver brief electric pulses into a targeted volume to destabilize cellular membranes. Nonthermal irreversible electroporation (IRE) provides focal ablation with effects dependent on the electric field distribution, which changes in heterogeneous environments. It should be determined if highly conductive metallic implants in targeted regions, such as radiotherapy