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1

Exposure of Treating Physician to Radiation during Pro-state Brachytherapy using Iodine-125 Seeds  

E-print Network

. Key Words: Prostate cancer, brachytherapy, Iodine-125 seeds, radiation expos- ure, TLD Short Title: Exposure to Radiation during Prostate Brachytherapy Kurztitel: Strahlenexposition bei der Brachytherapie1 Exposure of Treating Physician to Radiation during Pro- state Brachytherapy using Iodine-125

Krusche, Bernd

2

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

3

Magnetic Resonance Imaging-Defined Treatment Margins in Iodine-125 Prostate Brachytherapy  

SciTech Connect

Purpose: Low-dose-rate prostate brachytherapy achieves a very high and effective intraprostatic dose. Implant quality parameters concentrate on the dose received by the prostate (D90, V100) but not that received by the periprostatic tissue. We calculated implant quality parameters, D90 and V100, for the magnetic resonance imaging (MRI)-defined prostate plus 2, 3, and 5 mm. Methods and Materials: A total of 131 men with early-stage prostate cancer treated with iodine-125 brachytherapy represent all those treated with brachytherapy monotherapy in our institution in 2005. Postplan assessment was performed at 1 month using magnetic resonance (MR)-computed tomography (CT) fusion. The prostate V100 and D90 were calculated with 2-, 3-, and 5-mm margins. Results were compared with those in 8 patients with biopsy-proven local failure occurring in an experience of more than 1,100 implants. Results: Mean prostate V100 (SD) and D90 (SD) were 95.6% (4.1) and 117.2% (12.7). For prostate plus a 2-mm margin the D90 was 107.9% (14.3) and for a 3-mm margin 96.0 % (14.0). For prostate plus a 5-mm margin, the D90 was only 78.4% (11.0). The 8 patients experiencing local failure, despite adequate implants, had a lower mean V100 of 91.2% (SD, 2.8; p = 0.0008) and D90 of 103.7% (SD, 8.3; p = 0.002) and significantly inferior margin coverage. Conclusions: Satisfactory coverage of a 2-mm and 3-mm periprostatic margin is obtained with the described planning approach. Coverage falls off significantly by 5 mm. The 8 patients who experienced local failure had significantly lower doses than the margin cohort. Although the V100 and D90 would be considered acceptable, the fall-off in margin coverage was observed by 3 mm.

Crook, Juanita, E-mail: jcrook@bccancer.bc.c [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Patil, Nikhilesh [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Ma, Clement [Department of Biostatistics, Princess Margaret Hospital, Toronto, ON (Canada); McLean, Michael [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, ON (Canada); Borg, Jette [Department of Radiation Physics, Princess Margaret Hospital, Toronto, ON (Canada)

2010-07-15

4

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. PMID:23878549

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

2013-01-01

5

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

6

Novel Parameter Predicting Grade 2 Rectal Bleeding After Iodine-125 Prostate Brachytherapy Combined With External Beam Radiation Therapy  

SciTech Connect

Purpose: To propose a novel parameter predicting rectal bleeding on the basis of generalized equivalent uniform doses (gEUD) after {sup 125}I prostate brachytherapy combined with external beam radiation therapy and to assess the predictive value of this parameter. Methods and Materials: To account for differences among radiation treatment modalities and fractionation schedules, rectal dose–volume histograms (DVHs) of 369 patients with localized prostate cancer undergoing combined therapy retrieved from corresponding treatment planning systems were converted to equivalent dose-based DVHs. The gEUDs for the rectum were calculated from these converted DVHs. The total gEUD (gEUD{sub sum}) was determined by a summation of the brachytherapy and external-beam radiation therapy components. Results: Thirty-eight patients (10.3%) developed grade 2+ rectal bleeding. The grade 2+ rectal bleeding rate increased as the gEUD{sub sum} increased: 2.0% (2 of 102 patients) for <70 Gy, 10.3% (15 of 145 patients) for 70-80 Gy, 15.8% (12 of 76 patients) for 80-90 Gy, and 19.6% (9 of 46 patients) for >90 Gy (P=.002). Multivariate analysis identified age (P=.024) and gEUD{sub sum} (P=.000) as risk factors for grade 2+ rectal bleeding. Conclusions: Our results demonstrate gEUD to be a potential predictive factor for grade 2+ late rectal bleeding after combined therapy for prostate cancer.

Shiraishi, Yutaka, E-mail: shiraishi@rad.med.keio.ac.jp [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Hanada, Takashi; Ohashi, Toshio [Department of Radiology, Keio University School of Medicine, Tokyo (Japan); Yorozu, Atsunori; Toya, Kazuhito [Department of Radiology, National Hospital Organization Tokyo Medical Center, Tokyo (Japan); Saito, Shiro [Department of Urology, National Hospital Organization Tokyo Medical Center, Tokyo (Japan); Shigematsu, Naoyuki [Department of Radiology, Keio University School of Medicine, Tokyo (Japan)

2013-09-01

7

Outcomes Following Iodine-125 Monotherapy for Localized Prostate Cancer: The Results of Leeds 10-Year Single-Center Brachytherapy Experience  

SciTech Connect

Purpose: This study reports the 10-year experience of permanent brachytherapy monotherapy at a single UK center. Methods and Materials: Between March 1995 and September 2004, 1,298 patients underwent trans-rectal ultrasound (TRUS) planned transperineal brachytherapy delivering 145 Gy using I-125. No patient received supplemental external beam; 44.2% received neoadjuvant hormones. In 688, CT postimplant dosimetry was available. Outcome data were analyzed in terms of overall survival (OS), disease specific survival (DSS), and PSA relapse-free survival (PSA-RFS). Results: The mean age was 62.9 (range, 34-83) years. Median follow-up was 4.9 years (range, 2.03-11.7 years). OS and DSS were 85% and 95%, respectively, at 10 years. Twenty-one patients died from prostate cancer (1.6%) and 34 (2.5%) from unrelated causes. Seventy-four (5.7%) developed evidence of clinical failure. Overall PSA-RFS was 79.9% and 72.1% at 10 years (American Society for Therapeutic Radiology and Oncology [ASTRO] and Nadir+2 definitions, respectively). Higher presenting PSA or Gleason score and use of neoadjuvant hormones were associated with an increased risk of biochemical failure (p <0.01). Biochemical control was achieved in 86.4%, 76.7%, and 60.6% (ASTRO) and 72.3%, 73.5%, and 57.6% (Nadir+2) of patients in low-, intermediate-, and high-risk groups, respectively. Biochemical control was achieved in 88% of patients with D{sub 90} >=140 Gy and in 78% of patients with D{sub 90} <140 Gy (p <0.01). Conclusions: I-125 brachytherapy alone achieved excellent rates of medium-term biochemical control in both low- and selected intermediate-risk localized prostate cancer patients. Postimplant dosimetry improved with experience and longer follow-up, confirming the relationship of D{sub 90} with biochemical control.

Henry, Ann M., E-mail: Ann.Henry@leedsth.nhs.u [Department of Clinical Oncology, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom); Al-Qaisieh, Bashar [Department of Medical Physics, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom); Gould, Kathy [Department of Clinical Oncology, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom); Bownes, Peter [Department of Medical Physics, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom); Smith, Jonathan; Carey, Brendan [Department of Clinical Radiology, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom); Bottomley, David; Ash, Dan [Department of Clinical Oncology, St. James's Institute of Oncology, St. James's University Hospital, Leeds (United Kingdom)

2010-01-15

8

Biochemical Disease-Free Rate and Toxicity for Men Treated With Iodine-125 Prostate Brachytherapy With D{sub 90} {>=}180 Gy  

SciTech Connect

Purpose: Iodine-125 ({sup 125}I) prostate brachytherapy is planned with a prescribed dose of 145 Gy and minimal dose received by 90% of the prostate (D{sub 90}) of 120-125% (174-181 Gy). We examined the clinical outcomes and toxicity profile of men receiving a D{sub 90} (isodose enclosing 90% of the prostate) of {>=}180 Gy. Methods and Materials: Between March 1999 and May 2006, 129 men (17% of our total brachytherapy population) treated with {sup 125}I monotherapy for Stage T1-T2 prostate cancer received a D{sub 90} {>=}180 Gy. Implants were performed using transrectal ultrasonography and fluoroscopic guidance. The 1-month postplan dosimetry used magnetic resonance imaging-computed tomography fusion. The minimal follow-up was 2 years. Toxicity was scored according to the National Cancer Institute Common Terminology Criteria for Adverse Events toxicity scale, version 3. Results: The median patient age was 63 years (range, 50-76), and the pretreatment prostate-specific antigen level was 5.5 ng/mL (range, 0.6-13.5). The Gleason score was {<=}6 in 125 patients and was 7 in 4 patients. The median follow-up period was 40 months (range, 24-111), and the median D{sub 90} was 186 Gy. The median minimal dose received by 30% of the urethra was 203 Gy, and the median rectal volume receiving a minimum of 100% of the prescribed dose was 0.81 cm{sup 3}. Acute Grade 2 genitourinary toxicity was seen in 5.4% and late Grade 2 in 7%. Late urinary retention (Grade 3) was seen in 2 patients (1.5%). Grade 1 rectal bleeding occurred in 9.3% and Grade 2 in 2.3%. On univariate logistic regression analysis, none of the clinical and dosimetric parameters predicted for rectal bleeding. Of 110 men who were potent before treatment, 81% remained potent 5 years after treatment. Three biochemical failures and only one local failure developed. The 5-year biochemical no evidence of disease rate using the 'nadir plus 2' definition was 96.8%. Conclusion: A D{sub 90} of {>=}180 Gy is associated with excellent biochemical disease-free survival and acceptable toxicity.

Gomez-Iturriaga Pina, Alfonso [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Crook, Juanita, E-mail: jcrook@bccancer.bc.c [Department of Radiation Oncology, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Borg, Jette [Department of Radiation Physics, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada); Ma, Clement [Department of Biostatistics, Princess Margaret Hospital, University Health Network, Toronto, ON (Canada)

2010-10-01

9

Iodine-125 brachytherapy for brain tumours - a review  

PubMed Central

Iodine-125 brachytherapy has been applied to brain tumours since 1979. Even though the physical and biological characteristics make these implants particularly attractive for minimal invasive treatment, the place for stereotactic brachytherapy is still poorly defined. An extensive review of the literature has been performed, especially concerning indications, results and complications. Iodine-125 seeds have been implanted in astrocytomas I-III, glioblastomas, metastases and several other tumour entities. Outcome data given in the literature are summarized. Complications are rare in carefully selected patients. All in all, for highly selected patients with newly diagnosed or recurrent primary or metastatic tumours, this method provides encouraging survival rates with relatively low complication rates and a good quality of life. PMID:22394548

2012-01-01

10

Iodine 125 interstitial irradiation for localized prostate cancer.  

PubMed Central

We present the technique, complications, and 5-year results of transperineal percutaneous template permanent interstitial iodine 125 endocurietherapy of localized prostate cancer in 85 treated patients. The 5-year outcome appears similar to that of external beam radiation therapy or radical surgery, but the iatrogenic mortality, morbidity, treatment time, and hospitalization are significantly reduced. Images Figure 1 Figure 2 Figure 3 PMID:2319613

Kumar, P. P.; Good, R. R.; Bartone, F. F.

1990-01-01

11

Post implant dosimetric analysis for prostate brachytherapy.  

E-print Network

??[Truncated abstract] Purpose: Permanent prostate brachytherapy (PPB) as a treatment option for prostate cancer requires implantation of 80-150 radioactive iodine-125 (I-125) "seeds" into the prostate.… (more)

Haworth, Annette

2005-01-01

12

Correlation Between Pre- and Postimplant Dosimetry for Iodine-125 Seed Implants for Localized Prostate Cancer  

SciTech Connect

Purpose: In order to evaluate implant quality for permanent prostate brachytherapy in patients with localized prostate cancer, American Brachytherapy Society and ESTRO guidelines recommend that postimplant dosimetry should be performed. To understand more about the relationship between pre- and postimplant dosimetry, a comparison was made of patients who received iodine-125 ({sup 125}I) brachytherapy between March 1995 and the end of 2004, using a preplan technique. Methods and Materials: CT postimplant dosimetry was available for 707 patients. Detailed dose volume analysis was performed using both preimplant ultrasound and postimplant CT data sets for a subgroup of 445 patients. The following parameters were compared: prostate volume covered by 100% of the prescription dose (Vp100), Vp150, and Vp200 and dose to 90% (D90) of the prostate. In addition, volume implanted (Vi) parameters were used to compare pre- and postimplant dosimetry. Vi parameters describe dose levels inside the patient, based on number of seeds, seed activity, and their spatial distribution relative to each other, without reference to the actual prostate volume or position. Results: The mean {+-} standard deviation values of preimplant (34.7 {+-} 8.9 cm{sup 3}) and postimplant (36.7 {+-} 9.4 cm{sup 3}) prostate volumes were similar. The mean ({+-}standard deviation) planned D90 was 183.4 ({+-}12.1) Gy while the D90 that was achieved was 145.5 ({+-}20.4) Gy. Over the study period, there was a steady increase of the average D90. Postimplant CT D90 and Vp100 values correlated significantly (R = 0.84; p < 0.001). The Vi and Vp parameters all showed a strong correlation. Conclusions: In this study, we showed that there is a strong correlation between transrectal ultrasound-based preimplant and CT-based postimplant dosimetry. The excellent correlation between prostate D90 and V100 values demonstrates they are both equally valid quality indices. Vi parameters are an additional measure that can be used to assess the quality of the implant.

Al-Qaisieh, Bashar [Department of Medical Physics and Engineering, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom); Witteveen, Thelma [Department of Oncology, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom)], E-mail: Bashar@medphysics.leeds.ac.uk; Carey, Brendan [Department of Radiology, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom); Henry, Ann; Bottomley, David [Department of Oncology, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom); Smith, Jonathan; Franks, Kevin [Department of Radiology, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom); Bownes, Peter [Department of Medical Physics and Engineering, St James's Institute of Oncology, Leeds LS9 7TF (United Kingdom)

2009-10-01

13

Iodine seed prostate brachytherapy: an alternative first-line choice for early prostate cancer  

Microsoft Academic Search

This article on permanent iodine-125 seed prostate brachytherapy reviews the techniques, results, and patient selection issues for early prostate cancer. The long-term 10 y results of brachytherapy from Seattle, and their reproducibility in other centres both in the USA and UK are reported. The use of hormone therapy in brachytherapy and the value of combining external beam radiotherapy with a

S E M Langley; R W Laing; SEM Langley

2004-01-01

14

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

15

Factor Analysis of the Expanded Prostate Cancer Index Composite in a Patient Group after Primary (External Beam Radiotherapy and Permanent Iodine125 Brachytherapy) and Postoperative Radiotherapy for Prostate Cancer  

Microsoft Academic Search

Background: The Expanded Prostate Cancer Index Composite questionnaire is widely used as a comprehensive assessment of health-related quality of life issues in prostate cancer management, distinguishing urinary, bowel, sexual, hormonal domains. The primary purpose of this study was to assess the factor structure of this questionnaire. Patients and Methods: A principal component analysis with orthogonal (varimax) rotation was conducted on

Eftychia Volz-Sidiropoulou; Michael Pinkawa; Karin Fischedick; Gerhard Jakse; Siegfried Gauggel; Michael J. Eble

2008-01-01

16

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

PubMed

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. PMID:23050115

Niu, Lizhi; Zhou, Liang; Xu, Kecheng; Mu, Feng

2012-10-01

17

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. PMID:23050115

Zhou, Liang; Xu, Kecheng; Mu, Feng

2012-01-01

18

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

PubMed

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. PMID:25083464

Xu, Kecheng; Niu, Lizhi; Mu, Feng; Hu, Yize

2013-05-01

19

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. PMID:25083464

Xu, Kecheng; Mu, Feng; Hu, Yize

2013-01-01

20

[Which modality for prostate brachytherapy?].  

PubMed

Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20 years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. For both techniques, several topics still need to be clarified dealing with a recent enlargement of indications (HDR alone for low-risk, iodine-125 seeds boost for intermediate-high-risk cancers), or with technical aspects (loose seeds versus linked ones, number of fractions and dose for HDR protocols), while dosimetric issues have only recently been addressed by cooperatives groups. Last but not least, there is a real need to address and clearly characterize the correct definition of biochemical disease control both for iodine permanent implant and for HDR implant. New challenges are facing the prostate-brachytherapy community in the near future: local relapse after external beam radiotherapy are currently managed by several salvage treatments (prostatectomy, cryo, high intensity focused ultrasounds [HIFU]) but the role of reirradiation by brachytherapy is also actively investigated. Focal therapy has gained considerable interest in the last 5 years aiming at treating only the area of cancer foci inside the prostate and preserving nearby healthy tissues. Encouraging results have been obtained with the so-called "minimally invasive" approaches and both permanent seed implantation and HDR brachytherapy techniques may be worthwhile testing in this setting because of their capability of exactly sculpting the dose inside the prostatic gland. PMID:20724190

Bossi, A

2010-10-01

21

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

22

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

PubMed

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. PMID:2803104

Mieler, W F; Jaffe, G J; Steeves, R A

1989-10-01

23

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

24

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

25

Original Articles: Prostate Cancer: Detailed Preliminary Analysis of Iodine125 Implantation for Localized Prostate Cancer Using Percutaneous Approach  

Microsoft Academic Search

Recent developments have permitted accurate seed placement and dosimetry for interstitial brachytherapy of selected patients with localized prostate cancer. We present our experience with 76 patients divided into 2 groups. Group 1 included 45 patients with smaller, more well differentiated tumors, usually less than 2 cm. in diameter on digital rectal examination or transrectal ultrasound and a Gleason score of

Keith W. Kaye; Douglas J. Olson; J. Thomas. Payne

1995-01-01

26

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, ...

27

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

28

Phase I Trial of Gross Total Resection, Permanent Iodine-125 Brachytherapy, and Hyperfractionated Radiotherapy for Newly Diagnosed Glioblastoma Multiforme  

SciTech Connect

Purpose: To evaluate the feasibility of gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy for patients with newly diagnosed glioblastoma. Methods and Materials: From April 1999 to May 2002, 21 patients with glioblastoma multiforme were enrolled on a Phase I protocol investigating planned gross total resection and immediate placement of permanent I-125 seeds, followed by postoperative hyperfractionated radiotherapy to a dose of 60 Gy at 100 cGy b.i.d., 5 days per week. Median age and Karnofsky performance status were 50 years (range, 32-65 years) and 90 (range, 70-100), respectively. Toxicity was assessed according to Radiation Therapy Oncology Group criteria. Results: Eighteen patients completed treatment according to protocol. The median preoperative tumor volume on magnetic resonance imaging was 18.6 cm{sup 3} (range, 4.4-41.2 cm{sup 3}). The median brachytherapy dose measured 5 mm radially outward from the resection cavity was 400 Gy (range, 200-600 Gy). Ten patients underwent 12 reoperations, with 11 of 12 reoperations demonstrating necrosis without evidence of tumor. Because of high toxicity, the study was terminated early. Median progression-free survival and overall survival were 57 and 114 weeks, respectively, but not significantly improved compared with historical patients treated at University of California, San Francisco, with gross total resection and radiotherapy without brachytherapy. Conclusions: Treatment with gross total resection and permanent I-125 brachytherapy followed by hyperfractionated radiotherapy as performed in this study results in high toxicity and reoperation rates, without demonstrated improvement in survival.

Chen, Allen M. [Department of Radiation Oncology, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Chang, Susan [Department of Neurological Surgery, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Pouliot, Jean; Sneed, Penny K. [Department of Radiation Oncology, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Prados, Michael D.; Lamborn, Kathleen R.; Malec, Mary K. [Department of Neurological Surgery, University of California, San Francisco School of Medicine, San Francisco, CA (United States); McDermott, Michael W. [Department of Radiation Oncology, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Department of Neurological Surgery, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Berger, Mitchell S. [Department of Neurological Surgery, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Larson, David A. [Department of Radiation Oncology, University of California, San Francisco School of Medicine, San Francisco, CA (United States); Department of Neurological Surgery, University of California, San Francisco School of Medicine, San Francisco, CA (United States)], E-mail: larson@radonc17.ucsf.edu

2007-11-01

29

Localized prostate cancer: brachytherapy  

Microsoft Academic Search

Opinion statement  Brachytherapy is a treatment for localized prostate cancer that has become popular with physicians and patients. The use and\\u000a convenience of transrectal ultrasound and transperineal placement of the sources make contemporary forms of this procedure\\u000a more accurate and more patient-friendly than their predecessors. In addition, the early detection of cancer by the use of\\u000a prostate-specific antigen (PSA) makes contemporary

Anthony L. Zietman

2002-01-01

30

Robotic brachytherapy of the prostate.  

PubMed

Recent applications of robotics in the field of prostate brachytherapy are seeding the future and could potentially lead to a fully automated prostate brachytherapy surgery. Currently, a typical prostate brachytherapy surgery involves the implantation of upwards of 100 radioactive I-125 seeds by a surgeon. This review supplies background information on prostate biology, brachytherapy of the prostate, robotic brachytherapy, and transrectal ultrasound. Subsequently, it examines the physics involved in ultrasound, radiation from an I-125 source, dosimetry, and robotics. A current semi-automated robotic brachytherapy system is examined in detail and a discussion on future improvements is outlined. Finally, future work to improve prostate brachytherapy is postulated, most notably, phantom optimization using polyvinyl alcohol cryogel. The future of robotic brachytherapy lies in the advent of more sophisticated robotics. This review will give the reader a superior understanding of brachytherapy and its recent robotic advancements. Hopefully, this review will generate new ideas needed to advance prostate brachytherapy procedures leading to more accurate dosimetry, faster procedure time, less ionizing radiation received by surgery staff, more rapid patient recovery, and an overall safer procedure. PMID:20201771

Wilson, Kyle J

2009-01-01

31

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  

SciTech Connect

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 (Na{sub 2}S{sub 2}O{sub 3}{center_dot}5H{sub 2}O) 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.

Chen Qinsheng; Russell, John L. Jr.; Macklis, Roger R.; Weinhous, Martin S.; Blair, Henry F. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, Ohio 44195 (United States)

2006-07-15

32

Prostate brachytherapy under local anesthesia  

Microsoft Academic Search

Purpose: Local anesthesia for prostate brachytherapy was instituted at the Puget Sound Veterans Hospital in 1999, peforming the procedure in our own department without anesthesia personnel in attendance. Materials and Methods: The patient is brought into the simulator suite in the radiation oncology department, an i.v. line is started, a cardiac monitor attached, and a urinary catheter is inserted. He

Kent Wallner

2002-01-01

33

Brachytherapy for advanced prostate cancer bleeding  

Microsoft Academic Search

Advanced prostate cancer patients frequently deal with intractable prostatic bleeding which is a difficult problem to manage. Intraurethral high-dose rate (HDR) brachytherapy may palliate this condition. Advanced prostate cancer patients with intractable prostatic bleeding were offered brachytherapy with Iridium-192 using a Micro-selectron HDR machine. During a 5-year period, analysis was performed in 23 patients with a median age and Gleason

R Thurairaja; R Pocock; M Crundwell; M Stott; C Rowlands; R Srinivasan; D Sheehan

2008-01-01

34

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients  

SciTech Connect

Purpose: To report outcomes for 1,111 men treated with iodine-125 brachytherapy (BT) at a single institution. Methods and Materials: A total of 1,111 men (median age, 63) were treated with iodine-125 prostate BT for low- or intermediate-risk prostate cancer between March 1999 and November 2008. Median prostate-specific antigen (PSA) level was 5.4 ng/ml (range, 0.9-26.1). T stage was T1c in 66% and T2 in 34% of patients. Gleason score was 6 in 90.1% and 7 or 8 in 9.9% of patients. Neoadjuvant hormonal therapy (2-6 months course) was used in 10.1% of patients and combined external radiotherapy (45 Gy) with BT (110 Gy) in 4.1% (n = 46) of patients. Univariate and multivariate Cox proportional hazards were used to determine predictors of failure. Results: Median follow-up was 42 months (range, 6-114), but for biochemical freedom from relapse, a minimum PSA test follow-up of 30 months was required (median 54; n = 776). There were 27 failures, yielding an actuarial 7-year disease-free survival rate of 95.2% (96 at risk beyond 84 months). All failures underwent repeat 12-core transrectal ultrasound -guided biopsies, confirming 8 local failures. On multivariate analysis, Gleason score was the only independent predictor of failure (p = 0.001; hazard ratio, 4.8 (1.9-12.4). Median International Prostate Symptom score from 12 to 108 months ranged between 3 and 9. Of the men reporting baseline potency, 82.8% retained satisfactory erectile function beyond 5 years. Conclusion: Iodine-125 prostate BT is a highly effective treatment option for favorable- and intermediate-risk prostate cancer and is associated with maintenance of good urinary and erectile functions.

Crook, Juanita, E-mail: jcrook@bccancer.bc.ca [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario (Canada); Borg, Jette [Department of Radiation Physics, Princess Margaret Hospital, Toronto, Ontario (Canada); Evans, Andrew [Department of Pathology, Princess Margaret Hospital, Toronto, Ontario (Canada); Toi, Ants [Department of Radiology, Princess Margaret Hospital, Toronto, Ontario (Canada); Saibishkumar, E.P. [Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario (Canada); Fung, Sharon; Ma, Clement [Department of Biostatistics, Princess Margaret Hospital, Toronto, Ontario (Canada)

2011-08-01

35

Segmental Urethral Dosimetry and Urinary Toxicity in Patients With No Urinary Symptoms Before Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To determine whether segmental urethral dosimetry is predictive for the degree of urinary morbidity after prostate brachytherapy in patients with no urinary symptoms before prostate brachytherapy. Methods and Materials: Between May 2000 and November 2005, 1,107 patients underwent iodine-125 monotherapy with urethral sparing techniques. A total of 166 patients fulfilled the selection criteria: baseline (International Prostate Symptom Score) IPSS {<=}5, no androgen deprivation therapy, and prostate ultrasound planning volumes (PUTV) <45 mL. The median follow-up was 44 months. Urinary morbidity was defined by maximum increase in IPSS, time to IPSS resolution, maximum Radiation Therapy Oncology Group (RTOG) score, time to RTOG resolution, and urinary retention. Surrogate deviated urethra was contoured and doses calculated at the base, mid-prostate, apex, and urogenital diaphragm. Univariate and multivariate analysis was used to evaluate urethral and prostate dosimetry, age, PUTV, and number of needles for their association with urinary morbidity. Results: Urethral dose was fairly constant in all urethra segments except prostate base, where the variation in does was large. On multivariate analysis, higher urethral base D50, V100, and larger PUTV were predictive for higher maximum increase in IPSS. Higher urethral base V100 and larger PUTV predicted for prolonged IPSS resolution. Higher urethral base D50 and larger needle number predicted for longer RTOG resolution. Higher urethral base V100 predicted for RTOG {>=}2 toxicity. Conclusions: Radiation dose to the urethral base, larger PUTV, and needle number, predicted for increased urinary toxicity after prostate brachytherapy. Correlation between urinary morbidity and urethral base dosimetry may reflect a large variation in urethral dose observed at the prostate base.

Thomas, Carys [Department of Radiation Oncology, Vancouver Cancer Centre, Vancouver, BC (Canada); Keyes, Mira [Department of Radiation Oncology, Vancouver Cancer Centre, Vancouver, BC (Canada)], E-mail: mkeyes@bccancer.bc.ca; Liu, Mitchell [Radiation Oncology, Fraser Valley Cancer Centre, Surrey, BC (Canada); Moravan, Veronika [Surveillance and Outcomes Unit, British Columbia Cancer Agency, Vancouver, BC (Canada)

2008-10-01

36

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

37

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

38

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

SciTech Connect

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 achieved consistently 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; R{sup 2} = 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 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., E-mail: rkudchad@mdanderson.org [Department of Radiation Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Pugh, Thomas J. [Department of Radiation Oncology, 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); Bruno, Teresa L.; Bolukbasi, Yasemin; Frank, Steven J. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)

2012-01-01

39

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

PubMed

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 achieved consistently 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; R(2) = 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 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. PMID:22560295

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

2012-01-01

40

Transperineal Permanent Brachytherapy of Localised Prostate Cancer  

Microsoft Academic Search

Context: In absence of prospective randomized trials determining the optimal management of localized prostate cancer remains undefined. Objective: To develop and disseminate an update on outcome of different treatment modalities, recommendations and guidelines of transperineal prostate brachytherapy. Evidence acquisition: In the past decade, the average number of bra- chytherapy patients per centre has increased by at least 10%. Bra- chytherapy

Nader Naderi; Jelmer van Beek

41

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

42

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

E-print Network

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results. Christophe Reynier, Jocelyne 217, F-38043 Grenoble cedex 09, France (Received Prostate brachytherapy involves implanting radioactive seeds (I125 for instance) permanently in the gland for the treatment of localized prostate cancers

Paris-Sud XI, Université de

43

Salvage low-dose-rate 125I partial prostate brachytherapy after dose-escalated external beam radiotherapy  

PubMed Central

Purpose To report outcomes on 5 patients treated with salvage partial low-dose-rate (LDR) 125-iodine (125I) permanent prostate seed brachytherapy (BT) for biopsy-proven locally persistent prostate cancer, following failure of dose-escalated external beam radiotherapy (EBRT). Material and methods A retrospective review of the Fox Chase Cancer Center prostate cancer database identified five patients treated with salvage partial LDR 125I seed implant for locally persistent disease following dose-escalated EBRT to 76-84 Gy in 2 Gy per fraction equivalent. All patients had post-EBRT biopsies confirming unilateral locally persistent prostate cancer. Pre-treatment, EBRT and BT details, as well as post-treatment characteristics were documented and assessed. Results The median follow-up post-implant was 41 months. All five patients exhibited low acute genitourinary and gastrointestinal toxicities. Increased erectile dysfunction was noted in three patients. There were no biochemical failures following salvage LDR 125I seed BT to date, with a median post-salvage PSA of 0.4 ng/mL. Conclusions In carefully selected patients with local persistence of disease, partial LDR 125I permanent prostate seed implant appears to be a feasible option for salvage local therapy with an acceptable toxicity profile. Further study is needed to determine long-term results of this approach. PMID:25337135

Chang, Lynn

2014-01-01

44

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

45

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

46

Intraoperative dosimetry analysis of prostate brachytherapy using transrectal ultrasound and x-ray fluoroscopy.  

E-print Network

??Permanent prostate brachytherapy, which is an effective treatment option for early stage prostate cancer, involves implantation of radioactive seeds into the prostate under transrectal ultrasound… (more)

Tutar, Ismail B

2007-01-01

47

Prostate Brachytherapy With Oblique Needles to Treat Large Glands and Overcome Pubic Arch Interference  

SciTech Connect

Purpose: First, to show that low-dose-rate prostate brachytherapy plans using oblique needle trajectories are more successful than parallel trajectories for large prostates with pubic arch interference (PAI); second, to test the accuracy of delivering an oblique plan by using a three-dimensional (3D) transrectal ultrasonography (TRUS)-guided mechatronic system. Methods and Materials: Prostates were contoured for 5 subjects' 3D TRUS images showing a maximum PAI of {<=}1 cm and a prostate volume of <50 cc. Two planning studies were done. First, prostate contours were artificially enlarged to 45 to 80 cc in 5- to 10-cc increments for a single subject. Second, all subject prostate contours were enlarged to 60 cc. For each study, three types of plans were manually created for comparison: a parallel needle template (PT) plan, a parallel needle no-template (PNT) plan, and an oblique needle no-template (OBL) plan. Needle positions and angles were not discretized for nontemplate plans. European Society for Therapeutic Radiology and Oncology dose-volume histogram guidelines, iodine-125 (145-Gy prescription, 0.43 U), and needle angles of <15 Degree-Sign were used. An OBL plan was delivered to a pubic arch containing a 60-cc prostate phantom that mimicked the anatomy of the subject with the greatest PAI (23% by volume). Results: In the increasing-prostate volume study, OBL plans were successful for prostates of {<=}80 cc, and PT plans were successful for prostates of <65 cc. In paired, one-sided t tests for the 60-cc volume study, OBL plans showed dosimetric improvements for all organs compared to both of the parallel type plans (p < 0.05); PNT plans showed a benefit only in planning target volumes receiving more than 100 Gy compared to PT plans. A computed tomography scan of the phantom showed submillimeter seed placement accuracy in all directions. Conclusion: OBL plans were significantly better than parallel plans, and an OBL plan was accurately delivered to a 60-cc prostate phantom with 23% PAI by volume.

Ryu, Bon [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada) [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada); Bax, Jeff [Department of Biomedical Engineering, University of Western Ontario, London, Ontario (Canada) [Department of Biomedical Engineering, University of Western Ontario, London, Ontario (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada); Edirisinge, Chandima [Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada)] [Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada); Lewis, Craig; Chen, Jeff; D'Souza, David [Department of Oncology, University of Western Ontario, London, Ontario (Canada) [Department of Oncology, University of Western Ontario, London, Ontario (Canada); Radiation Treatment Program, London Regional Cancer Program, London Health Sciences Centre, London, Ontario (Canada); Fenster, Aaron [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada) [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Biomedical Engineering, University of Western Ontario, London, Ontario (Canada); Imaging Research Laboratories, Robarts Research Institute, University of Western Ontario, London, Ontario (Canada); Department of Oncology, University of Western Ontario, London, Ontario (Canada); Wong, Eugene, E-mail: ewong4@uwo.ca [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada) [Department of Physics and Astronomy, University of Western Ontario, London, Ontario (Canada); Department of Medical Biophysics, University of Western Ontario, London, Ontario (Canada); Department of Oncology, University of Western Ontario, London, Ontario (Canada)

2012-08-01

48

Therapeutic implications of iodine-125 cytotoxicity  

SciTech Connect

The biological consequences of differential subcellular radionuclide accumulation within nuclear structures have important implications for the design and development of new therapeutic agents for cancer management. A growing body of experimental data demonstrates that localization of /sup 125/I within the genome results in marked cytotoxicity. Investigations of iodine-125 labeled iododeoxyuridine, DNA intercalators and tamoxifen are reviewed as representative of this new group of potential radiotherapeutic agents.

Bloomer, W.D.; McLaughlin, W.H.; Adelstein, S.J.

1982-11-01

49

Therapeutic implications of iodine-125 cytotoxicity  

SciTech Connect

The biological consequences of differential subcellular radionuclide accumulation within nuclear stuctures have important implications for the design and development of new therapeutic agents for cancer management. A growing body of experimental data demonstrates that localization of /sup 125/I within the genome results in marked cytotoxicity. Investigations of iodine-125 labeled iododeoxyuridine, DNA intercalators and tamoxifen are reviewed as representative of this new group of potential radiotherapeutic agents.

Bloomer, W.D.; McLaughlin, W.H.; Adelstein, S.J.

1982-11-01

50

A Novel MRI Marker for Prostate Brachytherapy  

SciTech Connect

Purpose: Magnetic resonance imaging (MRI) is the optimal imaging modality for the prostate and surrounding critical organ structures. However, on MRI, the titanium radioactive seeds used for brachytherapy appear as black holes (negative contrast) and cannot be accurately localized. We sought to develop an encapsulated contrast agent marker (ECAM) with high-signal intensity on MRI to permit accurate localization of radioactive seeds with MRI during and after prostate brachytherapy. Methods and Materials: We investigated several agents with paramagnetic and superparamagnetic properties. The agents were injected into titanium, acrylic, and glass seeds, which were linked together in various combinations and imaged with MRI. The agent with the greatest T1-weighted signal was tested further in a canine prostate and agarose phantom. Studies were performed on a 1.5-T clinical MRI scanner. Results: The cobalt-chloride complex contrast (C4) agent with stoichiometry (CoCl{sub 2}){sub 0.8}(C{sub 2}H{sub 5}NO{sub 2}){sub 0.2} had the greatest T1-weighted signal (positive contrast) with a relaxivity ratio >1 (r{sub 2}/r{sub 1} = 1.21 {+-} 0.29). Acrylic-titanium and glass-titanium seed strands were clearly visualized with the encapsulated contrast agent marker. Conclusion: We have developed a novel ECAM that permits positive identification of the radioactive seeds used for prostate brachytherapy on MRI. Preclinical in vitro phantom studies and in vivo canine studies are needed to further optimize MRI sequencing techniques to facilitate MRI-based dosimetry.

Frank, Steven J. [Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)], E-mail: sjfrank@mdanderson.org; Stafford, R. Jason; Bankson, James A. [Department of Imaging Physics, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States); Li Chun [Department of Experimental Diagnostic Imaging, 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); 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)

2008-05-01

51

Fast dose kernel interpolation using Fourier transform with application to permanent prostate brachytherapy dosimetry  

SciTech Connect

Purpose: Boyer and Mok proposed a fast calculation method employing the Fourier transform (FT), for which calculation time is independent of the number of seeds but seed placement is restricted to calculation grid points. Here an interpolation method is described enabling unrestricted seed placement while preserving the computational efficiency of the original method. Methods: The Iodine-125 seed dose kernel was sampled and selected values were modified to optimize interpolation accuracy for clinically relevant doses. For each seed, the kernel was shifted to the nearest grid point via convolution with a unit impulse, implemented in the Fourier domain. The remaining fractional shift was performed using a piecewise third-order Lagrange filter. Results: Implementation of the interpolation method greatly improved FT-based dose calculation accuracy. The dose distribution was accurate to within 2% beyond 3 mm from each seed. Isodose contours were indistinguishable from explicit TG-43 calculation. Dose-volume metric errors were negligible. Computation time for the FT interpolation method was essentially the same as Boyer's method. Conclusions: A FT interpolation method for permanent prostate brachytherapy TG-43 dose calculation was developed which expands upon Boyer's original method and enables unrestricted seed placement. The proposed method substantially improves the clinically relevant dose accuracy with negligible additional computation cost, preserving the efficiency of the original method.

Liu, Derek, E-mail: dmliu@ualberta.ca; Sloboda, Ron S. [Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada and Department of Oncology, University of Alberta, Edmonton, Alberta T6G 2R3 (Canada)] [Department of Medical Physics, Cross Cancer Institute, Edmonton, Alberta T6G 1Z2, Canada and Department of Oncology, University of Alberta, Edmonton, Alberta T6G 2R3 (Canada)

2014-05-15

52

A dynamic dosimetry system for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

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

2013-03-01

53

Haptic System Design for MRI-Guided Needle Based Prostate Brachytherapy  

E-print Network

Feedback, Needle Driver, Prostate Needle Brachytherapy. 1 INTRODUCTION Prostate cancer is the most common biopsies are performed, yielding about 220,000 new prostate cancer cases [14]. Over 40,000 brachytherapiesHaptic System Design for MRI-Guided Needle Based Prostate Brachytherapy Hao Su Weijian Shang

Camesano, Terri

54

Improved seed-based MR and CT image registration for prostate brachytherapy  

E-print Network

Prostate cancer's high incidence and high survivability motivate its treatment using tightly focused radiation therapy. Brachytherapy treatment, the implantation of radioactive seeds into the prostate, is increasing in ...

Kim, Elizabeth S. (Elizabeth Seon-wha), 1979-

2004-01-01

55

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

56

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

Microsoft Academic Search

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.

Jason A. Efstathiou; Rafi Y. Skowronski; John J. Coen; Joseph A. Grocela; Ariel E. Hirsch; Anthony L. Zietman

2008-01-01

57

Factors influencing outcome of I-125 prostate cancer brachytherapy  

Microsoft Academic Search

Brachytherapy is becoming an increasingly popular prostate cancer treatment, probably due to the specific advantages of the procedure, such as the minimal invasiveness and the lower chance of impotence and incontinence. Nonetheless, because of the long follow-up that is required to obtain prostate cancer related results, only recently a sufficient body of evidence has started to emerge to assess the

K. A. Hinnen

2011-01-01

58

[Salvage 125I brachytherapy of locally recurrent prostate cancer].  

PubMed

The purpose of the study is to report a case of salvage low dose rate (LDR) prostate brachytherapy in a patient with locally recurrent prostate cancer, four years after his first treatment with combined external beam radiation therapy (EBRT) and high dose rate (HDR) brachytherapy. A 61-year-old man was treated with 1x10 Gy HDR brachytherapy and a total of 60 Gy EBRT for an organ confined intermediate risk carcinoma of the prostate in 2009. The patient's tumor had been in regression with the lowest PSA level of 0.09 ng/ml, till the end of 2013. After slow but continuous elevation, his PSA level had reached 1.46 ng/ml by February 2014. Pelvis MRI and whole body acetate PET/CT showed recurrent tumor in the dorsal-right region of the prostate. Bone scan was negative. After discussing the possible salvage treatment options with the patient, he chose LDR brachytherapy. In 2014, in spinal anesthesia 21 125I "seeds" were implanted with transrectal ultrasound guidance into the prostate. The prescribed dose to the whole prostate was 100 Gy, to the volume of the recurrent tumor was 140 Gy. The patient tolerated the salvage brachytherapy well. The postimplant dosimetry was evaluated using magnetic resonance imaging-computed tomography (MR-CT) fusion and appeared satisfactory. PSA level decreased from the pre-salvage value of 1.46 ng/ml to 0.42 ng/ml by one month and 0.18 ng/ml by two months after the brachytherapy. No gastrointestinal side effects appeared, the patient's urination became slightly more frequent. In selected patients, salvage LDR brachytherapy can be a good choice for curative treatment of locally recurrent prostate cancer, after primary radiation therapy. Multiparametric MRI is fundamental, acetate PET/CT can play an important role when defining the localization of the recurrent tumor. PMID:25260087

Gesztesi, László; Agoston, Péter; Major, Tibor; Gõdény, Mária; Andi, Judit; Lengyel, Zsolt; Polgár, Csaba

2014-09-01

59

Predictive factors of urinary retention following prostate brachytherapy  

Microsoft Academic Search

Purpose: To evaluate the incidence and duration of urinary retention requiring catheterization and the factors predictive for these end points.Methods and Materials: Two hundred eighty-two patients treated with prostate brachytherapy alone were evaluated. Clinical and treatment-related factors examined included: age, baseline International Prostate Symptom Score (IPSS), presence of comorbidity, planning ultrasound target volume (PUTV), postimplant prostate CT scan volume, the

Joseph Bucci; W. James Morris; Mira Keyes; Ingrid Spadinger; Sabeena Sidhu; Veronika Moravan

2002-01-01

60

Interstitial rotating shield brachytherapy for prostate cancer  

SciTech Connect

Purpose: To present a novel needle, catheter, and radiation source system for interstitial rotating shield brachytherapy (I-RSBT) of the prostate. I-RSBT is a promising technique for reducing urethra, rectum, and bladder dose relative to conventional interstitial high-dose-rate brachytherapy (HDR-BT). Methods: A wire-mounted 62 GBq{sup 153}Gd source is proposed with an encapsulated diameter of 0.59 mm, active diameter of 0.44 mm, and active length of 10 mm. A concept model I-RSBT needle/catheter pair was constructed using concentric 50 and 75 ?m thick nickel-titanium alloy (nitinol) tubes. The needle is 16-gauge (1.651 mm) in outer diameter and the catheter contains a 535 ?m thick platinum shield. I-RSBT and conventional HDR-BT treatment plans for a prostate cancer patient were generated based on Monte Carlo dose calculations. In order to minimize urethral dose, urethral dose gradient volumes within 0–5 mm of the urethra surface were allowed to receive doses less than the prescribed dose of 100%. Results: The platinum shield reduced the dose rate on the shielded side of the source at 1 cm off-axis to 6.4% of the dose rate on the unshielded side. For the case considered, for the same minimum dose to the hottest 98% of the clinical target volume (D{sub 98%}), I-RSBT reduced urethral D{sub 0.1cc} below that of conventional HDR-BT by 29%, 33%, 38%, and 44% for urethral dose gradient volumes within 0, 1, 3, and 5 mm of the urethra surface, respectively. Percentages are expressed relative to the prescription dose of 100%. For the case considered, for the same urethral dose gradient volumes, rectum D{sub 1cc} was reduced by 7%, 6%, 6%, and 6%, respectively, and bladder D{sub 1cc} was reduced by 4%, 5%, 5%, and 6%, respectively. Treatment time to deliver 20 Gy with I-RSBT was 154 min with ten 62 GBq {sup 153}Gd sources. Conclusions: For the case considered, the proposed{sup 153}Gd-based I-RSBT system has the potential to lower the urethral dose relative to HDR-BT by 29%–44% if the clinician allows a urethral dose gradient volume of 0–5 mm around the urethra to receive a dose below the prescription. A multisource approach is necessary in order to deliver the proposed {sup 153}Gd-based I-RSBT technique in reasonable treatment times.

Adams, Quentin E., E-mail: quentin-adams@uiowa.edu; Xu, Jinghzu; Breitbach, Elizabeth K.; Li, Xing; Rockey, William R.; Kim, Yusung; Wu, Xiaodong; Flynn, Ryan T. [Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States)] [Department of Radiation Oncology, University of Iowa, 200 Hawkins Drive, Iowa City, Iowa 52242 (United States); Enger, Shirin A. [Medical Physics Unit, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4 (Canada)] [Medical Physics Unit, McGill University, 1650 Cedar Ave, Montreal, Quebec H3G 1A4 (Canada)

2014-05-15

61

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

62

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

63

Brachytherapy treatment planning algorithm applied to prostate cancer  

NASA Astrophysics Data System (ADS)

An application of Genetic Algorithms (GAs) for treatment planning optimization in prostate brachytherapy is presented. The importance of multi-objective selection criteria based on the contour of the volume of interest and radiosensitive structures such as the rectum and urethra is discussed. First results are obtained for a simple test case which presents radial symmetry.

Herrera-Rodríguez, M. R.; Martínez-Dávalos, A.

2000-10-01

64

A reappraisal of local anesthesia for prostate brachytherapy  

Microsoft Academic Search

Purpose: Faced with rapidly increasing patient numbers, the authors adopted and modified a technique to perform prostate implants under local anesthesia in a radiation oncology facility. Our reasons for assembling the current report detailing 20 consecutive, unselected patients are to show how patients tolerate brachytherapy without the use of sedatives, to provide more technical detail regarding the procedure's practical aspects,

Amy Mueller; Kent Wallner; Jacques Corriveau; Sandy Arthurs; Micah Gwinn; Steven Sutlief

2003-01-01

65

Development of a Novel Robot for Transperineal Needle-based Interventions: Focal Therapy, Brachytherapy and Prostate Biopsies.  

E-print Network

, Brachytherapy and Prostate Biopsies. Jean-Alexandre Long, MD (1,2), Nikolai Hungr, PhD (2), Michael Baumann to brachytherapy, focal therapy and transperineal prostate biopsies. Keywords: Brachytherapy, Focal Therapy, Image fusion, Motion Tracking, Prostate cancer, Robotics , prostate biopsies Acknowledgements: This work

Paris-Sud XI, Université de

66

Abstract--Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been introduced in  

E-print Network

Abstract--Magnetic Resonance Imaging (MRI) guided prostate biopsy and brachytherapy has been-guided prostate biopsy and brachytherapy. A preliminary evaluation of the robot was conducted using previously improvements in early detection and/or treatment [1]. A typical diagnosis method for prostate cancer is core

Camesano, Terri

67

Brachytherapy Anatomy-based inverse planning dose optimization in HDR prostate  

E-print Network

Brachytherapy Anatomy-based inverse planning dose optimization in HDR prostate implant: A toxicity and methods: Between September 1999 and October 2002, 44 patients with locally advanced prostate cancer (PSA R-planned HDR brachytherapy is a viable option to deliver higher dose to the prostate as a boost without

Pouliot, Jean

68

System for Prostate Brachytherapy and Biopsy in a Standard 1.5 T MRI Scanner  

E-print Network

System for Prostate Brachytherapy and Biopsy in a Standard 1.5 T MRI Scanner Robert C. Susil,1-dose-rate (HDR) prostate brachytherapy and needle biopsy in a standard 1.5 T MRI scan- ner is demonstrated. In each of eight procedures (in four pa- tients with intermediate to high risk localized prostate cancer

Atalar, Ergin

69

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

70

Brachytherapy in the therapy of prostate cancer – an interesting choice  

PubMed Central

Brachytherapy is a curative alternative to radical prostatectomy or external beam radiation [i.e. 3D conformal external beam radiation therapy (CRT), intensity-modulated radiation therapy (IMRT)] with comparable long-term survival and biochemical control and the most favorable toxicity. HDR brachytherapy (HDR-BT) in treatment of prostate cancer is most frequently used together with external beam radiation therapy (EBRT) as a boost (increasing the treatment dose precisely to the tumor). In the early stages of the disease (low, sometimes intermediate risk group), HDR-BT is more often used as monotherapy. There are no significant differences in treatment results (overall survival rate – OS, local recurrence rate – LC) between radical prostatectomy, EBRT and HDR-BT. Low-dose-rate brachytherapy (LDR-BT) is a radiation method that has been known for several years in treatment of localized prostate cancer. The LDR-BT is applied as a monotherapy and also used along with EBRT as a boost. It is used as a sole radical treatment modality, but not as a palliative treatment. The use of brachytherapy as monotherapy in treatment of prostate cancer enables many patients to keep their sexual functions in order and causes a lower rate of urinary incontinence. Due to progress in medical and technical knowledge in brachytherapy (“real-time” computer planning systems, new radioisotopes and remote afterloading systems), it has been possible to make treatment time significantly shorter in comparison with other methods. This also enables better protection of healthy organs in the pelvis. The aim of this publication is to describe both brachytherapy methods. PMID:24596528

2013-01-01

71

Urethral toxicity after LDR brachytherapy: Experience in Japan.  

PubMed

Urinary toxicity is common after low-dose-rate (LDR) brachytherapy, and the resolution of urinary toxicity is a concern. In particular, urinary frequency is the most common adverse event among the urinary toxicities. We have previously reported that approximately 70% of patients experience urinary frequency during the first 6 months after seed implantation. Most urinary adverse events were classified as Grade 1, and Grade 2 or higher adverse events were rare. The incidence of urinary retention was approximately 2-4%. A high International Prostate Symptom Score before seed implantation was an independent predictor of acute urinary toxicity of Grade 2 or higher. Several previous reports from the United States also supported this trend. In Japan, LDR brachytherapy was legally approved in 2003. A nationwide prospective cohort study entitled Japanese Prostate Cancer Outcome Study of Permanent Iodine-125 Seed Implantation was initiated in July 2005. It is an important issue to limit urinary toxicities in patients who undergo LDR brachytherapy. PMID:25455383

Tanaka, Nobumichi; Asakawa, Isao; Hasegawa, Masatoshi; Fujimoto, Kiyohide

2014-11-01

72

The current role of imaging for prostate brachytherapy.  

PubMed

Prostate brachytherapy is a radiotherapy technique for early stage prostate cancer that uses imaging guidance to place radioactive sources directly into the prostate gland. Transrectal ultrasound is used to facilitate a template-guided transperineal approach to the prostate and permits a highly conformal method of prostate radiotherapy with doses far higher than can be achieved with other radiation techniques. Maturing data has validated this technique as an acceptable treatment option with favourable and durable biochemical outcomes. The radiologist has a major role to play in the process: patient selection, guiding source delivery and follow-up after treatment all require close collaboration with colleagues in Radiation Oncology and Medical Physics. This review emphasises the specific contribution of imaging in the context of currently reported outcomes data. PMID:17339141

Carey, Brendan; Swift, Sarah

2007-01-01

73

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

74

Prostate Brachytherapy in Men {>=}75 Years of Age  

SciTech Connect

Purpose: To evaluate cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) in prostate cancer patients aged {>=}75 years undergoing brachytherapy with or without supplemental therapies. Methods and Materials: Between April 1995 and August 2004, 145 consecutive patients aged {>=}75 years underwent permanent prostate brachytherapy. Median follow-up was 5.8 years. Biochemical progression-free survival was defined by a prostate-specific antigen level {<=}0.40 ng/mL after nadir. Patients with metastatic prostate cancer or hormone-refractory disease without obvious metastases who died of any cause were classified as dead of prostate cancer. All other deaths were attributed to the immediate cause of death. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on survival. Results: Nine-year CSS, bPFS, and OS rates for the entire cohort were 99.3%, 97.1%, and 64.5%, respectively. None of the evaluated parameters predicted for CSS, whereas bPFS was most closely predicted by percentage positive biopsies. Overall survival and non-cancer deaths were best predicted by tobacco status. Thirty-seven patients have died, with 83.8% of the deaths due to cardiovascular disease (22 patients) or second malignancies (9 patients). To date, only 1 patient (0.7%) has died of metastatic prostate cancer. Conclusions: After brachytherapy, high rates of CSS and bPFS are noted in elderly prostate cancer patients. Overall, approximately 65% of patients are alive at 9 years, with survival most closely related to tobacco status. We believe our results support an aggressive locoregional approach in appropriately selected elderly patients.

Merrick, Gregory S. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)], E-mail: gmerrick@urologicresearchinstitute.org; Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Galbreath, Robert W. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States); Butler, Wayne M.; Brammer, Sarah G.; Allen, Zachariah A. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States)

2008-10-01

75

Prosper: image and robot-guided prostate brachytherapy  

E-print Network

Brachytherapy for localized prostate cancer consists in destroying cancer by introducing iodine radioactive seeds into the gland through hollow needles. The planning of the position of the seeds and their introduction into the prostate is based on intra-operative ultrasound (US) imaging. We propose to optimize the global quality of the procedure by: i) using 3D US; ii) enhancing US data with MRI registration; iii) using a specially designed needle-insertion robot, connected to the imaging data. The imaging methods have been successfully tested on patient data while the robot accuracy has been evaluated on a realistic deformable phantom.

Baumann, Michael; Daanen, Vincent; Descotes, Jean-Luc; Giraud, Jean-Yves; Hungr, Nikolai; Leroy, Antoine; Long, Jean-Alexandre; Martin, Sébastien; Troccaz, Jocelyne

2011-01-01

76

Serum Testosterone Kinetics After Brachytherapy for Clinically Localized Prostate Cancer  

SciTech Connect

Purpose: To evaluate temporal changes in testosterone after prostate brachytherapy and investigate the potential impact of these changes on response to treatment. Methods and Materials: Between January 2008 and March 2009, 221 consecutive patients underwent Pd-103 brachytherapy without androgen deprivation for clinically localized prostate cancer. Prebrachytherapy prostate-specific antigen (PSA) and serum testosterone were obtained for each patient. Repeat levels were obtained 3 months after brachytherapy and at least every 6 months thereafter. Multiple clinical, treatment, and dosimetric parameters were evaluated to determine an association with temporal testosterone changes. In addition, analysis was conducted to determine if there was an association between testosterone changes and treatment outcomes or the occurrence of a PSA spike. Results: There was no significant difference in serum testosterone over time after implant (p = 0.57). 29% of men experienced an increase {>=}25%, 23% of men experienced a decrease {>=}25%, and the remaining 48% of men had no notable change in testosterone over time. There was no difference in testosterone trends between men who received external beam radiotherapy and those who did not (p = 0.12). On multivariate analysis, preimplant testosterone was the only variable that consistently predicted for changes in testosterone over time. Men with higher than average testosterone tended to experience drop in testosterone (p < 0.001), whereas men with average or below average baseline testosterone had no significant change. There was no association between men who experienced PSA spike and testosterone temporal trends (p = 0.50) nor between initial PSA response and testosterone trends (p = 0.21). Conclusion: Prostate brachytherapy does not appear to impact serum testosterone over time. Changes in serum testosterone do not appear to be associated with PSA spike phenomena nor with initial PSA response to treatment; therefore, PSA response does not seem related to temporal testosterone changes.

Taira, Al V. [Western Radiation Oncology, Mountain View, CA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.org [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert W.; Butler, Wayne M.; Lief, Jonathan H.; Allen, Zachariah A. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation Group Health Cooperative, University of Washington, Seattle, WA (United States)

2012-01-01

77

Ejaculatory Function After Permanent {sup 125}I Prostate Brachytherapy for Localized Prostate Cancer  

SciTech Connect

Purpose: Ejaculatory function is an underreported aspect of male sexuality in men treated for prostate cancer. We conducted the first detailed analysis of ejaculatory function in patients treated with permanent {sup 125}I prostate brachytherapy for localized prostate cancer. Patients and Methods: Of 270 sexually active men with localized prostate cancer treated with permanent {sup 125}I prostate brachytherapy, 241 (89%), with a mean age of 65 years (range, 43-80), responded to a mailed questionnaire derived from the Male Sexual Health Questionnaire regarding ejaculatory function. Five aspects of ejaculatory function were examined: frequency, volume, dry ejaculation, pleasure, and pain. Results: Of the 241 sexually active men, 81.3% had conserved ejaculatory function after prostate brachytherapy; however, the number of patients with rare/absent ejaculatory function was double the pretreatment number (p < .0001). The latter finding was correlated with age (p < .001) and the preimplant International Index of Erectile Function score (p < .001). However, 84.9% of patients with maintained ejaculatory function after implantation reported a reduced volume of ejaculate compared with 26.9% before (p < .001), with dry ejaculation accounting for 18.7% of these cases. After treatment, 30.3% of the patients experienced painful ejaculation compared with 12.9% before (p = .0001), and this was associated with a greater number of implanted needles (p = .021) and the existence of painful ejaculation before implantation (p < .0001). After implantation, 10% of patients who continued to be sexually active experienced no orgasm compared with only 1% before treatment. in addition, more patients experienced late/difficult or weak orgasms (p = .001). Conclusion: Most men treated with brachytherapy have conserved ejaculatory function after prostate brachytherapy. However, most of these men experience a reduction in volume and a deterioration in orgasm.

Huyghe, Eric [Department of Urology and Andrology, University Hospital, CHU Rangueil, Toulouse (France); Department of Urology and Andrology, Paul Sabatier University, CHU Paule de Viguier, Toulouse (France)], E-mail: huyghe.e@chu-toulouse.fr; Delannes, Martine [Institut Claudius Regaud, Toulouse (France); Wagner, Fabien M. [Department of Urology and Andrology, Paul Sabatier University, CHU Paule de Viguier, Toulouse (France); Delaunay, Boris [Department of Urology and Andrology, University Hospital, CHU Rangueil, Toulouse (France); Nohra, Joe; Thoulouzan, Matthieu; Shut-Yee, J. Yeung [Department of Urology and Andrology, Paul Sabatier University, CHU Paule de Viguier, Toulouse (France); Plante, Pierre [Department of Urology and Andrology, University Hospital, CHU Rangueil, Toulouse (France); Department of Urology and Andrology, Paul Sabatier University, CHU Paule de Viguier, Toulouse (France); Soulie, Michel [Department of Urology and Andrology, University Hospital, CHU Rangueil, Toulouse (France); Thonneau, Patrick [Department of Urology and Andrology, Paul Sabatier University, CHU Paule de Viguier, Toulouse (France); Bachaud, Jean Marc [Institut Claudius Regaud, Toulouse (France)

2009-05-01

78

Prognostic Importance of Small Prostate Size in Men Receiving Definitive Prostate Brachytherapy  

SciTech Connect

Purpose: To assess whether small prostate size is an adverse prognostic factor in men undergoing brachytherapy in the same manner in which it seems to be for men undergoing radical prostatectomy. Methods and Materials: From April 1995 to June 2008, 2024 patients underwent brachytherapy by a single brachytherapist. Median follow-up was 7.4 years. The role of small prostate size ({<=}20 cm{sup 3}) as a prognostic factor for biochemical progression-free survival, cause-specific survival, and all-cause mortality was investigated. The differences in survival between men with small and larger prostates were compared using Kaplan-Meier curves and log-rank tests. Results: Median prostate size for the entire cohort was 32.7 cm{sup 3}. For the 167 men with small prostates, median prostate size was 17.4 cm{sup 3}. There was no difference in biochemical progression-free survival (95.2% vs 96.2%, P=.603), cause-specific survival (97.7% vs 98.3%, P=.546), or all-cause mortality (78.0% vs 77.2%, P=.838) at 10 years for men with small prostates compared with men with larger prostates. On univariate and multivariate analysis, small prostate size was not associated with any of the primary outcome measures. Conclusion: Men with small prostates treated with brachytherapy have excellent outcomes and are at no higher risk of treatment failure than men with larger glands. High-quality implants with adequate margins seem sufficient to address the increased adverse risk factors associated with small prostate size.

Taira, Al V. [Western Radiation Oncology, Mountain View, California (United States)] [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. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States)] [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, West Virginia (United States)] [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)] [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, Washington (United States)

2012-10-01

79

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

80

A comprehensive review of prostate cancer brachytherapy: defining an optimal technique  

Microsoft Academic Search

Purpose: A comprehensive review of prostate cancer brachytherapy literature was performed to determine if an optimal method of implantation could be identified, and to compare and contrast techniques currently in use.Methods and Materials: A MEDLINE search was conducted to obtain all articles in the English language on prostate cancer brachytherapy from 1985 through 1998. Articles were reviewed and grouped to

Frank A Vicini; Vijay R Kini; Gregory Edmundson; Gary S Gustafson; Jannifer Stromberg; Alvaro Martinez

1999-01-01

81

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

82

A Multi-Atlas-Based Segmentation Framework for Prostate Brachytherapy.  

PubMed

Low-dose-rate brachytherapy is a radiation treatment method for localized prostate cancer. The standard of care for this treatment procedure is to acquire transrectal ultrasound images of the prostate in order to devise a plan to deliver sufficient radiation dose to the cancerous tissue. Brachytherapy planning involves delineation of contours in these images, which closely follow the prostate boundary, i.e. clinical target volume. This process is currently performed either manually or semiautomatically, which requires user interaction for landmark initialization. In this paper, we propose a multi-atlas fusion framework to automatically delineate the clinical target volume in ultrasound images. A dataset of a priori segmented ultrasound images, i.e. atlases, is registered to a target image. We introduce a pairwise atlas agreement factor that combines an imagesimilarity metric and similarity between a priori segmented contours. This factor is used in an atlas selection algorithm to prune the dataset before combining the atlas contours to produce a consensus segmentation. We evaluate the proposed segmentation approach on a set of 280 transrectal prostate volume studies. The proposed method produces segmentation results that are within the range of observer variability when compared to a semi-automatic segmentation technique that is routinely used in our cancer clinic. PMID:25474806

Nouranian, Saman; Mahdavi, S Sara; Spadinger, Ingrid; Morris, William; Salcudean, Septimiu; Abolmaesumi, Purang

2014-12-01

83

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. PMID:24515272

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

84

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

85

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

86

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

87

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

88

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

89

Radiation-Induced Leiomyosarcoma of the Prostate after Brachytherapy for Prostatic Adenocarcinoma  

PubMed Central

Abstract Radiation therapy (RTx) has been employed as a curative therapy for prostatic adenocarcinoma. RTx-induced sarcomas (RISs) are rare, late adverse events, representing less than 0.2% of all irradiated patients. RISs are more aggressive tumors than prostatic adenocarcinomas. Herein, we present a case with RTx-induced prostatic leiomyosarcoma after permanent brachytherapy for prostatic adenocarcinoma. A 69-year-old male presented with dysuria and gross hematuria. Six years previously, he had been diagnosed with localized prostate cancer and was treated by permanent brachytherapy. Urethroscopy showed stenosis by a tumor at the prostate. Transurethral prostatectomy was performed for a diagnosis. Based on pathological findings, the diagnosis was leiomyosarcoma of the prostate. He was treated with three cycles of neoadjuvant chemotherapy (CTx) that consisted of doxorubicin and ifosfamide (AI), followed by a prostatocystectomy with intrapelvic lymphadenectomy. The tumor extended from the prostate and infiltrated the bladder wall and serosa with lymphatic and venous invasion. The surgical margin was negative, and no residual prostatic adenocarcinoma was observed. The proportion of necrotic tumor cells by neoadjuvant CTx was around 50%. Subsequently, adjuvant CTx was offered, but the patient chose a follow-up without CTx. Local recurrence and lung metastasis were detected by computed tomography 3 months after the surgery. He was treated again with AI. However, CTx was not effective and he died 6 months after the operation. In conclusion, an effective treatment strategy for prostatic sarcoma should be developed in the near future, although the clinical feature of prostatic sarcoma remains unclear due to its rare incidence. PMID:25232328

Horiguchi, Hiroto; Takada, Kohichi; Kamihara, Yusuke; Ibata, Soushi; Iyama, Satoshi; Sato, Tsutomu; Hayashi, Tsuyoshi; Miyanishi, Koji; Sato, Yasushi; Takimoto, Rishu; Kobune, Masayoshi; Kobayashi, Ko; Hirayama, Yasuo; Masumori, Naoya; Hasegawa, Tadashi; Kato, Junji

2014-01-01

90

A hybrid deformable model for simulating prostate brachytherapy  

NASA Astrophysics Data System (ADS)

Ultrasound (US) guided prostate brachytherapy is a minimally invasive form of cancer treatment during which a needle is used to insert radioactive seeds into the prostate at pre-planned positions. Interaction with the needle can cause the prostate to deform and this can lead to inaccuracy in seed placement. Virtual reality (VR) simulation could provide a way for surgical residents to practice compensating for these deformations. To facilitate such a tool, we have developed a hybrid deformable model that combines ChainMail distance constraints with mass-spring physics to provide realistic, yet customizable deformations. Displacements generated by the model were used to warp a baseline US image to simulate an acquired US sequence. The algorithm was evaluated using a gelatin phantom with a Young's modulus approximately equal to that of the prostate (60 kPa). A 2D US movie was acquired while the phantom underwent needle insertion and inter-frame displacements were calculated using normalized cross correlation. The hybrid model was used to simulate the same needle insertion and the two sets of displacements were compared on a frame-by-frame basis. The average perpixel displacement error was 0.210 mm. A simulation rate of 100 frames per second was achieved using a 1000 element triangular mesh while warping a 300x400 pixel US image on an AMD Athlon 1.1 Ghz computer with 1 GB of RAM and an ATI Radeon 9800 Pro graphics card. These results show that this new deformable model can provide an accurate solution to the problem of simulating real-time prostate brachytherapy.

Levin, David; Fenster, Aaron; Ladak, Hanif M.

2006-03-01

91

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

92

MRI/TRUS data fusion for prostate brachytherapy. Preliminary results  

E-print Network

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 pape...

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

2008-01-01

93

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

94

The influence of isotope and prostate volume on urinary morbidity after prostate brachytherapy  

SciTech Connect

Purpose: To evaluate the influence of isotope and prostate size on International Prostate Symptom Score (IPSS) normalization, catheter dependency, and the need for surgical intervention secondary to bladder outlet obstruction after prostate brachytherapy. Methods and Materials: Between January 1998 and June 2003, 976 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (2002 American Joint Committee on Cancer) prostate cancer. Seven hundred eighty-nine (80.8%) were implanted with {sup 103}Pd and 187 (19.2%) with {sup 125}I. The median follow-up was 41.2 months. Patients were stratified into size cohorts {<=}25 cm{sup 3}, 25.1-35 cm{sup 3}, 35.1-45 cm{sup 3}, and >45 cm{sup 3}. Four hundred eighteen patients (42.8%) received androgen deprivation therapy (ADT). Four hundred eighty-six patients (49.7%) received supplemental external-beam radiation therapy (XRT). In all patients, an alpha blocker was initiated before implantation and continued at least until the IPSS returned to baseline. IPSS resolution was defined as a return to within one point of baseline. The median number of IPSS determinations per patient was 21. Clinical, treatment, and dosimetric parameters evaluated included patient age, pretreatment PSA, Gleason score, clinical T stage, percent positive biopsies, preimplant IPSS, ultrasound volume, planning volume, isotope, V{sub 100/150/20}, D{sub 9}, urethral dose (average and maximum), supplemental XRT, ADT, and the duration of ADT ({<=}6 months vs. >6 months). Catheter dependency and the need for postsurgical intervention were also evaluated. Results: For both isotopes and all prostate size cohorts, IPSS peaked 1 month after implantation and returned to baseline at a mean of 1.9 months. Stratification of prostate size cohorts by isotope demonstrated no significant differences in prolonged catheter dependency ({>=}5 days), IPSS resolution, or postimplant surgical intervention. In Cox regression analysis, IPSS normalization was best predicted by preimplant IPSS, XRT, and any need for a catheter after brachytherapy. Catheter dependency correlated with prostate size and ADT, whereas the need for surgical intervention was most closely related to any catheter dependency, maximum urethral dose, ADT, and maximum IPSS increase. Conclusions: Regardless of prostate size, isotope did not impact IPSS resolution, catheter dependency, or the need for postbrachytherapy surgical intervention. Although prostate size did predict for short-term (<5 days) catheter dependency, it did not influence IPSS resolution or the need for surgical intervention.

Niehaus, Angela [Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States); Merrick, Gregory S. [Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M. [Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare CorporationGroup Health Cooperative and University of Washington, Seattle, WA (United States); Allen, Zachariah A. [Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert W. [Schiffler Cancer Center and Department of Physics, Wheeling Jesuit University, Wheeling, WV (United States); Department of Physical Education and Sport Science, Ohio University, Eastern Campus, St. Clairsville, OH (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States)

2006-01-01

95

Prostate brachytherapy seed segmentation using spoke transform  

NASA Astrophysics Data System (ADS)

Permanent implantation of radioactive seeds is a viable and effective therapeutic option widely used today for early stage prostate cancer. In order to perform intraoperative dosimetry the seed locations must be determined accurately with high efficiency. However, the task of seed segmentation is often hampered by the wide range of signal-to-noise ratios represented in the x-ray images due to highly non-uniform background. To circumvent the problem we have developed a new method, the spoke transform, to segment the seeds from the background. This method uses spoke-like rotating line segments within the two concentric windows. The mean intensity value of the pixels that fall on each rotated line segment best describing the intersection between the seed that we are trying to segment is chosen. The inner window gives an indication of the background level immediately surrounding the seeds. The outer window is an isolated region not being segmented and represents a non-seed area in need of enhancement and a detection decision. The advantages of the method are its ability (1) to work with spatially varying local backgrounds and (2) to segment the hidden seeds. Pd-103 and I-125 images demonstrate the effectiveness of the spoke transform.

Lam, Steve; Marks, Robert J., II; Cho, Paul S.

2001-07-01

96

In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging  

NASA Astrophysics Data System (ADS)

We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10-20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ?2 mm. Results provide insights into the potential for clinical translation to humans.

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

2014-12-01

97

In vivo visualization of prostate brachytherapy seeds with photoacoustic imaging.  

PubMed

We conducted a canine study to investigate the in vivo feasibility of photoacoustic imaging for intraoperative updates to brachytherapy treatment plans. A fiber coupled to a 1064-nm Nd:YAG laser was inserted into high-dose-rate brachytherapy needles, which diffused light spherically. These needles were inserted through the perineum into the prostate for interstitial light delivery and the resulting acoustic waves were detected with a transrectal ultrasound probe. Postoperative computed tomography images and ex vivo photoacoustic images confirmed seed locations. Limitations with insufficient light delivery were mitigated with short-lag spatial coherence (SLSC) beamforming, providing a 10-20 dB contrast improvement over delay-and-sum (DAS) beamforming for pulse energies ranging from 6.8 to 10.5 mJ with a fiber-seed distance as large as 9.5 mm. For the same distance and the same range of energy densities, signal-to-noise ratios (SNRs) were similar while the contrast-to-noise ratio (CNR) was higher in SLSC compared to DAS images. Challenges included visualization of signals associated with the interstitial fiber tip and acoustic reverberations between seeds separated by ? 2 mm. Results provide insights into the potential for clinical translation to humans. PMID:25531797

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

2014-12-01

98

Iodine-125 induces apoptosis via regulating p53, microvessel density, and vascular endothelial growth factor in colorectal cancer  

PubMed Central

Background Iodine interstitial brachytherapy has been widely reported for treating colorectal cancer (CRC). However, the inhibitory molecular mechanism of iodine-125 (I-125) on CRC has not been reported. Methods To illustrate the inhibitory mechanism of iodine-125 (I-125) on CRC, we established the animal models of CRC via the injection of HCT-8 cells into nude mice. Subsequently, the I-125 granules were implanted into the tumor of the animal model at different dosages. Proliferating cell nuclear antigen and terminal transferase dUTP nick end labeling were used to detect the apoptosis of the tumor cells. Immunohistochemistry SP staining was used to measure the expression of p53 protein. The protein levels were examined with western blot and ELISA. Meanwhile, microvessel density (MVD) was counted by endothelial cells immunostained by anti-CD34 antibody. Results The results showed that I-125 protests against CRC via increasing the protein level of p53 and decreasing the level of vascular endothelial growth factor (VEGF), leading to the decrease of MVD in CRC (P <0.0001). An effective inhibition dosage of I-125 ranged from 0.4 to 0.8 mCi. Conclusions The inhibitory mechanisms of iodine on CRC acted through an increase in the level of p53 and a decrease in the level of VEGF, resulting in a decrease of MVD. PMID:25033896

2014-01-01

99

Inverse planning anatomy-based dose optimization for HDR-brachytherapy of the prostate using fast simulated annealing algorithm and dedicated  

E-print Network

in the delivery of an high dose-rate HDR brachytherapy boost for the treatment of prostate cancer. The dwell timesInverse planning anatomy-based dose optimization for HDR-brachytherapy of the prostate using fast, brachytherapy, HDR, prostate, simulated annealing I. INTRODUCTION The last decade has seen major changes

Pouliot, Jean

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

Early channel transurethral resection of the prostate for patients with urinary retention after brachytherapy  

PubMed Central

Objective: It is recommended that transurethral resection of the prostate (TURP) after brachytherapy should not be performed at an early stage after implantation. Herein we report our experiences and the results of channel TURP (cTURP) within six months post-implant for patients with refractory urinary retention. Methods: One hundred and ninety patients with localized prostate cancer of clinical stages T1c to T2c were treated by brachytherapy as monotherapy at our institution from February 2009 to July 2013. Nine patients who developed refractory urinary retention and underwent cTURP within six months after brachytherapy were retrospectively reviewed and analyzed. Results: The median interval between prostate brachytherapy and cTURP was three months (range 1.5 to 5.0 months). There were no intraoperative or postoperative complications and no incontinence resulting from the surgery. All urinary retention was relieved per the American Brachytherapy Society urinary symptom score. With a mean follow-up time of 16 months (range 6 to 26 months) after cTURP, no patient experienced biochemical recurrence. The mean serum prostate-specific antigen (PSA) of the patients who underwent cTURP was 0.42 ng/ml (range 0.08 to 0.83 ng/ml) at the end of their follow-up. Conclusions: Early cTURP was found to be safe and effective in relieving urinary retention after brachytherapy and could be performed without compromising its therapeutic efficacy. PMID:25091995

Zhang, You-yun; Zhang, Zhi-gen; Yu, Yan-lan; Chen, Yi-cheng; Ni, Kang-xin; Wang, Ming-chao; Zhao, Wei-ping; Rehman, Faisal; Wan, Shaw P.; Li, Gong-hui

2014-01-01

103

Registration of prostate brachytherapy seeds with prostate anatomy for improved patient dosimetry  

NASA Astrophysics Data System (ADS)

Brachytherapy of prostate cancer involves permanent implantation of radioactive seeds in the prostate gland under transrectal ultrasound (TRUS) and fluoroscopic guidance with the goal to treat the entire gland to a prescribed tumoricidal dose. The seed coordinates are calculated prior to the procedure. However, due to uncertainties associated with the seed insertion process and changes in the anatomy, it is difficult to faithfully reproduce the planned dose distribution. The procedure can be improved substantially by identifying the underdosed regions via real-time dosimetry before the completion of implantation. The physician can then insert additional seeds to achieve clinically needed dose distribution. One possible method of performing such dosimetry is to fuse TRUS (which images the prostate gland very well but not the metallic seeds) and fluoroscopy (which images metallic seeds well but not soft tissue) data. We have developed a technique to register the 3D seed positions reconstructed from multiple fluoroscopic images with the prostate TRUS images. The technique utilizes a set of fiducials that are detectable by both imaging modalities. The method was tested using a prostate mimicking phantom. The results demonstrate that the method is sufficiently accurate and practical for clinical use.

Gong, Lixin; Cho, Paul S.; Han, Ben; Pathak, Sayan D.; Haynor, David R.; Wallner, Kent; Sutlief, Steve; Kim, Yongmin

2002-05-01

104

Alternative Dose for Choroidal Melanoma Treated With an Iodine-125 Radioactive Plaque: A Single-Institution Retrospective Study  

SciTech Connect

Purpose: The Collaborative Ocular Melanoma Study (COMS) established iodine-125 plaque brachytherapy as an accepted standard treatment for medium-size choroidal melanoma. In the COMS, the prescription dose was 85 Gy. This is a retrospective review of our outcomes in patients treated with lower doses than those used in the COMS. Methods and Materials: From 1990 to 2004, 62 patients were treated with iodine-125 plaque brachytherapy for choroidal melanoma. COMS eye plaques were used with dose prescribed to the apex of the tumor. The median and average dose rates at the tumor apex were 63.5 cGy/h and 62.7 cGy/h, respectively. The median and average total doses were 63.0 Gy and 62.5 Gy (range, 56-69 Gy), respectively. The median and mean durations of implant were 100.0 hours and 101.1 hours (range, 71-165 hours). Results: Median follow-up time was 58.2 months. The 5-year outcomes including overall survival, disease-free survival, cause-specific survival, local failure, secondary enucleation rate, and visual acuity (VA) <20/200 were estimated using the Kaplan-Meier method. Overall, there were 7 local failures, 4 distant failures, and 10 secondary enucleations (6 due to local failure and 4 due to treatment complications). Univariate analysis was performed to identify significant prognostic factors associated with disease-free survival (baseline VA in tumor eye, tumor shape), cause-specific survival (diabetic retinopathy), local failure (none found), secondary enucleation rate (diabetic retinopathy, basal tumor dimension) and VA <20/200 (diabetic retinopathy, tumor shape, age, retinal detachment, treatment depth, and history of vision-limiting condition). Conclusions: Our survival and local control outcomes are comparable to those of the COMS. However, VA at 5 years seems to be better. Lower doses of radiation could potentially lead to better visual outcomes.

Saconn, Paul A. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Gee, Christopher J.; Greven, Craig M. [Department of Ophthalmology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); McCoy, Thomas P. [Department of Biostatistical Sciences-Division of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Ekstrand, Kenneth E. [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States); Greven, Kathryn M., E-mail: kgreven@wfubmc.ed [Department of Radiation Oncology, Wake Forest University School of Medicine, Winston-Salem, NC (United States)

2010-11-01

105

High dose rate prostate brachytherapy: an overview of the rationale, experience and emerging applications in the treatment of prostate cancer  

PubMed Central

The technological advances in real-time ultrasound image guidance for high dose rate (HDR) prostate brachytherapy places this treatment modality at the forefront of innovation in radiotherapy. This review article will explore the rationale for HDR brachytherapy as a highly conformal method of dose delivery and safe dose escalation to the prostate, in addition to the particular radiobiological advantages it has over low dose rate and external beam radiotherapy. The encouraging outcome data and favourable toxicity profile will be discussed before looking at emerging applications for the future and how this procedure will feature alongside stereotactic radiosurgery. PMID:23118099

Challapalli, A; Jones, E; Harvey, C; Hellawell, G O; Mangar, S A

2012-01-01

106

Iodine-125 Seeds Strand for Treatment of Tumor Thrombus in Inferior Vena Cava: An Experimental Study in a Rabbit Model  

SciTech Connect

Objective: The purpose of this study was to establish an animal model of implanted inferior vena cava tumor thrombus (IVCTT) and to evaluate the effect of linear iodine-125 seeds strand in treating implanted IVCTT. Methods: Tumor cell line VX{sub 2} was inoculated subcutaneously into New Zealand rabbit to develop the parent tumor. The tumor strip was inoculated into inferior vena cava (IVC) to establish the IVCTT model. The IVCTT was confirmed by multidetector computed tomography (MDCT) after 2 weeks. Twelve rabbits with IVCTT were randomly divided into two groups. Treatment group (group T; n = 6) underwent Iodine-125 seeds brachytherapy, and the control group (group C; n = 6) underwent blank seeds strand. The blood laboratory examination (including blood routine examination, hepatic and renal function), body weight, survival time, and IVCTT volume by MDCT were monitored. All rabbits were dissected postmortem, and the therapeutic effects were evaluated on the basis of histopathology. The proliferating cell nuclear antigen index (PI) and apoptosis index (AI) of IVCTT were compared between two groups. T test, Wilcoxon rank test, and Kaplan-Meier survival curve analysis were used. Results: The success rate of establishing IVCTT was 100 %. The body weight loss and cachexia of rabbits in group C appeared earlier than in group T. Body weight in the third week, the mean survival time, PI, AI in groups T and C were 2.23 {+-} 0.12 kg, 57.83 {+-} 8.68 days, (16.73 {+-} 5.18 %), (29.47 {+-} 7.18 %), and 2.03 {+-} 0.13 kg, 43.67 {+-} 5.28 days, (63.01 {+-} 2.01 %), (6.02 {+-} 2.93 %), respectively. There were statistically significant differences between group T and group C (P < 0.05). The IVCTT volume of group T was remarkably smaller than that of group C. Conclusions: Injecting and suspensory fixing VX2 tumor strip into IVC is a reliable method to establish IVCTT animal model. The linear Iodine-125 seeds strand brachytherapy was a safe and effective method for treating IVCTT in rabbit model.

Zhang, Wen, E-mail: wenzhangxiao@126.com; Yan, Zhiping, E-mail: Yan.zhiping@zs-hospital.sh.cn; Luo, Jianjun, E-mail: luo.jianjun@zs-hospital.sh.cn; Fang, Zhuting, E-mail: 470389481@qq.com; Wu, Linlin, E-mail: linlinzhifubao@126.com; Liu, QingXin, E-mail: liu.qingxin@zs-hospital.sh.cn; Qu, Xudong, E-mail: qu.xudong@zs-hospital.sh.cn; Liu, Lingxiao, E-mail: liu.lingxiao@zs-hospital.sh.cn; Wang, Jianhua, E-mail: wang.jianhua@zs-hospital.sh.cn [Fudan University, Department of Interventional Radiology, Zhongshan Hospital (China)] [Fudan University, Department of Interventional Radiology, Zhongshan Hospital (China)

2013-10-15

107

Prostate brachytherapy postimplant dosimetry: Automatic plan reconstruction of stranded implants  

SciTech Connect

Purpose: Plan reconstruction for permanent implant prostate brachytherapy is the process of determining the correspondence between planned and implanted seeds in postimplant analysis. Plan reconstruction informs many areas of brachytherapy quality assurance, including the verification of seed segmentation, misplacement and migration assessment, implant simulations, and the dosimetry of mixed-activity or mixed-species implants. Methods: An algorithm has been developed for stranded implants which uses the interseed spacing constraints imposed by the suture to improve the accuracy of reconstruction. Seventy randomly selected clinical cases with a mean of 23.6 (range 18-30) needles and mean density of 2.0 (range 1.6-2.6) 2.0 (range 1.6-2.6) seeds/cm{sup 3} were automatically reconstructed and the accuracy compared to manual reconstructions performed using a custom 3D graphical interface. Results: Using the automatic algorithm, the mean accuracy of the assignment relative to manual reconstruction was found to be 97.7{+-}0.5%. Fifty-two of the 70 cases (74%) were error-free; of seeds in the remaining cases, 96.7{+-}0.3% were found to be attributed to the correct strand and 97.0{+-}0.3% were correctly connected to their neighbors. Any necessary manual correction using the interface is usually straightforward. For the clinical data set tested, neither the number of seeds or needles, average density, nor the presence of clusters was found to have an effect on reconstruction accuracy using this method. Conclusions: Routine plan reconstruction of stranded implants can be performed with a high degree of accuracy to support postimplant dosimetry and quality analyses.

Chng, N.; Spadinger, I.; Morris, W. J.; Usmani, N.; Salcudean, S. [Department of Medical Physics, British Columbia Cancer Agency, Vancouver Cancer Centre, 600 West 10th, Vancouver, British Columbia V5Z 4E6 (Canada); Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Cancer Centre, 600 West 10th, Vancouver, British Columbia V5Z 4E6 (Canada); Department of Radiation Oncology, Cross Cancer Institute, Edmonton, 11460 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Department of Electrical and Computer Engineering, University of British Columbia, 5500-2332 Main Mall, Vancouver, British Columbia V6T 1Z4 (Canada)

2011-01-15

108

The use of supplemental external beam radiotherapy in men with low-risk prostate cancer undergoing brachytherapy before and after the 1999 American Brachytherapy Society Guideline statement  

Microsoft Academic Search

PurposeIn 1999, the American Brachytherapy Society (ABS) recommended brachy-monotherapy for men with low-risk prostate cancer because of the potential for increased toxicity with combined external beam radiotherapy (EBRT) and brachytherapy without the proof of increased efficacy. We investigated the patterns of care in the community in this patient population before and after the reporting of the ABS guideline.

Arthur K. Cheung; Ming-Hui Chen; Brian J. Moran; Michelle H. Braccioforte; Daniel E. Dosoretz; Sharon Salenius; Michael Katin; Rudi Ross; Anthony V. D'Amico

2010-01-01

109

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.

110

Temporal relationship between prostate brachytherapy and the diagnosis of colorectal cancer  

SciTech Connect

Purpose: To identify the location of pretreatment and posttreatment colorectal malignancies and posttreatment colorectal polyps in patients with clinically localized prostate cancer managed with brachytherapy. Methods and Materials: From April 1995 through July 2004, 1,351 consecutive patients underwent brachytherapy for clinical stage T1b-T3a (American Joint Committee on Cancer, 2002) prostate cancer. Supplemental external beam radiotherapy (XRT) was administered to 699 patients. The median follow-up was 4.6 years. Operative and pathology reports were reviewed for all patients with pretreatment and posttreatment colorectal cancer and posttreatment colorectal polyps. Multiple parameters were evaluated for the development of colorectal cancer or colorectal polyps. Results: Colorectal cancer was diagnosed in 23 and 25 patients before and after prostate brachytherapy, respectively. No differences were identified in the distribution of colorectal cancers either before or after treatment (3 and 4 rectal cancers in the pre- and postbrachytherapy cohorts). Thirty-five of the 48 colorectal cancers (73%) were diagnosed within 5 years of brachytherapy with a peak incidence 1 year after brachytherapy. One hundred ninety-two colorectal polyps were diagnosed after brachytherapy, 160 (83%) occurred within 4 years of brachytherapy, and only 27 (14%) were located in the rectum. In multivariate Cox regression analysis, prostate D{sub 9} (minimum percentage of the dose covering 90% of the target volume) predicted for posttreatment colorectal cancer. Rectal polyps were most closely related to patient age and percent positive biopsies, whereas sigmoid/colon polyps were best predicted by patient age, planning volume, and supplemental XRT. Conclusions: Colorectal cancer was diagnosed with equal frequency before and after brachytherapy with comparable geographic distributions. In addition, the vast majority of postbrachytherapy colorectal polyps were located beyond the confines of the rectum.

Gutman, Sarah A. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Merrick, Gregory S. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@urologicresearchinstitute.org; Butler, Wayne M. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Allen, Zachariah A. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert W. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States); Adamovich, Edward [Wheeling Hospital, Department of Pathology, Wheeling, WV (United States)

2006-09-01

111

Abstract--In prostate brachytherapy, the analysis of the 3D pose information of each individual implanted seed is one of the  

E-print Network

and therapeutic methods for prostate cancer has become increasingly important. The low-risk prostate brachytherapy Abstract--In prostate brachytherapy, the analysis of the 3D pose information of each individual of 152 per 100,000 men worldwide per year for 2006-2010, prostate cancer is the second most frequently

Boyer, Edmond

112

Rectal ulcer: Due to ketoprofen, argon plasma coagulation and prostatic brachytherapy  

PubMed Central

Prostatic brachytherapy with permanent seed implants is a recent and safe radiation therapy technique associated with radiation-induced digestive disease. Argon plasma coagulation procedure is a validated modality in the management of haemorrhagic radiation proctitis, which is known to occasionally induce chronic rectal ulcers. We report here an original case report of an acute painful rectal ulcer as a consequence of the combination of short-term therapy with non-steroidal anti-inflammatory drugs therapy, prostatic brachytherapy with malposition of seed implants and argon plasma coagulation procedure in a patient with haemorrhagic radiation proctitis. The description of this clinical observation is essential to recommend the discontinuation of non-steroidal anti-inflammatory drugs therapy and the control of the position of seed implants in case of prostatic brachytherapy before argon plasma coagulation for radiation-induced proctitis. PMID:25493041

Koessler, Thibaud; Servois, Vincent; Mariani, Pascale; Aubert, Emilie; Cacheux, Wulfran

2014-01-01

113

Predictors of Urinary Morbidity in Cs-131 Prostate Brachytherapy Implants  

SciTech Connect

Purpose: Cesium-131 is a newer radioisotope being used in prostate brachytherapy (PB). This study was conducted to determine the predictors of urinary morbidity with Cs-131 PB. Methods and Materials: A cohort of 159 patients underwent PB with Cs-131 at our institution and were followed by using Expanded Prostate Cancer Index Composite (EPIC) surveys to determine urinary morbidity over time. EPIC scores were obtained preoperatively and postoperatively at 2 and 4 weeks, and 3 and 6 months. Different factors were evaluated to determine their individual effect on urinary morbidity, including patient characteristics, disease characteristics, treatment, and dosimetry. Multivariate analysis of covariance was carried out to identify baseline determinants affecting urinary morbidity. Factors contributing to the need for postoperative catheterization were also studied and reported. Results: At 2 weeks, patient age, dose to 90% of the organ (D90), bladder neck maximum dose (D{sub max}), and external beam radiation therapy (EBRT) predicted for worse function. At 4 weeks, age and EBRT continued to predict for worse function. At the 3-month mark, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT predicted for worse urinary morbidity. At 6 months, better preoperative urinary function, preoperative alpha blockers, bladder neck D{sub max}, and EBRT were predictive of increased urinary problems. High bladder neck D{sub max} and poor preoperative urinary function predicted for the need for catheterization. Conclusions: The use of EBRT plus Cs-131 PB predicts for worse urinary toxicity at all time points studied. Patients should be cautioned about this. Age was a consistent predictor of worsened morbidity immediately following Cs-131 PB, while bladder D{sub max} was the only consistent dosimetric predictor. Paradoxically, patients with better preoperative urinary function had worse urinary morbidity at 3 and 6 months, consistent with recently published literature.

Smith, Ryan P., E-mail: smithrp@upmc.edu [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States); Jones, Heather A.; Beriwal, Sushil; Gokhale, Abhay [Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States); Benoit, Ronald [Department of Urology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States)

2011-11-01

114

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. PMID:24049459

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

2013-01-01

115

Pr Glass Seeds for the Brachytherapy of Prostate Cancer.  

E-print Network

A beta-emitting glass seed was proposed for the brachytherapy treatment of prostate cancer. Criteria for seed design were derived and several beta-emitting nuclides were examined for suitability. 142 Pr was selected as the isotope of choice. Seeds 0.08 cm in diameter and 0.9 cm long were manufactured for testing. The seeds were activated in the Texas A&M University research reactor. The activity produced was as expected when considering the meta-stable state and epi-thermal neutron flux. The MCNP5 Monte Carlo code was used to calculate the quantitative dosimetric parameters suggested in the American Association of Physicists in Medicine (AAPM) TG-43/60. The Monte Carlo calculation results were compared with those from a dose point kernel code. The dose profiles agree well with each other. The gamma dose of 142 Pr was evaluated. The gamma dose is 0.3 Gy at 1.0 cm with initial activity of 5.95 mCi and is insignificant to other organs. Measurements were performed to assess the 2-dimensional axial dose distributions using Gafchromic radiochromic film. The radiochromic film was calibrated using an X-ray machine calibrated against a National

unknown authors

2007-01-01

116

Real-time photoacoustic imaging of prostate brachytherapy seeds using a clinical ultrasound system  

NASA Astrophysics Data System (ADS)

Prostate brachytherapy is a popular prostate cancer treatment option that involves the permanent implantation of radioactive seeds into the prostate. However, contemporary brachytherapy procedure is limited by the lack of an imaging system that can provide real-time seed-position feedback. While many other imaging systems have been proposed, photoacoustic imaging has emerged as a potential ideal modality to address this need, since it could easily be incorporated into the current ultrasound system used in the operating room. We present such a photoacoustic imaging system built around a clinical ultrasound system to achieve the task of visualizing and localizing seeds. We performed several experiments to analyze the effects of various parameters on the appearance of brachytherapy seeds in photoacoustic images. We also imaged multiple seeds in an ex vivo dog prostate phantom to demonstrate the possibility of using this system in a clinical setting. Although still in its infancy, these initial results of a photoacoustic imaging system for the application of prostate brachytherapy seed localization are highly promising.

Kuo, Nathanael; Kang, Hyun Jae; Song, Danny Y.; Kang, Jin U.; Boctor, Emad M.

2012-06-01

117

Permanent prostate brachytherapy extracapsular radiation dose distributions: analysis of a multi-institutional database  

PubMed Central

Purpose Periprostatic brachytherapy doses impact biochemical control. In this study, we evaluate extracapsular volumetric dosimetry following permanent prostate brachytherapy in patients entered in a multi-institutional community database. Material and methods In the database, 4547 patients underwent brachytherapy (3094 – 125I, 1437 – 103Pd and 16 – 131Cs). Using the originally determined prostate volume, a 5 mm, 3-dimensional peri-prostatic anulus was constructed around the prostate (except for a 2 mm posterior margin), and evaluated in its entirety and in 90° segments. Prostate dosimetric parameters consisted of a V100 and D90 while the annular dosimetry was reported as a V100. Results The intraprostatic V100 and D90 for 103Pd, and 125I were statistically comparable when stratified by isotope and/or monotherapy vs. boost. The overall mean V100 for the periprostatic annulus was 62.8%. The mean V100 at the base (51.6%) was substantially less than the apex (73.5%) and midgland (65.9%). In addition, for all patients, the anterior V100 (45.7%) was less than the lateral (68.8%) and the posterior (75.0%). The geometric V100 annular differences were consistent when evaluated by isotope. Overall, the V100 was higher in the 125I cohort. Conclusions The optimal extracapsular brachytherapy dose and radial extent remains unknown, but will prove increasingly important with reductions and/or elimination of supplemental external beam radiation therapy. The large multi-institutional community database demonstrates periprostatic annular doses that are not as robust as those in selected high volume brachytherapy centers, and may be inadequate for optimal biochemical control following monotherapeutic brachytherapy, especially in higher risk patients. PMID:24143144

Butler, Wayne M.; Grimm, Peter; Morris, Mallory; Lief, Jonathan H.; Bennett, Abbey; Fiano, Ryan

2013-01-01

118

Distinguishing prostate-specific antigen bounces from biochemical failure after low-dose-rate prostate brachytherapy  

PubMed Central

Purpose The purpose of this study was to characterize benign prostate-specific antigen (PSA) bounces of at least 2.0 ng/mL and biochemical failure as defined by the Phoenix definition after prostate brachytherapy at our institution, and to investigate distinguishing features between three outcome groups: patients experiencing a benign PSA bounce, biochemical failure, or neither. Material and methods Five hundred and thirty consecutive men treated with low-dose-rate brachytherapy with follow-up of at least 3 years were divided into outcome groups experiencing bounce, failure, or neither. A benign bounce was defined as a rise of at least 2.0 ng/mL over the pre-rise nadir followed by a decline to 0.5 ng/mL or below, without intervention. Patient and tumor characteristics, treatment variables, and PSA kinetics were analyzed between groups. Results Thirty-two (6.0%) men experienced benign bounces and 47 (8.9%) men experienced failure. Men experiencing a bounce were younger (p = 0.01), had a higher 6-month PSA level (p = 0.03), and took longer to reach a final nadir (p < 0.01). Compared to the failure group, men with bounce had a lower pre-treatment PSA level (p = 0.01) and experienced a rise of at least 2.0 ng/mL that occurred sooner after the implant (p < 0.01) with a faster PSA doubling time (p = 0.01). Only time to PSA rise independently differentiated between bounce and failure (p < 0.01), with a benign bounce not being seen after 36 months post-treatment. Prostate-specific antigen levels during a bounce reached levels as high as 12.6 ng/mL in this cohort, and in some cases took over 5 years to decline to below 0.5 ng/mL. Conclusions Although there is substantial overlap between the features of benign PSA bounces and failure, physicians may find it useful to evaluate the timing, absolute PSA level, initial response to treatment, and rate of rise when contemplating management for a PSA rise after low-dose-rate brachytherapy. PMID:25337125

Hackett, Cian; Ghosh, Sunita; Sloboda, Ron; Martell, Kevin; Lan, Lanna; Pervez, Nadeem; Pedersen, John; Yee, Don; Murtha, Albert; Amanie, John

2014-01-01

119

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

120

Maximum vs. Mono Androgen Blockade and the Risk of Recurrence in Men With Localized Prostate Cancer Undergoing Brachytherapy  

Microsoft Academic Search

Purpose: We examined whether maximum androgen blockade (MAB) is associated with a decreased recurrence risk vs. single-agent androgen suppression (monotherapy) for men undergoing brachytherapy (BT) for localized prostate cancer. Methods and Materials: Data from 223 men in Cancer of the Prostate Strategic Urologic Research Endeavor database who received androgen deprivation therapy (ADT) concurrent with BT for intermediate- or high-risk prostatic

Ronald C. Chen; Natalia Sadetsky; Ming-Hui Chen; Peter R. Carroll; Anthony V. D'Amico

2009-01-01

121

Risk of All-Cause and Prostate Cancer-Specific Mortality After Brachytherapy in Men With Small Prostate Size  

SciTech Connect

Background: Brachytherapy for prostate cancer can be technically challenging in men with small prostates ({<=}20 cc), but it is unknown whether their outcomes are different than those of men with larger prostates. Methods and Materials: We studied 6,416 men treated with brachytherapy in one of 21 community-based practices. Cox regression and Fine and Gray's regression were used to determine whether volume {<=}20 cc was associated with a higher risk of all-cause mortality (ACM) or prostate cancer-specific mortality (PCSM), respectively, after adjustment for other known prognostic factors. Results: 443 patients (6.9%) had a prostate volume {<=}20 cc. After a median follow-up of 2.91 years (interquartile range, 1.06-4.79), volume {<=}20 cc was associated with a significantly higher risk of ACM (adjusted hazard ratio = 1.33 [95% CI 1.08-1.65], p = 0.0085) with 3-year estimates of ACM for {<=}20 cc vs. >20 cc of 13.0% vs. 6.9% (p = 0.028). Only 23 men (0.36%) have died of prostate cancer, and no difference was seen in PCSM by volume (p = 0.4). Conclusion: Men with small prostates at the time of implant had a 33% higher risk of ACM, and the underlying cause of this remains uncertain. No increase in PCSM was observed in men with volume {<=}20cc, suggesting that a small prostate should not in itself be a contraindication for brachytherapy, but inasmuch as absolute rates of PCSM were small, further follow-up will be needed to confirm this finding.

Nguyen, Paul L., E-mail: E-pnguyen@LROC.harvard.ed [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Chen, Ming H. [Department of Statistics, University of Connecticut, Storrs, CT (United States); Choueiri, Toni K. [Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Hoffman, Karen E. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, TX (United States); Hu, Jim C. [Department of Urology, Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Martin, Neil E.; Beard, Clair J. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); Dosoretz, Daniel E. [21st Century Oncology, Fort Myers, FL (United States); Moran, Brian J. [Chicago Prostate Center, Westmont, IL (United States); Katin, Michael J. [21st Century Oncology, Fort Myers, FL (United States); Braccioforte, Michelle H. [Chicago Prostate Center, Westmont, IL (United States); Ross, Rudi; Salenius, Sharon A. [21st Century Oncology, Fort Myers, FL (United States); Kantoff, Philip W. [Department of Medical Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Dana Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States); Harvard Medical School, Boston, MA (United States)

2011-04-01

122

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

123

Needle Insertion Simulation for Image-Guided Brachytherapy of Prostate Cancer  

Microsoft Academic Search

Brachytherapy is an effective treatment for prostate cancer. Preciously implant of seeds with planned radioactive dose irradiate surrounding tissue over several months will minimize healthy tissue damage while maximize the destruction of cancerous cells. However, force load on the tip of insertion needle will cause the tissue deformation during the process and result in the misplaced seeds. This will lead

Shan Jiang; Nobuhiko Hata; Ron Kikinis

2008-01-01

124

Praseodymium-142 glass seeds for the brachytherapy of prostate cancer  

NASA Astrophysics Data System (ADS)

A beta-emitting glass seed was proposed for the brachytherapy treatment of prostate cancer. Criteria for seed design were derived and several beta-emitting nuclides were examined for suitability. 142Pr was selected as the isotope of choice. Seeds 0.08 cm in diameter and 0.9 cm long were manufactured for testing. The seeds were activated in the Texas A&M University research reactor. The activity produced was as expected when considering the meta-stable state and epi-thermal neutron flux. The MCNP5 Monte Carlo code was used to calculate the quantitative dosimetric parameters suggested in the American Association of Physicists in Medicine (AAPM) TG-43/60. The Monte Carlo calculation results were compared with those from a dose point kernel code. The dose profiles agree well with each other. The gamma dose of 142Pr was evaluated. The gamma dose is 0.3 Gy at 1.0 cm with initial activity of 5.95 mCi and is insignificant to other organs. Measurements were performed to assess the 2-dimensional axial dose distributions using Gafchromic radiochromic film. The radiochromic film was calibrated using an X-ray machine calibrated against a National Institute of Standards and Technology (NIST) traceable ion chamber. A calibration curve was derived using a least squares fit of a second order polynomial. The measured dose distribution agrees well with results from the Monte Carlo simulation. The dose was 130.8 Gy at 6 mm from the seed center with initial activity of 5.95 mCi. AAPM TG-43/60 parameters were determined. The reference dose rate for 2 mm and 6 mm were 0.67 and 0.02 cGy/s/mCi, respectively. The geometry function, radial dose function and anisotropy function were generated.

Jung, Jae Won

125

Dose uncertainty due to computed tomography ,,CT... slice thickness in CT-based high dose rate brachytherapy of the prostate cancer  

E-print Network

brachytherapy of the prostate cancer Yongbok Kim,a) I-Chow Joe Hsu, Etienne Lessard, and Jean Pouliot Department brachytherapy for prostate cancer has significantly improved the ability to define the targets and organs uncertainty. Catheter coordinates were extracted from five patients treated for prostate cancer, and three

Pouliot, Jean

126

Comparison of 3 different postimplant dosimetry methods following permanent {sup 125}I prostate seed brachytherapy  

SciTech Connect

Postimplant dosimetry (PID) after Iodine-125 ({sup 125}I) implant of the prostate should offer a reliable qualitative assessment. So far, there is no consensus regarding the optimum PID method, though the latest literature is in favor of magnetic resonance imaging (MRI). This study aims to simultaneously compare 3 PID techniques: (1) MRI-computed tomography (CT) fusion; (2) ultrasound (US)-CT fusion; and (3) manual target delineation on CT. The study comprised 10 patients with prostate cancer. CT/MR scans with urinary catheters in place for PID were done either on day 0 or day 1 postimplantation. The main parameter evaluated and compared among methods was target D90. The results show that CT-based D90s are lower than US-CT D90s (median difference,?6.85%), whereas MR-CT PID gives higher D90 than US-CT PID (median difference, 4.25%). Manual contouring on CT images tends to overestimate the prostate volume compared with transrectal ultrasound (TRUS) (median difference, 23.33%), whereas on US images the target is overestimated compared with MR-based contouring (median difference, 13.25%). Although there are certain differences among the results given by various PID techniques, the differences are statistically insignificant for this small group of patients. Any dosimetric comparison between 2 PID techniques should also account for the limitations of each technique, to allow for an accurate quantification of data. Given that PID after permanent radioactive seed implant is mandatory for quality assurance, any imaging method–based PID (MR-CT, US-CT, and CT) available in a radiotherapy department can be indicative of the quality of the procedure.

Marcu, Loredana G., E-mail: loredana@marcunet.com [Department of Medical Physics, Royal Adelaide Hospital, South Australia (Australia); Faculty of Science, University of Oradea (Romania); School of Chemistry and Physics, University of Adelaide, South Australia (Australia); Gowda, Raghu [Department of Radiation Oncology, Royal Adelaide Hospital, South Australia (Australia)

2013-10-01

127

Impact of comorbidity in elderly prostate cancer patients treated with brachytherapy  

PubMed Central

Objective To analyze the correlations among comorbidity and overall survival (OS), biochemical progression-free survival (b-PFS) and toxicity in elderly patients with localized prostate cancer treated with 125I brachytherapy. Methods Elderly men, aged ?65 years, with low-intermediate risk prostate cancer, were treated with permanent 125I brachytherapy as monotherapy. Comorbidity data were obtained from medical reports using age-adjusted Charlson comorbidity index (a-CCI). The patients were categorized into two age groups (<75 and ?75 years old), and two comorbidity score groups (a-CCI ?3 and >3). Toxicity was scored with Radiation Therapy Oncology Group (RTOG) scale. Results From June 2003 to October 2009, a total of 92 elderly patients underwent prostate brachytherapy, including 57 men (62%) with low-risk prostate cancer, and 35 men (38%) with intermediate-risk prostate cancer. The median age of patients was 75 years (range, 65-87 years). Forty-seven patients (51%) had a-CCI ?3 and 45 patients (49%) a-CCI >3. With a median follow-up period of 56 months (range, 24-103 months), the 5-year actuarial OS and b-PFS were 91.3% and 92.4% respectively, without statistical significance between two Charlson score groups. Toxicity was mild. None of the patients experienced gastrointestinal (GI) toxicity, and only 4 patiens (4%) experienced late genitourinary (GU) grade-3 (G3) toxicity. No correlation between acute GU and GI toxicity and comorbidity was showed (P=0.50 and P=0.70, respectively). Conclusions Our data suggest that elderly men with low-intermediate risk prostate cancer and comorbidity can be considered for a radical treatment as 125I low-dose rate brachytherapy. PMID:23825903

Fiorentino, Alba; Cozzolino, Mariella; Caivano, Rocchina; Clemente, Stefania; Pedicini, Piernicola; Fusco, Vincenzo

2013-01-01

128

Disease-specific survival following the brachytherapy management of prostate cancer  

SciTech Connect

Purpose: To determine disease-specific survival (DSS) and associated predictive factors after prostate brachytherapy. Methods and Materials: A total of 1561 patients underwent brachytherapy for prostate cancer from 1990 to 2004 (median follow-up, 3.8 years). Treatment included brachytherapy alone (n = 634), brachytherapy and hormonal therapy (n = 420), and implant and external beam therapy (n = 507). Results: The DSS and overall survival rates at 10 years were 96% and 74%, respectively. Gleason score significantly impacted DSS, with 10-year rates of 98%, 91%, and 92% for scores of {<=}6, 7, and {>=}8, respectively (p < 0.0001). Multivariate analysis revealed that PSA status after treatment had the most significant effect on DSS. Ten-year DSS rates were 100%, 52%, and 98%, respectively for patients without PSA failure (n = 1430), failure with a doubling time (DT) {<=}10 months (n = 64), and failure with a DT >10 months (n = 67), respectively (p < 0.0001). In patients with PSA failure, DSS rates were 30%, 67%, and 98%, for those with DT {<=}6 months, >6-10 months, and >10 months, respectively (p < 0.0001). Conclusions: The 10-year DSS rate supports the efficacy of brachytherapy. Patients dying with disease within 10 years after treatment harbor inherently aggressive cancer with high Gleason scores and short DT.

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

2006-03-01

129

Palladium103 versus iodine-125 for ophthalmic plaque radiotherapy  

Microsoft Academic Search

A dosimetry study compared the use of I-125 vs. Pd-103 radioactive seeds for ophthalmic plaque brachytherapy. Pd-103 seeds in ophthalmic plaques were used to treat 15 patients with intraocular malignant melanoma. Computer-aided simulations were performed to evaluate the intraocular dose distribution of I-125 versus Pd-103 ophthalmic plaques (delivering equivalent apex doses). Seven target points were selected. Starting at the outer

Paul T. Finger; Dongfeng Lu; Alfonso Buffa; Daniels Deblasio; Jay L. Bosworth

1993-01-01

130

PSA Bounce and Biochemical Failure After Brachytherapy for Prostate Cancer: A Study of 820 Patients With a Minimum of 3 Years of Follow-Up  

SciTech Connect

Purpose: To determine clinical or dosimetric factors associated with a prostate-specific antigen (PSA) bounce, as well as an association between a PSA bounce and biochemical relapse-free survival (bRFS), in patients treated with iodine-125 brachytherapy. Methods and Materials: A variety of clinical and treatment factors were examined in 820 patients who had a minimum of 3 years of PSA follow-up with T1-T2cN0M0 prostate cancer. Four different PSA threshold values were used for defining a PSA bounce: a PSA rise of {>=}0.2, {>=}0.4, {>=}0.6, and {>=}0.8 ng/mL. Results: A PSA bounce of {>=}0.2, {>=}0.4, {>=}0.6, and {>=}0.8 ng/mL was noted in 247 patients (30.1%), 161 (19.6%), 105 (12.8%), and 78 (9.5%), respectively. The median time to the first PSA rise was 17.4, 16.25, 16.23, and 15.71 months, respectively, vs. 34.35 months for a biochemical failure (p < 0.0001). A PSA rise of {>=}0.2 ng/mL was the only definition for which there was a significant difference in bRFS between bounce and non-bounce patients. The 5-year bRFS rate of patients having a PSA bounce of {>=}0.2 was 97.7% vs. 91% for those who did not have a PSA bounce (p = 0.0011). On univariate analysis for biochemical failure, age, risk group, and PSAs per year had a statistically significant correlation with PSA bounce of {>=}0.2 ng/mL. On multivariate analysis, age and PSAs per year remained statistically significant (p < 0.0001 and p = 0.0456, respectively). Conclusions: A bounce definition of a rise {>=}0.2 ng/mL is a reliable definition among several other definitions. The time to first PSA rise is the most valuable factor for distinguishing between a bounce and biochemical failure.

Caloglu, Murat, E-mail: caloglumurat@hotmail.com [Department of Radiation Oncology, Faculty of Medicine, Trakya University, Edirne (Turkey); Ciezki, Jay P.; Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Angermeier, Kenneth; Ulchaker, James [Glickman Urologic Institute, Cleveland Clinic, Cleveland, OH (United States); Chehade, Nabil; Altman, Andrew [Department of Urology, Kaiser Permanente-Ohio, Parma, OH (United States); Magi-Galuzzi, Christina [Department of Anatomic Pathology, Cleveland Clinic, Cleveland, OH (United States); Klein, Eric A. [Glickman Urologic Institute, Cleveland Clinic, Cleveland, OH (United States)

2011-07-01

131

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

PubMed Central

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

2013-01-01

132

Review Article HDR Brachytherapy in the Management of High-Risk Prostate Cancer  

E-print Network

which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. High-dose-rate (HDR) brachytherapy is used with increasing frequency for the treatment of prostate cancer. It is a technique which allows delivery of large individual fractions to the prostate without exposing adjacent normal tissues to unacceptable toxicity. This approach is particularly favourable in prostate cancer where tumours are highly sensitive to dose escalation and to increases in radiotherapy fraction size, due to the unique radiobiological behaviour of prostate cancers in contrast with other malignancies. In this paper we discuss the rationale and the increasing body of clinical evidence for the use of this technique in patients with highrisk prostate cancer, where it is combined with external beam radiotherapy. We highlight practical aspects of delivering treatment and discuss toxicity and limitations, with particular reference to current practice in the United Kingdom. 1.

unknown authors

133

Migration of a strand of four seeds in low-dose-rate brachytherapy.  

PubMed

We report a case of stranded-seed migration (one strand of four seeds), via the prostatic venous plexus to the internal pudendal vein, in low-dose-rate (LDR) prostate brachytherapy. A 70-year-old man with low-risk prostate adenocarcinoma underwent transperineal permanent seed implantation. A total of 93 iodine-125 seeds were implanted (91 stranded seeds and 2 loose seeds). Immediate postimplantation fluoroscopic image and day 1 postimplantation CT scan indicated all implanted seeds to be within the vicinity of the prostate as planned. Day 30 pelvic X-ray and CT scan revealed migration of a strand of four seeds to the right pelvis (adjacent to ischial spine). At 2?years postimplantation, the patient continues to have good disease control with prostate specific antigen level of 0.69??g/L, and asymptomatic. To the best of our knowledge, this is the first report of migration of an entire strand of seeds following LDR prostate brachytherapy. PMID:24879735

Dedic-Hagan, Jasmina; Teh, Amy Y M; Liang, Eisen; Collett, Nicholas; Woo, Henry H

2014-01-01

134

COMPARISONS OF NEEDLE INSERTION IN BRACHYTHERAPY  

E-print Network

aims at comparing the results of different prostate brachytherapy protocols concerning needle insertion order and its influence on tissue deformations. Prostate brachytherapy of other parameters was also demonstrated through the different simulations. PROSTATE BRACHYTHERAPY

Promayon, Emmanuel

135

Intraoperative optimized inverse planning for prostate brachytherapy: early experience  

Microsoft Academic Search

Purpose: To demonstrate the feasibility of an intraoperative inverse planning technique with advanced optimization for prostate seed implantation.Methods and Materials: We have implemented a method for optimized inverse planning of prostate seed implantation in the operating room (OR), based on the genetic algorithm (GA) driven Prostate Implant Planning Engine for Radiotherapy (PIPER). An integrated treatment planning system was deployed, which

Edward M Messing; J. B. Y Zhang; Deborah J Rubens; Ralph A Brasacchio; John G Strang; Arvind Soni; M. C Schell; Paul G Okunieff; Yan Yu

1999-01-01

136

The impact of brachytherapy on prostate cancer specific mortality for definitive radiation therapy of high grade prostate cancer: A population based analysis  

Microsoft Academic Search

PurposeThis population-based analysis compared prostate cancer-specific mortality (PCSM) in a cohort of patients with high risk prostate cancer after non-surgical treatment with external beam radiation therapy (EBRT), brachytherapy (BT), or combination (BT+EBRT).

Xinglei Shen; Scott W. Keith; Mark V. Mishra; Adam P. Dicker; Timothy N. Showalter

137

High Intensity Focused Ultrasound (HIFU) as a Salvage Treatment for Recurrent Prostate Cancer after Brachytherapy — a Feasibility Study  

Microsoft Academic Search

HIFU may be an effective salvage treatment for patients who develop local recurrence after permanent low-dose brachytherapy. It has been suggested that the presence of seeds in the prostate may obstruct the HIFU beam or alter the heating characteristics of the prostate tissue. Acoustic field measurements were made using a membrane hydrophone and lesioning experiments were carried out in ex

Alexander T. Chapman; Ian H. Rivens; Alan C. Thompson; Gail R. ter Haar

2007-01-01

138

High Intensity Focused Ultrasound (HIFU) as a Salvage Treatment for Recurrent Prostate Cancer after Brachytherapy - a Feasibility Study  

Microsoft Academic Search

HIFU may be an effective salvage treatment for patients who develop local recurrence after permanent low-dose brachytherapy. It has been suggested that the presence of seeds in the prostate may obstruct the HIFU beam or alter the heating characteristics of the prostate tissue. Acoustic field measurements were made using a membrane hydrophone and lesioning experiments were carried out in ex

Alexander T. Chapman; Ian H. Rivens; Alan C. Thompson; Gail R. Ter Haar

2007-01-01

139

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

Microsoft Academic Search

Purpose: The etiology of erectile dysfunction after definitive local therapy for carcinoma of the prostate gland represents a multifactorial phenomenon including neurogenic compromise, venous insufficiency, local trauma, and psychogenic causes. It has been suggested that impotence after prostate brachytherapy is a consequence of excessive radiation dose to the neurovascular bundles (NVB). Herein we evaluate the potential relationship between radiation dose

Gregory S Merrick; Wayne M Butler; Anthony T Dorsey; Jonathan H Lief; Joseph G Donzella

2000-01-01

140

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

141

On the Sensitivity of ?/? Prediction to Dose Calculation Methodology in Prostate Brachytherapy  

SciTech Connect

Purpose: To study the relationship between the accuracy of the dose calculation in brachytherapy and the estimations of the radiosensitivity parameter, ?/?, for prostate cancer. Methods and Materials: In this study, Monte Carlo methods and more specifically the code ALGEBRA was used to produce accurate dose calculations in the case of prostate brachytherapy. Equivalent uniform biologically effective dose was calculated for these dose distributions and was used in an iso-effectiveness relationship with external beam radiation therapy. Results: By considering different levels of detail in the calculations, the estimation for the ?/? parameter varied from 1.9 to 6.3 Gy, compared with a value of 3.0 Gy suggested by the American Association of Physicists in Medicine Task Group 137. Conclusions: Large variations of the ?/? show the sensitivity of this parameter to dose calculation modality. The use of accurate dose calculation engines is critical for better evaluating the biological outcomes of treatments.

Afsharpour, Hossein [Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC (Canada); Centre Intégré de Cancérologie de la Montérégie, Hôpital Charles-LeMoyne, Greenfield Park, QC (Canada); Walsh, Sean [Department of Radiation Oncology Maastricht Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht (Netherlands); Gray Institute for Radiation Oncology and Biology, The University of Oxford, The United Kingdom (United Kingdom); Collins Fekete, Charles-Antoine; Vigneault, Eric [Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC (Canada); Verhaegen, Frank [Department of Radiation Oncology Maastricht Radiation Oncology (MAASTRO), GROW, University Hospital Maastricht, Maastricht (Netherlands); Medical Physics Unit, Department of Oncology, McGill University, Montréal, Québec (Canada); Beaulieu, Luc, E-mail: Luc.Beaulieu@phy.ulaval.ca [Centre de Recherche sur le Cancer, Université Laval and Département de Radio-Oncologie, Centre Hospitalier Universitaire de Québec, Québec, QC (Canada)

2014-02-01

142

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

143

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

144

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. PMID:25076821

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

2014-01-01

145

Dose reduction in LDR brachytherapy by implanted prostate gold fiducial markers  

SciTech Connect

Purpose: The dosimetric impact of gold fiducial markers (FM) implanted prior to external beam radiotherapy of prostate cancer on low dose rate (LDR) brachytherapy seed implants performed in the context of combined therapy was investigated. Methods: A virtual water phantom was designed containing a single FM. Single and multi source scenarios were investigated by performing Monte Carlo dose calculations, along with the influence of varying orientation and distance of the FM with respect to the sources. Three prostate cancer patients treated with LDR brachytherapy for a recurrence following external beam radiotherapy with implanted FM were studied as surrogate cases to combined therapy. FM and brachytherapy seeds were identified on post implant CT scans and Monte Carlo dose calculations were performed with and without FM. The dosimetric impact of the FM was evaluated by quantifying the amplitude of dose shadows and the volume of cold spots. D{sub 90} was reported based on the post implant CT prostate contour. Results: Large shadows are observed in the single source-FM scenarios. As expected from geometric considerations, the shadows are dependent on source-FM distance and orientation. Large dose reductions are observed at the distal side of FM, while at the proximal side a dose enhancement is observed. In multisource scenarios, the importance of shadows appears mitigated, although FM at the periphery of the seed distribution caused underdosage (prostate contour, cold spots (<95% prescription dose) of the order of 20 mm{sup 3} were observed. D{sub 90} proved insensitive to the presence of FM for the cases selected. Conclusions: There is a major local impact of FM present in LDR brachytherapy seed implant dose distributions. Therefore, reduced tumor control could be expected from FM implanted in tumors, although our results are too limited to draw conclusions regarding clinical significance.

Landry, Guillaume; Reniers, Brigitte; Lutgens, Ludy; Murrer, Lars; Afsharpour, Hossein; Haas-Kock, Danielle de; Visser, Peter; Gils, Francis van; Verhaegen, Frank [Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht (Netherlands); Departement de Physique, de Genie Physique et d'Optique, Universite Laval, Quebec (Canada) and Departement de Radio-Oncologie et Centre de Recherche en Cancerologie, Universite Laval, CHUQ Pavillon L'Hotel-Dieu de Quebec, Quebec (Canada); Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht (Netherlands); Department of Radiation Oncology (MAASTRO), GROW-School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht (Netherlands) and Department of Oncology, McGill University, Montreal (Canada)

2012-03-15

146

Challenge of dose escalation in locally advanced unfavourable prostate cancer using HDR brachytherapy  

Microsoft Academic Search

In men with locally advanced\\/high-risk prostate cancer, there is an ongoing challenge to achieve improved results. Dose escalation studies using three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) have shown benefit particularly in the intermediate and poor risk groups of patients. Of concern, however, is the increase in documented rectal toxicity. High-dose rate brachytherapy (HDR-BT) as a boost

O Al-Salihi; A Mitra; H Payne

2006-01-01

147

Simulation of 3D needle-tissue interaction with application to image guided prostate brachytherapy  

Microsoft Academic Search

To improve global control of disease and reduce global toxicity, a complex seed distribution pattern should be achieved with\\u000a great accuracy during brachytherapy. However, the interaction between the needle and prostate will cause large deformation\\u000a of soft tissue. As a result, seeds will be misplaced, sharp demarcation between irradiated volume and healthy structures is\\u000a unavailable and this will cause side

Shan Jiang; Nobuhiko Hata; Bohan Xiao; Weijin An

2010-01-01

148

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

149

Is the Use of a Surrogate Urethra an Option in Prostate High-Dose-Rate Brachytherapy?  

SciTech Connect

Purpose: To investigate the accuracy and the dosimetric consequences of substituting a surrogate urethra assumed to be at the geometric center of the prostate, in place of the true urethra when using high-dose-rate (HDR) brachytherapy for the treatment of prostate cancer. Methods and Materials: One hundred prostate cancer patients treated with HDR brachytherapy constituted the study group. A pre-plan was made with the urethra visualized. The true urethra was defined, and a surrogate urethra was placed at the geometric center of the prostate. The distance between the two urethras was measured. The deviation was evaluated at the base, middle, and apex. To evaluate the dosimetric consequences for the true urethra when using a surrogate urethra, two different dose plans were made: one based on the true urethra and one based on the surrogate urethra. The dose-volume histograms for the true urethra were analyzed. Results: The deviation between the true urethra and the surrogate urethra was greatest at the base of the prostate. A statistically significant difference was seen between the dosimetric parameters for the true and the surrogate urethra when the dose plan was made using the surrogate urethra. In this situation the dose to the true urethra was increased above our defined maximum tolerance limit. Conclusions: When using dose plans made according to a surrogate urethra the dose to the true urethra might be too high to be acceptable. If the true urethra is not visualized, severe damage could easily develop in a significant number of patients.

Nilsson, Josef [Department of Medical Physics, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden)], E-mail: josef.nilsson@karolinska.se; Kaelkner, Karl Mikael; Berg, Lars [Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden); Levitt, Seymour [Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden); Department of Therapeutic Radiology, University of Minnesota, Minneapolis, MN (United States); Holmberg, Carina; Nilsson, Sten [Department of Oncology, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden); Lundell, Marie [Department of Medical Physics, Radiumhemmet, Karolinska University Hospital, Stockholm (Sweden)

2008-05-01

150

Multi-atlas-based automatic 3D segmentation for prostate brachytherapy in transrectal ultrasound images  

NASA Astrophysics Data System (ADS)

One of the commonly used treatment methods for early-stage prostate cancer is brachytherapy. The standard of care for planning this procedure is segmentation of contours from transrectal ultrasound (TRUS) images, which closely follow the prostate boundary. This process is currently performed either manually or using semi-automatic techniques. This paper introduces a fully automatic segmentation algorithm which uses a priori knowledge of contours in a reference data set of TRUS volumes. A non-parametric deformable registration method is employed to transform the atlas prostate contours to a target image coordinates. All atlas images are sorted based on their registration results and the highest ranked registration results are selected for decision fusion. A Simultaneous Truth and Performance Level Estimation algorithm is utilized to fuse labels from registered atlases and produce a segmented target volume. In this experiment, 50 patient TRUS volumes are obtained and a leave-one-out study on TRUS volumes is reported. We also compare our results with a state-of-the-art semi-automatic prostate segmentation method that has been clinically used for planning prostate brachytherapy procedures and we show comparable accuracy and precision within clinically acceptable runtime.

Nouranian, Saman; Mahdavi, S. Sara; Spadinger, Ingrid; Morris, William J.; Salcudean, S. E.; Abolmaesumi, P.

2013-03-01

151

Radiotherapeutic Techniques for Prostate Cancer, Dose Escalation and Brachytherapy  

Microsoft Academic Search

There is evidence to confirm a dose–response relationship in prostate cancer. The relative benefit is dependent on the clinical prognostic risk factors (T stage, Gleason score and presenting prostate-specific antigen [PSA]) being more favourable for intermediate-risk patients. Refinement of prognostic groups and clinical threshold parameters is ongoing. Escalation of dose in prostate radiotherapy using conventional techniques is limited by rectal

V. S. Khoo

2005-01-01

152

Predictors of Prostate Cancer–Specific Mortality in Elderly Men With Intermediate-Risk Prostate Cancer Treated With Brachytherapy With or Without External Beam Radiation Therapy  

Microsoft Academic Search

Purpose: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for comorbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy. Methods and Materials: The study cohort comprised 1,978 men of median age 71 (interquartile range, 66-75) years with intermediate-risk disease (Gleason score 7, prostate-specific antigen (PSA) 20

Akash Nanda; Ming-Hui Chen; Brian J. Moran; Michelle H. Braccioforte; Daniel Dosoretz; Sharon Salenius; Michael Katin; Rudi Ross; Anthony V. D'Amico

2010-01-01

153

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. PMID:23634153

2013-01-01

154

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

SciTech Connect

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 {sup 103}Pd and 119 with {sup 125}I. Additionally, 44 patients underwent combined external beam radiotherapy and brachytherapy and 120 patients underwent brachytherapy alone. The postimplant dosimetry with computed tomography was performed at 4 weeks and compared with the RTDPB dose plan using the intraclass correlation coefficient. The millicurie/gram of the prostate volume and the percentage of the minimal dose to 90% of the prostate relative to the prescribed implant dose (D{sub 9}%) of the RTDPB patients was compared with 400 patients treated with a free-seed technique. Results: The mean D{sub 9}% achieved in the operating room and on the 3-week dose plan was 109% (range, 93-139%) and 105% (range, 88-140), respectively. The mean percentage of prostate volume receiving 100% of the prescribed minimal peripheral dose (V{sub 10}) achieved in the operating room and on the 3-week dose plan was 93% (range, 78-98%) and 91% (range, 64-98%), respectively. The intraclass correlation coefficient for each calculated relationship was 0.586 for D{sub 9} (p < 0.001), 1.19 for V{sub 10} (p = 0.135), 0.692 for the urethral D{sub 9} (p < 0.001), 0.602 for the maximal rectal dose (p < 0.001), 0.546 for D{sub 9} with {sup 125}I (p < 0.001), and 0.565 for D{sub 9} with {sup 103}Pd (p < 0.001). A 12% decrease was noted in the millicurie/gram of the isotope, with a 2.5% increase in the D{sub 9} comparing RTDPB and the free-seed technique. Conclusion: The results of this study demonstrated a correlation between the dose assessment obtained intraoperatively and postoperatively at 3 weeks. With reliable dose data available in the operating room, our results question the need for routine postimplant dose studies. Furthermore, patients treated with RTDPB received less radioactivity per gram of the prostate with a corresponding small increase in the D{sub 9}. Future analyses will assess variations in the inverse dose planning rules and the clinical correlation of patients undergoing RTDPB vs. older techniques for toxicity and biochemical outcomes.

Potters, Louis [New York Prostate Institute, South Nassau Communities Hospital, Oceanside, NY (United States)]. E-mail: pottersL@yahoo.com; Calugaru, Emel [New York Prostate Institute, South Nassau Communities Hospital, Oceanside, NY (United States); Jassal, Anup [New York Prostate Institute, South Nassau Communities Hospital, Oceanside, NY (United States); Presser, Joseph [New York Prostate Institute, South Nassau Communities Hospital, Oceanside, NY (United States)

2006-07-15

155

Factors predicting for postimplantation urinary retention after permanent prostate brachytherapy  

Microsoft Academic Search

Purpose: Urinary retention requiring catheterization is a known complication among prostate cancer patients treated with permanent interstitial radioactive seed implantation. However, the factors associated with this complication are not well known. This study was conducted to determine these factors.Methods and Materials: Ninety-one consecutive prostate cancer patients treated with permanent interstitial implantation at our institution from 1996 to 1999 were evaluated.

Nancy Lee; Cheng-Shie Wuu; Rachel Brody; Joe L Laguna; Aaron E Katz; Emilia Bagiella; Ronald D Ennis

2000-01-01

156

Hybrid dosimetry: Feasibility of mixing angulated and parallel needles in planning prostate brachytherapy  

SciTech Connect

Pubic arch interference (PAI) often caused inadequate prostate coverage during transperineal brachytherapy using all parallel needles. In this paper, a hybrid implantation approach is presented in which additional angulated needles can be used to avoid PAI. This approach can be applied in prostate brachytherapy using a robotic assisted device. To examine the feasibility of this approach, volume data from three prostate seed implant patients were selected, which represent small, medium, and large prostates. As the blocking area was artificially increased simulating pubic arch overlap, the dosimetry outcomes and ratio of number of angulated needles to the total number of needles were analyzed. The hybrid dosimetry broke down when blocking is over 42%. As the percent of blocking increased, the ratio of the number of angulated needles to the total number of needles increased, while the dosimetry outcomes only had a slight trend of worsening. When close to the breakdown point, the dosimetry outcomes worsen drastically. Therefore, for moderate PAI the hybrid dosimetry is feasible.

Fu Lei; Liu Haisong; Ng Wansing; Rubens, Deborah; Strang, John; Messing, Edward; Yu Yan [Departments of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642 (United States); School of Mechanical and Aerospace Engineering, Nanyang Technological University, 50 Nanyang Avenue, Singapore 639798 (Singapore); Departments of Radiology, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Departments of Urology, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642 (United States); Departments of Radiation Oncology, James P. Wilmot Cancer Center, University of Rochester Medical Center, 601 Elmwood Avenue, Rochester, New York 14642 (United States)

2006-05-15

157

The influence of brachytherapy dose heterogeneity on estimates of ?/? for prostate cancer  

NASA Astrophysics Data System (ADS)

The sensitivity of estimates of ?/? for prostate tumours to dose heterogeneity in 125I brachytherapy implants, as well as to variation in selected radiobiological parameters, is analysed. The tumour control probabilities of brachytherapy and external beam radiotherapy are equated for ranges of ?, Tpot, RBE and external beam dose. For each combination of parameters, the equality is used to derive the value of ?/?. Different clinical (non-uniform) brachytherapy dose distributions, and three uniform brachytherapy dose distributions (120, 144 and 160 Gy) are used. For 'nominal' input parameter values of Tpot = 45 days, ? = 0.2 Gy-1, RBE = 1.4, and an external beam dose of 70 Gy, the values obtained for ?/? ranged between 2.1 and 12.3 Gy for all of the clinical DVHs, between 2.1 and 3.8 Gy for the better quality clinical implants and between 1.0 and 1.8 Gy for the uniform brachytherapy doses. When only 2% of the volume receiving the lowest dose is omitted from the clinical DVHs, the estimated ?/? values ranged between 1.4 and 2.1 Gy. When ranges of input parameters were also considered, the overall range of ?/? values for the clinical brachytherapy dose distributions lay between 1.1 and 12.3 Gy for the three best clinical implants, and between 0.7 and 6.3 Gy for uniform doses. We conclude that estimation of ?/? without taking into account dose heterogeneity and inter-patient variation may underestimate the actual value ?/?.

Lindsay, P. E.; Moiseenko, V. V.; Van Dyk, J.; Battista, J. J.

2003-02-01

158

Actuarial disease-free survival after prostate cancer brachytherapy using interactive techniques with biplane ultrasound and fluoroscopic guidance  

Microsoft Academic Search

Purpose: To evaluate the effectiveness and safety of interactive transperineal brachytherapy under biplane ultrasound and fluoroscopic guidance in patients with localized prostate cancer.Methods and Materials: Brachytherapy using 125I or 103Pd radioactive seeds either alone or in combination with adjunctive external beam radiotherapy (XRT) was administered to 490 patients at a single institution. Post-treatment follow-up included clinical assessment of disease status,

Gordon L Grado; Thayne R Larson; Carrie S Balch; Mary M Grado; Joseph M Collins; J. Scott Kriegshauser; Gregory P Swanson; Roberta J Navickis; Mahlon M Wilkes

1998-01-01

159

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

160

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

NASA Astrophysics Data System (ADS)

Previous studies have shown that 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 strongly depends 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 (1998 Int. J. Radiat. Oncol. Biol. Phys. 41 1069-77) was used to characterize the edema evolutions previously observed during clinical PIB for prostate cancer. The concept of biologically effective dose, 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 appropriately taken into account, can increase the cell survival and decrease the probability of local control of PIB. The magnitude of an edema-induced increase in cell survival increased with increasing edema severity, decreasing half-life of radioactive decay and decreasing photon 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.

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

2011-08-01

161

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. PMID:24927341

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

2014-01-01

162

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

163

Effects of video digitization of ultrasound images in predicting pubic arch interference for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

Prostate brachytherapy is an effective treatment for localized prostate cancer. It has been recently shown that prior to surgery a transrectal ultrasound (TRUS) study of the prostate and pubic arch can effectively assess pubic arch interference (PAI), a major stumbling block for the brachytherapy procedure. This study involved the use of digital images acquired directly from an ultrasound (US) machine. However, not all US machines allow the saving or transfer of digital image data. To allow PAI assessment regardless of US platform, we need to digitize the images from the US video output when there is no direct digital saving/transfer capability. During video digitization, the internal digital images go through a D/A and A/D conversion process, introducing quantization errors and other noises. To show that PAI assessment is still viable on the digitized images, we evaluated and refined a PAI assessment algorithm to predict the location of the pubic arch on both digital images and those captured after digitization. These predicted arch locations were statistically compared to each other. Based on the results from 33 patients, we conclude that the ability to assess PAI from TRUS images is not affected by video digitization.

Haberman, Ken; Pathak, Sayan D.; Kim, Yongmin

2000-04-01

164

Measurement of the strength of iodine-125 seed moving at unknown speed during implantation in brachytherapy  

PubMed Central

The aim of this study is to demonstrate the feasibility of estimating the strength of the moving radiation source during patient implantation. The requirement for the counting time was investigated by comparing the results of the measurements for the static source with those for the source moving at 2, 5, 10 and 20 cm s?1. The utilized source was 125I with an air-kerma strength of 0.432 U (?Gym2h–1). The detector utilized was a plastic scintillation detector (8 cm × 5 cm × 2 cm in thickness) set at 8 cm away from the needle to guide the source. Experiments were conducted in order to determine the most desirable counting time. Analysis using the maximum of the measured values while the source passed through the needle indicated that the results for the moving source increased more than those for the static source as the counting time decreased. The combined standard uncertainty, with the coverage factor of 1, was within 4% at the counting time of 100 ms. This investigation supported the feasibility of the method proposed for estimating the source strength during the implantation procedure, regardless of the source speed. The method proposed is a potential option for reducing the risk of accidental replacements of sources with those of incorrect strengths. PMID:23816530

Tanaka, Kenichi; Endo, Satoru; Tateoka, Kunihiko; Asanuma, Osamu; Kamo, Ken-ichi; Sato, Kaori; Takeda, Hiromitsu; Takagi, Masaru; Hareyama, Masato; Takada, Jun

2014-01-01

165

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

166

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. PMID:24885287

2014-01-01

167

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

168

Predictive Factors and Management of Rectal Bleeding Side Effects Following Prostate Cancer Brachytherapy  

SciTech Connect

Purpose: To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ?grade 2 proctitis. Methods and Materials: A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities. Results: Actuarial risk of ?grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ?2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model. Conclusions: Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following BT.

Price, Jeremy G. [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stone, Nelson N. [Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York (United States)

2013-08-01

169

High-Dose-Rate Brachytherapy Boost for Prostate Cancer: Comparison of Two Different Fractionation Schemes  

SciTech Connect

Purpose: This is a retrospective study comparing our experience with high-dose-rate (HDR) brachytherapy boost for prostate cancer, using two different fractionation schemes, 600 cGy Multiplication-Sign 3 fractions (patient group 1) and 950 cGy Multiplication-Sign 2 fractions (patient group 2). Methods and Materials: A total of 165 patients were treated for prostate cancer using external beam radiation therapy up to a dose of 45 Gy, followed by an HDR brachytherapy prostate radiation boost. Between July 1997 and Nov 1999, 64 patients were treated with an HDR boost of 600 cGy Multiplication-Sign 3 fractions; and between June 2000 and Nov 2005, 101 patients were treated with an HDR boost of 950 cGy Multiplication-Sign 2 fractions. All but 9 patients had at least one of the following risk features: pretreatment prostate-specific antigen (PSA) level >10, a Gleason score {>=}7, and/or clinical stage T3 disease. Results: Median follow-up was 105 months for group 1 and 43 months for group 2. Patients in group 2 had a greater number of high-risk features than group 1 (p = 0.02). Adjusted for comparable follow-up, there was no difference in biochemical no-evidence-of-disease (bNED) rate between the two fractionation scheme approaches, with 5-year Kaplan-Meier estimates of 93.5% in group 1 and 87.3% in group 2 (p = 0.19). The 5-year estimates of progression-free survival were 86% for group 1 and 83% for group 2 (p = 0.53). Among high-risk patients, there were no differences in bNED or PFS rate due to fractionation. Conclusions: Results were excellent for both groups. Adjusted for comparable follow-up, no differences were found between groups.

Kaprealian, Tania [Department of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Weinberg, Vivian [Biostatistics and Computational Biology Core, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Speight, Joycelyn L. [Department of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Department of Urology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Gottschalk, Alexander R. [Department of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Roach, Mack [Department of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Department of Urology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Shinohara, Katsuto [Department of Urology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States); Hsu, I.-Chow, E-mail: IHsu@radonc.ucsf.edu [Department of Radiation Oncology, University of California, San Francisco Helen Diller Family Comprehensive Cancer Center, San Francisco, California (United States)

2012-01-01

170

Seed-based transrectal ultrasound-fluoroscopy registration method for intraoperative dosimetry analysis of prostate brachytherapy  

SciTech Connect

Prostate brachytherapy is an effective treatment option for early-stage prostate cancer. During a prostate brachytherapy procedure, transrectal ultrasound (TRUS) and fluoroscopy imaging modalities complement each other by providing good visualization of soft tissue and implanted seeds, respectively. Therefore, the registration of these two imaging modalities, which are readily available in the operating room, could facilitate intraoperative dosimetry, thus enabling physicians to implant additional seeds into the underdosed portions of the prostate while the patient is still on the operating table. It is desirable to register TRUS and fluoroscopy images by using the seeds as fiducial markers. Although the locations of all the implanted seeds can be reconstructed from three fluoroscopy images, only a fraction of these seeds can be located in TRUS images. It is challenging to register the TRUS and fluoroscopy images by using the identified seeds, since the correspondence between them is unknown. Furthermore, misdetection of nonseed structures as seeds can lead to the inclusion of spurious points in the data set. We developed a new method called iterative optimal assignment (IOA) to overcome these challenges in TRUS-fluoroscopy registration. By using the Hungarian method in an optimization framework, IOA computes a set of transformation parameters that yield the one-to-one correspondence with minimum cost. We have evaluated our registration method at varying noise levels, seed detection rates, and number of spurious points using data collected from 25 patients. We have found that IOA can perform registration with an average root mean square error of about 0.2 cm even when the seed detection rate is only 10%. We believe that IOA can offer a robust solution to seed-based TRUS-fluoroscopy registration, thus making intraoperative dosimetry possible.

Tutar, Ismail B.; Gong Lixin; Narayanan, Sreeram; Pathak, Sayan D.; Cho, Paul S.; Wallner, Kent; Kim, Yongmin [Departments of Electrical Engineering and Bioengineering, Image Computing Systems Laboratory, University of Washington, Seattle, Washington 98195 (United States); Insightful Corporation, 1700 Westlake Avenue, Suite 500, Seattle, Washington 98109 (United States); Department of Radiation Oncology, University of Washington, Seattle, Washington 98195 (United States); Departments of Electrical Engineering and Bioengineering, Image Computing Systems Laboratory, University of Washington, Seattle, Washington 98195 (United States); Department of Radiation Oncology, University of Washington, Seattle, Washington 98195 (United States); Department of Bioengineering, University of Washington, Box 355061, Seattle, Washington 98195 (United States)

2008-03-15

171

DuraSeal® as a spacer to reduce rectal doses in low-dose rate brachytherapy for prostate cancer.  

PubMed

The purpose of this study was to evaluate the utility of off-label use of DuraSeal® polyethylene glycol (PEG) gel in low-dose rate (LDR) prostate brachytherapy seed implantation to reduce rectal doses. Diluted DuraSeal® was easy to use and, in spite of a clearance effect, useful in decreasing D2cc rectal doses. PMID:25201125

Heikkilä, Vesa-Pekka; Kärnä, Aarno; Vaarala, Markku H

2014-08-01

172

Factors impacting all-cause mortality in prostate cancer brachytherapy patients with or without androgen deprivation therapy  

Microsoft Academic Search

PurposeCertain subsets of patients have an increased risk of all-cause mortality when androgen deprivation therapy (ADT) is used with definitive radiotherapy. We evaluated the relationship between pretreatment serum testosterone, age, and comorbidities on survival after prostate brachytherapy in men treated with and without ADT.

Al V. Taira; Gregory S. Merrick; Robert W. Galbreath; Wayne M. Butler; Kent E. Wallner

2010-01-01

173

Overall survival and biochemical failure-free survival comparison of brachytherapy treatment options versus external beam radiation therapy for both low and intermediate-risk prostate cancer: A propensity-score matched analysis.  

E-print Network

??Purpose: This study compares overall survival (OS) and biochemical failure-free survival (bFFS) in low- and intermediate-risk prostate cancer patients that received brachytherapy [low-dose-rate brachytherapy (LDR-BT)… (more)

Smith, Graham D

2014-01-01

174

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

NASA Astrophysics Data System (ADS)

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. For a given 125I or 103Pd PB, the EUD for tumour that corresponds to a dose distribution delivered by EBRT is calculated based on the linear quadratic model. The EUD calculation is based on the dose volume histogram (DVH) obtained retrospectively from representative actual patient data. Tumour control probabilities (TCPs) are also determined in order to compare the relative effectiveness of different dose levels. The EUD for normal tissue is computed using the Lyman model. A commercial inverse treatment planning algorithm is used to investigate the feasibility of escalating the dose to prostate with acceptable dose increases in the rectum and urethra. The dosimetric calculation is performed for five representative patients with different prostate sizes. A series of PB dose levels are considered for each patient using 125I and 103Pd seeds. It is found that the PB prescribed doses (minimum peripheral dose) that give an equivalent EBRT dose of 64.8, 70.2, 75.6 and 81 Gy with a fraction size of 1.8 Gy are 129, 139, 150 and 161 Gy for 125I and 103, 112, 122 and 132 Gy for 103Pd implants, respectively. Estimates of the EUD and TCP for a series of possible prescribed dose levels (e.g., 145, 160, 170 and 180 Gy for 125I and 125, 135, 145 and 155 for 103Pd implants) are tabulated. The EUD calculation was found to depend strongly on DVHs and radiobiological parameters. The dosimetric calculations suggest that the dose to prostate can be escalated without a substantial increase in both rectal and urethral dose. For example, increasing the PB prescribed dose from 145 to 180 Gy increases EUD for the rectum by only 3%. Our studies indicate that the dose to urethra can be kept within 100-120% of the prescription dose for all the dose levels studied. In conclusion, dose escalation in permanent implant for localized prostate cancer may be advantageous. It is dosimetrically possible to increase dose to prostate without a substantial increase in the dose to the rectum and urethra. Based on the results of our studies, a prospective dose escalation trial for prostate permanent implants has been initiated at our institution.

Li, X. Allen; Wang, Jian Z.; Stewart, Robert D.; Di Biase, Steven J.

2003-09-01

175

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

176

The Influence of Prostate Volume on Outcome After High-Dose-Rate Brachytherapy Alone for Localized Prostate Cancer  

SciTech Connect

Objective: To determine whether late genitourinary toxicity, biochemical control of prostate cancer, and dosimetric parameters in patients with large prostate glands is different from those variables in men with smaller glands after treatment with high-dose-rate brachytherapy alone (HDR-BT). Methods: From November 2003 to July 2009, 164 patients with locally advanced prostate carcinoma were sequentially enrolled and treated with 34 or 36 Gy in 4 fractions and 31.5 Gy in 3 fractions of {sup 192}Ir HDR-BT alone. The median follow-up time was 71 months. Gland size was not considered in the selection criteria for this study. Estimates of freedom from biochemical relapse (FFbR) and late morbidity, stratified by median clinical target volume (CTV), were obtained, and differences were compared. Results: The median CTV volume was 60 cc (range, 15-208 cc). Dose–volume parameters D90 and V100 (ie, minimum dose to 90% of the prostate volume and volume receiving 100% of the prescribed isodose) achieved in patients with glands ?60 cc were not significantly different from those with glands <60 cc (P?.2). Nonetheless, biochemical control in patients with larger CTV was significantly higher (91% vs 78% at 6 years; P=.004). In univariate and multivariate analysis, CTV was a significant predictor for risk of biochemical relapse. This was not at the expense of an increase in either moderate (P=.6) or severe (P=.3) late genitourinary toxicity. The use of hormonal therapy was 17% lower in the large gland group (P=.01). Conclusions: Prostate gland size does not affect dosimetric parameters in HDR-BT assessed by D90 and V100. In patients with larger glands, a significantly higher biochemical control of disease was observed, with no difference in late toxicity. This improvement cannot be attributed to differences in dosimetry. Gland size should not be considered in the selection of patients for HDR-BT.

Le, Hien, E-mail: hien.le@health.sa.gov.au; Rojas, Ana; Alonzi, Roberto; Hughes, Robert; Ostler, Peter; Lowe, Gerry; Bryant, Linda; Hoskin, Peter

2013-10-01

177

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.

2008-03-01

178

Automatic segmentation of seeds and fluoroscope tracking (FTRAC) fiducial in prostate brachytherapy x-ray images  

NASA Astrophysics Data System (ADS)

C-arm X-ray fluoroscopy-based radioactive seed localization for intraoperative dosimetry of prostate brachytherapy is an active area of research. The fluoroscopy tracking (FTRAC) fiducial is an image-based tracking device composed of radio-opaque BBs, lines, and ellipses that provides an effective means for pose estimation so that three-dimensional reconstruction of the implanted seeds from multiple X-ray images can be related to the ultrasound-computed prostate volume. Both the FTRAC features and the brachytherapy seeds must be segmented quickly and accurately during the surgery, but current segmentation algorithms are inhibitory in the operating room (OR). The first reason is that current algorithms require operators to manually select a region of interest (ROI), preventing automatic pipelining from image acquisition to seed reconstruction. Secondly, these algorithms fail often, requiring operators to manually correct the errors. We propose a fast and effective ROI-free automatic FTRAC and seed segmentation algorithm to minimize such human intervention. The proposed algorithm exploits recent image processing tools to make seed reconstruction as easy and convenient as possible. Preliminary results on 162 patient images show this algorithm to be fast, effective, and accurate for all features to be segmented. With near perfect success rates and subpixel differences to manual segmentation, our automatic FTRAC and seed segmentation algorithm shows promising results to save crucial time in the OR while reducing errors.

Kuo, Nathanael; Lee, Junghoon; Deguet, Anton; Song, Danny; Burdette, E. Clif; Prince, Jerry

2010-02-01

179

A simple technique for the generation of institution-specific nomograms for permanent prostate cancer brachytherapy  

PubMed Central

Purpose Nomograms once had a vital role in prostate brachytherapy practice. Although some of their functions have been assumed by computerized dosimetry, many programs still find them useful to determine the number and strength of seeds to be ordered in advance of the implant. As it has been demonstrated that brachytherapists differ in their implant practices and preferences (in regard to seed distribution and total implanted activity), we propose a simple technique for generating institution-specific nomograms. Material and methods Using the data generated by previous implants, we demonstrate a simple technique, utilizing ubiquitous software, for generating nomograms to predict seed number, strength, and total implant activity. Results Despite wide variations in the degree of post-implant swelling (+12% to +56%), nine of the first ten implants using the generated nomogram have met all target dose parameters. Conclusions It is appropriate for each institution to develop nomograms specific to their prostate brachytherapy technique and constraints. Nomograms can estimate the number and strength of seeds to be ordered, and may partially compensate for the effects of implant-induced swelling. PMID:25337132

Lafata, Kyle J.; Bushe, Harry

2014-01-01

180

Detection and correction of patient movement in prostate brachytherapy seed reconstruction  

NASA Astrophysics Data System (ADS)

Intraoperative dosimetry of prostate brachytherapy can help optimize the dose distribution and potentially improve clinical outcome. Evaluation of dose distribution during the seed implant procedure requires the knowledge of 3D seed coordinates. Fluoroscopy-based seed localization is a viable option. From three x-ray projections obtained at different gantry angles, 3D seed positions can be determined. However, when local anaesthesia is used for prostate brachytherapy, the patient movement during fluoroscopy image capture becomes a practical problem. If uncorrected, the errors introduced by patient motion between image captures would cause seed mismatches. Subsequently, the seed reconstruction algorithm would either fail to reconstruct or yield erroneous results. We have developed an algorithm that permits detection and correction of patient movement that may occur between fluoroscopy image captures. The patient movement is decomposed into translational shifts along the tabletop and rotation about an axis perpendicular to the tabletop. The property of spatial invariance of the co-planar imaging geometry is used for lateral movement correction. Cranio-caudal movement is corrected by analysing the perspective invariance along the x-ray axis. Rotation is estimated by an iterative method. The method can detect and correct for the range of patient movement commonly seen in the clinical environment. The algorithm has been implemented for routine clinical use as the preprocessing step for seed reconstruction.

Lam, Steve T.; Cho, Paul S.; Marks, Robert J., II; Narayanan, Sreeram

2005-05-01

181

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

NASA Astrophysics Data System (ADS)

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 less compared to current methods. We measured the momentum that is applied when manually tapping the needle into the prostate and found a mean momentum of 0.50 ± 0.07 N s. The tapping device is pneumatically driven and we found that the delivered momentum increased linearly with the applied air pressure. The efficacy of the tapping device was tested on a piece of beef, placed on a freely moving and rotating platform. A significant correlation was found between the applied pressure and the rotation and displacement of the beef. Displacements and rotations were minimal for the highest pressure (4 bar) and amounted to only 2 mm and 6°, respectively. Higher air pressures will further reduce displacements and rotations.

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

2006-02-01

182

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

183

Predictive Factors for Acute and Late Urinary Toxicity After Permanent Prostate Brachytherapy: Long-Term Outcome in 712 Consecutive Patients  

SciTech Connect

Purpose: To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity. Results: The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02). Conclusion: Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low. Refined patient selection and greater technical experience in prostate brachytherapy were associated with less urinary toxicity.

Keyes, Mira [Vancouver Cancer Center, Vancouver, BC (Canada)], E-mail: mkeyes@bccancer.bc.ca; Miller, Stacy [Vancouver Cancer Center, Vancouver, BC (Canada); Moravan, Veronika [Population and Preventive Oncology, Vancouver Island Cancer Centre, Vancouver, BC (Canada); Pickles, Tom; McKenzie, Michael [Vancouver Cancer Center, Vancouver, BC (Canada); Pai, Howard [Population and Preventive Oncology, Vancouver Island Cancer Centre, Vancouver, BC (Canada); Liu, Mitchell; Kwan, Winkle; Agranovich, Alexander [Fraser Valley Cancer Centre for Southern Interior Provincial Prostate Brachytherapy Program, Vancouver, BC (Canada); Spadinger, Ingrid; Lapointe, Vincent [Vancouver Cancer Center, Vancouver, BC (Canada); Halperin, Ross [British Columbia Cancer Agency, Vancouver, BC (Canada); Morris, W. James [Vancouver Cancer Center, Vancouver, BC (Canada)

2009-03-15

184

Comparison of High-Dose Proton Radiotherapy and Brachytherapy in Localized Prostate Cancer: A Case-Matched Analysis  

SciTech Connect

Purpose: To report a case-matched analysis comparing high-dose external-beam radiation (EBRT) for prostate cancer delivered on Proton Radiation Oncology Group (PROG) 95-09, a randomized trial, with permanent prostate brachytherapy over the same era. Methods: From 1996 to 1999, 196 patients were accrued to the high-dose arm (79.2 Gray equivalent (GyE) using photons and protons) of PROG 95-09 at the Massachusetts General Hospital and Loma Linda University Medical Center. Entry criteria specified T1-2 and prostate-specific antigen {<=}15 ng/mL. When Gleason score >7 was excluded, 177 men were left for case matching. At Massachusetts General Hospital, 203 similar patients were treated by a single brachytherapist from 1997 to 2002. Minimum follow-up was 3 years. Case matching, based on T stage, Gleason score, prostate-specific antigen, and age resulted in 141 matches (282 patients). Median follow-up was 8.6 and 7.4 years for EBRT and brachytherapy, respectively. The primary endpoint was biochemical failure (BF). Results: Using the Phoenix definition, the 8-year BF rates were 7.7% and 16.1% for EBRT and brachytherapy, respectively (p = 0.42). A stratified analysis was performed by risk group. In the EBRT group, 113 and 28 patients were low and intermediate risk, respectively. In the brachytherapy group, 118 and 23 were. When stratified by risk group, the BF rates were similar by either technique. Conclusions: High-dose EBRT and brachytherapy result in similar BF rates for men with localized prostate cancer. Comparative quality-of-life and cost-effectiveness studies are warranted.

Coen, John J., E-mail: jcoen@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Rossi, Carl J. [Department of Radiation Oncology, Loma Linda University Medical Center, Loma Linda, CA (United States); Grocela, Joseph A. [Department of Urology, Massachusetts General Hospital, Boston, MA (United States); Efstathiou, Jason A. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Yan, Yan [Department of Statistics, Radiation Oncology Therapy Group, Philadelphia, PA (United States); Shipley, William U. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

2012-01-01

185

High-Dose-Rate Monotherapy: Safe and Effective Brachytherapy for Patients With Localized Prostate Cancer  

SciTech Connect

Purpose: High-dose-rate (HDR) brachytherapy used as the only treatment (monotherapy) for early prostate cancer is consistent with current concepts in prostate radiobiology, and the dose is reliably delivered in a prospectively defined anatomic distribution that meets all the requirements for safe and effective therapy. We report the disease control and toxicity of HDR monotherapy from California Endocurietherapy (CET) and William Beaumont Hospital (WBH) in low- and intermediate-risk prostate cancer patients. Methods and Materials: There were 298 patients with localized prostate cancer treated with HDR monotherapy between 1996 and 2005. Two biologically equivalent hypofractionation protocols were used. At CET the dose was 42 Gy in six fractions (two implantations 1 week apart) delivered to a computed tomography-defined planning treatment volume. At WBH the dose was 38 Gy in four fractions (one implantation) based on intraoperative transrectal ultrasound real-time treatment planning. The bladder, urethral, and rectal dose constraints were similar. Toxicity was scored with the National Cancer Institute Common Toxicity Criteria for Adverse Events version 3. Results: The median follow-up time was 5.2 years. The median age of the patients was 63 years, and the median value of the pretreatment prostate-specific antigen was 6.0 ng/mL. The 8-year results were 99% local control, 97% biochemical control (nadir +2), 99% distant metastasis-free survival, 99% cause-specific survival, and 95% overall survival. Toxicity was scored per event, meaning that an individual patient with more than one symptom was represented repeatedly in the morbidity data table. Genitourinary toxicity consisted of 10% transient Grade 2 urinary frequency or urgency and 3% Grade 3 episode of urinary retention. Gastrointestinal toxicity was <1%. Conclusions: High disease control rates and low morbidity demonstrate that HDR monotherapy is safe and effective for patients with localized prostate cancer.

Demanes, D. Jeffrey, E-mail: jdemanes@mednet.ucla.edu [California Endocurietherapy at UCLA, Department of Radiation Oncology, David Geffen School of Medicine of University of California at Los Angeles, Los Angeles, CA (United States); Martinez, Alvaro A.; Ghilezan, Michel [William Beaumont Hospital, Royal Oak, MI (United States); Hill, Dennis R.; Schour, Lionel; Brandt, David [California Endocurietherapy, Oakland, CA (United States); Gustafson, Gary [William Beaumont Hospital, Royal Oak, MI (United States)

2011-12-01

186

Predicting pubic arch interference using multiplanar transrectal ultrasound (TRUS) for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

Prostate brachytherapy is a treatment procedure for localized prostate cancer. It involves placing needles and subsequently radioactive seeds under ultrasound guidance into predetermined targets within the prostate. As the pubic arch can be a barrier to successful placement of the needles, preoperative assessment requires visualization of the pubic arch with respect to the prostate. Current CT- based techniques to assess pubic arch interference (PAI) are expensive and time-consuming. This paper describes a new technique using transrectal ultrasound that enables the visualization of the pubic arch bone and the prostate gland simultaneously. The technique involves speckle suppression in the pubic arch ultrasound image and contrast enhancement of the pubic bones using sticks algorithm. This step is followed by noise filtering using percentile thresholding and curve fitting. The detected arch is superimposed on the transverse cross-sectional image of the prostate at its largest position predicted by the algorithm was compared with the 'true' pubic arch position determined at surgery by placing needles into multiple coordinates corresponding and adjacent to the predicted arch position. The accuracy of the algorithm in detecting the pubic arch was tested on 50 patients. Of 1030 points tested, the algorithm prediction was correct at 932 points. The mean Type II error, i.e., the algorithm predicted soft tissue while bone was encountered during needle insertion, was 2.9 percent, which corresponds to less than 1 out of 22 test points along the predicted pubic arch. The accuracy of our algorithm is good and the errors are within clinically-acceptable limits.

Pathak, Sayan D.; Grimm, Peter D.; Estlund, Jacque; Chalana, Vikram; Kim, Yongmin

1999-05-01

187

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. PMID:24143145

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

2013-01-01

188

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

189

Prospective comparison of PSA kinetics following two different prostate cancer brachytherapy planning methods: Preoperative and real-time intraoperative dosimetry planning  

Microsoft Academic Search

ObjectivesPreoperative planning (PP) and intraoperative planning (IoP) are established 125I-brachytherapy techniques for the treatment of localized prostate cancer. We prospectively compared the effects of each method on reducing PSA levels.

Haim Matzkin; Juza Chen; Amira Stenger; Rubi Agai; Nicola J. Mabjeesh

2010-01-01

190

Predictors of the use of supplemental androgen suppression therapy and external beam radiation in men with high-risk prostate cancer undergoing brachytherapy in community practice  

Microsoft Academic Search

PurposeWe assessed clinical- and practice-related variables associated with the use of trimodality treatment (androgen suppression therapy, external beam radiation therapy, and brachytherapy) in a community-based cohort of men with high-risk prostate cancer.

Jona A. Hattangadi; Ming-Hui Chen; Michelle H. Braccioforte; Brian J. Moran; Anthony V. D’Amico

2011-01-01

191

Ultrasound-guided high dose rate conformal brachytherapy boost in prostate cancer: Treatment description and preliminary results of a phase I II clinical trial  

Microsoft Academic Search

To improve results for locally advanced prostate cancer, a prospective clinical trial of concurrent external beam irradiation and fractionated iridium-192 (IR-192) high dose rate (HDR) conformal boost brachytherapy was initiated. This technique of concurrent external pelvic irradiation and conformal HDR brachytherapy was well tolerated. No significant intraoperative or perioperative complications occurred. Three patients (9%) experienced Grade 3 acute toxicity (two

Jannifer Stromberg; Alvaro Martinez; Jose Gonzalez; Gregory Edmundson; Neshan Ohanian; Frank Vicini; Jay Hollander; Gary Gustafson; William Spencer; Di Yan; Donald Brabbins

1995-01-01

192

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

Microsoft Academic Search

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

Richard G. Stock; Thomas J. Klein; Jamie A. Cesaretti; Nelson N. Stone

2009-01-01

193

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

Microsoft Academic Search

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

Nathan Bittner; Gregory S. Merrick; Kent E. Wallner; Wayne M. Butler; Robert Galbreath; Edward Adamovich

2010-01-01

194

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

PubMed

Publications have reported the benefits of using high-dose-rate brachytherapy (HDRB) for the treatment of prostate cancer, since it provides similar biochemical control as other treatments while showing lowest long-term complications to the organs at risk (OAR). With the inclusion of anatomy-based inverse planning opti- mizers, HDRB has the advantage of potentially allowing dose escalation. Among the algorithms used, the Inverse Planning Simulated Annealing (IPSA) optimizer is widely employed since it provides adequate dose coverage, minimizing dose to the OAR, but it is known to generate large dwell times in particular positions of the catheter. As an alternative, the Hybrid Inverse treatment Planning Optimization (HIPO) algorithm was recently implemented in Oncentra Brachytherapy V. 4.3. The aim of this work was to compare, with the aid of radiobiological models, plans obtained with IPSA and HIPO to assess their use in our clinical practice. Thirty patients were calculated with IPSA and HIPO to achieve our department's clinical constraints. To evaluate their performance, dosimetric data were collected: Prostate PTV D90(%), V100(%), V150(%), and V200(%), Urethra D10(%), Rectum D2cc(%), and conformity indices. Additionally tumor control probability (TCP) and normal tissue complication probability (NTCP) were calculated with the BioSuite software. The HIPO optimization was performed firstly with Prostate PTV (HIPOPTV) and then with Urethra as priority 1 (HIPOurethra). Initial optimization constraints were then modified to see the effects on dosimetric parameters, TCPs, and NTCPs. HIPO optimizations could reduce TCPs up to 10%-20% for all PTVs lower than 74 cm3. For the urethra, IPSA and HIPOurethra provided similar NTCPs for the majority of volume sizes, whereas HIPOPTV resulted in large NTCP values. These findings were in agreement with dosimetric values. By increasing the PTV maximum dose constraints for HIPOurethra plans, TCPs were found to be in agreement with IPSA without affecting the urethral NTCPs.  PMID:25493531

Panettieri, Vanessa; Smith, Ryan L; Mason, Natasha J; Millar, Jeremy L

2014-01-01

195

A study of optimization techniques in HDR brachytherapy for the prostate  

NASA Astrophysics Data System (ADS)

Several studies carried out thus far are in favor of dose escalation to the prostate gland to have better local control of the disease. But optimal way of delivery of higher doses of radiation therapy to the prostate without hurting neighboring critical structures is still debatable. In this study, we proposed that real time high dose rate (HDR) brachytherapy with highly efficient and effective optimization could be an alternative means of precise delivery of such higher doses. This approach of delivery eliminates the critical issues such as treatment setup uncertainties and target localization as in external beam radiation therapy. Likewise, dosimetry in HDR brachytherapy is not influenced by organ edema and potential source migration as in permanent interstitial implants. Moreover, the recent report of radiobiological parameters further strengthen the argument of using hypofractionated HDR brachytherapy for the management of prostate cancer. Firstly, we studied the essential features and requirements of real time HDR brachytherapy treatment planning system. Automating catheter reconstruction with fast editing tools, fast yet accurate dose engine, robust and fast optimization and evaluation engine are some of the essential requirements for such procedures. Moreover, in most of the cases we performed, treatment plan optimization took significant amount of time of overall procedure. So, making treatment plan optimization automatic or semi-automatic with sufficient speed and accuracy was the goal of the remaining part of the project. Secondly, we studied the role of optimization function and constraints in overall quality of optimized plan. We have studied the gradient based deterministic algorithm with dose volume histogram (DVH) and more conventional variance based objective functions for optimization. In this optimization strategy, the relative weight of particular objective in aggregate objective function signifies its importance with respect to other objectives. Based on our study, DVH based objective function performed better than traditional variance based objective function in creating a clinically acceptable plan when executed under identical conditions. Thirdly, we studied the multiobjective optimization strategy using both DVH and variance based objective functions. The optimization strategy was to create several Pareto optimal solutions by scanning the clinically relevant part of the Pareto front. This strategy was adopted to decouple optimization from decision such that user could select final solution from the pool of alternative solutions based on his/her clinical goals. The overall quality of treatment plan improved using this approach compared to traditional class solution approach. In fact, the final optimized plan selected using decision engine with DVH based objective was comparable to typical clinical plan created by an experienced physicist. Next, we studied the hybrid technique comprising both stochastic and deterministic algorithm to optimize both dwell positions and dwell times. The simulated annealing algorithm was used to find optimal catheter distribution and the DVH based algorithm was used to optimize 3D dose distribution for given catheter distribution. This unique treatment planning and optimization tool was capable of producing clinically acceptable highly reproducible treatment plans in clinically reasonable time. As this algorithm was able to create clinically acceptable plans within clinically reasonable time automatically, it is really appealing for real time procedures. Next, we studied the feasibility of multiobjective optimization using evolutionary algorithm for real time HDR brachytherapy for the prostate. The algorithm with properly tuned algorithm specific parameters was able to create clinically acceptable plans within clinically reasonable time. However, the algorithm was let to run just for limited number of generations not considered optimal, in general, for such algorithms. This was done to keep time window desirable for real time procedures. Therefore, it requires further s

Pokharel, Ghana Shyam

196

Conventional Versus Automated Implantation of Loose Seeds in Prostate Brachytherapy: Analysis of Dosimetric and Clinical Results  

SciTech Connect

Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (P=.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

Genebes, Caroline, E-mail: genebes.caroline@claudiusregaud.fr [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Filleron, Thomas; Graff, Pierre [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France); Jonca, Frédéric [Department of Urology, Clinique Ambroise Paré, Toulouse (France); Huyghe, Eric; Thoulouzan, Matthieu; Soulie, Michel; Malavaud, Bernard [Department of Urology and Andrology, CHU Rangueil, Toulouse (France); Aziza, Richard; Brun, Thomas; Delannes, Martine; Bachaud, Jean-Marc [Radiation Oncology Department, Institut Claudius Regaud, Toulouse (France)

2013-11-15

197

Penile necrosis requiring penectomy complicating recto-urethral fistula post prostate cancer external beam radiation and brachytherapy  

PubMed Central

Radiation therapy is a well-recognized treatment for unfavourable risk localized prostate cancer. Radiation induced recto-urethral fistulae are known rare complications particularly from brachytherapy. We report a case of a recto-urethral fistula 7 years post-external beam radiation and I-125 brachytherapy, which was complicated by a severe polymicrobial soft tissue infection. This infection required penectomy and pelvic exenteration with diverting colostomy, Indiana pouch urinary diversion and gracilis myo-cutaneuos flap closure of the perineum. PMID:24454604

Kinahan, John; Pai, Howard; Martens, Mildred; Gray, Jason; Biberdorf, Darren; Mihailovic, Alex; McAuley, Iain

2014-01-01

198

Acute urinary morbidity after a permanent 125I implantation for localized prostate cancer.  

PubMed

We evaluated the predictive factors of acute urinary morbidity (AUM) after prostate brachytherapy. From November 2005 to January 2007, 62 patients with localized prostate cancer were treated using brachytherapy. The (125)Iodine ((125)I) seed-delivering method was a modified peripheral pattern. The prescribed dose was 144 Gy. Urinary morbidity was scored at 3 months after implantation. The clinical and treatment parameters were analysed for correlation with AUM. In particular, in this study, Du90 (the minimal dose received by 90% of the urethra), Dup90 (the minimal dose received by 90% of the proximal half of the urethra on the bladder side) and Dud90 (the minimal dose received by 90% of the distal half of the urethra on the penile side) were analysed. We found that 43 patients (69.4%) experienced acute urinary symptoms at 3 months after implantation. Of them, 40 patients had Grade 1 AUM, one patient had Grade 2 pain, and two patients had Grade 2 urinary frequency. None of the patients had ?Grade 3. Univariate and multivariate analysis revealed that Du90 and Dup90 were significantly correlated with AUM. In this study, Du90 and Dup90 were the most significant predictors of AUM after prostate brachytherapy. PMID:25062753

Ohga, Saiji; Nakamura, Katsumasa; Shioyama, Yoshiyuki; Tatsugami, Katsunori; Sasaki, Tomonari; Nonoshita, Takeshi; Yoshitake, Tadamasa; Asai, Kaori; Hirata, Hideki; Naito, Seiji; Honda, Hiroshi

2014-11-01

199

Acute urinary morbidity after a permanent 125I implantation for localized prostate cancer  

PubMed Central

We evaluated the predictive factors of acute urinary morbidity (AUM) after prostate brachytherapy. From November 2005 to January 2007, 62 patients with localized prostate cancer were treated using brachytherapy. The 125Iodine (125I) seed-delivering method was a modified peripheral pattern. The prescribed dose was 144 Gy. Urinary morbidity was scored at 3 months after implantation. The clinical and treatment parameters were analysed for correlation with AUM. In particular, in this study, Du90 (the minimal dose received by 90% of the urethra), Dup90 (the minimal dose received by 90% of the proximal half of the urethra on the bladder side) and Dud90 (the minimal dose received by 90% of the distal half of the urethra on the penile side) were analysed. We found that 43 patients (69.4%) experienced acute urinary symptoms at 3 months after implantation. Of them, 40 patients had Grade 1 AUM, one patient had Grade 2 pain, and two patients had Grade 2 urinary frequency. None of the patients had ?Grade 3. Univariate and multivariate analysis revealed that Du90 and Dup90 were significantly correlated with AUM. In this study, Du90 and Dup90 were the most significant predictors of AUM after prostate brachytherapy. PMID:25062753

Ohga, Saiji; Nakamura, Katsumasa; Shioyama, Yoshiyuki; Tatsugami, Katsunori; Sasaki, Tomonari; Nonoshita, Takeshi; Yoshitake, Tadamasa; Asai, Kaori; Hirata, Hideki; Naito, Seiji; Honda, Hiroshi

2014-01-01

200

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

201

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

202

Automated seed localization for intraoperative prostate brachytherapy based on 3D line segment patterns  

NASA Astrophysics Data System (ADS)

Transrectal ultrasound (TRUS)-guided brachytherapy is a treatment option for localized prostate cancer, in which 125I or 103Pd radioactive seeds are implanted into the prostate. In this procedure, automated seed localization is important for intra-operative evaluation of dose delivery, which permits the identification of under-dosed regions and remedial seed placement, and ensures that the entire prostate receives the prescribed dose. In this paper, we describe the development of an automated seed segmentation method for use with 3D TRUS images. It is composed of five steps: 1) 3D needle segmentation; 2) volume cropping along the detected needle; 3) non-seed structure removal based on tri-bar model projection; 4) seed candidate recognition using 3D line segment detection; and 5) localization of seed positions. Experiments with the agar and chicken phantom images demonstrated that our method could segment 93% of the seeds in the 3D TRUS images with a mean distance error of 1.0 mm in an agar phantom and 1.7 mm in a chicken phantom, both with respect to manual segmented seed positions. The false positive rate was 7% while the segmentation time on a PC computer with dual AMD Athlon 1.8GHz processor was 280 seconds.

Ding, Mingyue; Wei, Zhouping; Downey, Donal B.; Fenster, Aaron

2005-04-01

203

Irradiation of localized prostatic carcinoma with a combination of high dose rate iridium-192 brachytherapy and external beam radiotherapy with three target definitions and dose levels inside the prostate gland  

Microsoft Academic Search

Purpose: Localized prostate cancer was treated with combined external beam radiotherapy and high dose rate Ir-192 brachytherapy with the purpose of a high dose. The technical aspects of a modified treatment are described.Methods: The brachytherapy was given in two sessions preceded and succeeded by external beam radiation. The radioactive source was temporarily implanted by a remote afterloading device through six

Göran Borghede; Hans Hedelin; Sten Holmäng; Karl Axel Johansson; Göran Sernbo; Claes Mercke

1997-01-01

204

Young Men Have Equivalent Biochemical Outcomes Compared With Older Men After Treatment With Brachytherapy for Prostate Cancer  

SciTech Connect

Purpose: To evaluate retrospectively the biochemical outcomes of young men treated with low-dose-rate brachytherapy for prostate cancer. Methods and Materials: From 1990 to 2005, 1,665 men with clinically localized prostate cancer were treated with low-dose-rate brachytherapy {+-} hormone therapy (HT) {+-} external beam radiotherapy and underwent {>=}2 years of follow-up. Patients were stratified on the basis of age: {<=}60 (n = 378) and >60 years (n = 1,287). Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/mL. Univariate and multivariate analyses were used to determine the association of variables with freedom from biochemical failure (FFbF). Results: Median follow-up was 68 months (range, 24-180) for men {<=}60 years and 66 months (range, 24-200) for men >60. For the entire group, the actuarial 5- and 8-year FFbF rates were 94% and 88%, respectively. Men {<=}60 demonstrated similar 5- and 8-year FFbF (95% and 92%) compared with men >60 (93% and 87%; p = 0.071). A larger percent of young patients presented with low-risk disease; lower clinical stage, Gleason score (GS), and pretreatment PSA values; were treated after 1997; did not receive any HT; and had a high biologic effective dose (BED) of radiation (all ps <0.001). On multivariate analysis, PSA (p = 0.001), GS (p = 0.005), and BED (p < 0.001) were significantly associated with FFbF, but age was not (p = 0.665). Conclusion: Young men achieve excellent 5- and 8-year biochemical control rates that are comparable to those of older men after prostate brachytherapy. Young age should not be a deterrent when considering brachytherapy as a primary treatment option for clinically localized prostate cancer.

Burri, Ryan J. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York (United States); Ho, Alice Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Forsythe, Kevin [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York (United States); Cesaretti, Jamie A. [Florida Radiation Oncology Group, Jacksonville, Florida (United States); Stone, Nelson N. [Department of Urology, Mount Sinai School of Medicine, New York, New York (United States); Stock, Richard G., E-mail: richard.stock@mountsinai.or [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York (United States)

2010-08-01

205

Androgen-deprivation therapy does not impact cause-specific or overall survival after permanent prostate brachytherapy  

SciTech Connect

Purpose: To determine if androgen-deprivation therapy (ADT) has an impact on cause-specific, biochemical progression-free, or overall survival after prostate brachytherapy. Methods and Materials: From April 1995 through June 2002, 938 consecutive patients underwent brachytherapy for clinical Stage T1b to T3a (2002 AJCC) prostate cancer. All patients underwent brachytherapy more than 3 years before analysis. A total of 382 patients (40.7%) received ADT with a duration of 6 months or less in 277 and more than 6 months in 105. The median follow-up was 5.4 years. Multiple clinical, treatment, and dosimetric parameters were evaluated as predictors of cause-specific, biochemical progression-free, and overall survival. Results: The 10-year cause-specific, biochemical progression-free, and overall survival rates for the entire cohort were 96.4%, 95.9%, and 78.1%, respectively. Except for biochemical progression-free survival in high-risk patients, ADT did not statistically impact any of the three survival categories. A Cox linear-regression analysis demonstrated that Gleason score was the best predictor of cause-specific survival, whereas percent-positive biopsies, prostate volume, and risk group predicted for biochemical progression-free survival. Patient age and tobacco use were the strongest predictors of overall survival. One hundred two patients have died, with 80 of the deaths a result of cardiovascular disease (54) and second malignancies (26). To date, only 12 patients have died of metastatic prostate cancer. Conclusions: After brachytherapy, androgen-deprivation therapy did not have an impact on cause-specific or overall survival for any risk group; however, ADT had a beneficial effect on biochemical progression-free survival in high-risk patients. Cardiovascular disease and second malignancies far outweighed prostate cancer as competing causes of death.

Merrick, Gregory S. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@wheelinghospital.com; Butler, Wayne M. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Galbreath, Robert W. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Health and Human Services Department, Ohio University Eastern, St. Clairsville, OH (United States); Allen, Zachariah A. M.S. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States)

2006-07-01

206

Multi-Active Catheters For Real Time Dose Distribution Measurements In Prostate Brachytherapy Treatments  

NASA Astrophysics Data System (ADS)

We have performed real time 3D dose distribution measurements of high dose rate brachytherapy sources. These data demonstrate the possibility of in-vivo dosimetry monitoring of the dose rate while treating patients with particle radiation therapy. The prototype used for these experiments is made out of 16 scintillating fibers, 30 cm long and with a 1 mm^2 transverse cross section. Each fiber was coupled to a 16 channel Hamamatsu photo-multiplier tube for photon to current conversion. Millimeter accuracy in position was attained with sub-seconds timing scale. No correction was done from Cherenkov radiation background. The (over)estimated systematic uncertainty is 10% and includes electronic and computer dead times, channel-to-channel efficiency, and signal attenuation. We will discuss the impact of such device to clinical prostate cancer treatments and treatment planning softwares.

Velasco, Carlos

2006-03-01

207

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

E-print Network

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 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 seconds, which confirms earlier results. We propose an iterative procedure for QP that allows to prescribe the target dose as an interval, while retaining independence between the solution time and the number of dose calculation points. This iter...

Gorissen, Bram L; Hoffmann, Aswin L

2014-01-01

208

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

209

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

210

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

211

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

212

Interactive tool for visualization and segmentation of permanent radioactive seeds in postoperative prostate brachytherapy CT images  

NASA Astrophysics Data System (ADS)

Implantation of radioactive isotopes within the prostate for the treatment of early stage localized prostate cancer is becoming a popular treatment option. Postoperative calculation of the dose delivered to the prostate requires accurate verification of the number and location of seeds within the prostate. Current post operative dosimetry technique requires the dosimetrist to manually count and record the position of each seed from x-ray computed tomography (CT) images. This procedure is operator-dependent and time-consuming, thus limiting the ability of different brachytherapy centers to compare results and create a standard methodology. Seed identification is performed by thresholding the CT images interactively, using a graphical user interface, followed by mathematical morphology to remove noise. Segmented seeds are grouped into regions via connected-component analysis. Regions are then classified into seeds using a prior knowledge of the seed dimensions and their relative positions in the consecutive CT images. Unresolved regions, which can indicate the presence of more than one seed, are corrected manually. The efficiency of this tool was evaluated by comparing the time to manually count the seeds to the time required to do the same task using the automated program. For 15 sets of images from 15 patients, the average time for manually counting the seeds was 45 minutes per patient versus 6.4 minutes on average per patients, the average time for manually counting the seeds was 45 minutes per patient versus 6.4 minutes on average per patient when the software was used to perform the same task. Using the interactive visualization and segmentation algorithm, the time required to count the seeds during post- implant dosimetry has been reduced by a factor of 7 compared to the existing manual technique.

Pathak, Sayan D.; Stoknes, Kevin; Grimm, Peter D.; Estlund, Jacque; Chalana, Vikram; Kim, Yongmin

1999-05-01

213

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

214

Effect of Family History on Outcomes in Patients Treated With Definitive Brachytherapy for Clinically Localized Prostate Cancer  

SciTech Connect

Purpose: To determine the impact familial prostate cancer has on prognosis in men treated with brachytherapy for clinically localized prostate cancer. Methods and Materials: A total of 1,738 consecutive patients with prostate cancer (cT1-3, N0/X, M0) received low-dose-rate brachytherapy alone or in combination with external beam radiation therapy or hormone ablation from 1992 to 2005. The primary end-point was freedom from biochemical failure (FFBF) using the Phoenix definition. Minimum follow-up was 2 years and the median follow-up was 60 months (range, 24-197 months). Results: A total of 187 of 1,738 men (11%) had a family history of prostate cancer in a first-degree relative. For the low-risk patients, both groups had similar actuarial 5-year FFBF (97.2% vs. 95.5%, p = 0.516). For intermediate-risk patients, there was a trend toward improved biochemical control in men positive for family history (5-yr FFBF 100% vs. 93.6%, p = 0.076). For the high-risk patients, men with a positive family history had similar 5-year FFBF (92.8% vs. 85.2%, p = 0.124). On multivariate analysis, family history was not significant; use of hormones, high biologic effective dose, initial prostate-specific antigen value, and Gleason score were the significant variables predicting biochemical control. Conclusions: This is the first study to examine the relationship of familial prostate cancer and outcomed in men treated with brachytherapy alone or in combination therapy. Men with a positive family history have clinicopathologic characteristics and biochemical outcomes similar to those with sporadic disease.

Peters, Christopher A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)], E-mail: christopher.peters@mountsinai.org; Stock, Richard G.; Blacksburg, Seth R. [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)

2009-01-01

215

High Intensity Focused Ultrasound (HIFU) as a Salvage Treatment for Recurrent Prostate Cancer after Brachytherapy — a Feasibility Study  

NASA Astrophysics Data System (ADS)

HIFU may be an effective salvage treatment for patients who develop local recurrence after permanent low-dose brachytherapy. It has been suggested that the presence of seeds in the prostate may obstruct the HIFU beam or alter the heating characteristics of the prostate tissue. Acoustic field measurements were made using a membrane hydrophone and lesioning experiments were carried out in ex vivo bovine liver. These revealed a significant effect of the seeds on the HIFU focal region as well as a reduction in lesion length when seeds were placed in a pre-focal position. Further work is needed to evaluate the full effects of implanted brachytherapy seeds on the clinical delivery of HIFU.

Chapman, Alexander T.; Rivens, Ian H.; Thompson, Alan C.; ter Haar, Gail R.

2007-05-01

216

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

217

Health-Related Quality of Life after Radical Prostatectomy and Low-Dose-Rate Brachytherapy for Localized Prostate Cancer  

Microsoft Academic Search

Objective: To evaluate quality of life (QOL) after radical retropubic prostatectomy (RP) and low-dose-rate brachytherapy (BT). Methods: Between 2001 and 2004, RP or BT was performed in 212 patients. QOL data were evaluated with the European Organization for Research and Treatment of Cancer QLQ-C30 version 3.0, the International Prostate Symptom Score (IPSS) and the International Index of Erectile Function-5 questionnaires.

Stephen Frederic Wyler; Daniel Stephan Engeler; Wolfhart Seelentag; Gerhard Ries; Hans-Peter Schmid

2009-01-01

218

A mathematical approach for evaluating the influence of dose heterogeneity on TCP for prostate cancer brachytherapy treatment  

Microsoft Academic Search

The low-dose-rate brachytherapy technique has proven suitable for the management of prostate cancer. However, published data generally report the clinical outcome and the minimum peripheral dose (mPD) to the target volume and not the actual dose distribution in patients. To this end, modern guidelines recommend the use of specific dose and volume indices describing dose distribution throughout the target. The

L. Strigari; L. C. Orlandini; I. Andriani; A. d'Angelo; M. Stefanacci; A. M. Di Nallo; Marcello Benassi

2008-01-01

219

Maximum vs. Mono Androgen Blockade and the Risk of Recurrence in Men With Localized Prostate Cancer Undergoing Brachytherapy  

SciTech Connect

Purpose: We examined whether maximum androgen blockade (MAB) is associated with a decreased recurrence risk vs. single-agent androgen suppression (monotherapy) for men undergoing brachytherapy (BT) for localized prostate cancer. Methods and Materials: Data from 223 men in Cancer of the Prostate Strategic Urologic Research Endeavor database who received androgen deprivation therapy (ADT) concurrent with BT for intermediate- or high-risk prostatic adenocarcinoma were included; 159 (71%) received MAB, and 64 (29%) monotherapy (luteinizing hormone-releasing hormone agonist or anti-androgen alone). Cox regression analysis was performed to assess whether the choice of ADT was associated with disease recurrence adjusting for known prognostic factors. Results: Men who received MAB had similar Gleason scores, T categories, and pretreatment prostate-specific antigen as those who received monotherapy. After a median follow-up of 49 months, the use of MAB was not associated with a decrease in the risk recurrence (p = 0.72), after adjusting for known prognostic factors. A higher PSA at diagnosis (p = 0.03) and younger age at diagnosis (p < 0.01) were associated with increased recurrence risk. The 3-year recurrence free survival was 76% for patients in both monotherapy and MAB groups. Conclusions: There are varied practice patterns in physicians' choice of the extent of concurrent ADT when used with brachytherapy for men with intermediate- or high-risk prostate cancer. Given a lack of demonstrated superiority from either ADT choice, both appear to be reasonable options.

Chen, Ronald C. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA (United States)], E-mail: rcchen@partners.org; Sadetsky, Natalia [Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA (United States); Chen, M.-H. [Department of Statistics, University of Connecticut, Storrs, CT (United States); Carroll, Peter R. [Department of Urology, Program in Urologic Oncology, Urology Outcomes Research Group, UCSF Comprehensive Cancer Center, University of California, San Francisco, CA (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Brigham and Women's Hospital and Dana-Farber Cancer Institute, Boston, MA (United States)

2009-09-01

220

High dose rate brachytherapy as monotherapy for localised prostate cancer: a hypofractionated two-implant approach in 351 consecutive patients  

PubMed Central

Background To report the clinical outcome of high dose rate brachytherapy as sole treatment for clinically localised prostate cancer. Methods Between March 2004 and January 2008, a total of 351 consecutive patients with clinically localised prostate cancer were treated with transrectal ultrasound guided high dose rate brachytherapy. The prescribed dose was 38.0 Gy in four fractions (two implants of two fractions each of 9.5 Gy with an interval of 14 days between the implants) delivered to an intraoperative transrectal ultrasound real-time defined planning treatment volume. Biochemical failure was defined according to the Phoenix Consensus and toxicity evaluated using the Common Toxicity Criteria for Adverse Events version 3. Results The median follow-up time was 59.3 months. The 36 and 60 month biochemical control and metastasis-free survival rates were respectively 98%, 94% and 99%, 98%. Toxicity was scored per event with 4.8% acute Grade 3 genitourinary and no acute Grade 3 gastrointestinal toxicity. Late Grade 3 genitourinary and gastrointestinal toxicity were respectively 3.4% and 1.4%. No instances of Grade 4 or greater acute or late adverse events were reported. Conclusions Our results confirm high dose rate brachytherapy as safe and effective monotherapy for clinically organ-confined prostate cancer. PMID:23656899

2013-01-01

221

Catheter displacement prior to the delivery of high-dose-rate brachytherapy in the treatment of prostate cancer patients  

PubMed Central

Purpose The purpose of this work was to report measured catheter displacement prior to the delivery of high-dose-rate brachytherapy (HDR) in the treatment of prostate cancer. Material and methods Data from 30 prostate cancer patients treated with HDR brachytherapy were analyzed retrospectively. Eighteen transperineal hollow catheters were inserted under transrectal ultrasound guidance. Gold marker seeds were also placed transperineally into the base and apex of the prostate gland. Five treatment fractions of 7.5 Gy each were administered over 3 days. The patient underwent CT scanning prior to each treatment fraction. Catheter displacement was measured from the pre-treatment CT dataset reconstructed at 1.25 mm slice thickness. Results Most of catheters were displaced in the caudal direction. Variations of 18 catheters for each patient were small (standard deviations < 1 mm for all but one patient). Mean displacements relative to the apex marker were 6 ± 4 mm, 12 ± 6 mm, 12 ± 6 mm, 12 ± 6 mm, and 12 ± 6 mm from plan to 1st, 2nd, 3rd, 4th, and 5th fractions, respectively. Conclusions Our results indicate that catheter positions must be confirmed and if required, adjusted, prior to every treatment fraction for the precise treatment delivery of HDR brachytherapy, and to potentially reduce over-dosage to the bulbo-membranous urethra. PMID:25097556

Kawakami, Shogo; Terazaki, Tsuyoshi; Soda, Itaru; Satoh, Takefumi; Kitano, Masashi; Kurosaka, Shinji; Sekiguchi, Akane; Komori, Shouko; Iwamura, Masatsugu; Hayakawa, Kazushige

2014-01-01

222

High-dose-rate brachytherapy boost for prostate cancer: rationale and technique.  

PubMed

High-dose-rate brachytherapy (HDR) is a method of conformal dose escalation to the prostate. It can be used as a local boost in combination with external beam radiotherapy, with a high degree of efficacy and low rate of long term toxicity. Data consistently reports relapse free survival rates of greater than 90% for intermediate risk patients and greater than 80% for high risk. Results are superior to those achieved with external beam radiotherapy alone. A wide range of dose and fractionation is reported, however, we have found that a single 15 Gy HDR combined with hypofractionated radiotherapy to a dose of 37.5 Gy in 15 fractions is well tolerated and is associated with a long term relapse-free survival of over 90%. Either CT-based or trans-rectal ultrasound-based planning may be used. The latter enables treatment delivery without having to move the patient with risk of catheter displacement. We have found it to be an efficient and quick method of treatment, allowing catheter insertion, planning, and treatment delivery to be completed in less than 90 minutes. High-dose-rate boost should be considered the treatment of choice for many men with high and intermediate risk prostate cancer. PMID:25337138

Morton, Gerard C

2014-10-01

223

High-dose-rate brachytherapy boost for prostate cancer: rationale and technique  

PubMed Central

High-dose-rate brachytherapy (HDR) is a method of conformal dose escalation to the prostate. It can be used as a local boost in combination with external beam radiotherapy, with a high degree of efficacy and low rate of long term toxicity. Data consistently reports relapse free survival rates of greater than 90% for intermediate risk patients and greater than 80% for high risk. Results are superior to those achieved with external beam radiotherapy alone. A wide range of dose and fractionation is reported, however, we have found that a single 15 Gy HDR combined with hypofractionated radiotherapy to a dose of 37.5 Gy in 15 fractions is well tolerated and is associated with a long term relapse-free survival of over 90%. Either CT-based or trans-rectal ultrasound-based planning may be used. The latter enables treatment delivery without having to move the patient with risk of catheter displacement. We have found it to be an efficient and quick method of treatment, allowing catheter insertion, planning, and treatment delivery to be completed in less than 90 minutes. High-dose-rate boost should be considered the treatment of choice for many men with high and intermediate risk prostate cancer. PMID:25337138

2014-01-01

224

In vivo motion and force measurement of surgical needle intervention during prostate brachytherapy  

SciTech Connect

In this paper, we present needle insertion forces and motion trajectories measured during actual brachytherapy needle insertion while implanting radioactive seeds in the prostate glands of 20 different patients. The needle motion was captured using ultrasound images and a 6 degree-of-freedom electromagnetic-based position sensor. Needle velocity was computed from the position information and the corresponding time stamps. From in vivo data we found the maximum needle insertion forces to be about 15.6 and 8.9 N for 17 gauge (1.47 mm) and 18 gauge (1.27 mm) needles, respectively. Part of this difference in insertion forces is due to the needle size difference (17G and 18G) and the other part is due to the difference in tissue properties that are specific to the individual patient. Some transverse forces were observed, which are attributed to several factors such as tissue heterogeneity, organ movement, human factors in surgery, and the interaction between the template and the needle. However, theses insertion forces are significantly responsible for needle deviation from the desired trajectory and target movement. Therefore, a proper selection of needle and modulated velocity (translational and rotational) may reduce the tissue deformation and target movement by reducing insertion forces and thereby improve the seed delivery accuracy. The knowledge gleaned from this study promises to be useful for not only designing mechanical/robotic systems but also developing a predictive deformation model of the prostate and real-time adaptive controlling of the needle.

Podder, Tarun; Clark, Douglas; Sherman, Jason; Fuller, Dave; Messing, Edward; Rubens, Deborah; Strang, John; Brasacchio, Ralph; Liao, Lydia; Ng, W.-S.; Yu Yan [Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642 (United States); Departments of Radiation Oncology and Surgery, University of Rochester Medical Center, Rochester, New York 14642 (United States); Departments of Radiology and Surgery, University of Rochester Medical Center, Rochester, New York 14642 (United States) and Department of Biomedical Engineering, University of Rochester, Rochester, New York 14642 (United States); Department of Radiology, University of Rochester Medical Center, Rochester, New York 14642 (United States); Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642 (United States); Departments of Radiology and Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642 (United States); School of Mechanical and Aerospace Engineering, Nanyang Technological University, Singapore 639798 (Singapore); Department of Radiation Oncology, University of Rochester Medical Center, Rochester, New York 14642 and Department of Biomedical Engineering, University of Rochester, New York 14642 (United States)

2006-08-15

225

MRI of prostate brachytherapy seeds at high field: A study in phantom  

SciTech Connect

Postimplant evaluation of prostate brachytherapy using magnetic resonance imaging (MRI) at 1.5 T has met with some difficulties due to the uncertainty associated with seed localization despite the excellent anatomical delineation this imaging modality can achieve. Seeds in vascularized regions or outside the prostate, where signal heterogeneity or drop off can obscure their position, can be difficult to identify. The increase in SNR available at 3.0 T offers the potential to improve these issues with visualization. However, before moving directly to in vivo studies, it is important to investigate the effects of artifact size on the ability to localize multiple seeds in close proximity. These artifacts are of extra concern at higher field because of the increased induced field distortions surrounding the seeds. A single prostate brachytherapy seed (IMC6711, OncoSeed) and arrays of seed pairs were suspended in a porcine gel medium and imaged on 1.5 and 3 T MRI scanners for comparison. Two basic acquisition techniques utilized in a wide array of clinical sequences [spin-echo based and gradient-echo (GE) based] were investigated for the types of artifacts they produce, and their dependence on field. Analysis of the resulting voids was performed to determine the relative size of seeds as seen on the images, as well as the ability to distinguish seeds at close proximity. The seed voids at 3 T were only slightly larger than those obtained at 1.5 T (0.5 mm longer and wider) when using a spin-echo type sequence. For this work, the authors used a proton density fast spin-echo (FSE) sequence. These results are promising for the use of 3 T imaging for postimplant evaluation since the SNR will increase by roughly a factor of 2 with only a limited corresponding increase in artifact size. The minimum separation of the seeds to be completely distinguished using void analysis increased from between 1.5 and 3 mm to between 3 and 4.5 mm when going from 1.5 to 3 T FSE imaging. The minimum separation of the seeds for GE at the demonstration TE of 11 ms was found to be between 3 and 4.5 mm for 1.5 T and between 4.5 and 6 mm for 3 T. These GE artifact dimensions will scale down with TE and, as this happens, approach the dimensions of the FSE artifacts given above.

Thomas, S. D.; Wachowicz, K.; Fallone, B. G. [Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada) and Department of Physics, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada) and Department of Oncology, Division of Medical Physics, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada); Department of Medical Physics, Cross Cancer Institute, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada) and Department of Physics and Department of Oncology, Division of Medical Physics, University of Alberta, 11560 University Avenue, Edmonton, Alberta T6G 1Z2 (Canada)

2009-11-15

226

Predictors of distant metastasis after combined HDR brachytherapy and external beam radiation for prostate cancer  

PubMed Central

Purpose To determine predictors of distant metastases (DM) in prostate cancer patients treated with high dose rate brachytherapy boost (HDR-B) and external beam radiation therapy (EBRT). Material and methods From 1991 to 2002, 768 men with localized prostate cancer were treated with HDR-B and EBRT. The mean EBRT dose was 37.5 Gy (range: 30.6-45 Gy), and the HDR-B was 22 or 24 Gy delivered in 4 fractions. Univariate and multivariate analyses using a Cox proportional hazards model including age at diagnosis, T stage, Gleason score (GS), pretreatment PSA, biologically equivalent dose (BED), and use of androgen deprivation therapy (ADT) was used to determine predictors of developing distant metastases. Results The median follow-up time for the entire patient population was 4.2 years (range: 1-11.2 years). Distant metastases were identified in 22/768 (3%) of patients at a median of 4.1 years. PSA failure according to the Phoenix definition developed in 3%, 5%, and 14% of men with low, intermediate, and high risk disease with a median time to failure of 3.8 years. Prostate cancer specific mortality was observed in 2% of cases. T stage, GS, and use of ADT were significantly associated with developing DM on univariate analysis. GS, and use of ADT were the only factors significantly associated with developing DM on multivariate analysis (p < 0.01). Patients who received ADT had significantly higher risk features suggesting patient selection bias for higher DM in this group of patients rather than a negative interaction between HDR-B and EBRT. Conclusions In men treated with HDR-B and EBRT, GS is a significant factor on multivariate analysis for developing distant metastasis. PMID:24143146

Rwigema, Jean-Claude; Chung, Melody; Banerjee, Robyn; Wang, Jason; Steinberg, Michael; Demanes, David Jeffrey

2013-01-01

227

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

228

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

229

Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy.  

PubMed

Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this problem. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that inevitably result from catheter reconstruction errors and afterloader source positioning inaccuracies. This study quantifies the reduction of high-dose subvolumes and the robustness against these uncertainties by applying a DTMR to template-based prostate HDR brachytherapy implants.Three different DTMRs were consecutively applied to a linear dose-based penalty model (LD) and a dose-volume based model (LDV), both obtained from literature. The models were solved with DTMR levels ranging from no restriction to uniform dwell times within catheters in discrete steps. Uncertainties were simulated on clinical cases using in-house developed software, and dose-volume metrics were calculated in each simulation. For the assessment of high-dose subvolumes, the dose homogeneity index (DHI) and the contiguous dose volume histogram were analysed. Robustness was measured by the improvement of the lowest D90% of the planning target volume (PTV) observed in the simulations.For (LD), a DTMR yields an increase in DHI of approximately 30% and reduces the size of the largest high-dose volume by 2-5 cc. However, this comes at a cost of a reduction in D90% of the PTV of 10%, which often implies that it drops below the desired minimum of 100%. For (LDV), none of the DTMRs were able to improve high-dose volume measures. DTMRs were not capable of improving robustness of PTV D90% against uncertainty in dwell positions for both models. PMID:25549084

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

2015-01-21

230

Dwell time modulation restrictions do not necessarily improve treatment plan quality for prostate HDR brachytherapy  

NASA Astrophysics Data System (ADS)

Inverse planning algorithms for dwell time optimisation in interstitial high-dose-rate (HDR) brachytherapy may produce solutions with large dwell time variations within catheters, which may result in undesirable selective high-dose subvolumes. Extending the dwell time optimisation model with a dwell time modulation restriction (DTMR) that limits dwell time differences between neighboring dwell positions has been suggested to eliminate this problem. DTMRs may additionally reduce the sensitivity for uncertainties in dwell positions that inevitably result from catheter reconstruction errors and afterloader source positioning inaccuracies. This study quantifies the reduction of high-dose subvolumes and the robustness against these uncertainties by applying a DTMR to template-based prostate HDR brachytherapy implants. Three different DTMRs were consecutively applied to a linear dose-based penalty model (LD) and a dose-volume based model (LDV), both obtained from literature. The models were solved with DTMR levels ranging from no restriction to uniform dwell times within catheters in discrete steps. Uncertainties were simulated on clinical cases using in-house developed software, and dose-volume metrics were calculated in each simulation. For the assessment of high-dose subvolumes, the dose homogeneity index (DHI) and the contiguous dose volume histogram were analysed. Robustness was measured by the improvement of the lowest D90% of the planning target volume (PTV) observed in the simulations. For (LD), a DTMR yields an increase in DHI of approximately 30% and reduces the size of the largest high-dose volume by 2–5 cc. However, this comes at a cost of a reduction in D90% of the PTV of 10%, which often implies that it drops below the desired minimum of 100%. For (LDV), none of the DTMRs were able to improve high-dose volume measures. DTMRs were not capable of improving robustness of PTV D90% against uncertainty in dwell positions for both models.

Balvert, Marleen; Gorissen, Bram L.; den Hertog, Dick; Hoffmann, Aswin L.

2015-01-01

231

Matched-pair analysis and dosimetric variations of two types of software for interstitial permanent brachytherapy for prostate cancer  

SciTech Connect

The purpose of this study was to determine whether identical dosimetric results could be achieved using different planning software for permanent interstitial brachytherapy for prostate cancer. Data from 492 patients treated with brachytherapy were used for matched-pair analysis. Interplant and Variseed were used as software for ultrasound-based treatment planning. Institution, neoadjuvant hormonal therapy, prostate volume, and source strength were used for factors to match the 2 groups. The study population comprised of 126 patients with treatment planning using Interplant software and 127 matched patients using Variseed software. Dosimetric results were compared between the 2 groups. The Variseed group showed significantly higher values for dose covering 90% of prostate volume (pD90), prostate volume covered by 150% of prescription dose (pV150), and dose covering 30% of the urethra (uD30) compared with the Interplant group. Our results showed that use of different software could lead to different dosimetric results, which might affect the clinical outcomes.

Ishiyama, Hiromichi, E-mail: hishiyam@kitasato-u.ac.jp [Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Nakamura, Ryuji [Department of Radiology, Iwate Medical University, Morioka, Iwate (Japan); Satoh, Takefumi [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Tanji, Susumu [Department of Urology, Iwate Medical University, Morioka, Iwate (Japan); Teh, Bin S. [Department of Radiation Oncology, The Methodist Hospital, Houston, TX (United States); Uemae, Mineko [Division of Radiation Oncology, Kitasato University Hospital, Sagamihara, Kanagawa (Japan); Baba, Shiro [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Hayakawa, Kazushige [Department of Radiology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan)

2012-04-01

232

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

PubMed Central

Purpose: Low dose-rate brachytherapy is commonly used to treat prostate cancer. However, once implanted, the seeds are vulnerable to loss and movement. The goal of this work is to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. Methods: Five patients were used in this study. For each patient three treatment plans were created using Iodine-125, Palladium-103, and Cesium-131 seeds. The three seeds that were closest to the urethra were identified and modeled as the seeds lost through the urethra. The three seeds closest to the exterior of prostatic capsule were identified and modeled as those lost from the prostate periphery. The seed locations and organ contours were exported from Prowess and used by in-house software to perform the dosimetric and radiobiological evaluation. Seed loss was simulated by simultaneously removing 1, 2, or 3 seeds near the urethra 0, 2, or 4 days after the implant or removing seeds near the exterior of the prostate 14, 21, or 28 days after the implant. Results: Loss of one, two or three seeds through the urethra results in aD90 reduction of 2%, 5%, and 7% loss, respectively. Due to delayed loss of peripheral seeds, the dosimetric effects are less severe than for loss through the urethra. However, while the dose reduction is modest for multiple lost seeds, the reduction in tumor control probability was minimal. Conclusions: The goal of this work was to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. The results presented show that loss of multiple seeds can cause a substantial reduction ofD90 coverage. However, for the patients in this study the dose reduction was not seen to reduce tumor control probability. PMID:22755712

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

2012-01-01

233

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

SciTech Connect

Purpose: Low dose-rate brachytherapy is commonly used to treat prostate cancer. However, once implanted, the seeds are vulnerable to loss and movement. The goal of this work is to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. Methods: Five patients were used in this study. For each patient three treatment plans were created using Iodine-125, Palladium-103, and Cesium-131 seeds. The three seeds that were closest to the urethra were identified and modeled as the seeds lost through the urethra. The three seeds closest to the exterior of prostatic capsule were identified and modeled as those lost from the prostate periphery. The seed locations and organ contours were exported from Prowess and used by in-house software to perform the dosimetric and radiobiological evaluation. Seed loss was simulated by simultaneously removing 1, 2, or 3 seeds near the urethra 0, 2, or 4 days after the implant or removing seeds near the exterior of the prostate 14, 21, or 28 days after the implant. Results: Loss of one, two or three seeds through the urethra results in a D{sub 90} reduction of 2%, 5%, and 7% loss, respectively. Due to delayed loss of peripheral seeds, the dosimetric effects are less severe than for loss through the urethra. However, while the dose reduction is modest for multiple lost seeds, the reduction in tumor control probability was minimal. Conclusions: The goal of this work was to investigate the dosimetric and radiobiological effects of the types of seed loss and migration commonly seen in prostate brachytherapy. The results presented show that loss of multiple seeds can cause a substantial reduction of D{sub 90} coverage. However, for the patients in this study the dose reduction was not seen to reduce tumor control probability.

Knaup, Courtney; Mavroidis, Panayiotis; Esquivel, Carlos; Stathakis, Sotirios; Swanson, Gregory; Baltas, Dimos; Papanikolaou, Nikos [Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States); Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States) and Department of Medical Radiation Physics, Karalinska Institutet and Stockholm University, Stockholm 17176 (Sweden); Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States); Department of Medical Physics and Engineering Offenbach Clinic, Offenbach 63069 (Germany) and Nuclear and Particle Physics Section, Physics Department, University of Athens (Greece); Department of Radiation Oncology, University of Texas Health Science Center at San Antonio, San Antonio, Texas 78229 (United States)

2012-06-15

234

Stereotactic body radiotherapy for low-risk prostate cancer: five-year outcomes  

E-print Network

High dose rate brachytherapy as prostate cancer monotherapycontrol of prostate cancer with (125)I brachytherapy. Int Jbrachytherapy without external beam irradiation for locally advanced prostate cancer.

Freeman, Debra E; King, Christopher R

2011-01-01

235

Isotope and Patient Age Predict for PSA Spikes After Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate prostate-specific antigen (PSA) spikes after permanent prostate brachytherapy in low-risk patients. Methods and Materials: The study population consisted of 164 prostate cancer patients who were part of a prospective randomized trial comparing {sup 103}Pd and {sup 125}I for low-risk disease. Of the 164 patients, 61 (37.2%) received short-course androgen deprivation therapy. The median follow-up was 5.4 years. On average, 11.1 post-treatment PSA measurements were obtained per patient. Biochemical disease-free survival was defined as a PSA level of {<=}0.40 ng/mL after nadir. A PSA spike was defined as an increase of {>=}0.2 ng/mL, followed by a durable decline to prespike levels. Multiple parameters were evaluated as predictors for a PSA spike. Results: Of the 164 patients, 44 (26.9%) developed a PSA spike. Of the 46 hormone-naive {sup 125}I patients and 57 hormone-naive {sup 103}Pd patients, 21 (45.7%) and 8 (14.0%) developed a PSA spike. In the hormone-naive patients, the mean time between implantation and the spike was 22.6 months and 18.7 months for {sup 125}I and {sup 103}Pd, respectively. In patients receiving neoadjuvant androgen deprivation therapy, the incidence of spikes was comparable between isotopes ({sup 125}I 28.1% and {sup 103}Pd 20.7%). The incidence of spikes was substantially different in patients <65 years vs. {>=}65 years old (38.5% vs. 16.3%). On multivariate Cox regression analysis, patient age (p < 0.001) and isotope (p = 0.002) were significant predictors for spike. Conclusion: In low-risk prostate cancer, PSA spikes are most common in patients implanted with {sup 125}I and/or <65 years of age. Differences in isotope-related spikes are most pronounced in hormone-naive patients.

Bostancic, Chelsea [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Merrick, Gregory S. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@urologicresearchinstitute.org; Butler, Wayne M. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Allen, Zachariah [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Galbreath, Robert [Ohio University Eastern, St. Clairsville, OH (United States); Lief, Jonathan [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Gutman, Sarah E. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States)

2007-08-01

236

Urethra-Sparing, Intraoperative, Real-Time Planned, Permanent-Seed Prostate Brachytherapy: Toxicity Analysis  

SciTech Connect

Purpose: To report the toxicity outcome in patients with localized prostate cancer undergoing {sup 125}I permanent-seed brachytherapy (BT) according to a urethra-sparing, intraoperative (IO), real-time planned conformal technique. Methods and Materials: Data were analyzed on 250 patients treated consecutively for low- or intermediate-risk prostate cancer between 2005 and 2009. The planned goal was urethral V{sub 150} = 0. Acute and late genitourinary (GU), gastrointestinal (GI), and erectile toxicities were scored with the International Prostate Symptom Score (IPSS) questionnaire and Common Terminology Criteria for Adverse Events (version 3.0). Median follow-up time for patients with at least 2 years of follow-up (n = 130) was 34.4 months (range, 24-56.9 months). Results: Mean IO urethra V{sub 150} was 0.018% {+-} 0.08%. Mean prostate D{sub 90} and V{sub 100} on day-30 computed tomography scan were 158.0 {+-} 27.0 Gy and 92.1% {+-} 7.2%, respectively. Mean IPSS peak was 9.5 {+-} 6.3 1 month after BT (mean difference from baseline IPSS, 5.3). No acute GI toxicity was observed in 86.8% of patients. The 3-year probability of Grade {>=}2 late GU toxicity-free survival was 77.4% {+-} 4.0%, with Grade 3 late GU toxicity encountered in only 3 patients. Three-year Grade 1 late GI toxicity-free survival was 86.1% {+-} 3.2%. No patient presented Grade {>=}2 late GI toxicity. Of patients with normal sexual status at baseline, 20.7% manifested Grade {>=}2 erectile dysfunction after BT. On multivariate analysis, elevated baseline IPSS (p = 0.016) and high-activity sources (median 0.61 mCi) (p = 0.033) predicted increased Grade {>=}2 late GU toxicity. Conclusions: Urethra-sparing IO BT results in low acute and late GU toxicity compared with the literature. High seed activity and elevated IPSS at baseline increased long-term GU toxicity.

Zilli, Thomas [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada); Taussky, Daniel, E-mail: daniel.taussky.chum@ssss.gouv.qc.ca [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada); Donath, David; Le, Hoa Phong; Larouche, Renee-Xaviere; Beliveau-Nadeau, Dominique; Hervieux, Yannick; Delouya, Guila [Department of Radiation Oncology, Centre hospitalier de l'Universite de Montreal-Hopital Notre-Dame, Montreal, QC (Canada)

2011-11-15

237

Comparison between preoperative and real-time intraoperative planning 125I permanent prostate brachytherapy: long-term clinical biochemical outcome  

PubMed Central

Background The purpose of the study is to evaluate the long-term clinical outcome through biochemical no evidence of disease (bNED) rates among men with low to intermediate risk prostate cancer treated with two different brachytherapy implant techniques: preoperative planning (PP) and real-time planning (IoP). Methods From June 1998 to July 2011, 1176 men with median age of 67 years and median follow-up of 47 months underwent transperineal ultrasound-guided prostate 125I-brachytherapy using either PP (132) or IoP (1044) for clinical T1c-T2b prostate adenocarcinoma Gleason <8 and prostate-specific antigen (PSA) <20 ng/ml. Men with Gleason 7 received combination of brachytherapy, external beam radiation and 6-month androgen deprivation therapy (ADT). Biological effective dose (BED) was calculated using computerized tomography (CT)-based dosimetry 1-month postimplant. Failure was determined according to the Phoenix definition. Results The 5- and 7-year actuarial bNED rate was 95% and 90% respectively. The 7-year actuarial bNED was 67% for the PP group and 95% for the IoP group (P?

2013-01-01

238

Is a Loose-Seed Nomogram Still Valid for Prostate Brachytherapy in a Stranded-Seed Era?  

SciTech Connect

Purpose: To characterize the amount of activity required to treat the prostate with stranded {sup 125}I radioactive seeds and compare our stranded data with the amount of activity recommended when individual seeds are implanted using a Mick applicator. Methods and Materials: Data from two groups of patients at University of Texas M. D. Anderson Cancer Center who were treated with prostate brachytherapy as monotherapy were analyzed. The first group included 100 patients implanted with individual seeds in 2000 and 2001. The second group comprised 81 patients for whom stranded seeds were implanted in 2006 and 2007. Seeds in both groups were {sup 125}I seeds with an air kerma strength of 0.497 U per seed (0.391 mCi per seed). The prescribed dose to planning target volume was 145 Gy. Results: The total implanted activity and the number of seeds used were significantly lower in the second group (p < 0.0001) than in the first group. The reduction in activity in the stranded-seed group was approximately 23% for a 20-cm{sup 3} prostate and approximately 15% for a 60-cm{sup 3} prostate. With equivalent activity between the two groups, the stranded-seed treatment covered a larger treatment volume with the prescribed dose. Conclusions: The amount of activity required to effectively treat a prostate of a given volume was lower with stranded seeds than with loose seeds. Our experience suggests that prostate brachytherapy that uses stranded seeds leads to a more efficient implant with fewer seeds and lower overall activity, resulting in improved homogeneity.

Kudchadker, Rajat J. [Department of Radiation 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); Kuban, Deborah A.; Lee, Andrew K.; Bruno, Teresa L. C. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Frank, Steven J. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)], E-mail: sjfrank@mdanderson.org

2008-10-01

239

An Eight-Year Experience of HDR Brachytherapy Boost for Localized Prostate Cancer: Biopsy and PSA Outcome  

SciTech Connect

Purpose: To evaluate the biochemical recurrence-free survival (bRFS), the 2-year biopsy outcome and the prostate-specific antigen (PSA) bounce in patients with localized prostate cancer treated with an inversely planned high-dose-rate (HDR) brachytherapy boost. Materials and methods: Data were collected from 153 patients treated between 1999 and 2006 with external beam pelvic radiation followed by an HDR Ir-192 prostate boost. These patients were given a boost of 18 to 20 Gy using inverse-planning with simulated annealing (IPSA).We reviewed and analyzed all prostate-specific antigen levels and control biopsies. Results: The median follow-up was 44 months (18-95 months). When categorized by risk of progression, 74.5% of patients presented an intermediate risk and 14.4% a high one. Prostate biopsies at 2 years posttreatment were negative in 86 of 94 patients (91.5%), whereas two biopsies were inconclusive. Biochemical control at 60 months was at 96% according to the American Society for Therapeutic Radiology and Oncology and the Phoenix consensus definitions. A PSA bounce (PSA values of 2 ng/mL or more above nadir) was observed in 15 patients of 123 (9.8%). The median time to bounce was 15.2 months (interquartile range, 11.0-17.7) and the median bounce duration 18.7 months (interquartile range, 12.1-29). The estimate of overall survival at 60 months was 97.1% (95% CI, 91.6-103%). Conclusions: Considering that inverse planned HDR brachytherapy prostate boosts led to an excellent biochemical response, with a 2-year negative biopsy rate, we recommend a conservative approach in face of a PSA bounce even though it was observed in 10% of patients.

Bachand, Francois; Martin, Andre-Guy [Departement de Radio-oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec (CHUQ), Centre de Recherche en Cancerologie de l'Universite Laval, Quebec (Canada); Beaulieu, Luc [Departement de Radio-oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec (CHUQ), Centre de Recherche en Cancerologie de l'Universite Laval, Quebec (Canada); Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec (CHUQ), Centre de Recherche en Cancerologie de l'Universite Laval, Quebec (Canada); Harel, Francois M.Sc. [Centre de Recherche de L'Hotel-Dieu de Quebec, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec (CHUQ), Centre de Recherche en Cancerologie de l'Universite Laval, Quebec (Canada); Vigneault, Eric [Departement de Radio-oncologie, L'Hotel-Dieu de Quebec, Centre Hospitalier Universitaire de Quebec (CHUQ), Centre de Recherche en Cancerologie de l'Universite Laval, Quebec (Canada)], E-mail: eric.vigneault@chuq.qc.ca

2009-03-01

240

Genitourinary Toxicity After High-Dose-Rate (HDR) Brachytherapy Combined With Hypofractionated External Beam Radiotherapy for Localized Prostate Cancer: An Analysis to Determine the Correlation Between Dose-Volume Histogram Parameters in HDR Brachytherapy and Severity of Toxicity  

SciTech Connect

Purpose: To evaluate the severity of genitourinary (GU) toxicity in high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiotherapy (EBRT) for prostate cancer and to explore factors that might affect the severity of GU toxicity. Methods and Materials: A total of 100 Japanese men with prostate cancer underwent {sup 192}Ir HDR brachytherapy combined with hypofractionated EBRT. Mean (SD) dose to 90% of the planning target volume was 6.3 (0.7) Gy per fraction of HDR. After 5 fractions of HDR treatment, EBRT with 10 fractions of 3 Gy was administrated. The urethral volume receiving 1-15 Gy per fraction in HDR brachytherapy (V1-V15) and the dose to at least 5-100% of urethral volume in HDR brachytherapy (D5-D100) were compared between patients with Grade 3 toxicity and those with Grade 0-2 toxicity. Prostate volume, patient age, and International Prostate Symptom Score were also compared between the two groups. Results: Of the 100 patients, 6 displayed Grade 3 acute GU toxicity, and 12 displayed Grade 3 late GU toxicity. Regarding acute GU toxicity, values of V1, V2, V3, and V4 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Regarding late GU toxicity, values of D70, D80, V12, and V13 were significantly higher in patients with Grade 3 toxicity than in those with Grade 0-2 toxicity. Conclusions: The severity of GU toxicity in HDR brachytherapy combined with hypofractionated EBRT for prostate cancer was relatively high. The volume of prostatic urethra was associated with grade of acute GU toxicity, and urethral dose was associated with grade of late GU toxicity.

Ishiyama, Hiromichi [Department of Radiology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan)], E-mail: hishiyam@kitasato-u.ac.jp; Kitano, Masashi [Department of Radiology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan); Satoh, Takefumi [Department of Urology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan); Kotani, Shouko [Department of Radiology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan); Uemae, Mineko [Division of Radiation Oncology, Kitasato University Hospital, Kitasato, Sagamihara, Kanagawa (Japan); Matsumoto, Kazumasa; Okusa, Hiroshi; Tabata, Ken-ichi; Baba, Shiro [Department of Urology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan); Hayakawa, Kazushige [Department of Radiology, Kitasato University School of Medicine, Kitasato, Sagamihara, Kanagawa (Japan)

2009-09-01

241

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

242

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

243

Brachytherapy or Conformal External Radiotherapy for Prostate Cancer: A Single-Institution Matched-Pair Analysis  

SciTech Connect

Purpose: In the absence of randomized study data, institutional case series have shown brachytherapy (BT) to produce excellent biochemical control (bNED) in patients with localized prostate cancer compared with alternative curative treatments. This study was designed to overcome some of the limitations of case series studies by using a matched-pair design in patients treated contemporaneously with BT and external beam radiation therapy (EBRT) at a single institution. Methods and Materials: Six hundred one eligible patients treated between 1998 and 2001 were prospectively followed up in our institutional databases and matched on a 1:1 basis for the following known prognostic variables: prostate-specific antigen (PSA) level, Gleason score, T stage, the use and duration of neoadjuvant androgen deprivation therapy, and the percentage of positive tissue core samples. Two hundred seventy-eight perfect matches of patients (139 in each group) with low- and intermediate-risk cancer were further analyzed. bNED (Phoenix definition) was the primary endpoint. Other endpoints were toxicity, PSA kinetics, and the secondary use of androgen deprivation therapy. Results: The 5-year bNED rates were 95% (BT) and 85% (EBRT) (p < 0.001). After 7 years, the BT bNED result was unchanged, but the rate in EBRT patients had fallen to 75%. The median posttreatment PSA nadirs were 0.04 ng/mL (BT) and 0.62 ng/mL (EBRT, p < 0.001), which predicted a higher ongoing treatment failure rate in association with EBRT use than with BT use. Late urinary toxicity and rectal/bowel toxicity were worse in patients treated with BT and EBRT, respectively. Conclusions: BT for both low-risk and selected intermediate-risk cancers achieves exceptional cure rates. Even with dose escalation, it will be difficult for EBRT to match the proven track record of BT seen over the past decade.

Pickles, Tom, E-mail: tpickles@bccancer.bc.c [Prostate Outcomes and Provincial Prostate Brachytherapy Program, BC Cancer Agency, Vancouver, BC (Canada); Keyes, Mira; Morris, W. James [Prostate Outcomes and Provincial Prostate Brachytherapy Program, BC Cancer Agency, Vancouver, BC (Canada)

2010-01-15

244

In vivo real-time dosimetric verification in high dose rate prostate brachytherapy  

SciTech Connect

Purpose: To evaluate the performance of a diode array in the routine verification of planned dose to points inside the rectum from prostate high dose rate (HDR) brachytherapy using a real-time planning system. Methods: A dosimetric study involving 28 patients was undertaken where measured doses received during treatment were compared to those calculated by the treatment planning system (TPS). After the ultrasound imaging required for treatment planning had been recorded, the ultrasound probe was replaced with a geometric replica that contained an 8 mm diameter cylindrical cavity in which a PTW diode array type 9112 was placed. The replica probe was then positioned inside the rectum with the individual diode positions determined using fluoroscopy. Dose was then recorded during the patients' treatment and compared to associated coordinates in the planning system. Results: Factors influencing diode response and experimental uncertainty were initially investigated to estimate the overall uncertainty involved in dose measurements, which was determined to be {+-}10%. Data was acquired for 28 patients' first fractions, 11 patients' second fractions, and 13 patients' third fractions with collection dependent upon circumstances. Deviations between the diode measurements and predicted values ranged from -42% to +35% with 71% of measurements experiencing less than a 10% deviation from the predicted values. If the {+-}10% measurement uncertainty was combined with a tolerated dose discrepancy of {+-}10% then over 95% of the diode results exhibited agreement with the calculated data to within {+-}20%. It must also be noted that when large dose discrepancies were apparent they did not necessarily occur for all five diodes in the one measurement. Conclusions: This technique provided a method that could be utilized to detect gross errors in dose delivery of a real-time prostate HDR plan. Limitations in the detection system used must be well understood if meaningful results are to be achieved.

Seymour, Erin L.; Downes, Simon J.; Fogarty, Gerald B.; Izard, Michael A.; Metcalfe, Peter [Radiation Oncology Associates, Mater Hospital, Crows Nest, New South Wales 2065, Australia and Centre for Medical Radiation Physics, University of Wollongong, New South Wales 2522 (Australia); Radiation Oncology Associates, Mater Hospital, Crows Nest, New South Wales 2065 (Australia); Radiation Oncology Associates, Mater Hospital, Crows Nest, New South Wales 2065 Australia and Sydney Medical School, University of Sydney, New South Wales 2006 (Australia); Centre for Medical Radiation Physics, University of Wollongong, New South Wales 2522 (Australia)

2011-08-15

245

BrachyView, A novel inbody imaging system for HDR prostate brachytherapy: Design and Monte Carlo feasibility study  

SciTech Connect

Purpose: High dose rate (HDR) brachytherapy is a form of radiation therapy for treating prostate cancer whereby a high activity radiation source is moved between predefined positions inside applicators inserted within the treatment volume. Accurate positioning of the source is essential in delivering the desired dose to the target area while avoiding radiation injury to the surrounding tissue. In this paper, HDR BrachyView, a novel inbody dosimetric imaging system for real time monitoring and verification of the radioactive seed position in HDR prostate brachytherapy treatment is introduced. The current prototype consists of a 15 Multiplication-Sign 60 mm{sup 2} silicon pixel detector with a multipinhole tungsten collimator placed 6.5 mm above the detector. Seven identical pinholes allow full imaging coverage of the entire treatment volume. The combined pinhole and pixel sensor arrangement is geometrically designed to be able to resolve the three-dimensional location of the source. The probe may be rotated to keep the whole prostate within the transverse plane. The purpose of this paper is to demonstrate the efficacy of the design through computer simulation, and to estimate the accuracy in resolving the source position (in detector plane and in 3D space) as part of the feasibility study for the BrachyView project.Methods: Monte Carlo simulations were performed using the GEANT4 radiation transport model, with a {sup 192}Ir source placed in different locations within a prostate phantom. A geometrically accurate model of the detector and collimator were constructed. Simulations were conducted with a single pinhole to evaluate the pinhole design and the signal to background ratio obtained. Second, a pair of adjacent pinholes were simulated to evaluate the error in calculated source location.Results: Simulation results show that accurate determination of the true source position is easily obtainable within the typical one second source dwell time. The maximum error in the estimated projection position was found to be 0.95 mm in the imaging (detector) plane, resulting in a maximum source positioning estimation error of 1.48 mm.Conclusions: HDR BrachyView is a feasible design for real-time source tracking in HDR prostate brachytherapy. It is capable of resolving the source position within a subsecond dwell time. In combination with anatomical information obtained from transrectal ultrasound imaging, HDR BrachyView adds a significant quality assurance capability to HDR brachytherapy treatment systems.

Safavi-Naeini, M.; Han, Z.; Cutajar, D.; Guatelli, S.; Petasecca, M.; Lerch, M. L. F. [Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia); Franklin, D. R. [Faculty of Engineering and Information Technology, University of Technology, Sydney, NSW 2007 (Australia); Jakubek, J.; Pospisil, S. [Institute of Experimental and Applied Physics (IEAP), Czech Technical University in Prague (CTU) (Czech Republic); Bucci, J.; Zaider, M.; Rosenfeld, A. B. [St. George Hospital Cancer Care Centre, Gray Street, Kogarah, NSW 2217 (Australia); Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, New York 10065 (United States); Centre for Medical Radiation Physics, University of Wollongong, Wollongong, NSW 2522 (Australia)

2013-07-15

246

Characterization of ultrasound elevation beamwidth artifacts for prostate brachytherapy needle insertion  

SciTech Connect

Purpose: Ultrasound elevation beamwidth leads to image artifacts and uncertainties in localizing objects (such as a surgical needle) in ultrasound images. The authors examined the clinical significance of errors caused by elevation beamwidth artifacts and imaging parameters in needle insertion procedures. Methods: Beveled prostate brachytherapy needles were inserted through all holes of a grid template under real-time transrectal ultrasound (TRUS) guidance. The needle tip position as indicated by the TRUS image was compared to their observed physical location. A new device was developed to measure the ultrasound elevation beamwidth. Results: Imaging parameters of the TRUS scanner have direct impact on the localization error ranging from 0.5 up to 4 mm. The smallest localization error was observed laterally close to the center of the grid template and axially within the beam's focal zone. Largest localization error occurs laterally around both sides of the grid template and axially within the beam's far field. The authors also found that the localization errors vary with both lateral and elevation offsets. Conclusions: The authors found properly adjusting the TRUS imaging settings to lower the ultrasound gain and power effectively minimized the appearance of elevation beamwidth artifacts and in turn reduced the localization errors of the needle tip.

Peikari, Mohammad; Chen, Thomas Kuriran; Lasso, Anras; Heffter, Tamas; Fichtinger, Gabor; Burdette, Everette C. [Laboratory for Percutaneous Surgery (Perk), School of Computing, Queen's University, Kingston, Ontario K7L 3N6 (Canada); Acoustic MedSystems, 208 Burwash Avenue, Savoy, Illinois 61874 (United States)

2012-01-15

247

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. PMID:21361179

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

2011-01-01

248

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

249

Natural History of Clinically Staged Low- and Intermediate-Risk Prostate Cancer Treated With Monotherapeutic Permanent Interstitial Brachytherapy  

SciTech Connect

Purpose: To evaluate the natural history of clinically staged low- and intermediate-risk prostate cancer treated with permanent interstitial seed implants as monotherapy. Methods and Materials: Between April 1995 and May 2005, 463 patients with clinically localized prostate cancer underwent brachytherapy as the sole definitive treatment. Men who received supplemental external beam radiotherapy or androgen deprivation therapy were excluded. Dosimetric implant quality was determined based on the minimum dose that covered 90% of the target volume and the volume of the prostate gland receiving 100% of the prescribed dose. Multiple parameters were evaluated as predictors of treatment outcomes. Results: The 12-year biochemical progression-free survival (bPFS), cause-specific survival, and overall survival rates for the entire cohort were 97.1%, 99.7%, and 75.4%, respectively. Only pretreatment prostate-specific antigen level, percent positive biopsy cores, and minimum dose that covered 90% of the target volume were significant predictors of biochemical recurrence. The bPFS, cause-specific survival, and overall survival rates were 97.4%, 99.6%, and 76.2%, respectively, for low-risk patients and 96.4%, 100%, and 74.0%, respectively, for intermediate-risk patients. The bPFS rate was 98.8% for low-risk patients with high-quality implants versus 92.1% for those with less adequate implants (p < 0.01), and it was 98.3% for intermediate-risk patients with high-quality implants versus 86.4% for those with less adequate implants (p < 0.01). Conclusions: High-quality brachytherapy implants as monotherapy can provide excellent outcomes for men with clinically staged low- and intermediate-risk prostate cancer. For these men, a high-quality implant can achieve results comparable to high-quality surgery in the most favorable pathologically staged patient subgroups.

Taira, Al V. [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); Galbreath, Robert W. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Butler, Wayne M. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)

2010-02-01

250

Second Primary Cancer After Radiotherapy for Prostate Cancer-A SEER Analysis of Brachytherapy Versus External Beam Radiotherapy  

SciTech Connect

Purpose: To determine the incidence of second primary cancers (SPCs) and radiotherapy-induced SPCs (RTSPCs). Patients and Methods: The incidence of SPCs and RTSPCs was compared among four treatment groups with locoregional prostate adenocarcinoma in the 1973-2002 Surveillance, Epidemiology, and End Results database. These groups were no radiotherapy (RT), no surgery (Group 1); external beam RT (EBRT) (Group 2); brachytherapy (Group 3); and a combination of EBRT and brachytherapy (Group 4). Results: The age-adjusted estimates of SPCs were greater with EBRT than with brachytherapy (2,178 vs. 1,901 SPCs/100,000; p = 0.025) or with the no RT, no surgery group (1,971 SPCs/100,000; p <0.0001). The age-adjusted rate of late SPC ({>=}5 years) for EBRT (2,425 SPCs/100,000) was only significantly greater (p <0.0001) than that for no RT, no surgery (1,950 SPCs/100,000). The hazard ratio adjusted for age, race/ethnicity, and grade was constant at 1.263 for EBRT compared with no RT, no surgery (p <0.0001) but varied with the length of follow-up in both the brachytherapy (0.721 at 5 years to 1.200 at 9 years) and combination (0.920 at 5 years to 1.317 at 9 years) groups. The incidence of RTSPCs was only significantly different between the no RT, no surgery group and the EBRT group, with an increase of 162 cases/100,000 or a 0.16% increased SPC risk (p = 0.023). No significant differences in the incidence of RTSPC were seen between the RT groups. Conclusion: No significant differences were seen in the incidence of RTSPCs between the RT groups. The initial smaller relative risk of overall SPCs in the brachytherapy group increased with time until the curves converged, suggesting that the effect had resulted from patient selection bias.

Abdel-Wahab, May [Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, FL (United States)], E-mail: mwahab@med.miami.edu; Reis, Isildinha M. [Division of Biostatistics, Sylvester Comprehensive Cancer Center, Miami, FL (United States); Department of Epidemiology and Public Health, University of Miami Miller School of Medicine, Miami, FL (United States); Hamilton, Kara [Division of Biostatistics, Sylvester Comprehensive Cancer Center, Miami, FL (United States)

2008-09-01

251

Feasibility of salvage interstitial microwave thermal therapy for prostate carcinoma following failed brachytherapy: studies in a tissue equivalent phantom  

NASA Astrophysics Data System (ADS)

Thermal therapy is an experimental treatment to destroy solid tumours by heating them to temperatures ranging from 55 °C to 90 °C, inducing thermal coagulation and necrosis of the tumour. We are investigating the feasibility of interstitial microwave thermal therapy as a salvage treatment for prostate cancer patients with local recurrence following failed brachytherapy. Due to the electrical and thermal conductivity of the brachytherapy seeds, we hypothesized that the seeds could scatter the microwave energy and cause unpredictable heating. To investigate this, a 915 MHz helical antenna was inserted into a muscle-equivalent phantom with and without brachytherapy seeds. Following a 10 W, 5 s input to the antenna, the temperature rise was used to calculate absorbed power, also referred to as specific absorption rate (SAR). Plane wave models based on Maxwell's equations were also used to characterize the electromagnetic scattering effect of the seeds. In addition, the phantom was heated with 8 W for 5 min to quantify the effect of the seeds on the temperature distribution during extended heating. SAR measurements indicated that the seeds had no significant effect on the shape and size of the SAR pattern of the antenna. However, the plane wave simulations indicated that the seeds could scatter the microwave energy resulting in hot spots at the seed edges. Lack of experimental evidence of these hot spots was probably due to the complex polarization of the microwaves emitted by the helical antenna. Extended heating experiments also demonstrated that the seeds had no significant effect on the temperature distributions and rates of temperature rise measured in the phantom. The results indicate that brachytherapy seeds are not a technical impediment to interstitial microwave thermal therapy as a salvage treatment following failed brachytherapy.

McCann, Claire; Kumaradas, J. Carl; Gertner, Mark R.; Davidson, Sean R. H.; Dolan, Alfred M.; Sherar, Michael D.

2003-04-01

252

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

253

High-Dose-Rate Brachytherapy as a Monotherapy for Favorable-Risk Prostate Cancer: A Phase II Trial  

SciTech Connect

Purpose: There are multiple treatment options for favorable-risk prostate cancer. High-dose-rate (HDR) brachytherapy as a monotherapy is appealing, but its use is still investigational. A Phase II trial was undertaken to explore the value of such treatment in low-to-intermediate risk prostate cancer. Methods and Materials: This was a single-institution, prospective study. Eligible patients had low-risk prostate cancer features but also Gleason scores of 7 (51% of patients) and stage T2b to T2c cancer. Treatment with HDR brachytherapy with a single implant was administered over 2 days. One of four fractionation schedules was used in a dose escalation study design: 3 fractions of 10, 10.5, 11, or 11.5 Gy. Patients were assessed with the Common Terminology Criteria for Adverse Events version 2.0 for urinary toxicity, the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring schema for rectal toxicity, and the Expanded Prostate Cancer Index Composite (EPIC) questionnaire to measure patient-reported health-related quality of life. Biochemical failure was defined as a prostate-specific antigen (PSA) nadir plus 2 ng/ml. Results: Between 2003 and 2008, 79 patients were enrolled. With a median follow-up of 39.5 months, biochemical relapse occurred in 7 patients. Three- and 5-year actuarial biochemical control rates were 88.4% (95% confidence interval [CI], 78.0-96.2%) and 85.1% (95% CI, 72.5-94.5%), respectively. Acute grade 3 urinary toxicity was seen in only 1 patient. There was no instance of acute grade 3 rectal toxicity. Rates of late grade 3 rectal toxicity, dysuria, hematuria, urinary retention, and urinary incontinence were 0%, 10.3%, 1.3%, 9.0%, and 0%, respectively. No grade 4 or greater toxicity was recorded. Among the four (urinary, bowel, sexual, and hormonal) domains assessed with the EPIC questionnaire, only the sexual domain did not recover with time. Conclusions: HDR brachytherapy as a monotherapy for favorable-risk prostate cancer, administered using a single implant over 2 days, is feasible and has acceptable acute and late toxicities. Further follow-up is still required to better evaluate the efficacy of such treatment.

Barkati, Maroie [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Williams, Scott G., E-mail: scott.williams@petermac.org [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia); Foroudi, Farshad; Tai, Keen Hun; Chander, Sarat [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia); Dyk, Sylvia van [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); See, Andrew [Ballarat Austin Radiation Oncology Centre, Ballarat (Australia); Duchesne, Gillian M. [Division of Radiation Oncology, Peter MacCallum Cancer Centre, East Melbourne (Australia); Department of Pathology, University of Melbourne, Melbourne (Australia)

2012-04-01

254

Postoperative Nomogram Predicting the 9-Year Probability of Prostate Cancer Recurrence After Permanent Prostate Brachytherapy Using Radiation Dose as a Prognostic Variable  

SciTech Connect

Purpose: To report a multi-institutional outcomes study on permanent prostate brachytherapy (PPB) to 9 years that includes postimplant dosimetry, to develop a postimplant nomogram predicting biochemical freedom from recurrence. Methods and Materials: Cox regression analysis was used to model the clinical information for 5,931 patients who underwent PPB for clinically localized prostate cancer from six centers. The model was validated against the dataset using bootstrapping. Disease progression was determined using the Phoenix definition. The biological equivalent dose was calculated from the minimum dose to 90% of the prostate volume (D90) and external-beam radiotherapy dose using an alpha/beta of 2. Results: The 9-year biochemical freedom from recurrence probability for the modeling set was 77% (95% confidence interval, 73-81%). In the model, prostate-specific antigen, Gleason sum, isotope, external beam radiation, year of treatment, and D90 were associated with recurrence (each p < 0.05), whereas clinical stage was not. The concordance index of the model was 0.710. Conclusion: A predictive model for a postimplant nomogram for prostate cancer recurrence at 9-years after PPB has been developed and validated from a large multi-institutional database. This study also demonstrates the significance of implant dosimetry for predicting outcome. Unique to predictive models, these nomograms may be used a priori to calculate a D90 that likely achieves a desired outcome with further validation. Thus, a personalized dose prescription can potentially be calculated for each patient.

Potters, Louis, E-mail: LPotters@nshs.ed [Department of Radiation Medicine, North Shore Long Island Jewish Health System, New Hyde Park, NY (United States); Roach, Mack [Departments of Radiation Oncology and Urology, University of California at San Francisco, San Francisco, CA (United States); Davis, Brian J. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Stock, Richard G. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Ciezki, Jay P. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Stone, Nelson N. [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Fearn, Paul A. [Department of Urology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Yu Changhong [Glickman Urological Institute and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (United States); Shinohara, Katsuto [Departments of Radiation Oncology and Urology, University of California at San Francisco, San Francisco, CA (United States); Kattan, Michael W. [Glickman Urological Institute and the Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH (United States)

2010-03-15

255

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

256

The use of iodine-125 seeds as a substitute for iridium-192 seeds in temporary interstitial breast implants  

SciTech Connect

We have previously reported that the use of iodine-125 seeds in temporary plastic tube interstitial implants may be more advantageous than iridium-192 seeds due to less patient and personnel radiation exposure, reduced shielding requirements, and significant dosimetric advantages. The impact of this isotope on the rate of local control and cosmetic outcome in patients with early stage breast cancer treated with interstitial implants for their irradiation {open_quotes}boost{close_quotes} remains to be defined. We reviewed the treatment outcome of 402 consecutive cases of Stage I and II breast cancer undergoing breast conserving therapy between 1/1/80 and 12/31/87. All patients underwent excisional biopsy and received 45-50 Gy to the entire breast followed by a boost to the tumor bed using either electrons (104 patients), photons (15 patients), or an interstitial implant with either iridium-192 (197 patients) or iodine-125 (86 patients) to at least 60 Gy. Iodine-125 implants were primarily performed in patients with significant risk factors for local recurrence (71%) or in patients with large breasts (17%). Local tumor control and cosmetic outcome were assessed and contrasted between patients boosted with each modality. We conclude that patients with State I and II breast cancer undergoing breast conserving therapy and judged to be candidates for boosts with interstitial implants can be effectively treated with iodine-125 seeds. Use of the isotope results in less patient and personnel irradiation exposure and a better dose distribution than iridium-192, since dose optimization can be routinely employed. Overall, local control and cosmetic outcome have been excellent and are similar to either iridium-192, electrons, or photons. 21 refs., 4 tabs.

Vicini, F.; White, J.; Gustafson, G.; Matter, R.C.; Edmundson, G.; Martinez, A. [William Beaumont Hospital, Royal Oak, MI (United States); Clarke, D.H. [Northern Virginia Cancer Center, Alexandria, VA (United States)

1993-10-20

257

Prostate brachytherapy postimplant dosimetry: Seed orientation and the impact of dosimetric anisotropy in stranded implants  

SciTech Connect

Purpose: In postimplant dosimetry for prostate brachytherapy, dose is commonly calculated using the TG-43 1D formalism, because seed orientations are difficult to determine from CT images, the current standard for the procedure. However, the orientation of stranded seeds soon after implantation is predictable, as these seeds tend to maintain their relative spacing, and orient themselves along the implant trajectory. The aim of this study was to develop a method for determining seed orientations from reconstructed strand trajectories, and to use this information to investigate the dosimetric impact of applying the TG-43 2D formalism to clinical postimplant analysis. Methods: Using in-house software, the preplan to postimplant seed correspondence was determined for a cohort of 30 patients during routine day-0 CT-based postimplant dosimetry. All patients were implanted with stranded-seed trains. Spline curves were fit to each set of seeds composing a strand, with the requirement that the distance along the spline between seeds be equal to the seed spacing within the strand. The orientations of the seeds were estimated by the tangents to the spline at each seed centroid. Dose distributions were then determined using the 1D and 2D TG-43 formalisms. These were compared using the TG-137 recommended dose metrics for the prostate, prostatic urethra, and rectum. Results: Seven hundred and sixty one strands were analyzed in total. Defining the z-axis to be cranial-positive and the x-axis to be left-lateral positive in the CT coordinate system, the average seed had an inclination of 21 deg. {+-} 10 deg. and an azimuth of -81 deg. {+-} 57 deg. These values correspond to the average strand rising anteriorly from apex to base, approximately parallel to the midsagittal plane. Clinically minor but statistically significant differences in dose metrics were noted. Compared to the 2D calculation, the 1D calculation underestimated prostate V100 by 1.1% and D90 by 2.3 Gy, while overestimating V150 and V200 by 1.6% and 1.3%, respectively. Urethral and rectal dose quantifiers tended to be underestimated by the 1D calculation. The most pronounced differences were in the urethral D30 and rectal D2cc, which rose by 3.8 and 1.9 Gy, respectively, using the 2D calculation. The total volume of the 100% isodose region as a percentage of the prostate volume was found to increase by 0.4%. Conclusions: Stranded seeds in the supine patient are not oriented in a uniformly random manner, nor are they aligned along the axis of the CT scanner. Instead, this study identified a consistent anterior pitch that is likely attributable to differences in patient pose between implant and CT imaging. The angle of the ultrasound probe with respect to the patient during implant may have also been a contributing factor. The dose metrics derived using the 1D formalism were found to be within 2%, on average, of those derived using the 2D formalism. For greater accuracy, 2D dosimetry can be pursued using the strand-fitting method described in this work. If a 1D representation is used, integrating over the empirically determined seed orientation density reported here may be more appropriate than assuming that seed inclinations are distributed uniformly.

Chng, Nicholas; Spadinger, Ingrid; Rasoda, Rosey; Morris, W. James; Salcudean, Septimiu [Department of Medical Physics, British Columbia Cancer Agency, Vancouver Cancer Centre, 600 West 10th, Vancouver, British Columbia V5Z 4E6 (Canada); Department of Electrical and Computer Engineering, University of British Columbia, 5500-2332 Main Mall, Vancouver, British Columbia V6T 1Z4 (Canada); Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver Cancer Centre, 600 West 10th, Vancouver, British Columbia V5Z 4E6 (Canada); Department of Electrical and Computer Engineering, University of British Columbia, 5500-2332 Main Mall, Vancouver, British Columbia V6T 1Z4 (Canada)

2012-02-15

258

High-dose-rate interstitial brachytherapy as a monotherapy for localized prostate cancer: Treatment description and preliminary results of a phase I\\/II clinical trial  

Microsoft Academic Search

Purpose: To improve results for localized prostate cancer, a prospective clinical trial of hyperfractionated Iridium-192 high-dose-rate (HDR) brachytherapy as a monotherapy was initiated.Methods and Materials: Between May 1995 and September 1998, 22 implants were performed on 22 patients with localized prostate cancer (T1:T2:T3:T4 = 4:6:9:3) at Osaka University Hospital. Nineteen patients, who had T3-T4 tumors or pretreatment PSA ? 20.0

Yasuo Yoshioka; Takayuki Nose; Ken Yoshida; Takehiro Inoue; Hideya Yamazaki; Eiichi Tanaka; Hiroya Shiomi; Atsushi Imai; Satoaki Nakamura; Shigetoshi Shimamoto; Toshihiko Inoue

2000-01-01

259

Comparison of Dosimetric and Biologic Effective Dose Parameters for Prostate and Urethra Using {sup 131}Cs and {sup 125}I for Prostate Permanent Implant Brachytherapy  

SciTech Connect

Purpose: To compare the urethral and prostate absolute and biologic effective doses (BEDs) for {sup 131}Cs and {sup 125}I prostate permanent implant brachytherapy (PPI). Methods and Materials: Eight previously implanted manually planned {sup 125}I PPI patients were replanned manually with {sup 131}Cs, and re-planned using Inverse Planning Simulated Annealing. {sup 131}Cs activity and the prescribed dose (115 Gy) were determined from that recommended by IsoRay. The BED was calculated for the prostate and urethra using an {alpha}/{beta} ratio of 2 and was also calculated for the prostate using an {alpha}/{beta} ratio of 6 and a urethral {alpha}/{beta} ratio of 2. The primary endpoints of this study were the prostate D{sub 90} BED (pD{sub 90}BED) and urethral D{sub 30} BED normalized to the maximal potential prostate D{sub 90} BED (nuD{sub 30}BED). Results: The manual plan comparison ({alpha}/{beta} = 2) yielded no significant difference in the prostate D{sub 90} BED (median, 192 Gy{sub 2} for both isotopes). No significant difference was observed for the nuD{sub 30}BED (median, 199 Gy{sub 2} and 202 Gy{sub 2} for {sup 125}I and {sup 131}Cs, respectively). For the inverse planning simulated annealing plan comparisons ({alpha}/{beta} 2), the prostate D{sub 90} BED was significantly lower with {sup 131}Cs than with {sup 125}I (median, 177 Gy{sub 2} vs. 187 Gy{sub 2}, respectively; p = 0.01). However, the nuD{sub 30}BED was significantly greater with {sup 131}Cs than with {sup 125}I (median, 192 Gy{sub 2} vs. 189 Gy{sub 2}, respectively; p = 0.01). Both the manual and the inverse planning simulated annealing plans resulted in a significantly lower prostate D{sub 90} BED (p = 0.01) and significantly greater nuD{sub 30}BED for {sup 131}Cs (p = 0.01), compared with {sup 125}I, when the prostate {alpha}/{beta} ratio was 6 and the urethral {alpha}/{beta} ratio was 2. Conclusion: This report highlights the controversy in comparing the dose to both the prostate and the organs at risk with different radionuclides.

Sahgal, Arjun [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States); Department of Radiation Oncology, Odette Cancer Centre at Sunnybrook Hospital, University of Toronto, Toronto, ON (Canada); Jabbari, Siavash; Chen, Josephine; Pickett, Barbie; Roach, Mack [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States); Weinberg, Vivian [University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center Biostatistics Core, San Francisco, CA (United States); Hsu, I-C. [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States); Pouliot, Jean [Department of Radiation Oncology, University of California, San Francisco, School of Medicine, San Francisco, CA (United States)], E-mail: jpouliot@radonc.ucsf.edu

2008-09-01

260

Predictors of Prostate Cancer-Specific Mortality in Elderly Men With Intermediate-Risk Prostate Cancer Treated With Brachytherapy With or Without External Beam Radiation Therapy  

SciTech Connect

Purpose: To identify clinical factors associated with prostate cancer-specific mortality (PCSM), adjusting for comorbidity, in elderly men with intermediate-risk prostate cancer treated with brachytherapy alone or in conjunction with external beam radiation therapy. Methods and Materials: The study cohort comprised 1,978 men of median age 71 (interquartile range, 66-75) years with intermediate-risk disease (Gleason score 7, prostate-specific antigen (PSA) 20 ng/mL or less, tumor category T2c or less). Fine and Gray's multivariable competing risks regression was used to assess whether prevalent cardiovascular disease (CVD), age, treatment, year of brachytherapy, PSA level, or tumor category was associated with the risk of PCSM. Results: After a median follow-up of 3.2 (interquartile range, 1.7-5.4) years, the presence of CVD was significantly associated with a decreased risk of PCSM (adjusted hazard ratio, 0.20; 95% CI 0.04-0.99; p = 0.05), whereas an increasing PSA level was significantly associated with an increased risk of PCSM (adjusted hazard ratio 1.14; 95% CI 1.02-1.27; p = 0.02). In the absence of CVD, cumulative incidence estimates of PCSM were higher (p = 0.03) in men with PSA levels above as compared with the median PSA level (7.3 ng/mL) or less; however, in the setting of CVD there was no difference (p = 0.27) in these estimates stratified by the median PSA level (6.9 ng/mL). Conclusions: In elderly men with intermediate-risk prostate cancer, CVD status is a negative predictor of PCSM and affects the prognostic capacity of pretreatment PSA level. These observations support the potential utility of prerandomization stratification by comorbidity to more accurately assess prognostic factors and treatment effects within this population.

Nanda, Akash, E-mail: ananda@partners.or [Harvard Radiation Oncology Program, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA (United States); Chen, M.-H. [Department of Statistics, University of Connecticut, Storrs, CT (United States); Moran, Brian J.; Braccioforte, Michelle H. [Prostate Cancer Foundation of Chicago, Westmont, IL (United States); Dosoretz, Daniel; Salenius, Sharon; Katin, Michael; Ross, Rudi [21st Century Oncology, Fort Myers, FL (United States); D'Amico, Anthony V. [Department of Radiation Oncology, Brigham and Women's Hospital/Dana-Farber Cancer Institute, Boston, MA (United States)

2010-05-01

261

Calculated organ doses using Monte Carlo simulations in a reference male phantom undergoing HDR brachytherapy applied to localized prostate carcinoma  

SciTech Connect

Purpose: The aim of this study was to obtain equivalent doses in radiosensitive organs (aside from the bladder and rectum) when applying high-dose-rate (HDR) brachytherapy to a localized prostate carcinoma using {sup 60}Co or {sup 192}Ir sources. These data are compared with results in a water phantom and with expected values in an infinite water medium. A comparison with reported values from proton therapy and intensity-modulated radiation therapy (IMRT) is also provided. Methods: Monte Carlo simulations in Geant4 were performed using a voxelized phantom described in International Commission on Radiological Protection (ICRP) Publication 110, which reproduces masses and shapes from an adult reference man defined in ICRP Publication 89. Point sources of {sup 60}Co or {sup 192}Ir with photon energy spectra corresponding to those exiting their capsules were placed in the center of the prostate, and equivalent doses per clinical absorbed dose in this target organ were obtained in several radiosensitive organs. Values were corrected to account for clinical circumstances with the source located at various positions with differing dwell times throughout the prostate. This was repeated for a homogeneous water phantom. Results: For the nearest organs considered (bladder, rectum, testes, small intestine, and colon), equivalent doses given by {sup 60}Co source were smaller (8%-19%) than from {sup 192}Ir. However, as the distance increases, the more penetrating gamma rays produced by {sup 60}Co deliver higher organ equivalent doses. The overall result is that effective dose per clinical absorbed dose from a {sup 60}Co source (11.1 mSv/Gy) is lower than from a {sup 192}Ir source (13.2 mSv/Gy). On the other hand, equivalent doses were the same in the tissue and the homogeneous water phantom for those soft tissues closer to the prostate than about 30 cm. As the distance increased, the differences of photoelectric effect in water and soft tissue, and appearance of other materials such as air, bone, or lungs, produced variations between both phantoms which were at most 35% in the considered organ equivalent doses. Finally, effective doses per clinical absorbed dose from IMRT and proton therapy were comparable to those from both brachytherapy sources, with brachytherapy being advantageous over external beam radiation therapy for the furthest organs. Conclusions: A database of organ equivalent doses when applying HDR brachytherapy to the prostate with either {sup 60}Co or {sup 192}Ir is provided. According to physical considerations, {sup 192}Ir is dosimetrically advantageous over {sup 60}Co sources at large distances, but not in the closest organs. Damage to distant healthy organs per clinical absorbed dose is lower with brachytherapy than with IMRT or protons, although the overall effective dose per Gy given to the prostate seems very similar. Given that there are several possible fractionation schemes, which result in different total amounts of therapeutic absorbed dose, advantage of a radiation treatment (according to equivalent dose to healthy organs) is treatment and facility dependent.

Candela-Juan, Cristian [Radioprotection Department, La Fe University and Polytechnic Hospital, Valencia 46026 (Spain); Perez-Calatayud, Jose [Radiotherapy Department, La Fe University and Polytechnic Hospital, Valencia 46026 (Spain); Ballester, Facundo [Department of Atomic, Molecular and Nuclear Physics, University of Valencia, Burjassot 46100 (Spain); Rivard, Mark J. [Department of Radiation Oncology, Tufts University School of Medicine, Boston, Massachusetts 02111 (United States)

2013-03-15

262

Radiation Dose Predicts for Biochemical Control in Intermediate-Risk Prostate Cancer Patients Treated With Low-Dose-Rate Brachytherapy  

SciTech Connect

Purpose: To evaluate the influence of patient- and treatment-related factors on freedom from biochemical failure (FFbF) in patients with intermediate-risk prostate cancer. Methods and Materials: From a prospectively collected database of 2250 men treated at Mount Sinai Hospital from 1990 to 2004 with low-dose-rate brachytherapy for prostate cancer, 558 men with either one or more intermediate-risk features (prostate-specific antigen [PSA] level 10-20 ng/mL, Gleason score 7, or Stage T2b) were identified who had a minimum follow-up of 24 months and postimplant CT-based dosimetric analysis. Biologically effective dose (BED) values were calculated to compare doses from different isotopes and treatment regimens. Patients were treated with brachytherapy with or without hormone therapy and/or external-beam radiotherapy. Patient- and treatment-related factors were analyzed with respect to FFbF. The median follow-up was 60 months (range, 24-167 months). Biochemical failure was defined according to the Phoenix definition. Univariate analyses were used to determine whether any variable was predictive of FFbF. A two-sided p value of <0.05 was considered significant. Results: Overall, the actuarial FFbF at 10 years was 86%. Dose (BED <150 Gy{sub 2} vs. {>=}150 Gy{sub 2}) was the only significant predictor of FFbF (p < 0.001). None of the other variables (PSA, external-beam radiotherapy, Gleason score, treatment type, hormones, stage, and number of risk factors) was found to be a statistically significant predictor of 10-year FFbF. Conclusions: Radiation dose is an important predictor of FFbF in intermediate-risk prostate cancer. Treatment should continue to be individualized according to presenting disease characteristics until results from Radiation Therapy Oncology Group trial 0232 become available.

Ho, Alice Y. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Burri, Ryan J.; 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)], E-mail: richard.stock@mountsinai.org

2009-09-01

263

Urinary Symptom Flare in 712 {sup 125}I Prostate Brachytherapy Patients: Long-Term Follow-Up  

SciTech Connect

Purpose: To describe the late transient worsening of urinary symptoms ('urinary symptom flare') in 712 consecutive prostate brachytherapy patients, associated predictive factors, association with rectal and urinary toxicity, and the development of erectile dysfunction. Methods and Materials: Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). International Prostate Symptom Score (IPSS), Radiation Therapy Oncology Group (RTOG) toxicity, and erectile function data were prospectively collected. Flare was defined as an increase in IPSS of >=5 and of >=8 points greater than the post-treatment nadir. The relationships between the occurrence of flare and the patient, tumor, and treatment characteristics were examined. The Cox proportional hazards method was used to test individual variables and the multivariate models. Results: The incidence of flare was 52% and 30% using the flare definition of an IPSS of >=5 and >=8 points greater than the postimplant nadir, respectively. Of the patients with symptoms, 65% had resolution of their symptoms within 6 months and 91% within 1 year. Flares most commonly occurred 16-24 months after implantation. On multivariate analysis, a greater baseline IPSS and greater maximal postimplant IPSS were the predictors of flare, regardless of the flare definition used. Androgen suppression was a predictor for fewer flares (IPSS >=5). Diabetes and prostate edema predicted for more frequent flares (IPSS >=8). Patients with flare had a greater incidence of RTOG Grade 3 urinary toxicity and RTOG Grade 2 or greater rectal toxicity. No association was found between erectile dysfunction and the occurrence of flare. Conclusion: Urinary symptom flare is a common, transient phenomenon after prostate brachytherapy. A greater baseline IPSS and maximal postimplant IPSS were the strongest predictive factors. Flare was associated with a greater incidence of late RTOG Grade 3 urinary toxicity and greater rate of late RTOG Grade 2 or greater rectal toxicity.

Keyes, Mira, E-mail: mkeyes@bccancer.bc.c [Provincial Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada); Miller, Stacy; Moravan, Veronika; Pickles, Tom; Liu, Mitchell; Spadinger, Ingrid; Lapointe, Vincent; Morris, W. James [Provincial Prostate Brachytherapy Program, British Columbia Cancer Agency, Vancouver, BC (Canada)

2009-11-01

264

Unification of a common biochemical failure definition for prostate cancer treated with brachytherapy or external beam radiotherapy with or without androgen deprivation  

Microsoft Academic Search

Purpose: Minimal data are available regarding selection of an optimal biochemical failure (BF) definition for patients treated with brachytherapy, external beam radiotherapy (EBRT), and combinations of these treatments with or without androgen deprivation (AD). We retrospectively analyzed our institution's experience treating localized prostate cancer in an attempt to determine a BF definition that could be applied for these various treatment

Dwight L. Fitch; Samuel McGrath; Alvaro A. Martinez; Frank A. Vicini; Larry L.. Kestin

2006-01-01

265

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. PMID:24868334

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

2014-01-01

266

Fast radioactive seed localization in intraoperative cone beam CT for low-dose-rate prostate brachytherapy  

NASA Astrophysics Data System (ADS)

A fast knowledge-based radioactive seed localization method for brachytherapy was developed to automatically localize radioactive seeds in an intraoperative volumetric cone beam CT (CBCT) so that corrections, if needed, can be made during prostate implant surgery. A transrectal ultrasound (TRUS) scan is acquired for intraoperative treatment planning. Planned seed positions are transferred to intraoperative CBCT following TRUS-to-CBCT registration using a reference CBCT scan of the TRUS probe as a template, in which the probe and its external fiducial markers are pre-segmented and their positions in TRUS are known. The transferred planned seeds and probe serve as an atlas to reduce the search space in CBCT. Candidate seed voxels are identified based on image intensity. Regions are grown from candidate voxels and overlay regions are merged. Region volume and intensity variance is checked against known seed volume and intensity profile. Regions meeting the above criteria are flagged as detected seeds; otherwise they are flagged as likely seeds and sorted by a score that is based on volume, intensity profile and distance to the closest planned seed. A graphical interface allows users to review and accept or reject likely seeds. Likely seeds with approximately twice the seed volume are automatically split. Five clinical cases are tested. Without any manual correction in seed detection, the method performed the localization in 5 seconds (excluding registration time) for a CBCT scan with 512×512×192 voxels. The average precision rate per case is 99% and the recall rate is 96% for a total of 416 seeds. All false negative seeds are found with 15 in likely seeds and 1 included in a detected seed. With the new method, updating of calculations of dose distribution during the procedure is possible and thus facilitating evaluation and improvement of treatment quality.

Hu, Yu-chi; Xiong, Jian-ping; Cohan, Gilad; Zaider, Marco; Mageras, Gig; Zelefsky, Michael

2013-03-01

267

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

268

Regression Rate of Posterior Uveal Melanomas Following Iodine-125 Plaque Radiotherapy  

PubMed Central

Aim: To characterize the regression rate of posterior uveal melanoma following radioactive iodine-125 (I-125) plaque. Materials and Methods: We retrospectively analyzed 95 patients with posterior uveal melanoma who were treated with only radioactive I-125 plaque and had more than 3 years follow-up. All patients were treated with plaque radiotherapy using tumor dose of 85 Gy at the tumor apex, following COMS protocol. Regression rate was assessed with standardized A-scan ultrasonography. Associations with tumor regression were evaluated by means of mixed linear regression modeling. Results: Mean decrease in the tumor thickness (% original thickness) at 12, 24, and 36 months after radiotherapy for melanomas <3 mm in thickness was 29%, 38%, and 45%, for melanoma 3-8 mm in thickness was 32%, 44%, and 59%, and for melanoma more than 8 mm in thickness was 52%, 62%, and 68%, respectively. With a doubling of follow-up time (0.5-1 year, or 1-2 years of follow-up from treatment), tumors <3 mm in thickness at treatment showed a 0.5 mm decrease in tumor thickness, whereas melanomas 3-8 mm showed a 1 mm decrease, and melanomas >8 mm showed a 1.7 mm decrease. Uveal melanomas that developed systemic metastasis showed an additional 0.4 mm decrease with a doubling of follow-up time from treatment, compared with those that did not develop metastasis (P = 0.050). Conclusions: Posterior uveal melanomas with higher initial thickness show steeper and more reduction in tumor thickness following radioactive I-125 plaque. After the initial phases, the regression curve became similar for tumors with different thicknesses.

Demirci, Hakan; Saponara, Fiorella; Khan, Adam; Niziol, Leslie M.; Lee, Choonik; Hayman, James A.; Comer, Grant; Musch, David C.

2015-01-01

269

Iodine-125 decay in a synthetic oligodeoxynucleotide. I. Fragment size distribution and evaluation of breakage probability.  

PubMed

Lobachevsky, P. N. and Martin, R. F. Iodine-125 Decay in a Synthetic Oligodeoxynucleotide. I. Fragment Size Distribution and Evaluation of Breakage Probability. Incorporation of (125)I-dC into a defined location of a double-stranded oligodeoxynucleotide was used to investigate DNA breaks arising from decay of the Auger electron-emitting isotope. Samples of the oligodeoxynucleotide were also labeled with (32)P at either the 5' or 3' end of either the (125)I-dC-containing (so-called top) or opposite (bottom) strand and incubated in 20 mM phosphate buffer or the same buffer plus 2 M dimethylsulfoxide at 4 degrees C during 18-20 days. The (32)P-end-labeled fragments produced by (125)I decays were separated on denaturing polyacrylamide gels, and the (32)P activity in each fragment was determined by scintillation counting after elution of fragments from the gel. The relative fragment size distributions were then normalized on a per decay basis and converted to a distribution of single-strand break probabilities as a function of distance from the (125)I-dC. The results of three to five experiments for each of eight possible combinations of labels and incubation conditions are presented as a table showing the relative numbers of (32)P counts in different fragments as well as graphs of normalized fragment size distributions and probabilities of breakage. The average numbers of single-strand breaks per (125)I decay are 3. 3 and 3.7 in the top strand and 1.3 and 1.5 in the bottom strand with and without dimethylsulfoxide, respectively. Every (125)I decay event produces a break in the top strand, and breakage of the bottom strand occurs in 75-80% of the events. Thus a double-strand break is produced by (125)I decay with a probability of approximately 0.8. PMID:10669547

Lobachevsky, P N; Martin, R F

2000-03-01

270

Development of Late Toxicity and International Prostate Symptom Score Resolution After External-Beam Radiotherapy Combined With Pulsed Dose Rate Brachytherapy for Prostate Cancer  

SciTech Connect

Purpose: To investigate the development of gastrointestinal (GI) toxicity, genitourinary (GU) toxicity, erectile dysfunction, and International Prostate Symptom Score (IPSS) resolution in a cohort of patients treated with external-beam radiotherapy (EBRT) followed by a brachytherapy pulsed dose rate (PDR) boost. Methods and Materials: Between 2002 and 2008, 110 patients were treated with 46-Gy EBRT followed by PDR brachytherapy (24.96-28.80 Gy). The investigated outcome variables, GI toxicity, GU toxicity, erectile dysfunction, and IPSS were prospectively scored at several time points during follow-up. Association between time (as continuous and categorical variable) and the outcome variables was assessed using generalized linear models. Results: No statistically significant association was found between time (continuous) and GI toxicity (odds ratio [OR], 0.97; 95% confidence interval [CI], 0.89-1.06), GU toxicity (OR, 0.97; 95% CI, 0.91-1.03), erectile dysfunction (OR, 1.06; 95% CI, 0.99-1.11), and IPSS (-0.11; 95% CI, -0.41-0.20). Also, no statistically significant association was found between these variables and time as a categorical variable. GU toxicity was associated with IPSS resolution (OR, 1.16; 95% CI, 1.09-1.24). Posttreatment IPSS was associated with pretreatment IPSS (0.52; 95% CI, 0.25-0.79). Conclusions: No accumulation of high-grade toxicity over time could be established for a group of patients treated with EBRT and PDR brachytherapy for prostate cancer, probably because high-grade late toxicity resolves with time. Also, differences in IPSS values among patients are smaller after treatment than before treatment.

Pieters, Bradley R., E-mail: b.r.pieters@amc.uva.nl [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (Netherlands); Rezaie, Elisa; Geijsen, Elisabeth D.; Koedooder, Kees; Grient, Johan N.B. van der; Blank, Leo E.C.M. [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (Netherlands); Reijke, Theo M. de [Department of Urology, Academic Medical Center, University of Amsterdam (Netherlands); Koning, Caro C.E. [Department of Radiation Oncology, Academic Medical Center, University of Amsterdam (Netherlands)

2011-11-01

271

A mathematical approach for evaluating the influence of dose heterogeneity on TCP for prostate cancer brachytherapy treatment  

NASA Astrophysics Data System (ADS)

The low-dose-rate brachytherapy technique has proven suitable for the management of prostate cancer. However, published data generally report the clinical outcome and the minimum peripheral dose (mPD) to the target volume and not the actual dose distribution in patients. To this end, modern guidelines recommend the use of specific dose and volume indices describing dose distribution throughout the target. The introduction of a method, based on the standard linear quadratic model and Poisson statistics, entitled the F-factor allows the TCP from different DVHs to be calculated, by using the TCP from a uniform dose distribution as the reference. The F-factor sensitivity against radiobiological parameters and influence of the DVH were evaluated. We applied the F-formula on the post-plan DVHs of 58 patients treated with 125I permanent seed implant brachytherapy for localized prostate cancer. F shows a strong correlation with dosimetric parameters already reported as significant predictors of the biochemical outcome.

Strigari, L.; Orlandini, L. C.; Andriani, I.; d'Angelo, A.; Stefanacci, M.; Di Nallo, A. M.; Benassi, Marcello

2008-09-01

272

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. PMID:24885896

2014-01-01

273

A Small Tolerance for Catheter Displacement in High-Dose Rate Prostate Brachytherapy is Necessary and Feasible  

SciTech Connect

Purpose: We examined catheter displacement in patients treated with fractionated high-dose rate (HDR) brachytherapy boost for prostate cancer and the impact this had on tumor control probability (TCP). These data were used to make conclusions on an acceptable amount of displacement. Methods and Materials: The last 20 patients treated with HDR brachytherapy boost for prostate cancer at our center in 2007 were replanned using simulated interstitial catheter displacements of 3, 6, 9, and 12 mm with originally planned dwell times. The computer-modeled dose-volume histograms for the clinical target volumes were exported and used to calculate the TCP of plans with displaced needles relative to the original plan. Actual catheter displacements were also measured before and after manual adjustment in all patients treated in 2007. Results: In the 20 patients who were replanned for caudal catheter displacements of 3, 6, 9, and 12 mm, the median relative TCP was 0.998, 0.964, 0.797, and 0.265, respectively (p < 0.01 when all medians were compared). All patients replanned with a 3-mm displacement, compared with only 75% with a 6-mm displacement, had a relative TCP greater than 0.950. In the 91 patients treated in 2007, before adjustment, 82.3% of fractions had a displacement greater than 3 mm compared with 12.2% of fractions after adjustment. Conclusions: Catheter displacement in HDR brachytherapy significantly compromises the TCP. The tolerance for these movements should be small (<=3 mm). Correcting these displacements to within acceptable limits is feasible.

Tiong, Albert, E-mail: acdtiong@hotmail.co [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia (Australia); Bydder, Sean [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia (Australia); Ebert, Martin [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia (Australia); School of Physics, University of Western Australia, Perth, Western Australia (Australia); Caswell, Nikki; Waterhouse, David; Spry, Nigel; Camille, Peter; Joseph, David [Department of Radiation Oncology, Sir Charles Gairdner Hospital, Perth, Western Australia (Australia)

2010-03-15

274

Twelve-Month Prostate-Specific Antigen Values and Perineural Invasion as Strong Independent Prognostic Variables of Long-Term Biochemical Outcome After Prostate Seed Brachytherapy  

SciTech Connect

Purpose: To determine whether post-treatment prostate-specific antigen (ptPSA) values at 12 months and other clinical parameters predict long-term PSA relapse-free survival (PRFS) following prostate seed brachytherapy. Methods and Materials: Records of 204 hormone-naieve patients with localized adenocarcinoma of the prostate treated at St. Mary's Regional Medical Center in Reno, NV, and at Carson Tahoe Regional Medical Center in Carson City, NV, between 1998 and 2003, using I-125 or Pd-103 seed brachytherapy, were retrospectively analyzed. Treatment planning was done using a preplanned, modified peripheral loading technique. A total of 185 of 204 patients had PSA records at 12 months after implant. Variables included were age, initial pretreatment PSA, Gleason score, T stage, National Comprehensive Cancer Network (NCCN) risk group (RG), perineural invasion (PNI), external beam boost, dose, and ptPSA levels at 12 months with cutpoints at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml. Results: Median follow-up was 80 months, and median age was 69 years. The numbers of patients stratified by NCCN low, intermediate, and high RG were 110:65:10, respectively. Monotherapy and boost prescription doses were 145 Gy and 110 Gy for I-125, and 125 Gy and 100 Gy for Pd-103 seeds, respectively. The median dose (D90) was 95.4% of the prescribed dose. The 5-year PRFS at the 12-months ptPSA levels of {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml were 98.5%, 85.7%, 61.5%, and 22.2%, respectively. The 10-year PRFS at the 12-months ptPSA levels of {<=}1 and 1.01 to 2.00 ng/ml were 90.5% and 85.7%, respectively. In multivariate analysis, both ptPSA and PNI were significant independent predictors of PRFS. Hazard ratios (HR) for ptPSA levels at {<=}1, 1.01 to 2.00, 2.01 to 3.00, and >3.00 ng/ml at 12 months were 1, 4.96, 27.57, and 65.10, respectively. PNI had an HR of 6.1 (p = 0.009). Conclusions: Presence of PNI and ptPSA values at 12 months are strong prognostic variables for long-term PRFS after definitive prostate brachytherapy seed implantation.

Ding, William, E-mail: billyding888@gmail.com [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States)] [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Lee, John [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States)] [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Chamberlain, David [Department of Radiation Oncology, St. Mary's Regional Medical Center, Reno, Nevada (United States)] [Department of Radiation Oncology, St. Mary's Regional Medical Center, Reno, Nevada (United States); Cunningham, James [Carson Urology, Carson City, Nevada (United States)] [Carson Urology, Carson City, Nevada (United States); Yang Lixi [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States)] [Department of Radiation Oncology, California Pacific Medical Center, San Francisco, California (United States); Tay, Jonathan [Department of Radiation Oncology, St. Mary's Regional Medical Center, Reno, Nevada (United States)] [Department of Radiation Oncology, St. Mary's Regional Medical Center, Reno, Nevada (United States)

2012-11-15

275

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

NASA Astrophysics Data System (ADS)

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.

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

2011-03-01

276

Biologically Effective Dose (BED) Correlation With Biochemical Control After Low-Dose Rate Prostate Brachytherapy for Clinically Low-Risk Prostate Cancer  

SciTech Connect

Purpose: To assess the correlation of postimplant dosimetric quantifiers with biochemical control of prostate cancer after low-dose rate brachytherapy. Methods and Materials: The biologically effective dose (BED), dose in Gray (Gy) to 90% of prostate (D{sub 90}), and percent volume of the prostate receiving 100% of the prescription dose (V{sub 100}) were calculated from the postimplant dose-volume histogram for 140 patients undergoing low-dose rate prostate brachytherapy from 1997 to 2003 at Durham Regional Hospital and the Durham VA Medical Center (Durham, NC). Results: The median follow-up was 50 months. There was a 7% biochemical failure rate (10 of 140), and 91% of patients (127 of 140) were alive at last clinical follow-up. The median BED was 148 Gy (range, 46-218 Gy). The median D{sub 90} was 139 Gy (range, 45-203 Gy). The median V{sub 100} was 85% (range, 44-100%). The overall 5-year biochemical relapse-free survival (bRFS) rate was 90.1%. On univariate Cox proportional hazards modeling, no pretreatment characteristic (Gleason score sum, age, baseline prostate-specific antigen, or clinical stage) was predictive of bRFS. The BED, D{sub 90}, and V{sub 100} were all highly correlated (Pearson coefficients >92%), and all were strongly correlated with bRFS. Using the Youden method, we identified the following cut points for predicting freedom from biochemical failure: D{sub 90} >= 110 Gy, V{sub 100} >= 74%, and BED >= 115 Gy. None of the covariates significantly predicted overall survival. Conclusions: We observed significant correlation between BED, D{sub 90}, and V{sub 100} with bRFS. The BED is at least as predictive of bRFS as D{sub 90} or V{sub 100}. Dosimetric quantifiers that account for heterogeneity in tumor location and dose distribution, tumor repopulation, and survival probability of tumor clonogens should be investigated.

Miles, Edward F., E-mail: edward.miles@med.navy.mi [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Nelson, John W.; Alkaissi, Ali K.; Das, Shiva; Clough, Robert W. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Broadwater, Gloria [Cancer Center Biostatistics, Duke University Medical Center, Durham, NC (United States); Anscher, Mitchell S.; Chino, Junzo P.; Oleson, James R. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States)

2010-05-01

277

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

278

Long-Term Outcome and Toxicity of Salvage Brachytherapy for Local Failure After Initial Radiotherapy for Prostate Cancer  

SciTech Connect

Purpose: To describe long-term outcomes and toxicity after salvage brachytherapy (BT) for local failure after initial radiotherapy for prostate cancer. Methods and Materials: Between 1994 and 2008, 37 men with local failure after initial prostate radiotherapy (32 external-beam radiation therapy [EBRT] and 5 BT) underwent salvage BT with {sup 103}Pd or {sup 125}I. Estimates of freedom from biochemical failure (FFbF, Phoenix definition) and cause-specific survival (CSS) were calculated using the Kaplan-Meier method. Toxicities were graded using CTCv3.0. Results: Median follow-up was 86 months (range, 2-156). The median dose to 90% of the prostate volume was 122 Gy (range, 67-166). The 10-year FFbF and CSS were 54% and 96%, respectively. On univariate analysis, prostate-specific antigen (PSA) >10 ng/mL at initial diagnosis was significantly associated with FFbF (p = 0.01), and there were trends for both age <70 years (p = 0.08) and PSA <6 ng/mL (p = 0.08) at the time of salvage BT. On multivariate analysis, only presalvage PSA <6 ng/mL (p = 0.046) was significantly associated with improved FFbF. There were three Grade 3 toxicities and one Grade 4 toxicity. Pelvic lymph node dissection before salvage BT was the only variable significantly associated with Grade {>=}2 toxicity (p = 0.03). Conclusion: With a median follow-up of 86 months, salvage prostate BT was associated with a 10-year FFbF of 54% and CSS of 96%. Improved FFbF was associated with a presalvage PSA <6 ng/mL. Toxicity was worse in patients who had undergone pelvic lymph node dissection before salvage BT. Careful patient selection for salvage BT may result in improved outcomes and reduced toxicity.

Burri, Ryan J. [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); Unger, Pam [Department of Pathology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G., E-mail: richard.stock@mountsinai.or [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

2010-08-01

279

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

280

Metformin is not associated with improved biochemical free survival or cause-specific survival in men with prostate cancer treated with permanent interstitial brachytherapy  

PubMed Central

Purpose Several recent studies have suggested improved clinical outcomes in diabetic men with prostate cancer who also use metformin. We explore whether metformin use is associated with improved outcomes specifically in men undergoing prostate brachytherapy. Material and methods 2,298 consecutive patients underwent permanent interstitial brachytherapy by a single brachytherapist (GSM). The cohort included 2028 non-diabetic men, 144 men with diabetes who were not taking metformin, and 126 men with diabetes who were taking metformin. Median follow up was 8.3 years. Differences in biochemical free survival, cause specific survival, and overall survival between men taking metformin and those not taking metformin were compared using Kaplan-Meier curves and log rank tests. Results Fifteen year biochemical failure rate, cause specific mortality and overall mortality for non-diabetic men was 4.6%, 1.5%, 47.0%, respectively; for diabetic men taking metformin 4.8%, 2.0%, 37.2%; and for diabetic men not taking metformin was 2.8%, 0%, 72.7%, respectively. Metformin use was not predictive in multivariate analysis of biochemical failure or prostate cancer specific mortality. However, diabetic men not taking metformin had higher overall mortality than non-diabetic men. Conclusions Metformin use was not associated with improved biochemical survival or cancer specific survival in this cohort of men treated with prostate brachytherapy. PMID:25337126

Taira, Al V.; Galbreath, Robert W.; Morris, Mallory; Butler, Wayne M.; Adamovich, Edward

2014-01-01

281

Red cell autoantibodies characterized by competitive inhibition of iodine 125 Rh alloantibody binding and by immunoprecipitation of membrane proteins  

SciTech Connect

The relationship between determinants recognized by warm-type immunoglobulin G red cell autoantibodies and the Rh antigens was characterized by autoantibody competitive inhibition of iodine 125 Rh alloantibody binding and autoantibody immunoprecipitation of iodine 125 red blood cell membrane proteins. The majority of blood donor autoantibody recognized epitopes that are closely related to Rh antigens as determined by competitive inhibition studies. Eighteen of 20 (90%) autoantibodies inhibited anti-Rh(c) binding, 15 inhibited anti-Rh(E), 5 inhibited anti-Rh(D), and only 2 failed to inhibit any of the three Rh alloantibodies tested. Autoantibodies that inhibited anti-Rh(D) also inhibited anti-Rh(c) and anti-Rh(E) and all those that inhibited anti-Rh(E) also inhibited anti-Rh(c). Autoantibodies that inhibited all three Rh alloantibodies immunoprecipitated 30 kd membrane polypeptides, as did two of the three autoantibodies that inhibited only anti-Rh(c) and anti-Rh(E). One autoantibody in this group and two autoantibodies that inhibited only anti-Rh(c), as well as an autoantibody that did not inhibit any of the Rh alloantibodies, immunoprecipitated only a single membrane polypeptide identified as band 3. The majority of normal donor red blood cell autoantibodies inhibited the binding of Rh alloantibodies, which indicates that they either bound to the Rh polypeptides or to epitopes on band 3 that were closely associated with the Rh complex.

Pierce, S.W.; Victoria, E.J.; Masouredis, S.P. (Univ. of California, San Diego, La Jolla (USA))

1990-12-01

282

Radiation dose to rectum in high-dose-rate brachytherapy with a single implant and two fractions for prostate cancer, and its prediction by prostate volume.  

PubMed

We aimed to clarify the differences between the estimated rectal dose (ERD) and the first measured dose (FMD) and second measured dose (SMD) to the rectum during high-dose-rate (HDR) brachytherapy, and to predict FMD from the prostate volume (PV) or the rectal dose-volume parameters (RDVPs). ERD, FMD, and SMD were assessed with a rectal dosimeter during HDR brachytherapy of 18 Gy given in two fractions to 110 patients (48 hormone recipients, 62 hormone-naïve patients) with prostate cancer. The correlations between FMD and PV, and between FMD and RDVP (D 2ml-D 5ml) were investigated. ERD (mean ± SD) was 219 ± 44 cGy, FMD was 255 ± 52 cGy, and SMD was 298 ± 63 cGy, which differed significantly (p < 0.001). The correlation coefficients between ERD and FMD, and between FMD and SMD, were 0.82 and 0.78, respectively. SMD was equivalent to 118 ± 16 % FMD. The measured doses were significantly greater in the hormone recipients than in the hormone-naïve patients (p < 0.001). The increase in FMD correlated with the increases in PV and in RDVPs. The correlation coefficients between PV and FMD in all of the patients, in the hormone recipients, and in the hormone-naïve patients were 0.61, 0.64, and 0.64, respectively, whereas that between RDVPs and FMD was <0.53. In conclusion, the dose to the rectum increased with time and was correlated with the increases in PV and RDVPs. The correlation coefficient between FMD and PV was greater than that between FMD and RDVPs. PMID:25034872

Shimizu, Noritaka; Noda, Yasutaka; Sato, Morio; Shirai, Shintaro; Kawai, Nobuyuki; Harada, Shinji; Sakamoto, Takaki; Nishioku, Tadayoshi

2015-01-01

283

Dose measurement for medical staff with glass dosemeters and thermoluminescence dosemeters during 125I brachytherapy for prostate cancer.  

PubMed

Photoluminescence glass dosemeters (PLDs) and thermoluminescence dosemeters (TLDs) are commonly used as a personal monitoring dosemeter. PLDs and TLDs were used for surface dose monitoring of medical staff involved in (125)I brachytherapy for prostate cancer because these dosemeters have a wide dose-response linearity and high sensitivity for low photon energy. Surface doses measured with PLDs agreed with those with TLDs within ?20 % except for a few cases. Surface doses at a surgeon's left hand and arm were higher than those at the other measuring points. A surgeon received a maximum dose of 650 ?Gy at the back of left hand. Surface doses to an assistant were <100 ?Gy. Surface doses to a nurse, a radiologist, an anaesthesiologist and a radiological technologist were <10 ?Gy. The occupational exposure to a surgeon could be reduced by the adjustment of fluoroscopic parameters and the use of lead gloves. PMID:21212076

Fujii, K; Ko, S; Nako, Y; Tonari, A; Nishizawa, K; Akahane, K; Takayama, M

2011-03-01

284

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. PMID:23837971

2013-01-01

285

Pretreatment Serum Testosterone and Androgen Deprivation: Effect on Disease Recurrence and Overall Survival in Prostate Cancer Patients Treated With Brachytherapy  

SciTech Connect

Purpose: Low testosterone has been implicated as a possible adverse prognostic factor in patients with newly diagnosed prostate cancer. We evaluated the impact of pretreatment serum testosterone on survival after prostate brachytherapy. Methods and Materials: From October 2001 to November 2004, 619 patients underwent brachytherapy and 546 had a pretreatment serum testosterone level measured. Pretreatment serum testosterone levels were assigned by the following criteria: below-normal (n = 105), low normal (n = 246), mid normal (n = 132), high normal (n = 50), and above normal (n = 13). Median follow-up was 5.2 years. Cause of death was determined for each deceased patient. Results: Six-year biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) were 97.7%, 99.8%, and 89.2%. When comparing patients with low or low normal testosterone with those with average or higher testosterone, there was no significant difference in bPFS (97.6% vs. 98.4%; p = 0.72), CSS (99.8% vs. 100%; p = 0.72), or OS (88.9% vs. 90.8%; p = 0.73). Among patients with average and higher pretreatment testosterone, there was no significant difference in outcomes when comparing patients who did and did not receive androgen deprivation therapy (ADT). For patients with low or low normal testosterone levels, there was no significant difference in bPFS or CSS when comparing patients who did and did not receive ADT. However, there was a trend toward lower OS in patients with baseline lower testosterone levels who also received ADT (83.9% vs. 91.3%, p = 0.075). Conclusions: Low pretreatment testosterone levels alone did not affect disease recurrence or OS. Patients with baseline low testosterone who also were treated with ADT had a trend toward decreased OS.

Taira, Al V. [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Merrick, Gregory S. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)], E-mail: gmerrick@urologicresearchinstitute.org; Galbreath, Robert W.; Butler, Wayne M. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, Seattle, WA (United States); Allen, Zachariah A.; Lief, Jonathan H. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Wheeling Hospital, Department of Pathology, Wheeling, WV (United States)

2009-07-15

286

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

287

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

288

Phacoemulsification of irradiation cataract after brachytherapy.  

PubMed

A 24-year old man presented to the Policlinic with severe visual impairment in his left eye. The patient had been treated earlier with Iodine-125 brachytherapy due to iris melanoma. Clinical examination revealed low visual acuity, filtration device, iris atrophy, posterior synachiae and completely white cataract. Ultrasonography revealed scleral thinning with no signs of retinal detachment. The patient underwent synechiolysis, trypan blue capsule staining, phacoemulsification and implantation of 23D intraocular lens Alcon AcrySof (MA60BM). Phacoemulsification went uneventful and early postoperative recovery was successful. Visual acuity improved to 0,2 and fundus examination revealed radiation retinopathy with diffuse retinal scaring. PMID:23348192

?abri?, Emir; Zvor?anin, Jasmin; Jusufovi?, Vahid

2013-02-01

289

Treatment of localized prostate cancer using a combination of high dose rate Iridium-192 brachytherapy and external beam irradiation: initial Australian experience.  

PubMed

Combination high dose rate brachytherapy (HDRB) and external beam radiation therapy is technically and clinically feasible as definitive treatment for localized prostate cancer. We report the first large Australian experience using this technique of radiation dose escalation in 82 patients with intermediate- and high-risk disease. With a median follow up of 3 years (156 weeks), complications were low and overall prostate-specific antigen progression-free survival was 91% using the American Society for Therapeutic Radiology and Oncology consensus definition. The delivery of hypofractionated radiation through the HDRB component shortens overall treatment time and is both biologically and logistically advantageous. As a radiation boost strategy, HDRB is easy to learn and could be introduced into most facilities with brachytherapy capability. PMID:12780444

Stevens, M J; Stricker, P D; Saalfeld, J; Brenner, P C; Kooner, R; O'Neill, G F A; Duval, P J; Jagavkar, R S; Cross, P; Martland, J

2003-06-01

290

Rectal bleeding after high-dose-rate brachytherapy combined with hypofractionated external-beam radiotherapy for localized prostate cancer: Impact of rectal dose in high-dose-rate brachytherapy on occurrence of grade 2 or worse rectal bleeding  

SciTech Connect

Purpose: To evaluate the incidence of Grade 2 or worse rectal bleeding after high-dose-rate (HDR) brachytherapy combined with hypofractionated external-beam radiotherapy (EBRT), with special emphasis on the relationship between the incidence of rectal bleeding and the rectal dose from HDR brachytherapy. Methods and Materials: The records of 100 patients who were treated by HDR brachytherapy combined with EBRT for {>=}12 months were analyzed. The fractionation schema for HDR brachytherapy was prospectively changed, and the total radiation dose for EBRT was fixed at 51 Gy. The distribution of the fractionation schema used in the patients was as follows: 5 Gy x 5 in 13 patients; 7 Gy x 3 in 19 patients; and 9 Gy x 2 in 68 patients. Results: Ten patients (10%) developed Grade 2 or worse rectal bleeding. Regarding the correlation with dosimetric factors, no significant differences were found in the average percentage of the entire rectal volume receiving 30%, 50%, 80%, and 90% of the prescribed radiation dose from EBRT between those with bleeding and those without. The average percentage of the entire rectal volume receiving 10%, 30%, 50%, 80%, and 90% of the prescribed radiation dose from HDR brachytherapy in those who developed rectal bleeding was 77.9%, 28.6%, 9.0%, 1.5%, and 0.3%, respectively, and was 69.2%, 22.2%, 6.6%, 0.9%, and 0.4%, respectively, in those without bleeding. The differences in the percentages of the entire rectal volume receiving 10%, 30%, and 50% between those with and without bleeding were statistically significant. Conclusions: The rectal dose from HDR brachytherapy for patients with prostate cancer may have a significant impact on the incidence of Grade 2 or worse rectal bleeding.

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); Tamaki, Tomoaki [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Harada, Kosaku [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); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)

2006-06-01

291

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

SciTech Connect

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 recurrent disease, all patients were treated with 36 Gy in six fractions using two transrectal ultrasound-guided HDR prostate implants, separated by 1 week. Eleven patients received neoadjuvant hormonal therapy immediately presalvage, whereas none received adjuvant hormonal therapy postsalvage. Median follow-up time from recurrence was 18.7 months (range, 6-84 months). Determination of subsequent biochemical failure after brachytherapy was based on the definition by the American Society for Therapeutic Radiology and Oncology. Results: Based on the Common Terminology Criteria for Adverse Events (CTCAE version 3), 18 patients reported Grade 1 to 2 genitourinary symptoms by 3 months postsalvage. Three patients developed Grade 3 genitourinary toxicity. Maximum observed gastrointestinal toxicity was Grade 2; all cases spontaneously resolved. The 2-year Kaplan-Meier estimate of biochemical control after recurrence was 89%. Thirteen patients have achieved a PSA nadir {<=}0.1 ng/ml, but at the time of writing this endpoint has not yet been reached for all patients. All patients are alive; however 2 have experienced biochemical failure, both with PSA nadirs {>=}1, and have subsequently been found to have distant metastases. Conclusions: Salvage HDR prostate brachytherapy appears to be feasible and effective.

Lee, Brian [Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States); Shinohara, Katsuto [Department of Urology, University of California-San Francisco, San Francisco, CA (United States); Weinberg, Vivian [Comprehensive Cancer Center Biostatistics Core, University of California-San Francisco, San Francisco, CA (United States); Gottschalk, Alexander R. [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); Roach, Mack [Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States); Hsu, I.-Chow [Department of Radiation Oncology, University of California-San Francisco, San Francisco, CA (United States)]. E-mail: Hsu@radonc17.ucsf.edu

2007-03-15

292

Results of high dose rate afterloading brachytherapy boost to conventional external beam radiation therapy for initial and locally advanced prostate cancer  

Microsoft Academic Search

Purpose: To evaluate the impact on biochemical control (bNED), acute and late gastro-intestinal (GI) and urological (GU) morbidity of initial and locally advanced prostate cancer treated with fractionated transrectal ultrasound-guided (TRUS) high dose rate after loading brachytherapy (HDR-B) as a boost to conventional external beam radiation therapy (EBRT).Patients and methods: From March 1997 to February 2000 a total of 119

Antonio Cassio Assis Pellizzon; Wladmir Nadalin; João Vitor Salvajoli; Ricardo Cesar Fogaroli; Paulo Eduardo R. S Novaes; Maria Aparecida Conte Maia; Robson Ferrigno

2003-01-01

293

15-Year biochemical relapse free survival in clinical Stage T1-T3 prostate cancer following combined external beam radiotherapy and brachytherapy; Seattle experience  

SciTech Connect

Purpose: Long-term biochemical relapse-free survival (BRFS) rates in patients with clinical Stages T1-T3 prostate cancer continue to be scrutinized after treatment with external beam radiation therapy and brachytherapy. Methods and Materials: We report 15-year BRFS rates on 223 patients with clinically localized prostate cancer that were consecutively treated with I{sup 125} or Pd {sup 103} brachytherapy after 45-Gy neoadjuvant EBRT. Multivariate regression analysis was used to create a pretreatment clinical prognostic risk model using a modified American Society for Therapeutic Radiology and Oncology consensus definition (two consecutive serum prostate-specific antigen rises) as the outcome. Gleason scoring was performed by the pathologists at a community hospital. Time to biochemical failure was calculated and compared by using Kaplan-Meier plots. Results: Fifteen-year BRFS for the entire treatment group was 74%. BRFS using the Memorial Sloan-Kettering risk cohort analysis (95% confidence interval): low risk, 88%, intermediate risk 80%, and high risk 53%. Grouping by the risk classification described by D'Amico, the BRFS was: low risk 85.8%, intermediate risk 80.3%, and high risk 67.8% (p = 0.002). Conclusions: I{sup 125} or Pd{sup 103} brachytherapy combined with supplemental EBRT results in excellent 15-year biochemical control. Different risk group classification schemes lead to different BRFS results in the high-risk group cohorts.

Sylvester, John E. [Seattle Prostate Institute, Seattle, WA (United States)]. E-mail: johnsylvester@seattleprostate.com; Grimm, Peter D. [Seattle Prostate Institute, Seattle, WA (United States); Blasko, John C. [Seattle Prostate Institute, Seattle, WA (United States); Millar, Jeremy [Department Radiation Oncology, William Buckland Radiotherapy Centre, Melbourne (Australia); Orio, Peter F. [Department Radiation Oncology, University of Washington, Seattle, WA (United States); Skoglund, Scott [Seattle Prostate Institute, Seattle, WA (United States); Galbreath, Robert W. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States); Merrick, Gregory [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)

2007-01-01

294

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

SciTech Connect

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. [Department of Radiation Oncology, Virginia Commonwealth University Medical Center, 401 College Street, Richmond, Virginia 23298 (United States)

2009-09-15

295

Prostate Cancer: Cryoablation Treatment  

MedlinePLUS

... systems has a different type of probe and placement strategy, but all aim to freeze the prostate, ... brachytherapy: Treatment for prostate cancer that involves the placement of tiny radioactive pellets into the prostate by ...

296

High-dose radiation employing external beam radiotherapy and high-dose rate brachytherapy with and without neoadjuvant androgen deprivation for prostate cancer patients with intermediate- and high-risk features  

Microsoft Academic Search

The role of neoadjuvant androgen deprivation (NAD) in high-risk prostate cancer patients receiving high-dose radiotherapy (RT) remains unstudied. To evaluate the effect of a course of NAD, we reviewed the experiences of three institutions treating these patients with combined RT and high-dose rate brachytherapy (HDR). Of 1260 prostate cancer patients with high-risk features (pretreatment prostate-specific antigen (PSA) ?10, Gleason Score

C Vargas; A Martínez; R Galalae; J Demanes; A Harsolia; L Schour; N Nuernberg; J Gonzalez

2006-01-01

297

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

298

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

299

[The distribution of iodine-125 labeled alpha-fetoprotein in the animal organism and its accumulation in the tumor].  

PubMed

The distribution of iodine-125 labeled human alpha-fetoprotein in mice was studied after its intravenous injection. The maximal accumulation of alpha-fetoprotein in different tissues and organs of animals was observed mainly 5 hours after injection. Then the protein was gradually eliminated from the body. In the liver, intestine and blood of intact animals 125I-alpha-fetoprotein persists for at least three days. Accumulation of alpha-fetoprotein in various tissues and organs may determine the different biological effects of this protein. In the mice with transplanted lymphatic leukemia cells P388 the high level of alpha-fetoprotein accumulation was detected in the tumor tissue, reaching 6% of the injected amount per 1 g of tissue. This allows considering the radionuclide-labeled alpha-fetoprotein as a promising medical radionuclide marker for the radiological detection of malignant tumors. PMID:22834322

Severin, S E; Kulakov, V N; Moskaleva, E Iu; Severin, E S; Slobodianik, I I; Klimova, T P

2012-01-01

300

Modern brachytherapy.  

PubMed

Brachytherapy consists of placing radioactive sources within, or directly adjacent to a tumor, and is a means of delivering highly targeted and conformal radiation. While its history dates back to the origins of the field, in recent years brachytherapy treatment paradigms have been evolving considerably. This has been driven primarily by advancements in imaging, which allow for precise placement of sources and applicators under image guidance, and volume-based optimization to ensure adequate tumor coverage while sparing adjacent normal tissue. There has been a shift towards high-dose-rate (HDR) brachytherapy for many of the disease sites treated with brachytherapy. Simultaneously, with increasingly conformal treatment, there has been a shift towards utilization of higher doses per fraction, over fewer fractions, for specific disease sites where hypofractionation is believed to confer a radiobiological benefit. Here we review recent data and trends for those disease sites and conditions that are commonly treated with brachytherapy, including prostate, gynecologic, breast, head and neck, and skin cancers and salvage of recurrent disease. PMID:25499641

Nicholas Lukens, J; Gamez, Mauricio; Hu, Kenneth; Harrison, Louis B

2014-12-01

301

103P d brachytherapy and external beam irradiation for clinically localized, high-risk prostatic carcinoma  

Microsoft Academic Search

Purpose: To summarize biochemical failure rates and morbidity of external irradiation (EBRT) combined with palladium (103Pd) boost for clinically localized high-risk prostate carcinoma.Methods and Materials: Sevently-three consecutive patients with stage T2a-T3 prostatic carcinoma were treated from 1991 through 1994. Each patient had at least one of the following wisk factors for extracapsular disease extension: Stage T2b or greater (71 patients),

Michael Dattoli; Kent Wallner; Richard Sorace; John Koval; Jennifer Cash; Rudolph Acosta; Charles Brown; James Etheridge; Michael Binder; Richard Brunelle; Novelle Kirwan; Servando Sanchez; Douglas Stein; Stuart Wasserman

1996-01-01

302

Local Control Following Permanent Prostate Brachytherapy: Effect of High Biologically Effective Dose on Biopsy Results and Oncologic Outcomes  

SciTech Connect

Purpose: To determine factors that influence local control and systemic relapse in patients undergoing permanent prostate brachytherapy (PPB). Methods and Materials: A total of 584 patients receiving PPB alone or PPB with external beam radiation therapy (19.5%) agreed to undergo prostate biopsy (PB) at 2 years postimplantion and yearly if results were positive or if the prostate-specific antigen (PSA) level increased. Short-term hormone therapy was used with 280 (47.9%) patients. Radiation doses were converted to biologically effective doses (BED) (using alpha/beta = 2). Comparisons were made by chi-square analysis and linear regression. Survival was determined by the Kaplan-Meier method. Results: The median PSA concentration was 7.1 ng/ml, and the median follow-up period was 7.1 years. PB results were positive for 48/584 (8.2%) patients. Positive biopsy results by BED group were as follows: 22/121 (18.2%) patients received a BED of <=150 Gy; 15/244 (6.1%) patients received >150 to 200 Gy; and 6/193 (3.1%; p < 0.001) patients received >200 Gy. Significant associations of positive PB results by risk group were low-risk group BED (p = 0.019), intermediate-risk group hormone therapy (p = 0.011) and BED (p = 0.040), and high-risk group BED (p = 0.004). Biochemical freedom from failure rate at 7 years was 82.7%. Biochemical freedom from failure rate by PB result was 84.7% for negative results vs. 59.2% for positive results (p < 0.001). Cox regression analysis revealed significant associations with BED (p = 0.038) and PB results (p = 0.002) in low-risk patients, with BED (p = 0.003) in intermediate-risk patients, and with Gleason score (p = 0.006), PSA level (p < 0.001), and PB result (p = 0.038) in high-risk patients. Fifty-three (9.1%) patients died, of which eight deaths were due to prostate cancer. Cause-specific survival was 99.2% for negative PB results vs. 87.6% for positive PB results (p < 0.001). Conclusions: Higher radiation doses are required to achieve local control following PPB. A BED of >200 Gy with an alpha/beta ratio of 2 yields 96.9% local control rate. Failure to establish local control impacts survival.

Stone, Nelson N., E-mail: nelsonstone@optonline.ne [Department of Urology, Mount Sinai School of Medicine, New York, New York (United States); Stock, Richard G.; Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, New York (United States); Unger, Pam [Department of Pathology, Mount Sinai School of Medicine, New York, New York (United States)

2010-02-01

303

Pretreatment Endorectal Coil Magnetic Resonance Imaging Findings Predict Biochemical Tumor Control in Prostate Cancer Patients Treated With Combination Brachytherapy and External-Beam Radiotherapy  

SciTech Connect

Purpose: To investigate the utility of endorectal coil magenetic resonance imaging (eMRI) in predicting biochemical relapse in prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Methods and Materials: Between 2000 and 2008, 279 men with intermediate- or high-risk prostate cancer underwent eMRI of their prostate before receiving brachytherapy and supplemental intensity-modulated radiotherapy. Endorectal coil MRI was performed before treatment and retrospectively reviewed by two radiologists experienced in genitourinary MRI. Image-based variables, including tumor diameter, location, number of sextants involved, and the presence of extracapsular extension (ECE), were incorporated with other established clinical variables to predict biochemical control outcomes. The median follow-up was 49 months (range, 1-13 years). Results: The 5-year biochemical relapse-free survival for the cohort was 92%. Clinical findings predicting recurrence on univariate analysis included Gleason score (hazard ratio [HR] 3.6, p = 0.001), PSA (HR 1.04, p = 0.005), and National Comprehensive Cancer Network risk group (HR 4.1, p = 0.002). Clinical T stage and the use of androgen deprivation therapy were not correlated with biochemical failure. Imaging findings on univariate analysis associated with relapse included ECE on MRI (HR 3.79, p = 0.003), tumor size (HR 2.58, p = 0.04), and T stage (HR 1.71, p = 0.004). On multivariate analysis incorporating both clinical and imaging findings, only ECE on MRI and Gleason score were independent predictors of recurrence. Conclusions: Pretreatment eMRI findings predict for biochemical recurrence in intermediate- and high-risk prostate cancer patients treated with combination brachytherapy and external-beam radiotherapy. Gleason score and the presence of ECE on MRI were the only significant predictors of biochemical relapse in this group of patients.

Riaz, Nadeem [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Afaq, Asim; Akin, Oguz [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Pei Xin; Kollmeier, Marisa A.; Cox, Brett [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Hricak, Hedvig [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)] [Department of Radiology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States); Zelefsky, Michael J., E-mail: zelefskm@mskcc.org [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

2012-11-01

304

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

SciTech Connect

Purpose: To estimate the rate of late Grade 3 or greater genitourinary (GU) and gastrointestinal (GI) adverse events (AEs) after treatment with external beam radiotherapy and prostate high-dose-rate (HDR) brachytherapy. Methods and Materials: Each participating institution submitted computed tomography-based HDR brachytherapy dosimetry data electronically for credentialing and for each study patient. Patients with locally confined Stage T1c-T3b prostate cancer were eligible for the present study. All patients were treated with 45 Gy in 25 fractions using external beam radiotherapy and one HDR implant delivering 19 Gy in two fractions. All AEs were graded according to the Common Terminology Criteria for Adverse Events, version 3.0. Late GU/GI AEs were defined as those occurring >9 months from the start of the protocol treatment, in patients with {>=}18 months of potential follow-up. Results: A total of 129 patients from 14 institutions were enrolled in the present study. Of the 129 patients, 125 were eligible, and AE data were available for 112 patients at analysis. The pretreatment characteristics of the patients were as follows: Stage T1c-T2c, 91%; Stage T3a-T3b, 9%; prostate-specific antigen level {<=}10 ng/mL, 70%; prostate-specific antigen level >10 but {<=}20 ng/mL, 30%; and Gleason score 2-6, 10%; Gleason score 7, 72%; and Gleason score 8-10, 18%. At a median follow-up of 29.6 months, three acute and four late Grade 3 GU/GI AEs were reported. The estimated rate of late Grade 3-5 GU and GI AEs at 18 months was 2.56%. Conclusion: This is the first prospective, multi-institutional trial of computed tomography-based HDR brachytherapy and external beam radiotherapy. The technique and doses used in the present study resulted in acceptable levels of AEs.

Hsu, I-Chow, E-mail: ihsu@radonc.ucsf.ed [University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA (United States); Bae, Kyounghwa [Department of Statistics, Radiation Therapy Oncology Group, Philadelphia, PA (United States); Shinohara, Katsuto; Pouliot, Jean [University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA (United States); Purdy, James [Image-Guided Therapy Quality Assurance Center, St. Louis, MO (United States); Ibbott, Geoffrey [Radiological Physics Center, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Speight, Joycelyn [University of California, San Francisco, Helen Diller Family Comprehensive Cancer Center, San Francisco, CA (United States); Vigneault, Eric [L'Hotel-Dieu De Quebec, Quebec, QC (Canada); Ivker, Robert M.D. [Newark Beth Israel Medical Center, Newark, NJ (Israel); Sandler, Howard M.D. [University of Michigan, Ann Arbor, MI (United States)

2010-11-01

305

3D MR-Spectroscopic Imaging Assessment of Metabolic Activity in the Prostate During the PSA 'Bounce' Following {sup 125}Iodine Brachytherapy  

SciTech Connect

Purpose: A temporary increase in prostate-specific antigen (PSA) values is observed in 30%-40% of men following {sup 125} I brachytherapy (BT) for prostate cancer. We present the results of a study to characterize prostate metabolic activity during the PSA 'bounce' and to correlate metabolic changes with PSA levels using three-dimensional magnetic resonance spectroscopic imaging (3D-MRSI). Methods and Materials: 3D-MRSI was performed in 24 patients during the PSA bounce. Eight of these had also had a baseline 3D-MRSI scan before BT for the purpose of tumor mapping. The 3D-MRSI was repeated at 6- and 12-month intervals, and PSA levels were monitored every 3 months. Twenty-one of the patients had favorable-risk prostate cancer, and 3 had intermediate risk. Results: The choline+creatine signal intensity, although markedly reduced, was observable following BT. Diffuse activity not corresponding to original biopsy-positive sites was observed in 22 cases, and 2 cases were documented to have local recurrence. No statistically significant correlation between metabolic activity and PSA levels at each interval was found. Conclusion: Post-BT prostate 3D-MRSI shows evidence of diffuse metabolic activity unrelated to residual malignancy. This supports the benign nature of the PSA bounce and suggests an inflammatory etiology. In the situation of a rising PSA, observation of focal activity on MRI/3D-MRSI could be a useful adjunct to suggest local recurrence at an earlier interval after brachytherapy when prostate biopsies would still be unhelpful. Longer follow-up is necessary to confirm the complex relationship between metabolic activity and PSA levels.

Kirilova, Anna [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto (Canada); Damyanovich, Andrei [Department of Radiation Physics, Princess Margaret Hospital, University of Toronto, Toronto (Canada); Crook, Juanita, E-mail: jcrook@bccancer.bc.c [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto (Canada); Jezioranski, John [Department of Radiation Physics, Princess Margaret Hospital, University of Toronto, Toronto (Canada); Wallace, Kris [Department of Radiation Oncology, Princess Margaret Hospital, University of Toronto, Toronto (Canada); Pintilie, Melania [Department of Biostatistics, Princess Margaret Hospital, University of Toronto, Toronto (Canada)

2011-02-01

306

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

307

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

308

Treatment planning for brachytherapy: an integer programming model, two computational approaches and experiments with permanent prostate implant planning.  

PubMed

An integer linear programming model is proposed as a framework for optimizing seed placement and dose distribution in brachytherapy treatment planning. The basic model involves using 0/1 indicator variables to describe the placement or non-placement of seeds in a prespecified three-dimensional grid of potential locations. The dose delivered to each point in a discretized representation of the diseased organ and neighbouring healthy tissue can then be modelled as a linear combination of the indicator variables. A system of linear constraints is imposed to attempt to keep the dose level at each point to within specified target bounds. Since it is physically impossible to satisfy all constraints simultaneously, each constraint uses a variable to either record when the target dose level is achieved, or to record the deviation from the desired level. These additional variables are embedded into an objective function to be optimized. Variations on this model are discussed and two computational approaches--a branch-and-bound algorithm and a genetic algorithm--for finding 'optimal' seed placements are described. Results of computational experiments on a collection of prostate cancer cases are reported. The results indicate that both optimization algorithms are capable of producing good solutions within 5 to 15 min, and that small variations in model parameters can have a measurable effect on the dose distribution of the resulting plans. PMID:10071881

Lee, E K; Gallagher, R J; Silvern, D; Wuu, C S; Zaider, M

1999-01-01

309

Treatment planning for brachytherapy: an integer programming model, two computational approaches and experiments with permanent prostate implant planning  

NASA Astrophysics Data System (ADS)

An integer linear programming model is proposed as a framework for optimizing seed placement and dose distribution in brachytherapy treatment planning. The basic model involves using 0/1 indicator variables to describe the placement or non-placement of seeds in a prespecified three-dimensional grid of potential locations. The dose delivered to each point in a discretized representation of the diseased organ and neighbouring healthy tissue can then be modelled as a linear combination of the indicator variables. A system of linear constraints is imposed to attempt to keep the dose level at each point to within specified target bounds. Since it is physically impossible to satisfy all constraints simultaneously, each constraint uses a variable to either record when the target dose level is achieved, or to record the deviation from the desired level. These additional variables are embedded into an objective function to be optimized. Variations on this model are discussed and two computational approaches - a branch-and-bound algorithm and a genetic algorithm - for finding `optimal' seed placements are described. Results of computational experiments on a collection of prostate cancer cases are reported. The results indicate that both optimization algorithms are capable of producing good solutions within 5 to 15 min, and that small variations in model parameters can have a measurable effect on the dose distribution of the resulting plans.

Lee, Eva K.; Gallagher, Richard J.; Silvern, David; Wuu, Cheng-Shie; Zaider, Marco

1999-01-01

310

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. PMID:23918571

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

2013-01-01

311

A Phase II Study of High-Dose-Rate Afterloading Brachytherapy as Monotherapy for the Treatment of Localized Prostate Cancer  

SciTech Connect

Purpose: A Phase II dose escalation study has been undertaken to evaluate high-dose-rate brachytherapy (HDRBT) monotherapy for prostate cancer. Methods and Materials: A total of 110 patients have been entered, all with locally advanced cancer. Three dose levels have been used; 34 Gy in four fractions, 36 Gy in four fractions, and 31.5 Gy in three fractions. These equate to 226Gy{sub 1.5}, 252Gy{sub 1.5}, and 252Gy{sub 1.5}, respectively. Thirty patients have received 34 Gy, 25 received 36 Gy, and 55 patients received 31.5 Gy. Acute and late toxicity was analyzed using the International Prostate Symptom Score, and urologic and rectal events were scored using the Radiation Therapy Oncology Group/Common Terminology Criteria scoring systems. Results: Seven patients required urethral catheterization at 2 weeks; 3 receiving 34 Gy, 1 receiving 36 Gy, and 3 receiving 31.5 Gy. Only 3 patients remained catheterized at 12 weeks. Radiation Therapy Oncology Group 1 and 2 gastrointestinal toxicity at 2 weeks was seen in 61%, 68%, and 77%, respectively. Grade 3 bladder toxicity was seen in 2 patients at 6 months, 1 each from the 36 Gy and 31.5 Gy arms. One patient from the 31.5-Gy cohort reported Grade 2 bowel toxicity at 6 months. Prostate-specific antigen (PSA), stratified for androgen deprivation therapy (ADT) and no-ADT patients ranged from 16.1-22.9 {mu}g/L and 11.1-12.5 {mu}g/L, respectively. This fell at 12 months to 0.2-0.6 {mu}g/L and 0.5-1.4 {mu}g/L, respectively. No PSA relapses have yet been seen with a median follow-up of 30 months (34 Gy), 18 months (36 Gy), and 11.8 months (31.5 Gy). Conclusions: Early results suggest an excellent biochemical response with no differences seen in acute and late toxicity between doses of 34 Gy/four fractions, 36 Gy/four fractions, or 31.5 Gy/three fractions.

Corner, Carie [Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom)], E-mail: cariecorner@yahoo.com; Rojas, Ana Maria; Bryant, Linda; Ostler, Peter; Hoskin, Peter [Mount Vernon Cancer Centre, Mount Vernon Hospital, Northwood, Middlesex (United Kingdom)

2008-10-01

312

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

PubMed

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 125I Or 103Pd 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 BEDi, equivalent uniform dose EUDi, and tumor control probability TCPi 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 125I and 103Pd due to less complete coverage of the target volume by the former isotope. The implant BED and TCP were highly correlated with the D90 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. PMID:19378738

Butler, Wayne M; Stewart, Renee R; Merrick, Gregory S

2009-03-01

313

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

SciTech Connect

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 years. The bPFS was defined by a PSA {<=}0.40 ng/mL after nadir. Multiple clinical, treatment, and dosimetric parameters were evaluated for the impact on survival. Results: The 10-year CSS, bPFS, and OS were 88.9%, 86.6%, and 68.6%, respectively. A statistically significant difference in bPFS was discerned between hormone naive, ADT {<=}6 months, and ADT >6 month cohorts (79.7% vs. 95.% vs. 89.9%, p = 0.032). Androgen deprivation therapy (ADT) did not impact CSS or OS. For bPFS patients, the median posttreatment PSA was <0.04 ng/mL. A Cox linear regression analysis demonstrated that Gleason score was the best predictor of CSS, whereas percent positive biopsies and duration of ADT best predicted for bPFS. The OS was best predicted by Gleason score and diabetes. Thirty-eight patients have died, with 26 of the deaths from cardiovascular/pulmonary disease or second malignancy. Eleven patients have died of metastatic prostate cancer. Conclusions: The ADT improved 10-year bPFS without statistical impact on CSS or OS. Death as a result of cardiovascular/pulmonary disease and second malignancies were more than twice as common as prostate cancer deaths. Strategies to improve cardiovascular health should positively impact OS.

Merrick, Gregory S. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)]. E-mail: gmerrick@urologicresearchinstitute.org; Butler, Wayne M. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Galbreath, Robert W. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Ohio University Eastern, St. Clairsville, OH (United States); Allen, Zachariah A. [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States); Lief, Jonathan [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States)

2007-05-01

314

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. PMID:20642386

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

2011-01-01

315

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

PubMed

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. PMID:20642386

Cunha, J Adam; Hsu, I-Chow; Pouliot, Jean; Roach Iii, Mack; Shinohara, Katsuto; Kurhanewicz, John; Reed, Galen; Stoianovici, Dan

2010-08-01

316

Second malignancies after prostate brachytherapy: Incidence of bladder and colorectal cancers in patients with 15 years of potential follow-up  

SciTech Connect

Purpose: To report the incidence of second bladder and colorectal cancers after prostate brachytherapy. Methods and Materials: This review included 125 patients treated with I-125 brachytherapy alone, and 223 patients who received supplemental external beam radiation therapy. Median follow-up was 10.5 years. Patients were followed for the development of lower genitourinary and colorectal cancers. Second malignancies arising five years after radiation therapy were defined as being potentially associated with treatment; observed rates were then compared with age-matched expected rates according to Surveillance, Epidemiology, and End Results data. Results: Five years out of treatment, there were 15 patients with a second solid tumor, including bladder cancer (n = 11), colorectal cancer (n = 3), and prostatic urethra cancer (n = 1). The incidence of second malignancy was no different in patients treated with brachytherapy alone (1.6%) vs. those receiving external beam radiotherapy (5.8%, p = 0.0623). There were more observed bladder cancers compared with those expected (relative risk, 2.34, 95% confidence interval 0.96-3.72; absolute excess risk 35 cancers per 10,000 patients). Relative risk did not significantly change over increasing follow-up intervals up to 20 years after treatment. Conclusions: There may be an increased but small risk of developing a second malignancy after radiation therapy for prostate cancer. This outcome could be related to radiation carcinogenesis, but more vigilant screening and thorough workup as a result of radiation side effects and predisposing conditions (e.g., genetic and environmental factors) in many of the patients found to have second malignancies likely contributed to the higher number of observed malignancies than expected.

Liauw, Stanley L. [Department of Radiation and Cellular Oncology, University of Chicago Pritzker School of Medicine, Chicago, IL (United States); Sylvester, John E. [Seattle Prostate Institute at Swedish Hospital, Seattle, WA (United States) and Swedish Cancer Center at Stevens Hospital, Edmonds, WA (United States)]. E-mail: johnsylvester@seattleprostateinst.com; Morris, Christopher G. [Department of Radiation Oncology, University of Florida, College of Medicine, Gainesville, FL (United States); Blasko, John C. [Seattle Prostate Institute at Swedish Hospital, Seattle, WA (United States); Grimm, Peter D. [Seattle Prostate Institute at Swedish Hospital, Seattle, WA (United States)

2006-11-01

317

Analysis of high–dose rate brachytherapy dose distribution resemblance in CyberKnife hypofractionated treatment plans of localized prostate cancer  

SciTech Connect

The present study is to analyze the CyberKnife hypofractionated dose distribution of localized prostate cancer in terms of high–dose rate (HDR) brachytherapy equivalent doses to assess the degree of HDR brachytherapy resemblance of CyberKnife dose distribution. Thirteen randomly selected localized prostate cancer cases treated using CyberKnife with a dose regimen of 36.25 Gy in 5 fractions were considered. HDR equivalent doses were calculated for 30 Gy in 3 fractions of HDR brachytherapy regimen. The D{sub 5%} of the target in the CyberKnife hypofractionation was 41.57 ± 2.41 Gy. The corresponding HDR fractionation (3 fractions) equivalent dose was 32.81 ± 1.86 Gy. The mean HDR fractionation equivalent dose, D{sub 98%}, was 27.93 ± 0.84 Gy. The V{sub 100%} of the prostate target was 95.57% ± 3.47%. The V{sub 100%} of the bladder and the rectum were 717.16 and 79.6 mm{sup 3}, respectively. Analysis of the HDR equivalent dose of CyberKnife dose distribution indicates a comparable resemblance to HDR dose distribution in the peripheral target doses (D{sub 98%} to D{sub 80%}) reported in the literature. However, there is a substantial difference observed in the core high-dose regions especially in D{sub 10%} and D{sub 5%}. The dose fall-off within the OAR is also superior in reported HDR dose distribution than the HDR equivalent doses of CyberKnife.

Sudahar, H., E-mail: h.sudahar@gmail.com [Department of Radiotherapy, Apollo Speciality Hospital, Chennai (India); Kurup, P.G.G.; Murali, V.; Mahadev, P. [Department of Radiotherapy, Apollo Speciality Hospital, Chennai (India); Velmurugan, J. [Department of Medical Physics, Anna University, Chennai (India)

2013-01-01

318

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

SciTech Connect

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 during a 5.5-week period. Median follow-up was 61 months. Patients were divided into groups with localized (T1c-T2b) and advanced disease (T3a-T3b). We used the American Society for Therapeutic Radiology and Oncology (ASTRO) definition for biochemical failure. According to recommendations of the Radiation Therapy Oncology Group-ASTRO Phoenix Consensus Conference, biochemical failure-free control rates (BF-FCRs) at 3 years were investigated as 2 years short of the median follow-up. Results: Between April 2000 and Sept 2007, Common Terminology Criteria for Adverse Events Version 2.0 late Grade 2 genitourinary and gastrointestinal toxicity rates were 0% and 3.8%, respectively. Erectile preservation was 25% at 5 years. Overall survival was 88.1% and cause-specific survival was 100%. At 3 years, ASTRO BF-FCRs of the localized and advanced groups were 100% and 42%, respectively (p = 0.001). Conclusions: The HDR brachytherapy of a single implant with two fractions plus EBRT is effective in treating patients with localized hormone-naive prostate cancer, with the least genitourinary and gastrointestinal toxicities; however, longer median BF-FCR follow-up is required to assess these findings.

Sato, Morio [Department of Radiology, Wakayama Medical University, Wakayama (Japan)], E-mail: morisato@mail.wakayama-med.ac.jp; Mori, Takashi [Department of Urology, Wakayama Medical University, Wakayama (Japan); Shirai, Shintaro; Kishi, Kazushi [Department of Radiology, Wakayama Medical University, Wakayama (Japan); Inagaki, Takeshi; Hara, Isao [Department of Urology, Wakayama Medical University, Wakayama (Japan)

2008-11-15

319

Monotherapeutic High-Dose-Rate Brachytherapy for Prostate Cancer: Five-Year Results of an Extreme Hypofractionation Regimen With 54 Gy in Nine Fractions  

SciTech Connect

Purpose: To evaluate an extreme hypofractionation regimen with 54 Gy in nine fractions provided by high-dose-rate (HDR) brachytherapy as monotherapy for prostate cancer by reporting 5-year clinical results. Methods and Materials: Between 1996 and 2005, 112 patients with localized prostate cancer were treated with HDR brachytherapy without external beam radiotherapy. Of the 112 patients, 15 were considered low risk, 29 intermediate risk, and 68 as high risk. The prescribed dose was uniformly 54 Gy in nine fractions within 5 days. Of the 112 patients, 94 also received hormonal therapy. The median follow-up time was 5.4 years. Results: All the patients safely completed the treatment regimen. The 5-year prostate-specific antigen (PSA) failure-free, local control, disease-free survival, and overall survival rate was 83%, 97%, 87%, and 96%, respectively. The 5-year PSA failure-free rate for low-, intermediate-, and high-risk patients was 85% (95% confidence interval, 66-100%), 93% (95% confidence interval, 83-100%), and 79% (95% confidence interval, 69-89%), respectively. The significant prognostic factors for PSA failure were the initial PSA level (p = .029) and younger age (p = .019). The maximal toxicities observed were Grade 3 using the Common Terminology Criteria for Adverse Events, version 3.0, for both acute and late toxicity (6 and 3 patients had acute and late Grade 3 toxicity, respectively). Late Grade 2 toxicity was observed in 13 patients. Conclusion: Monotherapeutic HDR brachytherapy with an extreme hypofractionation regimen of 54 Gy in nine fractions associated with hormonal therapy was feasible, and its toxicity was acceptable. The interim tumor control rate at a median 5.4 years was promising, even for patients with locally advanced disease. This dose-fractionation scheme might be referred to by other terms, such as stereotactic body radiotherapy. Studies with longer follow-up periods and from multiple institutions are needed to confirm the efficacy of this novel approach.

Yoshioka, Yasuo, E-mail: yoshioka@radonc.med.osaka-u.ac.j [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Konishi, Koji; Sumida, Iori; Takahashi, Yutaka; Isohashi, Fumiaki; Ogata, Toshiyuki; Koizumi, Masahiko [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan); Yamazaki, Hideya [Department of Radiology, Kyoto Prefectural University of Medicine, Kyoto (Japan); Nonomura, Norio; Okuyama, Akihiko [Department of Urology, Osaka University Graduate School of Medicine, Osaka (Japan); Inoue, Takehiro [Department of Radiation Oncology, Osaka University Graduate School of Medicine, Osaka (Japan)

2011-06-01

320

Implanting iodine-125 seeds into rat dorsal root ganglion for neuropathic pain: neuronal microdamage without impacting hind limb motion.  

PubMed

The use of iodine-125 ((125)I) in cancer treatment has been shown to relieve patients' pain. Considering dorsal root ganglia are critical for neural transmission between the peripheral and central nervous systems, we assumed that (125)I could be implanted into rat dorsal root ganglia to provide relief for neuropathic pain. (125)I seeds with different radioactivity (0, 14.8, 29.6 MBq) were implanted separately through L4-5 and L5-6 intervertebral foramen into the vicinity of the L5 dorsal root ganglion. von Frey hair results demonstrated the mechanical pain threshold was elevated after implanting (125)I seeds from the high radioactivity group. Transmission electron microscopy revealed that nuclear membrane shrinkage, nucleolar margination, widespread mitochondrial swelling, partial vacuolization, lysosome increase, and partial endoplasmic reticulum dilation were visible at 1,440 hours in the low radioactivity group and at 336 hours in the high radioactivity group. Abundant nuclear membrane shrinkage, partial fuzzy nuclear membrane and endoplasmic reticulum necrosis were observed at 1,440 hours in the high radioactivity group. No significant difference in combined behavioral scores was detected between preoperation and postoperation in the low and high radioactivity groups. These results suggested that the mechanical pain threshold was elevated after implanting (125)I seeds without influencing motor functions of the hind limb, although cell injury was present. PMID:25206783

Jiao, Ling; Zhang, Tengda; Wang, Huixing; Zhang, Wenyi; Fan, Saijun; Huo, Xiaodong; Zheng, Baosen; Ma, Wenting

2014-06-15

321

Multicenter Analysis of Effect of High Biologic Effective Dose on Biochemical Failure and Survival Outcomes in Patients With Gleason Score 7-10 Prostate Cancer Treated With Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To investigate the biochemical control rates and survival for Gleason score 7-10 prostate cancer patients undergoing permanent prostate brachytherapy as a function of the biologic effective dose (BED). Methods and Materials: Six centers provided data on 5,889 permanent prostate brachytherapy patients, of whom 1,078 had Gleason score 7 (n = 845) or Gleason score 8-10 (n = 233) prostate cancer and postimplant dosimetry results available. The median prostate-specific antigen level was 7.5 ng/mL (range, 0.4-300). The median follow-up for censored patients was 46 months (range, 5-130). Short-term hormonal therapy (median duration, 3.9 months) was used in 666 patients (61.8%) and supplemental external beam radiotherapy (EBRT) in 620 (57.5%). The patients were stratified into three BED groups: <200 Gy (n = 645), 200-220 Gy (n = 199), and >220 Gy (n = 234). Biochemical freedom from failure (bFFF) was determined using the Phoenix definition. Results: The 5-year bFFF rate was 80%. The bFFF rate stratified by the three BED groups was 76.4%, 83.5%, and 88.3% (p < 0.001), respectively. Cox regression analysis revealed Gleason score, prostate-specific antigen level, use of hormonal therapy, EBRT, and BED were associated with bFFF (p < 0.001). Freedom from metastasis improved from 92% to 99% with the greatest doses. The overall survival rate at 5 years for the three BED groups for Gleason score 8-10 cancer was 86.6%, 89.4%, and 94.6%, respectively (p = 0.048). Conclusion: These data suggest that permanent prostate brachytherapy combined with EBRT and hormonal therapy yields excellent bFFF and survival results in Gleason score 7-10 patients when the delivered BEDs are >220 Gy. These doses can be achieved by a combination of 45-Gy EBRT with a minimal dose received by 90% of the target volume of 120 Gy of {sup 103}Pd or 130 Gy of {sup 125}I.

Stone, Nelson N. [Mount Sinai School of Medicine, New York, NY (United States)], E-mail: nelsonstone@optonline.net; Potters, Louis [North Shore Long Island Jewish Health System, New Hyde Park, NY (United States); Davis, Brian J. [Mayo Clinic, Rochester, MN (United States); Ciezki, Jay P. [Cleveland Clinic, Cleveland, OH (United States); Zelefsky, Michael J. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Roach, Mack; Shinohara, Katsuto [University of California, San Francisco, San Francisco, CA (United States); Fearn, Paul A. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kattan, Michael W. [Cleveland Clinic, Cleveland, OH (United States); Stock, Richard G. [Mount Sinai School of Medicine, New York, NY (United States)

2009-02-01

322

The effect of needle number on the quality of high-dose-rate prostate brachytherapy implants.  

PubMed

The aim of this study is to evaluate the effect of the number of needles on the quality of dose distributions in high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity and dose to organs at risk. Treatment plans of 174 implants were evaluated using cumulative dose-volume histograms. The plans were divided into three groups according to the number of implanted needles: <15: LNG (low number group), 15-17: MNG (medium number group) and >17: HNG (high number group). Treatment planning was based on transrectal ultrasound imaging. Dose-volume parameters for target (V90, V100, V150, V200, D90, D(min)) and quality indices (DNR, DHI, CI, COIN) were calculated. Maximal dose in reference points and high dose volumes were determined for rectum and urethra. Nonparametric analysis of variance and correlation was used with regard to needle numbers. Between the groups differences were found only in the following parameters: V(p) was larger when more needles were used with the values of 22.8 cm(3), 28.0 cm(3) and 30.9 cm(3) for the three groups, and more needles were used when the central cross-section of the prostate was larger. V200 in MNG was lower than in LNG (12%, 14%). Dose to rectum was higher in MNG than in LNG (D(2): 51%, 47%). Doses to the urethra were higher in HNG than in MNG (D1: 142%, 137%, and D(0.1): 128%, 125%). There was no significant difference in other parameters. Different number of needles results significant differences in treatment plans. However, the optimal needle number depends on not only the size of the prostate, but also the individual anatomy of the patient. Based on our results, in most cases the use of 15-17 needles seems to provide a dosimetrically acceptable treatment plan in HDR prostate implants. PMID:20336408

Fröhlich, Georgina; Agoston, Péter; Lövey, József; Polgár, Csaba; Major, Tibor

2010-12-01

323

Sexual potency following interactive ultrasound-guided brachytherapy for prostate cancer  

Microsoft Academic Search

Purpose: The effect of a therapeutic modality on sexual potency is often an important consideration for patients choosing a treatment for prostate cancer. We prospectively assessed patient's penile erectile function before and following interactive ultrasound-guided transperineal permanent radioactive seed implantation to determine its effect on sexual function.Methods and Materials: Eighty-nine patients underwent permanent radioactive seed implantation from June 1990 to

Richard G. Stock; Nelson N. Stone; Christopher Iannuzzi

1996-01-01

324

Evaluation of Dosimetric Parameters and Disease Response After {sup 125}Iodine Transperineal Brachytherapy for Low- and Intermediate-Risk Prostate Cancer  

SciTech Connect

Purpose: To analyze dosimetric outcomes after permanent brachytherapy for men with low-risk and 'low-tier' intermediate-risk prostate cancer and explore the relationship between the traditional dosimetric values, V100 (volume of prostate receiving 100% of the prescribed dose) and D90 (minimum dose to 90% of the prostate), and risk of biochemical failure. Methods and Materials: A total of 1,006 consecutive patients underwent implantation between July 20, 1998, and Oct 23, 2003. Most (58%) had low-risk disease; the remaining 42% comprised a selected low-tier subgroup of intermediate-risk patients. The prescribed minimum peripheral dose (MPD) was 144 Gy. All implants used 0.33 mCi {sup 125}I sources using a preplan technique featuring right-left symmetry and a strong posterior-peripheral dose bias. Sixty-five percent of patients had 6 months of androgen deprivation therapy. Postimplantation dosimetry was calculated using day-28 CT scans. Results: With a median follow-up of 54 months, the actuarial 5-year rate of freedom from biochemical recurrence (bNED) was 95.6% {+-} 1.6%. Median D90 was 105% of MPD, median V100 was 92%, median V150 was 58%, and median V200 was 9%. Dosimetric values were not predictive of biochemical recurrence on univariate or multivariate analysis. Analysis of dosimetric values by implantation number showed statistically significant increases in all values with time (D90, V100, V150, and V200; p < 0.001), but this did not translate into improved bNED. Conclusions: In contrast to some previous studies, dosimetric outcomes did not correlate with biochemical recurrence in the first 1,006 patients treated with {sup 125}I prostate brachytherapy at the British Columbia Cancer Agency. Despite a median D90 of only 105% of MPD, our bNED rates are indistinguishable from series that reported higher D90 values.

Morris, W. James [Vancouver Cancer Centre, Vancouver (Canada)], E-mail: jmorris@bccancer.bc.ca; Keyes, Mira M.D.; Palma, David M.D.; McKenzie, Michael; Spadinger, Ingrid [Vancouver Cancer Centre, Vancouver (Canada); Agranovich, Alex [Fraser Valley Cancer Centre, Surrey (Canada); Pickles, Tom [Vancouver Cancer Centre, Vancouver (Canada); Liu, Mitchell; Kwan, Winkle [Fraser Valley Cancer Centre, Surrey (Canada); Wu, Jonn; Lapointe, Vince [Vancouver Cancer Centre, Vancouver (Canada); Berthelet, Eric; Pai, Howard [Vancouver Island Cancer Centre, Victoria (Canada); Harrison, Robert; Kwa, William [Vancouver Cancer Centre, Vancouver (Canada); Bucci, Joe [Saint George's Hospital, Sydney, NSW (Australia); Racz, Violet [Vancouver Cancer Centre, Vancouver (Canada); Woods, Ryan [Population and Preventive Oncology, Vancouver (Canada)

2009-04-01

325

CT, MR, and ultrasound image artifacts from prostate brachytherapy seed implants: The impact of seed size  

SciTech Connect

Purpose: To investigate the effects of brachytherapy seed size on the quality of x-ray computed tomography (CT), ultrasound (US), and magnetic resonance (MR) images and seed localization through comparison of the 6711 and 9011 {sup 125}I sources. Methods: For CT images, an acrylic phantom mimicking a clinical implantation plan and embedded with low contrast regions of interest (ROIs) was designed for both the 0.774 mm diameter 6711 (standard) and the 0.508 mm diameter 9011 (thin) seed models (Oncura, Inc., and GE Healthcare, Arlington Heights, IL). Image quality metrics were assessed using the standard deviation of ROIs between the seeds and the contrast to noise ratio (CNR) within the low contrast ROIs. For US images, water phantoms with both single and multiseed arrangements were constructed for both seed sizes. For MR images, both seeds were implanted into a porcine gel and imaged with pelvic imaging protocols. The standard deviation of ROIs and CNR values were used as metrics of artifact quantification. Seed localization within the CT images was assessed using the automated seed finder in a commercial brachytherapy treatment planning system. The number of erroneous seed placements and the average and maximum error in seed placements were recorded as metrics of the localization accuracy. Results: With the thin seeds, CT image noise was reduced from 48.5 {+-} 0.2 to 32.0 {+-} 0.2 HU and CNR improved by a median value of 74% when compared with the standard seeds. Ultrasound image noise was measured at 50.3 {+-} 17.1 dB for the thin seed images and 50.0 {+-} 19.8 dB for the standard seed images, and artifacts directly behind the seeds were smaller and less prominent with the thin seed model. For MR images, CNR of the standard seeds reduced on average 17% when using the thin seeds for all different imaging sequences and seed orientations, but these differences are not appreciable. Automated seed localization required an average ({+-}SD) of 7.0 {+-} 3.5 manual corrections in seed positions for the thin seed scans and 3.0 {+-} 1.2 manual corrections in seed positions for the standard seed scans. The average error in seed placement was 1.2 mm for both seed types and the maximum error in seed placement was 2.1 mm for the thin seed scans and 1.8 mm for the standard seed scans. Conclusions: The 9011 thin seeds yielded significantly improved image quality for CT and US images but no significant differences in MR image quality.

Robertson, Andrew K. H.; Basran, Parminder S.; Thomas, Steven D.; Wells, Derek [Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia V8W 3P6 (Canada); Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia V8W 3P6 (Canada) and Department of Medical Physics, British Columbia Cancer Agency-Vancouver Island Cancer Centre, Victoria, British Columbia V8R 6V5 (Canada); Department of Medical Physics, British Columbia Cancer Agency-Fraser Valley Cancer Centre, Victoria, British Columbia V3V 1Z2 (Canada); Department of Physics and Astronomy, University of Victoria, Victoria, British Columbia V8W 3P6 (Canada) and Department of Medical Physics, British Columbia Cancer Agency-Vancouver Island Cancer Centre, Victoria, British Columbia V8R 6V5 (Canada)

2012-04-15

326

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

327

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. PMID:24885327

2014-01-01

328

Brachytherapy 3 (2004) 147152 Comparison of inverse planning simulated annealing and geometrical  

E-print Network

optimization for prostate high-dose-rate brachytherapy I-Chow J. Hsu1,*, Etienne Lessard1 , Vivian Weinberg2. In this study, IPSA is compared with geometrical optimization (GO) for prostate brachytherapy. METHODS: Optimization; Inverse planning; Simulated annealing; Geometric optimization; HDR prostate brachytherapy

Pouliot, Jean

329

High dose rate brachytherapy boost for prostate cancer: a systematic review.  

PubMed

Studies of dose-escalated external beam radiation therapy (EBRT) and low dose rate brachytherapy (LDR-BT) have shown excellent rates of tumor control and cancer specific survival. Moreover, LDR-BT combined with EBRT (i.e. "LDR-BT boost") is hypothesized to improve local control. While phase II trials with LDR-BT boost have produced mature data of outcomes and toxicities, high dose rate (HDR)-BT has been growing in popularity as an alternative boost therapy. Boost from HDR-BT has theoretical advantages over LDR-BT, including improved cancer cell death and better dose distribution from customization of catheter dwell times, locations, and inverse dose optimization. Freedom from biochemical failure rates at five years for low-, intermediate-, high-risk, and locally advanced patients have generally been 85-100%, 80-98%, 59-96%, and 34-85%, respectively. Late Radiation Therapy Oncology Group grade 3-4 toxicities have also been encouraging with <6% of patients experiencing any toxicity. Limitations of current HDR-BT boost studies include reports of only single-institution experiences, and unrefined reports of toxicity or patient quality of life. Comparative effectiveness research will help guide clinicians in selecting the most appropriate treatment option for individual patients based on risk-stratification, expected outcomes, toxicities, quality of life, and cost. PMID:24231548

Zaorsky, Nicholas G; Doyle, Laura A; Yamoah, Kosj; Andrel, Jocelyn A; Trabulsi, Edouard J; Hurwitz, Mark D; Dicker, Adam P; Den, Robert B

2014-04-01