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1

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

SciTech Connect

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

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

2010-06-01

2

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

3

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

4

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.

2012-01-01

5

Iodine 125 interstitial irradiation for localized prostate cancer.  

PubMed

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. PMID:2319613

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

1990-03-01

6

Pulmonary embolization of iodine-125 seeds following prostate implantation  

Microsoft Academic Search

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

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

1991-01-01

7

Radioactive iodine-125 implantation for cancer of the prostate  

SciTech Connect

Localized cancer of the prostate can be treated by radical prostatectomy, external beam irradiation, or radioactive implantation with similar survival results. Radical prostatectomy, however, almost universally results in impotency, although a new, nerve-sparing procedure may preserve potency in B1 patients. External beam irradiation radiates a large volume of tissue with significant rectal and bladder morbidity, 23-47% risk of impotency, and requires prolonged treatment (6-8 weeks). Radioactive implantation may be done suprapubically or transperineally using iodine-125, gold-198, or radon-222 permanent implantation techniques and iridium-192 or radium-226 removable implantation techniques. Interstitial iodine-125 implantation is frequently employed since it is a short procedure and limits the morbidity to a 7% incidence of impotency, 20% urinary complications, and 5% rectal complications. The overall 5-year survival of patients with iodine-125 is 79%, the survival rate decreasing with increasing T or N stage or increasing grade of tumor.

Nag, S.

1985-01-01

8

Iodine-125 implants for carcinoma of the prostate  

SciTech Connect

One hundred-thirteen patients underwent Iodine-125 prostate implant and lymphadenectomy at Yale-New Haven Hospital from 1974 through 1980. The distribution by clinical stage was: 7 Stage A2, 86 Stage B, and 20 Stage C patients. Ninety-four patients had a negative lymphadenectomy and 19 patients (17%) had metastatic disease in the pelvic lymph nodes (N+). The actuarial 5-year survival for all 113 patients was 87%. Local tumor control was 85% for all Stage B patients and 75% for all Stage C patients. Only 10 patients (9%) have developed long-term gastrointestinal or genitourinary complications following their implant. Iodine-125 implant appears to be a reasonable alternate form of therapy in highly selected groups of patients with carcinoma of the prostate.

Peschel, R.E.; Fogel, T.D.; Kacinski, B.M.; Kelly, K.; Mate, T.P.

1985-10-01

9

Iodine-125 implants for carcinoma of the prostate.  

PubMed

One hundred-thirteen patients underwent Iodine-125 prostate implant and lymphadenectomy at Yale-New Haven Hospital from 1974 through 1980. The distribution by clinical stage was: 7 Stage A2, 86 Stage B, and 20 Stage C patients. Ninety-four patients had a negative lymphadenectomy (N-) and 19 patients (17%) had metastatic disease in the pelvic lymph nodes (N+). The actuarial 5-year survival for all 113 patients was 87% (+/- 6%: 95% confidence limits). Sixty-five percent of our 113 patients are disease free (NED) from 2 to 9 years following implant. Sixty-seven (N-) patients with clinical Stage B disease, whose tumors were either well differentiated or moderately well differentiated, have an actuarial 5-year NED survival of 84% (+/- 8%). Twenty (N-) patients with either clinical Stage C disease or poorly differentiated tumors have an actuarial 5-year NED survival of only 31% (+/- 20%). For the 19 (N+) patients, the actuarial 5-year NED survival is 38% (+/- 22%). Local tumor control was 85% for all Stage B patients and 75% for all Stage C patients. Only 10 patients (9%) have developed long-term gastrointestinal or genitourinary complications following their implant. Iodine-125 implant appears to be a reasonable alternate form of therapy in highly selected groups of patients with carcinoma of the prostate. PMID:4044340

Peschel, R E; Fogel, T D; Kacinski, B M; Kelly, K; Mate, T P

1985-10-01

10

Time-dose-volume considerations in iodine-125 interstitial brachytherapy  

SciTech Connect

Eighty-nine implants with iodine-125 (I-125) seeds in the lymph nodes and other superficial lesions in the head and neck areas were reviewed in order to determine the time-dose-volume relationship. The period required for complete tumor regression, as determined by clinical palpation, was approximately three months after implantation and was independent of matched peripheral dose (MPD) or tumor volume. The actual dose to the tumors was increased by a factor of approximately 1.8 to 2 when tumor regression effects were considered. The reactions of the skin overlying the implants of I-125 are discussed.

Tokita, N.; Kim, J.H.; Hilaris, B.S.

1980-12-01

11

Prostate biopsy after definitive treatment by interstitial iodine 125 implant or external beam radiation therapy  

Microsoft Academic Search

The response to definitive radiation therapy of localized carcinoma of the prostate by iodine 125 implantation or external beam radiotherapy was monitored by examining specimens from biopsies performed after treatment. We analyzed 126 biopsy specimens obtained 18 months or more after treatment: 71 were obtained from 109 patients treated by iodine 125 and 55 from 197 patients treated by external

P. F. Schellhammer; A. M. el-Mahdi; E. M. Higgins; T. E. Schultheiss; L. E. Ladaga; T. J. Babb

1987-01-01

12

Iodine125 Orbital Brachytherapy with a Prosthetic Implant In Situ  

Microsoft Academic Search

\\u000a Abstract\\u000a \\u000a \\u000a Purpose:\\u000a Brachytherapy is one method of irradiating the orbit after enucleation of an eye with a malignant tumor that has a potential\\u000a to recur. It consists of 6 trains of I-125 seeds placed around the periphery of the orbit, a shorter central train, and a\\u000a metal disc, loaded with seeds, placed beneath the eyelids. The presence of a

Clare Stannard; Gert Maree; Roger Munro; Karin Lecuona; Wolfgang Sauerwein

2011-01-01

13

Analysis of iodine-125 interstitial therapy in the treatment of localized carcinoma of the prostate  

SciTech Connect

Definitive treatment of localized carcinoma of the prostate has included radical surgery, external beam radiation therapy, and interstitial radiation therapy. The interstitial agent most commonly used is Iodine-125. Forty-eight patients were treated with interstitial radiation therapy using Iodine-125 implants with a median follow-up of 55 months. Forty-three percent of the evaluable patients had progressive disease with approximately 50% progressing at 5 years by Kaplan-Meier analysis. Overall actuarial survival in the group was 80% at 5 years. This and several other studies suggest that control of prostate cancer with Iodine-125 seeds may be suboptimal as compared with other treatment modalities, especially the radical retropubic prostatectomy. Analysis of treatment parameters is presented along with a discussion of the current status and future prospects for treatment of localized carcinoma of the prostate with interstitial radiation therapy.

Gomella, L.G.; Steinberg, S.M.; Ellison, M.F.; Reeves, W.W.; Flanigan, R.C.; McRoberts, J.W. (Univ. of Kentucky Medical Center, Lexington (USA))

1991-04-01

14

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

15

Permanent iodine 125 brachytherapy in patients with progressive or recurrent glioblastoma multiforme  

PubMed Central

This study reports the initial experience at the University of California San Francisco (UCSF) with tumor resection and permanent, low-activity iodine 125 (125I) brachytherapy in patients with progressive or recurrent glioblastoma multiforme (GM) and compares these results to those of similar patients treated previously at UCSF with temporary brachytherapy without tumor resection. Thirty-eight patients with progressive or recurrent GM were treated at UCSF with repeat craniotomy, tumor resection, and permanent, low-activity 125I brachytherapy between June 1997 and May 1998. Selection criteria were Karnofsky performance score ?60, unifocal, contrast-enhancing, well-circumscribed progressive or recurrent GM that was judged to be completely resectable, and no evidence of leptomeningeal or subependymal spread. The median brachytherapy dose 5 mm exterior to the resection cavity was 300 Gy (range, 150500 Gy). One patient was excluded from analysis. Median survival was 52 weeks from the date of brachytherapy. Age, Karnofsky performance score, and preimplant tumor volume were all statistically significant on univariate analyses. Multivariate analysis for survival showed only age to be significant. Median time to progression was 16 weeks. Both univariate and multivariate analysis of freedom from progression showed only preoperative tumor volume to be significant. Comparison to temporary brachytherapy patients showed no apparent difference in survival time. Chronic steroid requirements were low in patients with minimal postoperative residual tumor. We conclude that permanent 125I brachytherapy for recurrent or progressive GM is well tolerated. Survival time was comparable to that of a similar group of patients treated with temporary brachytherapy.

Larson, David A.; Suplica, Jeffrey M.; Chang, Susan M.; Lamborn, Kathleen R.; McDermott, Michael W.; Sneed, Penny K.; Prados, Michael D.; Wara, William M.; Nicholas, M. Kelly; Berger, Mitchel S.

2004-01-01

16

Comparison of Radical Prostatectomy and Iodine 125 Interstitial Radiotherapy for the Treatment of Clinically Localized Prostate Cancer: A 7Year Biochemical (PSA) Progression Analysis  

Microsoft Academic Search

Objectives. To evaluate the relative efficacy of brachytherapy to radical prostatectomy, we compared biochemical progression rates from a published series of men who underwent iodine 125 (125I) interstitial radiotherapy for localized prostate cancer to a similar group of men who underwent anatomic radical prostatectomy using appropriate end points.Methods. Seventy-six men who underwent anatomic radical prostatectomy between 1988 and 1990 were

Thomas J Polascik; Charles R Pound; Theodore L DeWeese; Patrick C Walsh

1998-01-01

17

Long-term follow-up of patients of intrahepatic malignancies treated with Iodine-125 brachytherapy  

SciTech Connect

Purpose: We investigated the role of intraoperative iodine-125 ({sup 125}I) brachytherapy as a treatment option for unresectable primary and metastatic liver tumors. Methods and Materials: Between 1989 and 2002, 64 patients with unresectable or residual disease after surgical resection for intrahepatic malignancies underwent 160-Gy permanent {sup 125}I brachytherapy. Results: The median length of follow-up was 13.2 years. The overall 1-year, 3-year, and 5-year actuarial intrahepatic local control rates were 44%, 22%, and 22%, respectively, with a median time to liver recurrence of 9 months (95% CI, 6-12 months). The 5-year actuarial intrahepatic control was higher for patients with solitary metastasis (38%) than for those with multiple metastases (6%, p = 0.04). The 1-year, 3-year, and 5-year actuarial overall survival rates were 73%, 23%, and 5%, respectively (median, 20 months; 95% CI, 16-24; longest survival, 7.5 years). Overall survival was higher for patients with smaller-volume implants (p = 0.003) and for patients without prior liver resection (p = 0.002). No mortality occurred. Radiation-related complications were minimal. Conclusions: For select patients with unresectable primary and metastatic liver tumors for whom curative surgical resection is not an option, {sup 125}I brachytherapy is a safe and effective alternative to other locally ablative techniques and can provide long-term local control and increased survival.

Nag, Subir [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States)]. E-mail: nag.1@osu.edu; DeHaan, Megan [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Scruggs, Granger [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Mayr, Nina [Department of Radiation Medicine, Ohio State University, Columbus, OH (United States); Martin, Edward W. [Division of Surgical Oncology, Ohio State University, Columbus, OH (United States)

2006-03-01

18

Brachytherapy of recurrent malignant brain tumors with removable high-activity iodine-125 sources  

SciTech Connect

Thirty-seven patients harboring recurrent malignant primary or metastatic brain tumors were treated by 40 implantations of high-activity iodine-125 (/sup 125/I) sources. All patients had been treated with irradiation and most had been treated with chemotherapeutic agents, primarily nitrosoureas. Implantations were performed using computerized tomography (CT)-directed stereotaxy; /sup 125/I sources were held in one or more afterloaded catheters that were removed after the desired dose (minimum tumor dose of 3000 to 12,000 rads) had been delivered. Patients were followed with sequential neurological examinations and CT scans. Results of 34 implantation procedures were evaluable: 18 produced documented tumor regression (response) for 4 to 13+ months; five, performed in deteriorating patients, resulted in disease stability for 4 to 12 months. The overall response rate was 68%. In 11 patients, implantation did not halt clinical deterioration. At exploratory craniotomy 5 to 12 months after implantation, focal radiation necrosis was documented in two patients whose tumor had responded initially and then progressed, and in three patients whose disease had progressed initially (four glioblastomas, one anaplastic astrocytoma); histologically identifiable tumor was documented in two of these patients. All improved after resection of the focal necrotic mass and are still alive 10, 15, 19, 24, and 25 months after the initial implantation procedure; only one patient has evidence of tumor regrowth. The median follow-up period after implantation for the malignant glioma (anaplastic astrocytoma and glioblastoma multiforme) group is 9 months, with 48% of patients still surviving. While direct comparison with the results of chemotherapy is difficult, results obtained in this patient group with interstitial brachytherapy are probably superior to results obtained with chemotherapy.

Gutin, P.H.; Phillips, T.L.; Wara, W.M.; Leibel, S.A.; Hosobuchi, Y.; Levin, V.A.; Weaver, K.A.; Lamb, S.

1984-01-01

19

IODINE125  

Microsoft Academic Search

There may be some advantage in substituting iodine-125 for iodine-131 in ; a number of clinical and experimental situations. Among these advantages are: ; the long half life of iodine-125 (60 days), which results in a greatly increased ; shelf-life of tagged compounds; the low energy (27 kev) of its photon radiations, ; which reduces shielding requirements and permits more

P. V. Harper; W. D. Siemens; K. A. Lathrop; H. E. Brizel; R. W. Harrison

1961-01-01

20

Intra-operative Iodine-125 prostatic implant following bilateral pelvic lymphadenectomy  

SciTech Connect

Sixty-five patients with prostatic adenocarcinoma Stages B and C were treated with intraoperative Iodine-125 prostatic implantation following bilateral pelvic lymphadenectomy. Pelvic nodal metastases were found in 31% of the patients. All the patients have been followed for a period of 1 1/2 to 6 years. Serial digital rectal examination revealed complete regression of the palpable disease in 15% of the patients at 6 months, 47% at 1 year, and 87% at 2 years. Post-operative complications were also evaluated: 13% of the patients became sexually impotent, 11% had impaired potency after the procedure, and 26% of patients complained of dry ejaculation; and 17% developed scrotal and/or penile swelling, which persisted up to 14 months, but usually subsided within 5 months. Two patients developed local recurrence.

Kwong, E.W.H.; Huh, S.H.; Nobler, M.P.; Smith, H.S.

1984-05-01

21

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

Microsoft Academic Search

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

Juanita Crook; Jette Borg; Andrew Evans; Ants Toi; E. P. Saibishkumar; Sharon Fung; Clement Ma

2011-01-01

22

Stereotactic iodine-125 brachytherapy for brain tumors: temporary versus permanent implantation  

PubMed Central

Stereotactic brachytherapy (SBT) has been described in several publications as an effective, minimal invasive and safe highly focal treatment option in selected patients with well circumscribed brain tumors <4?cm. However, a still ongoing discussion about indications and technique is hindering the definition of a clear legitimation of SBT in modern brain tumor treatment. These controversies encompass the question of how intense the irradiation should be delivered into the target volume (dose rate). For instance, reports about the use of high does rate (HDR) implantation schemes ( >40?cGy/h) in combination with adjuvant external beam radiation and/or chemotherapy for the treatment of malignant gliomas and metastases resulted in increased rates of radiation induced adverse tissue changes requiring surgical intervention. Vice versa, such effects have been only minimally observed in numerous studies applying low dose rate (LDR) regiments (38?cGy/h) for low grade gliomas, metastases and other rare indications. Besides these observations, there are, however, no data available directly comparing the long term incidences of tissue changes after HDR and LDR and there is, furthermore, no evidence regarding a difference between temporary or permanent LDR implantation schemes. Thus, recommendations for effective and safe implantation schemes have to be investigated and compared in future studies.

2012-01-01

23

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

24

Localized prostate cancer: brachytherapy  

Microsoft Academic Search

Opinion statementBrachytherapy 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

25

[High dose rate prostate brachytherapy].  

PubMed

This article aims at presenting the interest of high dose rate brachytherapy in the radiation treatment of prostatic adenocarcinoma. We will discuss successively the biological and dosimetric specificity of brachytherapy for this particular cancer. Afterwards, we will review the main phase II and III studies, the therapeutic indications in the daily practice from the evidence based medicine as well as the techniques of external beam radiation therapy for the same indications. Finally, the principal avenues of development will be discussed. PMID:23578898

Nickers, P; Blanchard, P; Hannoun-Lvi, J-M; Bossi, A; Chapet, O; Gurif, S

2013-04-08

26

Prostate cancer brachytherapy: guidelines overview  

PubMed Central

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

Bialas, Brygida

2012-01-01

27

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

28

Brachytherapy for advanced prostate cancer bleeding.  

PubMed

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 score of 78 years and 9, respectively. Following brachytherapy, haematuria resolved in 19 of the 23 patients and was recurrence free at 6 months. Intraurethral HDR brachytherapy is a potentially effective modality for treating haematuria in patients with advanced prostate cancer. PMID:18391938

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

2008-03-04

29

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

30

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

31

Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy  

Microsoft Academic Search

Purpose: To characterize the severity and time course of rectal toxicity following transperineal prostate brachytherapy using prospectively recorded data, and to determine factors associated with toxicity.Methods and Materials: One hundred thirty-four patients with prostate cancer treated with transperineal brachytherapy from 1997 to 1999 had rectal toxicity data available for analysis. Patients with Gleason score (GS) > 6, prostate-specific antigen (PSA)

Song K Kang; Rachel H Chou; Richard K Dodge; Robert W Clough; Hi-Sung L Kang; Carol A Hahn; Arthur W Whitehurst; Niall J Buckley; Jay H Kim; Raymond E Joyner; Gustavo S Montana; Sally S Ingram; Mitchell S Anscher

2002-01-01

32

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

33

The american brachytherapy society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis  

Microsoft Academic Search

Purpose: The purpose of this report is to establish guidelines for postimplant dosimetric analysis of permanent prostate brachytherapy.Methods: Members of the American Brachytherapy Society (ABS) with expertise in prostate dosimetry evaluation performed a literature review and supplemented with their clinical experience formulated guidelines for performing and analyzing postimplant dosimetry of permanent prostate brachytherapy.Results: The ABS recommends that postimplant dosimetry should

Subir Nag; William Bice; Keith DeWyngaert; Bradley Prestidge; Richard Stock; Yan Yu

2000-01-01

34

LEAKAGE TEST EVALUATION USED FOR QUALIFICATION OF IODINE125 SEEDS SEALING  

Microsoft Academic Search

The prostate cancer is a problem of public health i n Brazil, and the second cause of cancer deaths in men, exceeded only by lung cancer. Among the possible tr eatments available for prostate cancer is brachythe rapy, in which small seeds containing Iodine-125 radioisotop e are implanted in the prostate. The seed consists of a sealed titanium tube measuring

Anselmo Feher; Maria E. C. M. Rostelato; Carlos A. Zeituni; Wilson A. P. Calvo; Samir L. Somessari; Joo A. Moura; Eduardo S. Moura; Carla D. Souza; Paulo R. Rela

35

Potency after permanent prostate brachytherapy for localized prostate cancer  

Microsoft Academic Search

Purpose: The evaluation of potency preservation after treatment of localized prostate cancer with transperineal permanent prostate brachytherapy (PPB) and the efficacy of sildenafil were studied.Methods and Materials: This study comprised 482 patients who were able to maintain an erection suitable for intercourse before treatment from a cohort of 1166 patients with clinically localized prostate cancer treated with PPB. All patients

Louis Potters; Taryn Torre; Paul A Fearn; Steven A Leibel; Michael W Kattan

2001-01-01

36

Brachytherapy for Prostate Cancer: A Systematic Review  

PubMed Central

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

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

2009-01-01

37

Seed-less iodine-125 ophthalmic applicator.  

PubMed

A method of preparation a seed-less active insert of iodine-125 ophthalmic applicator is described. Internal electrolysis was applied for fixing iodine-125 on the concave surface of the silver shell which is afterwards hermetically sealed inside a spherically shaped acrylic insert. The current-voltage characteristics of the galvanic cell used for deposition of silver iodide were determined. The results of the measurements of the energy spectra of the radiation emitted by a seed-less and seed-containing applicator are presented. The iodine-125 surface distribution uniformity on a silver shell was measured. The depth dose rate measurements indicate that the total activity incorporated in a seed-less applicator can be lower than that in seed-containing, while simultaneously assuring the desired dose rate. PMID:12485658

Puchalska, Izabela; Mielcarski, Mieczyslaw

2003-01-01

38

Photoacoustic imaging of prostate brachytherapy seeds in ex vivo prostate  

NASA Astrophysics Data System (ADS)

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

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

2011-03-01

39

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

40

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

41

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

SciTech Connect

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

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

2005-11-01

42

Isotope selection for patients undergoing prostate brachytherapy  

Microsoft Academic Search

Purpose: Ultrasound-guided transperineal interstitial permanent prostate brachytherapy (TIPPB) is generally performed with either 103Pd or 125I. The use of 125I for low Gleason score tumors and 103Pd for higher Gleason scores has been suggested based on isotope dose rate and cell doubling time observed in in vitro studies. While many centers follow these isotope selection criteria, other centers have elected

Christine M Cha; Louis Potters; Richard Ashley; Katherine Freeman; Xiao-Hong Wang; Robert Waldbaum; Steven Leibel

1999-01-01

43

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

44

Examination of dosimetry accuracy as a function of seed detection rate in permanent prostate brachytherapy  

SciTech Connect

The variation of permanent prostate brachytherapy dosimetry as a function of seed detection rates was investigated for I125 implants with seed activities commonly employed in contemporary practice. Post-implant imaging and radiation dosimetry data from nine patients who underwent PPB served as the basis of this simulation study. One-thousand random configurations of detected seeds were generated for each patient dataset using various seed detection levels from 30% to 99%. Dose parameters, including D90, were computed for each configuration and compared with the actual dosimetry data. A total of 108 000 complete sets of post-PPB dose volume statistics were computed. The results demonstrated that although the average D90 differed from the true value by less than 5% when 70% or more seeds were identified, the D90 of an individual case could deviate up to 13%. The 95% confidence interval (CI) of estimated D90 values differ by less than 5% from the actual value when 95% or more seeds are detected, or approximately a 7 Gy difference in the D90 value for a prescription dose of 144 Gy. Estimated target volume dose parameters tended to decrease with reduced seed detection rates. The most variable dose parameter was the prostate V100 in absolute scale while the urethral V100 was most variable in a relative sense. Based on this comprehensive simulation study, it is suggested that 95% or more seeds need to be localized in order to provide an accurate estimation of dose parameters for contemporary iodine 125 permanent prostate brachytherapy.

Su Yi; Davis, Brian J.; Herman, Michael G.; Manduca, Armando; Robb, Richard A. [Biomedical Imaging Resource, Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Division of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Biomathematics Resource, Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Biomedical Imaging Resource, Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States)

2005-09-15

45

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

46

Erectile Function Durability Following Permanent Prostate Brachytherapy  

SciTech Connect

Purpose: To evaluate long-term changes in erectile function following prostate brachytherapy. Methods and Materials: This study included 226 patients with prostate cancer and preimplant erectile function assessed by the International Index of Erectile Function-6 (IIEF-6) who underwent brachytherapy in two prospective randomized trials between February 2001 and January 2003. Median follow-up was 6.4 years. Pre- and postbrachytherapy potency was defined as IIEF-6 >= 13 without pharmacologic or mechanical support. The relationship among clinical, treatment, and dosimetric parameters and erectile function was examined. Results: The 7-year actuarial rate of potency preservation was 55.6% with median postimplant IIEF of 22 in potent patients. Potent patients were statistically younger (p = 0.014), had a higher preimplant IIEF (p < 0.001), were less likely to be diabetic (p = 0.002), and were more likely to report nocturnal erections (p = 0.008). Potency preservation in men with baseline IIEF scores of 29-30, 24-28, 18-23, and 13-17 were 75.5% vs. 73.6%, 51.7% vs. 44.8%, 48.0% vs. 40.0%, and 23.5% vs. 23.5% in 2004 vs. 2008. In multivariate Cox regression analysis, preimplant IIEF, hypertension, diabetes, prostate size, and brachytherapy dose to proximal penis strongly predicted for potency preservation. Impact of proximal penile dose was most pronounced for men with IIEF of 18-23 and aged 60-69. A significant minority of men who developed postimplant impotence ultimately regained erectile function. Conclusion: Potency preservation and median IIEF scores following brachytherapy are durable. Thoughtful dose sparing of proximal penile structures and early penile rehabilitation may further improve these results.

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, 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); Wallner, Kent E. [Puget Sound Healthcare Corporation, Group Health Cooperative, University of Washington, Seattle, WA (United States); Kurko, Brian S.; Anderson, Richard; Lief, Jonathan H. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States)

2009-11-01

47

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

48

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

49

Predictors of Metastatic Disease After Prostate Brachytherapy  

SciTech Connect

Purpose: To identify predictors of metastatic disease after brachytherapy treatment for prostate cancer. Methods and Materials: All patients who received either brachytherapy alone (implant) or brachytherapy in combination with external beam radiation therapy for treatment of localized prostate cancer at The Mount Sinai Hospital between June 1990 and March 2007 with a minimum follow-up of 2 years were included. Univariate and multivariable analyses were performed on the following variables: risk group, Gleason score (GS), clinical T stage, pretreatment prostate-specific antigen level, post-treatment prostate-specific antigen doubling time (PSA-DT), treatment type (implant vs. implant plus external beam radiation therapy), treatment era, total biological effective dose, use of androgen deprivation therapy, age at diagnosis, and race. PSA-DT was analyzed in the following ordinate groups: 0 to 90 days, 91 to 180 days, 180 to 360 days, and greater than 360 days. Results: We included 1,887 patients in this study. Metastases developed in 47 of these patients. The 10-year freedom from distant metastasis (FFDM) rate for the entire population was 95.1%. Median follow-up was 6 years (range, 2-15 years). The only two significant predictors of metastatic disease by multivariable analyses were GS and PSA-DT (p < 0.001 for both variables). Estimated 10-year FFDM rates for GS of 6 or less, GS of 7, and GS of 8 or greater were 97.9%, 94.3%, and 76.1%, respectively (p < 0.001). Estimated FFDM rates for PSA-DT of 0 to 90 days, 91 to 180 days, 181 to 360 days, and greater than 360 days were 17.5%, 67.9%, 74%, and 94.8%, respectively (p < 0.001). Estimated 10-year FFDM rates for the low-, intermediate-, and high-risk groups were 98.6%, 96.2%, and 86.7%, respectively. A demographic shift to patients presenting with higher-grade disease in more recent years was observed. Conclusions: GS and post-treatment PSA-DT are both statistically significant independent predictors of metastatic disease. Patients with a high GS and/or short PSA-DT have a higher likelihood of developing metastatic disease and should be considered for systemic therapy.

Forsythe, Kevin [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan [Department of Radiation Oncology, New York-Presbyterian Hospital, New York, NY (United States); Stone, Nelson [Department of Urology, Mount Sinai School of Medicine, New York, NY (United States); Stock, Richard G., E-mail: richard.stock@moutsinai.org [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)

2012-06-01

50

Photoacoustic imaging of prostate brachytherapy seeds  

PubMed Central

Brachytherapy seed therapy is an increasingly common way to treat prostate cancer through localized radiation. The current standard of care relies on transrectal ultrasound (TRUS) for imaging guidance during the seed placement procedure. As visualization of individual metallic seeds tends to be difficult or inaccurate under TRUS guidance, guide needles are generally tracked to infer seed placement. In an effort to improve seed visualization and placement accuracy, the use of photoacoustic (PA) imaging, which is highly sensitive to metallic objects in soft tissue, was investigated for this clinical application. The PA imaging properties of bare (i.e., embedded in pure gelatin) and tissue-embedded (at depths of up to 13 mm) seeds were investigated with a multi-wavelength (750 to 1090 nm) PA imaging technique. Results indicate that, much like ultrasonic (US) imaging, an angular dependence (i.e., seed orientation relative to imaging transducer) of the PA signal exists. Despite this shortcoming, however, PA imaging offers improved contrast, over US imaging, of a seed in prostate tissue if sufficient local fluence is achieved. Additionally, although the PA signal of a bare seed is greatest for lower laser wavelengths (e.g., 750 nm), the scattering that results from tissue tends to favor the use of higher wavelengths (e.g., 1064 nm, which is the primary wavelength of Nd:YAG lasers) when the seed is located in tissue. A combined PA and US imaging approach (i.e., PAUS imaging) shows strong potential to visualize both the seed and the surrounding anatomical environment of the prostate during brachytherapy seed placement procedures.

Su, Jimmy L.; Bouchard, Richard R.; Karpiouk, Andrei B.; Hazle, John D.; Emelianov, Stanislav Y.

2011-01-01

51

Harmony search optimization for HDR prostate brachytherapy  

NASA Astrophysics Data System (ADS)

In high dose-rate (HDR) prostate brachytherapy, multiple catheters are inserted interstitially into the target volume. The process of treating the prostate involves calculating and determining the best dose distribution to the target and organs-at-risk by means of optimizing the time that the radioactive source dwells at specified positions within the catheters. It is the goal of this work to investigate the use of a new optimization algorithm, known as Harmony Search, in order to optimize dwell times for HDR prostate brachytherapy. The new algorithm was tested on 9 different patients and also compared with the genetic algorithm. Simulations were performed to determine the optimal value of the Harmony Search parameters. Finally, multithreading of the simulation was examined to determine potential benefits. First, a simulation environment was created using the Python programming language and the wxPython graphical interface toolkit, which was necessary to run repeated optimizations. DICOM RT data from Varian BrachyVision was parsed and used to obtain patient anatomy and HDR catheter information. Once the structures were indexed, the volume of each structure was determined and compared to the original volume calculated in BrachyVision for validation. Dose was calculated using the AAPM TG-43 point source model of the GammaMed 192Ir HDR source and was validated against Varian BrachyVision. A DVH-based objective function was created and used for the optimization simulation. Harmony Search and the genetic algorithm were implemented as optimization algorithms for the simulation and were compared against each other. The optimal values for Harmony Search parameters (Harmony Memory Size [HMS], Harmony Memory Considering Rate [HMCR], and Pitch Adjusting Rate [PAR]) were also determined. Lastly, the simulation was modified to use multiple threads of execution in order to achieve faster computational times. Experimental results show that the volume calculation that was implemented in this thesis was within 2% of the values computed by Varian BrachyVision for the prostate, within 3% for the rectum and bladder and 6% for the urethra. The calculation of dose compared to BrachyVision was determined to be different by only 0.38%. Isodose curves were also generated and were found to be similar to BrachyVision. The comparison between Harmony Search and genetic algorithm showed that Harmony Search was over 4 times faster when compared over multiple data sets. The optimal Harmony Memory Size was found to be 5 or lower; the Harmony Memory Considering Rate was determined to be 0.95, and the Pitch Adjusting Rate was found to be 0.9. Ultimately, the effect of multithreading showed that as intensive computations such as optimization and dose calculation are involved, the threads of execution scale with the number of processors, achieving a speed increase proportional to the number of processor cores. In conclusion, this work showed that Harmony Search is a viable alternative to existing algorithms for use in HDR prostate brachytherapy optimization. Coupled with the optimal parameters for the algorithm and a multithreaded simulation, this combination has the capability to significantly decrease the time spent on minimizing optimization problems in the clinic that are time intensive, such as brachytherapy, IMRT and beam angle optimization.

Panchal, Aditya

52

Irradiation of malignant eyelid melanoma with iodine 125 plaque  

SciTech Connect

We used contact irradiation with iodine 125 seeds to treat a large, exulcerative, nodular, amelanotic malignant eyelid melanoma with metastasis to the regional lymph nodes in an 80-year-old man. The procedure was similar to iodine 125 plaque irradiation of malignant choroidal melanoma; special equipment, however, was needed to protect the eye from radiation exposure. The response of the malignant eyelid melanoma to iodine 125 plaque irradiation was similar to that of malignant melanomas of the choroid. No complications were observed in a follow-up period of 15 months.

Stanowsky, A.; Krey, H.F.; Kopp, J.; Kanitz, W.; Wagner, T. (Eye Clinic, Central Clinic, Augsburg (West Germany))

1990-07-15

53

Permanent interstitial brachytherapy for prostate cancer: a current review  

Microsoft Academic Search

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

Jeffrey Woolsey; Nicole Miller; Dan Theodorescu

2003-01-01

54

Seed fixity in the prostate\\/periprostatic region following brachytherapy  

Microsoft Academic Search

Purpose: Although postoperative dosimetric analyses of prostate brachytherapy are commonly reported, the long-term persistence, or fixity, of seeds implanted in the prostate gland and periprostatic region remains unclear, with only a few reports regarding the loss or migration of the seeds in the implanted region and none which correlate lung embolization to pelvic seed loss.Methods and Materials: The study population

Gregory S. Merrick; Wayne M. Butler; Anthony T. Dorsey; Jonathan H. Lief; Mark L. Benson

2000-01-01

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

Tumour and target volumes in permanent prostate brachytherapy: A supplement to the ESTRO\\/EAU\\/EORTC recommendations on prostate brachytherapy  

Microsoft Academic Search

The aim of this paper is to supplement the GEC\\/ESTRO\\/EAU recommendations for permanent seed implantations in prostate cancer to develop consistency in target and volume definition for permanent seed prostate brachytherapy.Recommendations on target and organ at risk (OAR) definitions and dosimetry parameters to be reported on post implant planning are given.

Carl Salembier; Pablo Lavagnini; Philippe Nickers; Paola Mangili; Alex Rijnders; Alfredo Polo; Jack Venselaar; Peter Hoskin

2007-01-01

57

Brachytherapy in cancer of the prostate: an historical perspective.  

PubMed

Carcinoma of the prostate in the United States has increased dramatically in the last few years due to improved detection methods including prostatic specific antigen testing and transrectal ultrasound. More than half of all prostate cancers are discovered while still localized. Radical prostatectomy and definitive radiation are reserved for patients in good health, who have localized disease. Brachytherapy, with its inherent ability to deliver a high dose to an organ-confined tumor, while minimally irradiating the surrounding tissues, has successfully competed with external beam for the treatment of early prostatic tumors. Their respective role is constantly under scrutiny and re-evaluation to improve the accuracy of delivery of radiation. The present review focuses on the role of brachytherapy for treatment of early cancer of the prostate over the span of this century and its future in the next millennium. PMID:9358586

Hilaris, B S

58

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

59

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

Microsoft Academic Search

Background and purpose: To describe the rationale, protocol and procedure for the treatment of prostate cancer using high dose rate brachytherapy (HDR-BT) and a non-fixed template technique.Materials and methods: Between July 1991 and December 1998, 491 patients with carcinoma of the prostate were treated using HDR-BT and a non-fixed template technique. AJC stages T1CT3B, patients with prior transurethral resections of

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

2000-01-01

60

Brachytherapy for clinically localized prostate cancer: optimal patient selection.  

PubMed

The objective of this review is to present an overview of each modality and delineate how to best select patients who are optimal candidates for these treatment approaches. Prostate brachytherapy as a curative modality for clinically localized prostate cancer has become increasingly utilized over the past decade; 25% of all early cancers are now treated this way in the United States (1). The popularity of this treatment strategy lies in the highly conformal nature of radiation dose, low morbidity, patient convenience, and high efficacy rates. Prostate brachytherapy can be delivered by either a permanent interstitial radioactive seed implantation (low dose rate [LDR]) or a temporary interstitial insertion of iridium-192 (Ir192) afterloading catheters. The objective of both of these techniques is to deliver a high dose of radiation to the prostate gland while exposing normal surrounding tissues to minimal radiation dose. Brachytherapy techniques are ideal to achieve this goal given the close proximity of the radiation source to tumor and sharp fall off of the radiation dose cloud proximate to the source. Brachytherapy provides a powerful means of delivering dose escalation above and beyond that achievable with intensity-modulated external beam radiotherapy alone. Careful selection of appropriate patients for these therapies, however, is critical for optimizing both disease-related outcomes and treatment-related toxicity. PMID:22052766

Kollmeier, Marisa A; Zelefsky, Michael J

2011-10-01

61

Racial and socioeconomic disparities in the selection of prostate brachytherapy  

PubMed Central

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

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

2013-01-01

62

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

Microsoft Academic Search

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

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

2006-01-01

63

The Use of Iodine-125 for Interstitial Implants.  

National Technical Information Service (NTIS)

The use of iodine-125 seeds for the implant irradiation of malignant tumors was investigated in terms of efficacy and radiological safety. Studies over a 3-year period at the Memorial Hospital for Cancer and Allied Diseases in New York were supported by t...

B. S. Hilaris G. J. Holt J. St. Germain

1975-01-01

64

Radiobiological evaluation of low dose-rate prostate brachytherapy implants  

NASA Astrophysics Data System (ADS)

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

Knaup, Courtney James

65

Clinical Course of Rectal Bleeding Following I-125 Prostate Brachytherapy  

Microsoft Academic Search

Purpose: Despite the occurrence of some rectal complications in most large series of patients treated with radiation, there is surprisingly little information regarding their management. We report here the clinical course of such patients after I-125 brachytherapy, in an effort to help delineate a rational management policy.Methods and Materials: 109 patients with stage T1 to T2 prostatic carcinoma and Gleason

Kenneth Hu; Kent Wallner

1998-01-01

66

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

67

Quantification of Edematic Effects in Prostate Brachytherapy Interventions  

Microsoft Academic Search

We present a quantitative model to analyze the detrimental effects of edema on the quality of prostate brachytherapy implants.\\u000a We account for both tissue expansion and implant migration by mapping intra-operative ultrasound and post-implant CT. We pre-process\\u000a the ultrasound with a phase congruency filter, and map it to the volume CT using a B-spline deformable mutual information\\u000a similarity metric. To

Mohamed Hefny; Purang Abolmaesumi; Zahra Karimaghaloo; David G. Gobbi; Randy E. Ellis; Gabor Fichtinger

2008-01-01

68

Identifying the predictors of acute urinary retention following magnetic-resonance-guided prostate brachytherapy  

Microsoft Academic Search

Purpose: Larger prostate gland volumes have been associated with long-term urinary morbidity in prostate interstitial radiation therapy utilizing ultrasound image guidance technique. This study was performed to identify the clinical and technical predictors of acute urinary retention following magnetic-resonance (MR)-guided prostate interstitial brachytherapy.Methods and Materials: Fifty patients underwent MR-guided prostate brachytherapy between December 1997 and March 1999. Patient selection was

Michael D Thomas; Robert Cormack; Clare M Tempany; Sanjaya Kumar; Judi Manola; L Schneider; Mark. D Hurwitz; Anthony V DAmico

2000-01-01

69

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

70

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

71

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

72

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

73

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

74

Retreatment of recurrent pelvic tumors with iodine-125.  

PubMed

We describe our experience with successful retreatment of common pelvic tumors including recurrent cervical and endometrial cancer, colorectal cancer, and soft tissue sarcomas. Two different permanent interstitial 125iodine (125I) endocurietherapy (ECT) techniques were employed. The first technique, percutaneous transperineal template 125I ECT, was used in the retreatment of recurrent tumors located within the true pelvis. The second technique, implantation of 125I in Vicryl carrier following celiotomy, was used for retreatment of recurrent tumors located outside the true pelvis within the false pelvis. PMID:2685919

Kumar, P P; Good, R R; Jones, E O; Bartone, F F; Scott, J C

75

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

76

Comparison of biochemical failure definitions for permanent prostate brachytherapy  

SciTech Connect

Purpose: To assess prostate-specific antigen (PSA) failure definitions for patients with Stage T1-T2 prostate cancer treated by permanent prostate brachytherapy. Methods and Materials: A total of 2,693 patients treated with radioisotopic implant as solitary treatment for T1-T2 prostatic adenocarcinoma were studied. All patients had a pretreatment PSA, were treated at least 5 years before analysis, 1988 to 1998, and did not receive hormonal therapy before recurrence. Multiple PSA failure definitions were tested for their ability to predict clinical failure. Results: Definitions which determined failure by a certain increment of PSA rise above the lowest PSA level to date (nadir + x ng/mL) were more sensitive and specific than failure definitions based on PSA doubling time or a certain number of PSA rises. The sensitivity and specificity for the nadir + 2 definition were 72% and 83%, vs. 51% and 81% for 3 PSA rises. The surgical type definitions (PSA exceeding an absolute value) could match this sensitivity and specificity but only when failure was defined as exceeding a PSA level in the 1-3 ng/mL range and only when patients were allowed adequate time to nadir. When failure definitions were compared by time varying covariate regression analysis, nadir + 2 ng/mL retained the best fit. Conclusions: For patients treated by permanent radioisotopic implant for prostate cancer, the definition nadir + 2 ng/mL provides the best surrogate for failure throughout the entire follow-up period, similar to patients treated by external beam radiotherapy. Therefore, the same PSA failure definition could be used for both modalities. For brachytherapy patients with long-term follow-up, at least 6 years, defining failure as exceeding an absolute PSA level in the 0.5 ng/mL range may be reasonable.

Kuban, Deborah A. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States)]. E-mail: dakuban@mdanderson.org; Levy, Larry B. [Department of Radiation Oncology, University of Texas M. D. Anderson Cancer Center, Houston, TX (United States); Potters, Louis [New York Prostate Institute, Oceanside, NY (United States); Beyer, David C. [Arizona Oncology Services, Scottsdale, AZ (United States); Blasko, John C. [Seattle Prostate Institute, Seattle, WA (United States); Moran, Brian J. [Chicago Prostate Institute, Chicago, IL (United States); Ciezki, Jay P. [Department of Radiation Oncology, Cleveland Clinic, Cleveland, OH (United States); Zietman, Anthony L. [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Zelefsky, Michael J. [Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Pisansky, Thomas M. [Department of Radiation Oncology, Mayo Clinic, Rochester, MN (United States); Elshaikh, Mohamed [Department of Radiation Oncology, University of Michigan, Ann Arbor, MI (United States); Horwitz, Eric M. [Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA (United States)

2006-08-01

77

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

78

Regional treatment margins for prostate brachytherapy.  

PubMed

PURPOSE: This study quantified the treatment margin (TM) around the prostate that received 100% of the prescribed dose and analyzed postimplant dosimetry in different regions of the prostate for (125)I seed implants. METHODS AND MATERIALS: An average target volume (ATV) was created from postoperative MRI scan contours drawn independently by five radiation oncologists in 40 patients. The MRI was fused with the postoperative CT for dosimetry purposes. The TM, defined as the radial distance between the ATV and the 100% isodose line, was measured at 16 points at the base, midgland, and apex. The ATV was divided into four quadrants: anterior-superior, posterior-superior, anterior-inferior, and posterior-inferior quadrants. The values of the dose that covers 90% of the ATV (D90) and the percentage of the ATV receiving the prescribed dose (V100) received by the whole prostate and its four quadrants were documented. RESULTS: The range of the mean TM, in millimeter, was -8.88 to 3.68, 1.12 to 10.42, and 6.27 to 18.25 at the base, midgland, and apex, respectively. The mean D90 was 135.8, 162.8, 191.0, and 194.6Gy for the anterior-superior, posterior-superior, anterior-inferior, and posterior-inferior quadrants, respectively. CONCLUSIONS: Despite having a relatively uniform preoperative planning target volume, this study identified variable TMs postoperatively in different regions of the prostate. In particular, the anterior base is most underdosed, whereas the lateral regions of the midgland and apex have generous TMs. Postimplant dosimetric parameters were lowest in the anterior-inferior quadrant. PMID:23664644

Jastaniyah, Noha; Sloboda, Ron; Kamal, Wafa; Moore, Harrison; Ghosh, Sunita; Pervez, Nadeem; Pedersen, John; Yee, Don; Danielson, Brita; Murtha, Albert; Amanie, John; Usmani, Nawaid

2013-05-01

79

CHARGE AND LENGTH OF HOSPITAL STAY ANALYSIS OF RADICAL RETROPUBIC PROSTATECTOMY AND TRANSPERINEAL PROSTATE BRACHYTHERAPY  

Microsoft Academic Search

PurposeFor the treatment of clinically localized prostate cancer radical retropubic prostatectomy with its attendant hospital stay should be associated with higher charges than transperineal prostate brachytherapy. We report a comparative case series to determine patient charges and length of hospitalization of 2 modalities of monotherapy for localized prostate cancer.

THEODORE T. WAGNER; DONN YOUNG; ROBERT R. BAHNSON

1999-01-01

80

In vivo dosimetry and seed localization in prostate brachytherapy with permanent implants  

Microsoft Academic Search

This paper reports on the development of an interactive, intraoperative dose planning system for seed implant brachytherapy in cancer treatment. This system involves in vivo dosimetry and the ability to determine implanted seed positions. The first stage of this project is the development of a urethral alarm probe to measure the dose along the urethra during a prostate brachytherapy treatment

Anatoly B. Rosenfeld; D. L. Cutajar; M. L. F. Lerch; G. J. Takacs; J. Brady; T. Braddock; V. L. Perevertaylo; J. Bucci; J. Kearsley; M. Zaider; M. Zelefsky

2004-01-01

81

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

National Technical Information Service (NTIS)

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

J. A. Talcott

2007-01-01

82

Ultrasound-Fluoroscopy Registration for Prostate Brachytherapy Dosimetry  

PubMed Central

Prostate brachytherapy is a treatment for prostate cancer using radioactive seeds that are permanently implanted in the prostate. The treatment success depends on adequate coverage of the target gland with a therapeutic dose, while sparing the surrounding tissue. Since seed implantation is performed under transrectal ultrasound (TRUS) imaging, intraoperative localization of the seeds in ultrasound can provide physicians with dynamic dose assessment and plan modification. However, since all seeds cannot be seen in the ultrasound images, registration between ultrasound and fluoroscopy is a practical solution for intraoperative dosimetry. In this manuscript, we introduce a new image-based nonrigid registration method that obviates the need for manual seed segmentation in TRUS images and compensates for the prostate displacement and deformation due to TRUS probe pressure. First, we filter the ultrasound images for subsequent registration using thresholding and Gaussian blurring. Second, a computationally efficient point-to-volume similarity metric, an affine transformation and an evolutionary optimizer are used in the registration loop. A phantom study showed final registration errors of 0.84 0.45 mm compared to ground truth. In a study on data from 10 patients, the registration algorithm showed overall seed-to-seed errors of 1.7 1.0 mm and 1.5 0.9 mm for rigid and nonrigid registration methods, respectively, performed in approximately 30 seconds per patient.

Dehghan, Ehsan; Lee, Junghoon; Fallavollita, Pascal; Kuo, Nathanael; Deguet, Anton; Le, Yi; Burdette, E. Clif; Song, Danny Y.; Prince, Jerry L.; Fichtinger, Gabor

2012-01-01

83

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

SciTech Connect

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

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

2005-07-15

84

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

Microsoft Academic Search

Background and purposeThe aim of this paper is to present the GEC\\/ESTRO-EAU recommendations for template and transrectal ultrasound (TRUS) guided transperineal temporary interstitial prostate brachytherapy using a high dose rate iridium-192 stepping source and a remote afterloading technique. Experts in prostate brachytherapy developed these recommendations on behalf of the GEC\\/ESTRO and of the EAU. The paper has been approved by

Gyrgy Kovcs; Richard Ptter; Tillmann Loch; Josef Hammer; Inger-Karine Kolkman-Deurloo; Jean J. M. C. H. de la Rosette; Hagen Bertermann

2005-01-01

85

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

Microsoft Academic Search

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

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

1999-01-01

86

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

87

Prostate brachytherapy training with simulated ultrasound and fluoroscopy images.  

PubMed

In this paper, a novel computer-based virtual training system for prostate brachytherapy is presented. This system incorporates, in a novel way, prior methodologies of ultrasound image synthesis and haptic transrectal ultrasound (TRUS) transducer interaction in a complete simulator that allows a trainee to maneuver the needle and the TRUS, to see the resulting patient-specific images and feel the interaction forces. The simulated TRUS images reflect the volumetric tissue deformation and comprise validated appearance models for the needle and implanted seeds. Rendered haptic forces use validated models for needle shaft flexure and friction, tip cutting, and deflection due to bevel. This paper also presents additional new features that make the simulator complete, in the sense that all aspects of the brachytherapy procedure as practiced at many cancer centers are simulated, including simulations of seed unloading, fluoroscopy imaging, and transversal/sagittal TRUS plane switching. For real-time rendering, methods for fast TRUS-needle-seed image formation are presented. In addition, the simulator computes real-time dosimetry, allowing a trainee to immediately see the consequence of planning changes. The simulation is also patient specific, as it allows the user to import the treatment plan for a patient together with the imaging data in order for a physician to practice an upcoming procedure or for a medical resident to train using typical implant scenarios or rarely encountered cases. PMID:23047861

Goksel, Orcun; Sapchuk, Kirill; Morris, William J; Salcudean, Septimiu E

2012-10-03

88

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

89

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

90

Iridium 192 high-dose-rate brachytherapy a useful alternative therapy for localized prostate cancer?  

Microsoft Academic Search

We report on a novel protocol involving iridium 192 high-dose-rate brachytherapy and follow-up of up to 130 months in patients with prostatic carcinoma. Using regional anesthesia, five to seven hollow needles are placed within the prostate by perineal puncture under ultrasound guidance. A 9-Gy prostate dose is applied followed by 30 min of hyperthermia (since 1991). This treatment is repeated

R. Paul; R. Hofmann; J. U. Schwarzer; R. Stepan; H. J. Feldmann; P. Kneschaurek; M. Molls; R. Hartung

1997-01-01

91

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

92

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.

93

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

94

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.

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

2012-01-01

95

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

96

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

PubMed

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

2013-09-13

97

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

PubMed Central

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

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

2013-01-01

98

Prostate brachytherapy seed reconstruction using an adaptive grouping technique  

SciTech Connect

Fluoroscopy-based three-dimensional seed localization as a component of intraoperative dosimetry for prostate brachytherapy is an active area of research. A novel adaptive-grouping-based reconstruction approach is developed. This approach can recover overlapped seeds that are not detected from the fluoroscopic images. Two versions of the adaptive-grouping-based reconstruction approach are implemented and compared to an epipolar geometry-based seed reconstruction technique. Simulations based on nine patient datasets are used to validate the algorithms. A total of 2259 reconstructions is performed in which different types of error such as random noise in seed image locations and ambiguities in projection geometry are incorporated. Among those reconstructions, nine of the cases with overlapping seeds and the different types of error are performed. It is demonstrated that the adaptive-grouping-based reconstruction method is more accurate than the epipolar geometry method and allows faster reconstruction. At a random noise level of 0.6 mm, the mean distance error in reconstructed seed locations is approximately 1.0 mm for one of the relevant cases examined in detail. The best adaptive-grouping-based approach successfully recovered overlapped seeds in the majority of simulated cases (89%), with the remainder of cases generating one false positive seed. Phantom validation is also performed, and overlapped seeds are successfully recovered with all 92 seeds correctly localized and reconstructed. The mean distance error between segmented seed images and projected seeds is 0.5 mm in the phantom study.

Su Yi; Davis, Brian J.; Furutani, Keith M.; Herman, Michael G.; Robb, Richard A. [Department of Physiology and Biomedical Engineering, Biomedical Imaging Resource, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Department of Radiation Oncology, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States); Biomedical Imaging Resource, Department of Physiology and Biomedical Engineering, Mayo Clinic College of Medicine, Rochester, Minnesota 55905 (United States)

2007-07-15

99

Dosimetric consideration of transient volume enlargement induced by edema in prostate brachytherapy seed implants.  

PubMed

Purpose: To investigate enlargement of prostate volume by edema during brachytherapy seed implantation and develop a nomogram model to calculate air-kerma strength (AKS) required for implantation of the enlarged transient prostatic volume. Materials and Methods: The prostate volume was measured prior and after seed implantation using trans-rectal ultrasound imaging in the operating room to obtain volume enlargement. A nomogram model was developed that calculates AKS required for implantation of the enlarged transient prostate volume with optimal dose coverage. Results: The measured prostate enlargement in this study was up to 60% of the initial volume. The effective prostatic volume enlargement was calculated for three isotopes: 125I, 103Pd and 131Cs. The effective volume enlargement for 125I implants was relatively small (< 10%) because of its long half-life. For 103Pd and 131Cs with short half-lives, additional AKS up to 20% and 30%, respectively, might be required to provide appropriate dose coverage of possible enlarged prostatic volumes. Conclusions: Prostate volume enlargement should be considered to obtain optimal dose coverage particularly for short half-life isotopes such as 131Cs and 103Pd. The nomogram model developed in this work provides the AKS required for implants with a wide range of prostatic volume enlargements (5-100%) for three isotopes. Keywords: prostate brachytherapy; nomogram; air-kerma strength; edema; volume enlargement. PMID:23339976

Ali, I; Algan, O; Thompson, S; Sindhwani, P; Ahmad, S

2013-01-01

100

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.

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

2013-01-01

101

Contrast-enhanced ultrasound as support for prostate brachytherapy treatment planning  

PubMed Central

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

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

2012-01-01

102

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

PubMed

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 with EBRT; such combined-modality therapy (CMT) is typically used to treat patients with intermediate-risk to high-risk, clinically localized disease. Controversy persists with regard to indications for CMT, choice of LDR or HDR boost, isotope selection for LDR, and integration of EBRT and brachytherapy. Initial findings from prospective, multicenter trials of CMT support the feasibility of this strategy. Updated results from these trials as well as those of ongoing and new phase III trials should help to define the role of CMT in the management of prostate cancer. In the meantime, long-term expectations for outcomes of CMT are based largely on the experience of single institutions, which demonstrate that CMT with EBRT and either LDR or HDR brachytherapy can provide freedom from disease recurrence with acceptable toxicity. PMID:18825143

Hurwitz, Mark D

2008-09-30

103

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

104

Current topics in the treatment of prostate cancer with low-dose-rate brachytherapy.  

PubMed

The treatment of prostate cancer with low dose rate prostate brachytherapy has grown rapidly in the last 20 years. Outcome analyses performed in this period have enriched understanding of this modality. This article focuses on the development of a real-time ultrasound-guided implant technique, the importance of radiation dose, trimodality treatment of high-risk disease, long-term treatment outcomes, and treatment-associated morbidity. PMID:20152522

Stock, Richard G; Stone, Nelson N

2010-02-01

105

Reduction of radioactive seed embolization to the lung following prostate brachytherapy  

Microsoft Academic Search

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

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

1998-01-01

106

Role of Isotope Selection in Long-term Outcomes in Patients With Intermediate-risk Prostate Cancer Treated With a Combination of External Beam Radiotherapy and Low-dose-rate Interstitial Brachytherapy  

PubMed Central

OBJECTIVE To examine the rates of long-term biochemical recurrence-free survival (BRFS) with respect to isotope in intermediate-risk prostate cancer treated with external beam radiotherapy (EBRT) and brachytherapy. METHODS A total of 242 consecutive patients with intermediate-risk prostate cancer were treated with iodine-125 (125I) or palladium-103 (103Pd) implants after EBRT (range 45.050.4 Gy) from 1996 to 2002. Of the 242 patients, 119 (49.2%) were treated with 125I and 123 (50.8%) with 103Pd. Multivariate Cox regression analysis was used to analyze BRFS, defined according to the Phoenix definition (prostate-specific antigen nadir plus 2 ng/mL) with respect to Gleason score, stage, pretreatment prostate-specific antigen level, and source selection. Late genitourinary/gastrointestinal toxicities were assessed using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale. RESULTS At a median follow-up of 10 years, the BRFS rate was 77.3%. A statistically significant difference was found in the 10-year BRFS rate between the 125I- and 103Pd-treated groups (82.7% and 70.6%, respectively; P = .001). The addition of hormonal therapy did not improve the 10-year BRFS rate (77.6%) compared with RT alone (77.1%; P = .22). However, a statistically significant difference in the BRFS rate was found with the addition of hormonal therapy to 103Pd, improving the 10-year BRFS rate for (73.8%) compared with 103Pd alone (69.1%; P = .008). On multivariate analysis, isotope type (103Pd vs 125I), pretreatment prostate-specific antigen level > 10 ng/mL, and greater tumor stage increased the risk of recurrence by 2.6-fold (P = .007), 5.9-fold (P < .0001), and 1.7-fold (P = .14), respectively. CONCLUSION 125I renders a superior rate of BRFS compared with 103Pd when used with EBRT. Hormonal therapy does not provide additional benefit in patients with intermediate-risk prostate cancer treated with a combination of EBRT and brachytherapy, except for the addition of hormonal therapy to 103Pd.

Wernicke, A. Gabriella; Shamis, Michael; Yan, Weisi; Trichter, Samuel; Sabbas, Albert M.; Goltser, Yevgenia; Christos, Paul J.; Brennan, Jennifer S.; Parashar, Bhupesh; Nori, Dattatreyudu

2013-01-01

107

Intraoperative solid-state based urethral dosimetry in low dose rate prostate brachytherapy  

Microsoft Academic Search

This paper presents in phantom testing of a recently developed intraoperative minidosimetry system, designed to measure the dose along the urethra during low dose rate prostate brachytherapy. This system is based on a silicon minidetector and uses spectroscopy to calculate the localized dose from the treatment radiation. The minidosimetry system was demonstrated to be operational at body temperature, with a

D. L. Cutajar; G. J. Takacs; M. L. F. Lerch; T. Braddock; J. A. Bucci; J. Brady; L. J. Duggan; K. E. Enari; M. Zaider; M. Zelefsky; A. B. Rosenfeld

2006-01-01

108

Reality-Based Estimation of Needle and Soft-Tissue Interaction for Accurate Haptic Feedback in Prostate Brachytherapy Simulation  

Microsoft Academic Search

a Corresponding author. Abstract - Prostate Brachytherapy is the implantation of radioactive seeds into the prostate as a treatment for prostate cancer. The success rate of the procedure is directly related to the physician's level of experience. In addition, minor deviations in seed alignment caused by gland compression\\/retraction, gland edema (swelling) and needle deflections can create significant areas of over

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

2005-01-01

109

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

110

Determination of the prescription dose for biradionuclide permanent prostate brachytherapy  

SciTech Connect

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

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

2008-12-15

111

Photon spectral characteristics of a new double-walled iodine-125 source.  

PubMed

The photon spectral characteristics of a recently designed Iodine-125 source have been measured. The source has a physical length of 5 mm and a diameter of 0.8 mm. A thin tungsten filament coated with radioactive Iodine-125 is used as a radiographic marker and is encapsulated in a double wall titanium shell of uniform thickness all around. The photon spectral characteristics, measured with an intrinsic germanium (Ge) detector coupled to a multichannel analyzer, reveal that the seed emits the 27.4-keV K alpha and 31.4-keV K beta x rays and 35.5-keV gamma photons from the decay of Iodine-125. Because of their low energy, the tungsten x rays are not observed in the spectrum. The anisotropy of the radiation fluence for each of the above-mentioned photon energies was measured in planes containing the seed short and long axes. The 4 pi-averaged anisotropy factor for the total radiation fluence, i.e., sum of the above three photon energies is 0.92. The photon intensity radiated along the seed long axis is approximately equal to the intensity in the seed transverse direction due to the absence of end welds. The new Iodine-125 source is characterized by good radiographic visualization, greater structural strength due to double wall encapsulation design, and emission of more isotropic Iodine-125 photon spectrum. PMID:1518481

Rustgi, S N

112

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

113

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

SciTech Connect

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

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

2005-12-15

114

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 14 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.

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

2013-01-01

115

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

PubMed Central

Purpose We report updated results of magnetic resonance imaging guided partial prostate brachytherapy and propose a definition of biochemical failure following focal therapy. Materials and Methods From 1997 to 2007, 318 men with cT1c, prostate specific antigen less than 15 ng/ml, Gleason 3 + 4 or less prostate cancer received magnetic resonance imaging guided brachytherapy in which only the peripheral zone was targeted. To exclude benign prostate specific antigen increases due to prostatic hyperplasia, we investigated the usefulness of defining prostate specific antigen failure as nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. Cox regression was used to determine the factors associated with prostate specific antigen failure. Results Median followup was 5.1 years (maximum 12.1). While 36 patients met the nadir +2 criteria, 16 of 17 biopsy proven local recurrences were among the 26 men who also had a prostate specific antigen velocity greater than 0.75 ng/ml per year (16 of 26 vs 1 of 10, p = 0.008). Using the nadir +2 definition, prostate specific antigen failure-free survival for low risk cases at 5 and 8 years was 95.1% (91.097.3) and 80.4% (70.787.1), respectively. This rate improved to 95.6% (91.697.7) and 90.0% (82.694.3) using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year. For intermediate risk cases survival was 73.0% (55.084.8) at 5 years and 66.4% (44.881.1) at 8 years (the same values as using nadir +2 with prostate specific antigen velocity greater than 0.75 ng/ml per year). Conclusions Requiring a prostate specific antigen velocity greater than 0.75 ng/ml per year in addition to nadir +2 appears to better predict clinical failure after therapies that target less than the whole gland. Further followup will determine whether magnetic resonance imaging guided brachytherapy targeting the peripheral zone produces comparable cancer control to whole gland treatment in men with low risk disease. However, at this time it does not appear adequate for men with even favorable intermediate risk disease.

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

2013-01-01

116

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.

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

2013-01-01

117

Improved iodine-125 plaque design in the treatment of choroidal malignant melanoma.  

PubMed Central

The use and development of iodine-125 plaque therapy for choroidal malignant melanoma are described. Since 1975 experience has led to changes in plaque design and insertion techniques. Twenty-one patients were irradiated with local episcleral iodine-125 plaques. Three patients required a second plaque for tumour recurrence. Four eyes were enucleated because of continued tumour growth and a further eye was removed because of glaucoma secondary to radiation retinopathy. Two patients (9.5%) died of metastases. The remaining 19 patients are alive and clinically clear of metastases, with a mean follow up time of 73.1 months (range 43-142 months).

Hill, J C; Sealy, R; Shackleton, D; Stannard, C; Korrubel, J; Hering, E; Loxton, C

1992-01-01

118

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

SciTech Connect

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

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

2004-10-01

119

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

120

A haptic-enhanced 3D real-time interactive needle insertion simulation for prostate brachytherapy  

NASA Astrophysics Data System (ADS)

A virtual reality based surgical simulation can improve the accuracy and quality of prostate brachytherapy by facilitating surgeon training, rehearsal, and intra-operative assistance. In this paper, we describe a prototype 3D realtime interactive simulation environment for needle insertion and seed implantation for prostate brachytherapy. A restricted 3D ChainMail method, derived from the original 3D ChainMail method based on our modification, was used to account for dynamic soft tissue deformation during needle insertion. We improved the neighbor-searching algorithm for the original 3D ChainMail method to enable a complete search for any objects including strict-concave. A direct manipulation model for needle-tissue interaction was implemented. A haptic feedback has also been provided to enhance realism and training outcome. For simplicity and efficacy, we have adopted a distributed system structure functionally incorporating two software modules: visual simulation module and haptic simulation module. The simulation was demonstrated using four key steps of the brachytherapy procedure: 1) specification of seed positions inside the prostate; 2) placement of a needle at a specified entry point and trajectory; 3) insertion of the needle into the prostate consisting of two basic sub-steps: membrane contraction and penetration insertion; and, 4) retraction of the needle after seed implantation. The preliminary results of the simulation are promising.

Wang, Xiaogang; Fenster, Aaron

2004-05-01

121

Simple, accurate, safe, and cost-effective percutaneous transperineal template technique for permanent 125iodine interstitial brachytherapy of prostate cancer.  

PubMed

We present the technique, intraoperative and postoperative complications of percutaneous transperineal template permanent 125iodine interstitial brachytherapy of prostate cancer. The percutaneous transperineal template permanent iodine interstitial brachytherapy under "C-arm" fluoroscopic guidance is a simple, easily-learned, accurate and rapid procedure which can be performed without subjecting the patient to celiotomy. We have treated 58 patients by the transperineal percutaneous permanent interstitial brachytherapy. 33 of 58 patients also had a staging celiotomy just prior to the brachytherapy. In the group of 22 patients undergoing brachytherapy without celiotomy and without adjuvant external-beam pelvic radiotherapy, there were no major complications. Blood transfusions were not required by any patients who underwent percutaneous transperineal permanent iodine interstitial brachytherapy without celiotomy. PMID:3097859

Kumar, P P; Good, R R; Hussain, M B; Bartone, F F

1986-11-01

122

Dosimetric calculations and measurements of gold plaque ophthalmic irradiators using iridium-192 and iodine-125 seeds  

Microsoft Academic Search

The dosimetry of ophthalmic plaques designed to hold iridium-192 or iodine-125 seeds is investigated experimentally and by means of a computer model. A phantom for thermoluminescent dosimetry (TLD) which permits measurements to within 2 mm of the plaque surface is described. TLD data are compared with model calculations that take into account the active length of the seeds, anisotropy of

Gary Luxton; Melvin A. Astrahan; Peter E. Liggett; David L. Neblett; Dierdre M. Cohen; Zbigniew Petrovich

1988-01-01

123

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

PubMed Central

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

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

2011-01-01

124

Quality-of-life comparison of radical prostatectomy and interstitial brachytherapy in the treatment of clinically localized prostate cancer  

Microsoft Academic Search

Objectives. Interstitial brachytherapy (BT) is increasingly utilized as a curative treatment for localized prostate cancer because it is perceived as less morbid than surgical alternatives. However, to date no studies have directly compared the quality of life and symptoms of patients with localized prostate cancer treated with curative intent by radical prostatectomy with those treated by either BT alone or

Tracey Krupski; Gina R Petroni; Eric A Bissonette; Dan Theodorescu

2000-01-01

125

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

Microsoft Academic Search

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

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

2010-01-01

126

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

SciTech Connect

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

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

2010-04-15

127

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

NASA Astrophysics Data System (ADS)

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

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

2013-03-01

128

Robotically assisted prostate brachytherapy with transrectal ultrasound guidancedPhantom experiments  

Microsoft Academic Search

PURPOSE: To report the preliminary experimental results obtained with a robot-assisted trans- rectal ultrasound (TRUS)-guided prostate brachytherapy system. METHODS AND MATERIALS: The system consists of a TRUS unit, a spatially coregistered needle insertion robot, and an FDA-approved treatment planning and image-registered implant sys- tem. The robot receives each entry\\/target coordinate pair of the implant plan, inserts a preloaded needle, and

Gabor Fichtinger; Everette C. Burdette; Attila Tanacs; Alexandru Patriciu; Dumitru Mazilu; Louis L. Whitcomb; Dan Stoianovici

2006-01-01

129

Hypofractionated Conformal HDR Brachytherapy in Hormone Nave Men with Localized Prostate Cancer  

Microsoft Academic Search

Purpose:To analyze the long-term effect of local dose escalation using conformal hypofractionated high-dose-rate brachytherapy (HDR-BT) boost and pelvic external-beam radiation therapy (EBRT) in hormone-nave men with localized prostate cancer.Patients and Methods:A total of 579 men were consecutively treated with pelvic EBRT and dose escalating HDR-BT since 1986 in two prospective trials: 378 patients at William Beaumont Hospital (19912002), and 201

Razvan M. Galalae; Alvaro Martinez; Nils Nuernberg; Gregory Edmundson; Gary Gustafson; Jose Gonzalez; Bernhard Kimming

2006-01-01

130

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

131

A Dosimetric Selectivity Intercomparison of HDR Brachytherapy, IMRT and Helical Tomotherapy in Prostate Cancer Radiotherapy  

Microsoft Academic Search

\\u000a \\u000a Background and Purpose:\\u000a Dose escalation in order to improve the biochemical control in prostate cancer requires the application of irradiation techniques\\u000a with high conformality. The dosimetric selectivity of three radiation modalities is compared: high-dose-rate brachytherapy\\u000a (HDR-BT), intensity-modulated radiation radiotherapy (IMRT), and helical tomotherapy (HT).\\u000a \\u000a \\u000a \\u000a \\u000a Patients and Methods:\\u000a Ten patients with prostate adenocarcinoma treated by a 10-Gy HDR-BT boost after external-beam

Johanne Hermesse; Sylvie Biver; Nicolas Jansen; Eric Lenaerts; Nathalie De Patoul; Stefaan Vynckier; Philippe Coucke; Pierre Scalliet; Philippe Nickers

2009-01-01

132

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

Microsoft Academic Search

Purpose: To compare the urethral and prostate absolute and biologic effective doses (BEDs) for Cs and I prostate permanent implant brachytherapy (PPI). Methods and Materials: Eight previously implanted manually planned I PPI patients were replanned manually with Cs, and re-planned using Inverse Planning Simulated Annealing. Cs activity and the prescribed dose (115 Gy) were determined from that recommended by IsoRay.

Arjun Sahgal; Siavash Jabbari; Josephine Chen; Barbie Pickett; Mack Roach; Vivian Weinberg; I-Chow Hsu; Jean Pouliot

2008-01-01

133

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

134

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

135

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

Microsoft Academic Search

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

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

2000-01-01

136

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

PubMed

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

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

2013-09-04

137

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

PubMed Central

Prostate brachytherapy, administered by implanting tiny radioactive seeds to treat prostate cancer, currently relies on transrectal ultrasound imaging for intraoperative visualization of the metallic seeds. Photoacoustic (PA) imaging has been suggested as a feasible alternative to ultrasound imaging due to its superior sensitivity to metal surrounded by tissue. However, PA images suffer from poor contrast when seeds are distant from the light source. We propose a transperineal light delivery method and investigate the application of a short-lag spatial coherence (SLSC) beamformer to enhance low-contrast photoacoustic signals that are distant from this type of light source. Performance is compared to a conventional delay-and-sum beamformer. A pure gelatin phantom was implanted with black ink-coated brachytherapy seeds and the mean contrast was improved by 325 dB with the SLSC beamformer for fiber-seed distances ranging 0.66.3 cm, when approximately 10% of the receive aperture elements were included in the short-lag sum. For fiber-seed distances greater than 34 cm, the mean contrast-to-noise ratio (CNR) was approximately doubled with the SLSC beamformer, while mean signal-to-noise ratios (SNR) were mostly similar with both beamformers. Lateral resolution was decreased by 2 mm, but improved with larger short-lag values at the expense of poorer CNR and SNR. Similar contrast and CNR improvements were achieved with an uncoated brachytherapy seed implanted in ex vivo tissue. Results indicate that the SLSC beamformer has potential to enhance the visualization of prostate brachytherapy seeds that are distant from the light source.

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

2013-01-01

138

Predictors of Prostate CancerSpecific 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

139

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

140

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

Microsoft Academic Search

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

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

2001-01-01

141

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

PubMed Central

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

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

2012-01-01

142

Iodine-125 interstitial implants as salvage therapy for recurrent gynecologic malignancies  

SciTech Connect

Twenty-one patients with the diagnosis of recurrent gynecologic pelvic malignancy from various primary sites were treated with iodine-125 (I-125) interstitial implants. Eighteen of these patients had been treated with a combination of surgery and radiation therapy for their primary malignancies and 90% had responded. Seventy-five percent had complete local responses. The overall survival time, volume-response relationship, and complications are discussed and the radioresponse of various histologic types is presented.

Sharma, S.K.; Forgione, H.; Isaacs, J.H. (Loyola Univ. Medical Center, Maywood, IL (USA))

1991-05-15

143

Iodine125 interstitial implants as salvage therapy for recurrent gynecologic malignancies  

Microsoft Academic Search

Twenty-one patients with the diagnosis of recurrent gynecologic pelvic malignancy from various primary sites were treated with iodine-125 (I-125) interstitial implants. Eighteen of these patients had been treated with a combination of surgery and radiation therapy for their primary malignancies and 90% had responded. Seventy-five percent had complete local responses. The overall survival time, volume-response relationship, and complications are discussed

Sudarshan K. Sharma; H. Forgione; J. H. Isaacs

1991-01-01

144

Induction of lethality and DNA breakage by the decay of iodine-125 in bacteriophage T4  

Microsoft Academic Search

Iodine-125 was incorporated into the DNA of coliphage T4 in the form of ; 5-iododeoxyuridine (IUdR), an analogue of thymidine. ¹²⁵I decays by ; electron capture with consequent vacancy cascades and multiple ionization (Auger ; effect). This decay mode is known to cause extensive fragmentation of labeled ; small molecules. ¹²⁵Ilabeled T4 phage were stored in a glycerol-casamine ; acid

Robert E. Krisch; Ronald D. Ley

1974-01-01

145

Local radiolytic effectiveness of Auger electrons of iodine-125 in benzene-iodine solutions  

Microsoft Academic Search

The gas-chromatographic analysis of benzene-iodine solutions containing molecular iodine-125 after various storage times showed that no radiolytic products appeared while some products such as benzene, iodobenzene, biphenyl, and iodobiphenyl, were detected under the same analytical conditions in our recent studies concerning the reactions of iodine atoms activated by L shell photoelectric ionization in benzene-iodine solutions, and the self-radiolysis of iodobenzene

P. nak; T. nak

1987-01-01

146

Iodine125 implant and external beam irradiation in patients with localized pancreatic carcinoma. [Efficacy and complications  

Microsoft Academic Search

Twelve patients with biopsy-proven clinically localized ductal pancreatic cancers (less than 7 cm in greatest diameter) judged unsuitable for resection were treated by bypass surgery, an Iodine-125 implant (20 to 39 mCi), and postoperative irradiation (4000 to 4500 rads). The potential problems of significant bleeding, pancreatic fistula, or pancreatitis were not experienced. A local recurrence developed in one patient and

W. U. Shipley; G. L. Nardi; A. M. Cohen; C. C. Ling

1980-01-01

147

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

SciTech Connect

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

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

2005-04-01

148

Assessment of radiation dose for surrounding organs and persons approaching implanted patients upon brachytherapy of prostate cancer with Iridium-192.  

PubMed

To assess a proper dose for radiation therapy fitting the typical physical characteristics of male Korean bodies, a mathematical phantom was prepared based on standard Korean male measurements. Upon brachytherapy of prostate cancer by implanting 192Ir into the prostate gland (the source organ), the absorbed dose of the prostate gland and surrounding organs and the expected dose of people within the vicinity were assessed. 192Ir, which has been the radionuclide of choice for prostate cancer brachytherapy, was selected for the simulation. It was assumed that 1 Ci of initial radioactivity would be administered. As a result, 1.28E-02 Gy/Ci was exhibited in the prostate gland of the source organ, and the dose to which persons within the vicinity were exposed was exhibited to be 9.19E-06 Sv at a distance of 30 cm from the front. PMID:20643801

Kim, J H; Kim, C S; Whang, J H

2010-07-19

149

Long-Term Outcome for Clinically Localized Prostate Cancer Treated With Permanent Interstitial Brachytherapy  

SciTech Connect

Purpose: To present the largest series of prostate cancer brachytherapy patients treated with modern brachytherapy techniques and postimplant day 0 dosimetric evaluation. Methods and Materials: Between April 1995 and July 2006, 1,656 consecutive patients were treated with permanent interstitial brachytherapy. Risk group stratification was carried out according to the Mt. Sinai guidelines. Median follow-up was 7.0 years. The median day 0 minimum dose covering at least 90% of the target volume was 118.8% of the prescription dose. Cause of death was determined for each deceased patient. Multiple clinical, treatment, and dosimetric parameters were evaluated for impact on the evaluated survival parameters. Results: At 12 years, biochemical progression-free survival (bPFS), cause-specific survival (CSS), and overall survival (OS) for the entire cohort was 95.6%, 98.2%, and 72.6%, respectively. For low-, intermediate-, and high-risk patients, bPFS was 98.6%, 96.5%, and 90.5%; CSS was 99.8%, 99.3%, and 95.2%; and OS was 77.5%, 71.1%, and 69.2%, respectively. For biochemically controlled patients, the median posttreatment prostate-specific antigen (PSA) concentration was 0.02 ng/ml. bPFS was most closely related to percent positive biopsy specimens and risk group, while Gleason score was the strongest predictor of CSS. OS was best predicted by patient age, hypertension, diabetes, and tobacco use. At 12 years, biochemical failure and cause-specific mortality were 1.8% and 0.2%, 5.1% and 2.1%, and 10.4% and 7.1% for Gleason scores 5 to 6 and 7 and {>=}8, respectively. Conclusions: Excellent long-term outcomes are achievable with high-quality brachytherapy for low-, intermediate-, and high-risk patients. These results compare favorably to alternative treatment modalities including radical prostatectomy.

Taira, Al V. [Department of Radiation Oncology, University of Washington, Seattle, Washington (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.or [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, West Virginia (United States); Butler, Wayne M.; Galbreath, Robert W.; 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)

2011-04-01

150

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

SciTech Connect

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

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

2007-10-01

151

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

152

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

SciTech Connect

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

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

2011-05-01

153

Experimental and theoretical dosimetry of a new polymer encapsulated iodine-125 source--SmartSeed: Dosimetric impact of fluorescence x rays  

SciTech Connect

Purpose: The detailed study of a new permanent iodine-125 brachytherapy source, SmartSeed, is presented in this article. It is the first iodine seed made with biocompatible polymer and is manufactured by the IBt-Bebig group. Methods: Three dosimetric studies have been performed: The first one used thermoluminescent detectors in a solid water phantom with NIST (National Institute of Standards and Technology, USA) calibrated seeds, and two separate studies were of Monte Carlo photon transport calculations (MCNP5 code). The TG-43U1 protocol was applied to derive dosimetric parameters for clinical applications. Results: The radial dose function g(r) was determined at different distances ranging from 0.5 to 10 cm; and the anisotropy function F(r,{theta}) at angles ranging from 0 deg. to 350 deg. in 10 deg. increments. Monte Carlo calculations were performed in liquid water to obtain values for {Lambda}, g(r), F(r,{theta}), and {phi}{sub an}(r) as recommended by the TG-43U1 protocol for use in treatment planning system software. SmartSeed's biocompatible polymer capsule permits fluorescence x rays (3, 5, and 12 keV), generated by lead glass marker, to be present in the emission spectrum, influencing the dose rate constant. The impact on near field dosimetry in water from these x rays was also investigated and reported. The capsule also attenuates iodine-125 energies much less than typical titanium encased sources, resulting in a highly isotropic source. Conclusions: SmartSeed has a dose rate constant of 0.895{+-}7.3% cGy h{sup -1} U{sup -1}, a radial dose function nearly identical to the IBt-Bebig model I25.S06 seed, and a highly isotropic dose distribution. Fluorescence x rays account for the relatively low value of {Lambda}, yet their variable contribution to dosimetry arising from seed dimensional uncertainties is estimated to be <0.2%.

Abboud, F.; Hollows, M.; Scalliet, P.; Vynckier, S. [Department of Radiotherapy and Oncology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels 1200 (Belgium); MRH Technologies, Westminster 01473, Massachusetts (United States); Department of Radiotherapy and Oncology, Cliniques Universitaires Saint-Luc, Catholic University of Louvain, Brussels 1200 (Belgium)

2010-05-15

154

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

PubMed Central

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

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

2011-01-01

155

Fifteen-Year Biochemical Relapse-Free Survival, Cause-Specific Survival, and Overall Survival Following I 125 Prostate Brachytherapy in Clinically Localized Prostate Cancer: Seattle Experience  

Microsoft Academic Search

Purpose: To report 15-year biochemical relapse-free survival (BRFS), cause-specific survival (CSS), and overall survival (OS) outcomes of patients treated with I¹²⁵ brachytherapy monotherapy for clinically localized prostate cancer early in the Seattle experience. Methods and Materials: Two hundred fifteen patients with clinically localized prostate cancer were consecutively treated from 1988 to 1992 with I¹²⁵ monotherapy. They were prospectively followed as

John E. Sylvester; Peter D. Grimm; Jason Wong; Robert W. Galbreath; Gregory Merrick; John C. Blasko

2011-01-01

156

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

NASA Astrophysics Data System (ADS)

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

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

2008-04-01

157

Evaluation of Health-Related Quality of Life in Patients with Prostate Cancer after Treatment with Radical Retropubic Prostatectomy and Permanent Prostate Brachytherapy  

Microsoft Academic Search

Aim: The aims of this study were to evaluate the health-related quality of life (HRQOL) and make the treatment decision less difficult. Methods: Between 2007 and 2009 radical retropubic prostatectomy (RRP) was performed in 96 patients and permanent prostate brachytherapy (PPB) in 88 patients at our hospital. The general and disease-specific HRQOL was measured using two instruments, the Medical Outcome

2010-01-01

158

Late Urinary Morbidity With High Dose Prostate Brachytherapy as a Boost to Conventional External Beam Radiation Therapy for Local and Locally Advanced Prostate Cancer  

Microsoft Academic Search

PurposeLate urinary retention (UR) is a known complication that may occur when using high dose rate brachytherapy (HDR-B) to boost external beam radiation therapy (EBRT) when treating prostate cancer. However, the dosimetric, treatment and clinical factors associated with this complication are not well-known.

JOAO VICTOR SALVAJOLI; MARIA APARECIDA CONTE MAIA; ROBSON FERRIGNO; PAULO EDUARDO RIBEIRO DOS SANTOS NOVAES; RICARDO CESAR FOGAROLLI; RICARDO JOSE ASSIS PELLIZZON

2004-01-01

159

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

160

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

161

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

162

Clinical results of combined treatment conformal high-dose-rate iridium-192 brachytherapy and external beam radiotherapy using staging lymphadenectomy for localized prostate cancer  

Microsoft Academic Search

PurposeTo report the first long-term biochemical control rate of patients treated with two protocols using a combination of external beam radiotherapy (EBRT) and high-dose-rate (HDR) brachytherapy for localized prostate cancer in Japan.

Junichi Hiratsuka; Yoshimasa Jo; Kenji Yoshida; Naomi Nagase; Masato Fujisawa; Yoshinari Imajo

2004-01-01

163

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

164

GEC/ESTRO recommendations on high dose rate afterloading brachytherapy for localised prostate cancer: An update.  

PubMed

Background: HDR afterloading brachytherapy (HDRBT) for prostate cancer is now established as an effective technique to achieve dose escalation in the radical treatment of localized prostate cancer. The previous guidelines published in 2005 from GEC ESTRO and EAU have been updated to reflect the current and emerging roles for HDRBT in prostate cancer. Patients and method: The indications for HDRBT in dose escalation schedules with external beam are wide ranging with all patients having localized disease eligible for this technique. Exclusion criteria are few encompassing patients medically unfit for the procedure and those with significant urinary outflow symptoms. Results: Recommendations for patient selection, treatment facility, implant technique, dose prescription and dosimetry reporting are given. Conclusions: HDRBT in prostate cancer can be practiced effectively and safely within the context of these guidelines with the main indication being for dose escalation with external beam. HDRBT used alone is currently under evaluation and its role in focal treatment and recurrence will be areas of future development. PMID:23773409

Hoskin, Peter J; Colombo, Alessandro; Henry, Ann; Niehoff, Peter; Paulsen Hellebust, Taran; Siebert, Frank-Andre; Kovacs, Gyorgy

2013-06-14

165

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

SciTech Connect

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

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

1991-03-01

166

Sequential morphological changes in the dog brain after interstitial iodine- 125 irradiation  

SciTech Connect

Iodine- 125 seeds (3.55 mCi) were stereotactically implanted into the subcortical white matter of the left coronal gyrus in six beagle dogs. Morphological changes were studied at intervals ranging from 25 to 368 days after implantation. In all of the animals, there was a calcifying necrosis 3 to 6 mm in diameter with an adjacent small zone of demyelination. There were no signs of delayed radiation damage outside the demyelinated perifocal zone. The central tissue necrosis was sharply delineated and did not increase in size after 70 days, i.e., an accumulated dose of 18,000 cGy. In addition, widespread vasogenic edema was present in the homolateral hemisphere. The morphological changes observed differed in many aspects from those found with other radioactive sources, such as gold-198, yttrium-90, or iridium-192. The low energy gamma radiation, the absence of beta radiation, and the half-life of 60.2 days makes iodine-125 a favorable radioactive source to produce a well-defined necrosis without delayed radiation damage in the surrounding brain.

Ostertag, C.B.; Weigel, K.; Warnke, P.; Lombeck, G.; Kleihues, P.

1983-11-01

167

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

168

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

169

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

PubMed Central

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

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

2013-01-01

170

Rectal-wall dose dependence on postplan timing after permanent-seed prostate brachytherapy  

SciTech Connect

Purpose: Dose to rectal wall after permanent-seed prostate brachytherapy is dependent on distance between posterior prostatic seeds and anterior rectal wall and is influenced by postimplant periprostatic edema. We analyzed the effect of postplan timing on anterior rectal-wall dose. Methods and Materials: Twenty patients received permanent seed {sup 125}I brachytherapy as monotherapy (145 Gy). Implants were preplanned by use of transrectal ultrasound (TRUS) and carried out by use of preloaded needles. Postimplant dosimetry was calculated by use of magnetic resonance imaging-computed tomography fusion on Days 1, 8, and 30. The anterior rectal-wall dose is reported as the isodose enclosing 1.0 or 2.0 cc of rectal wall and as the RV100 in cc. Results: The dose to rectal wall increased progressively over time. The median increase in dose to 1.0 cc of rectal wall (RD [1 cc]) from Day 1 to 30 was 39.2 Gy (p < 0.001). RV100 increased from a median of 0.07 cc on Day 1 to 0.67 cc on Day 30. The most significant predictor of rectal-wall dose (RD [1 cc], RD [2 cc], or RV100) was the time of evaluation (p < 0.001). Conclusion: Although periprostatic edema cannot be quantified by postimplant imaging, the dose to the anterior rectal wall increases significantly over time as prostatic and periprostatic edema resolve. Critical-organ dose reporting and guidelines for minimizing toxicity must take into account the time of the assessment.

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

2006-06-01

171

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

172

A CsI(Na) based radiation detector for high resolution imaging studies using iodine 125 in small animal research  

SciTech Connect

The authors report on the development of a high resolution radiation imaging system which is capable of detecting and imaging the coincident gamma and X-ray emissions of the radioisotope iodine 125 ({sup 125}I). Iodine 125 is commonly available as a radioactive label to tag molecular biology probes. Iodine 125 decays via electron capture emitting a 35 keV gamma-ray with the prompt emission of several 27-32 keV X-rays. A coincidence condition can be set to detect the {sup 125}I decays thus reducing background radiation contribution to the image. They are testing the use of arrays of CsI(Na) crystal scintillators coupled to position sensitive photomultiplier tubes for this application. Laboratory studies have thus far been done on mice using a prototype of the detector which is intended to be used to image gene expression in live mice to advance research in neurobiology.

A. Weisenberger; E. Bradley; S. Majewski; and M. Saha

1997-05-01

173

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

174

Real-time magnetic resonance image-guided interstitial brachytherapy in the treatment of select patients with clinically localized prostate cancer  

Microsoft Academic Search

Purpose: This study was performed to establish the dose-localization capability and acute toxicity of a real-time intraoperative magnetic resonance (MR) image-guided approach to prostate brachytherapy in select patients with clinically localized prostate cancer.Methods and Materials: Nine patients with 1997 American Joint Commission on Cancer (AJCC) clinical stage T1cNxM0 prostate cancer, prostate-specific antigen (PSA) < 10 ng\\/ml, biopsy Gleason score not

Anthony V. DAmico; Robert Cormack; Clare M. Tempany; Sanjaya Kumar; George Topulos; Hanne M. Kooy; C. Norman Coleman

1998-01-01

175

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

Gran Borghede; Hans Hedelin; Sten Holmng; Karl Axel Johansson; Gran Sernbo; Claes Mercke

1997-01-01

176

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

177

Low-dose rate prostate brachytherapy is well tolerated in patients with a history of inflammatory bowel disease  

SciTech Connect

Purpose: We report on the follow-up of 24 patients with a prior history of inflammatory bowel disease (IBD) treated with brachytherapy for early-stage prostate cancer. Methods and Materials: Twenty-four patients with a history of inflammatory bowel disease (17 with ulcerative colitis (UC), 7 with Crohn's disease [CD]) underwent prostate brachytherapy between 1992 and 2004. Fifteen patients were treated with I-125 implantation and 6 patients were treated with Pd-103 alone or in combination with 45 Gy external beam radiation. Charts were reviewed for all patients, and all living patients were contacted by phone. National Cancer Institute common toxicity scores for proctitis were assigned to all patients. Actuarial risk of late toxicity was calculated by the Kaplan-Meier method. Statistical analysis was performed using SPSS software. Follow-up ranged from 3 to 126 months (median, 48.5 months; mean, 56.8 months). Results: None of the patients experienced Grade 3 or 4 rectal toxicity. Four patients experienced Grade 2 late rectal toxicity. The 5-year actuarial freedom from developing late Grade 2 rectal toxicity was 81%. At a median follow-up of 48.5 months, 23 patients were alive and had no evidence of disease with a median prostate-specific antigen for the sample of 0.1 ng/mL (range, <0.05-0.88 ng/mL). One patient died of other causes unrelated to his prostate cancer. Conclusions: Prostate brachytherapy is well tolerated in patients with a history of controlled IBD. Therefore, brachytherapy should be considered a viable therapeutic option in this patient population.

Peters, Christopher A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)]. E-mail: christopher.peters@mountsinai.org; Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Stone, Nelson N. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); 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)

2006-10-01

178

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

179

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

180

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

PubMed

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

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

2013-05-01

181

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

182

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

183

[Radiation therapy for prostate cancer in the new S3 guideline. Part 2: postoperative radiation therapy and brachytherapy].  

PubMed

Postoperative adjuvant radiation therapy has achieved special significance based on the results of three randomized studies on stage pT3R1 prostate cancer which provided evidence for prolonged survival in comparison to the "wait and see" strategy. When PSA levels persist or increase after radical prostatectomy, irradiation represents an alternative. In this instance, salvage radiotherapy should be initiated as early as possible, most suitably when the PSA level is <0.5 ng/ml. Side effects of percutaneous radiotherapy using modern techniques are minimal in this stage; severe grade 3 or 4 late sequelae occur in <3% of cases. Low dose rate (LDR) brachytherapy as monotherapy is a primary treatment option for low-risk tumors. In patients with intermediate-risk tumors, data are controversial and cannot be assessed conclusively. LDR brachytherapy should not be administered in high-risk tumors. High dose rate (HDR) brachytherapy combined with percutaneous radiotherapy as an example of a typical dose escalation approach is a primary option for intermediate- and high-risk prostate cancer. Whether additional hormone therapy is needed with HDR brachytherapy is unclear. HDR monotherapy can only be recommended in the clinical trial setting. PMID:20180062

Martin, T; Wenz, F; Bhmer, D; Sedlmayer, F; Hinkelbein, W; Henkel, T O; Miller, K; Wiegel, T

2010-02-01

184

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

SciTech Connect

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

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

2008-10-01

185

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

186

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

Microsoft Academic Search

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

Frank Vicini; Julia White; Gregory Gustafson; Richard C Matter; G. Edmundson; A. Martinez; D. H. Clarke

1993-01-01

187

Long-term outcome by risk factors using conformal high-dose-rate brachytherapy (HDR-BT) boost with or without neoadjuvant androgen suppression for localized prostate cancer  

Microsoft Academic Search

PurposeThe aim of this study is to analyze, during the prostate-specific antigen (PSA) era, the long-term outcome of patients treated with conformal high-dose-rate (HDR) brachytherapy boost to the prostate with or without androgen deprivation therapy (ADT) when patients are stratified by risk factors for failure.

Razvan M Galalae; Alvaro Martinez; Tim Mate; Christina Mitchell; Gregory Edmundson; Nils Nuernberg; Stephen Eulau; Gary Gustafson; Michael Gribble; Gyoergy Kovcs

2004-01-01

188

Feasibility study combining low dose rate 192Ir brachytherapy and external beam radiotherapy aiming at delivering 8085 Gy to prostatic adenocarcinoma  

Microsoft Academic Search

Background: Increasing the radiation dose to prostatic adenocarcinoma has provided higher local control rates. A total of 80 Gy seem necessary to achieve this goal but patient set-up and prostate motion remain difficult problems to solve in conformal radiotherapy. Brachytherapy which overcomes these points could be an alternative way to external beam boost fields. We wanted to transpose the irradiation

Phillippe Nickers; Luc Coppers; Marc Beauduin; Marcel Darimont; Jean de Leval; Jean-Marie Deneufbourg

2000-01-01

189

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

190

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

191

Virtual HDR SM CyberKnife Treatment for Localized Prostatic Carcinoma: Dosimetry Comparison With HDR Brachytherapy and Preliminary Clinical Observations  

Microsoft Academic Search

Background: We tested our ability to approximate the dose(38 Gy), fractionation (four fractions), and distribution of high-dose-rate (HDR) brachytherapy for prostate cancer with CyberKnife (CK) stereotactic body radiotherapy (SBRT) plans. We also report early clinical observations of CK SBRT treatment. Methods and Materials: Ten patients were treated with CK. For each CK SBRT plan, an HDR plan was designed using

Donald B. Fuller; John Naitoh; Charles Lee; Steven C. Hardy; Haoran Jin

2008-01-01

192

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

193

Case series analysis of post-brachytherapy prostate edema and its relevance to post-implant dosimetry. Post-implant prostate edema and dosimetry  

PubMed Central

Purpose We evaluated the post-operative pattern of prostate volume (PV) changes following prostate brachytherapy (PB) and analyzed variables which affect swelling. Material and methods Twenty-nine patients treated with brachytherapy (14) or combined brachytherapy and external beam radiotherapy modality (15) underwent pre- and post-implant computed tomography (CT). Prostate volume measurements were done on post-operative days 1, 9, 30, and 60. An observer performed 139 prostate volume (PV) measurements. We analyzed the influence of pre-implant PV, number of needles and insertion attempts, number and activity of seeds, Gleason score, use of hormonal therapy and external beam radiation therapy on the extent of edema. We computed a volume correction factor (CF) to account for dosimetric changes between day 1 and day 30. Using the calculated CF, the dose received by 90% (D90) of the prostate on day 30 (D90Day30) was obtained by dividing day 1 (D90Day1) by the CF. Results The mean PV recorded on post-operative day 1 was 67.7 cm3, 18.8 cm3 greater than average pre-op value (SD 15.6 cm3). Swelling returned to pre-implant volume by day 30. Seed activity, treatment modality, and Gleason score were significant variables. The calculated CF was 0.76. After assessment using the CF, the mean difference between estimated and actual D90Day30 was not significant. Conclusions We observed maximum prostate size on post-operative day 1, returning to pre-implant volume by day 30. This suggests that post-implant dosimetry should be obtained on or after post-operative day 30. If necessary, day 30 dosimetry can be estimated by dividing D90Day1 by a correction factor of 0.76.

Bieniek, Eva; Puckett, Lindsay; Lavaf, Amir; Guirguis, Adel; Bennish, Aaron; Ashamalla, Hani

2012-01-01

194

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

195

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

PubMed Central

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

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

2011-01-01

196

Customized Dose Prescription for Permanent Prostate Brachytherapy: Insights From a Multicenter Analysis of Dosimetry Outcomes  

SciTech Connect

Purpose: To investigate the biochemical control rate in patients undergoing permanent prostate brachytherapy as a function of the biologically effective dose (BED) and risk group. Methods and Materials: Six centers provided data on 3,928 permanent brachytherapy patients with postimplant dosimetry results. The mean prostate-specific antigen level was 8.9 ng/mL. {sup 125}I was used in 2,293 (58%), {sup 103}Pd in 1,635, and supplemental external beam radiotherapy in 882 (22.5%) patients. The patients were stratified into low- (n = 2,188), intermediate- (n = 1,188), and high- (n = 552) risk groups and into three BED groups of < 140 Gy (n = 524), 140-200 Gy (n = 2284), and >200 Gy (n = 1,115). Freedom from biochemical disease progression (biochemical freedom from failure [bFFF]) was determined using the American Society for Therapeutic Radiology Oncology and Phoenix definitions and calculated using the Kaplan-Meier method, with factors compared using the log-rank test. Results: The 10-year prostate-specific antigen bFFF rate for the American Society for Therapeutic Radiology Oncology and Phoenix definitions was 79.2% and 70%, respectively. The corresponding bFFF rates for the low-, intermediate-, and high-risk groups was 84.1% and 78.1%, 76.8% and 63.6%, and 64.4% and 58.2%, respectively (p < 0.0001). The corresponding bFFF rate for the three BED groups was 56.1% and 41.4%, 80% and 77.9%, and 91.1% and 82.9% (p < 0.0001). The corresponding bFFF rate for the low-risk patients by dose group was 69.8% and 49.8%, 86% and 85.2%, and 88.1% and 88.3% for the low-, intermediate, and high-dose group, respectively (p <0.0001). The corresponding bFFF rate for the intermediate-risk patients by dose group was 52.9% and 23.1%, 74.1% and 77.7%, and 94.3% and 88.8% for the low-, intermediate-, and high-dose group, respectively (p < 0.0001). The corresponding bFFF rate for high-risk patients by dose group was 19.2% and 41.7%, 61.8% and 53.2%, and 90% and 69.6% for the low-, intermediate-, and high-dose group, respectively (p < 0.0001). Conclusions: These data suggest that permanent brachytherapy dose prescriptions can be customized to risk status. In low-risk patients, achieving a BED of {>=}140 Gy might be adequate for prostate-specific antigen control. However, high-risk disease might require a BED dose of {>=}200 Gy.

Stone, Nelson N. [Mount Sinai School of Medicine, New York, NY (United States)], E-mail: nelsonstone@optonline.net; Potters, Louis [New York Prostate Institute at South Nassau Communities Hospital, Oceanside, NY (United States); Davis, Brian J. [Mayo Clinic, Rochester, MN (United States); Ciezki, Jay P. [Cleveland Clinic Foundation, Cleveland, OH (United States); Zelefsky, Michael J. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Roach, Mack [University of California, San Francisco, School of Medicine, San Francisco, CA (United States); Fearn, Paul A. B.A. [Memorial Sloan-Kettering Cancer Center, New York, NY (United States); Kattan, Michael W. [Cleveland Clinic Foundation, Cleveland, OH (United States); Stock, Richard G. [Mount Sinai School of Medicine, New York, NY (United States)

2007-12-01

197

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.

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

2013-01-01

198

Using the magnitude of PSA bounce after MRI-guided prostate brachytherapy to distinguish recurrence, benign precipitating factors, and idiopathic bounce  

Microsoft Academic Search

Purpose: To identify events that precipitated a prostate-specific antigen (PSA) bounce and characterize the magnitude, duration, and time to PSA bounce after MRI-guided prostate brachytherapy.Methods and Materials: Between 1997 and 2001, 186 patients with low-risk prostate cancer underwent MRI-guided permanent 125I source implantation, with or without external beam radiotherapy. A PSA bounce was defined as a ?15% elevation in PSA

Prajnan Das; Ming-H Chen; Kristin Valentine; Lynn Lopes; Robert A Cormack; Andrew A Renshaw; Clare M Tempany; Sanjaya Kumar; Anthony V DAmico

2002-01-01

199

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

200

Characterization of the performance of the new MOSkin dosimeter as a quality assurance tool for pulsed dose-rate (PDR) prostate brachytherapy, and the effect of rectal heterogeneity on the dose delivered to the rectal wall  

Microsoft Academic Search

Brachytherapy is a common treatment modality used for treating prostate cancer. The radiation is emitted from within the prostate, which focuses the damage on the tumour rather than the surrounding healthy tissue. However, due to the close proximity of the rectum to the prostate, there is a possibility that the rectum will receive too much radiation dose during prostate treatment.

Ian S Kwan

2009-01-01

201

Early observed transient prostate-specific antigen elevations on a pilot study of external beam radiation therapy and fractionated MRI guided High Dose Rate brachytherapy boost  

Microsoft Academic Search

PURPOSE: To report early observation of transient PSA elevations on this pilot study of external beam radiation therapy and magnetic resonance imaging (MRI) guided high dose rate (HDR) brachytherapy boost. MATERIALS AND METHODS: Eleven patients with intermediate-risk and high-risk localized prostate cancer received MRI guided HDR brachytherapy (10.5 Gy each fraction) before and after a course of external beam radiotherapy

Anurag K Singh; Peter Guion; Robert C Susil; Deborah E Citrin; Holly Ning; Robert W Miller; Karen Ullman; Sharon Smith; Nancy Sears Crouse; Denise J Godette; Bronwyn R Stall; C Norman Coleman; Kevin Camphausen; Cynthia Mnard

2006-01-01

202

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

203

Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma. [Efficacy and complications  

SciTech Connect

Twelve patients with biopsy-proven clinically localized ductal pancreatic cancers (less than 7 cm in greatest diameter) judged unsuitable for resection were treated by bypass surgery, an Iodine-125 implant (20 to 39 mCi), and postoperative irradiation (4000 to 4500 rads). The potential problems of significant bleeding, pancreatic fistula, or pancreatitis were not experienced. A local recurrence developed in one patient and two recurred in regional lymph nodes. The projected median survival of the group is 11 months with four of the 12 patients still surviving. For purposes of comparison all patients with pancreatic ductal carcinoma treated by radical resection during a similar time were evaluated. All ten have died with a median survival of six months. Twelve of 22 (55%) of the combined implanted and resected groups have developed distant metastasis. Further pursuit of intraoperative techniques of irradiation in combination with adjuvant multidrug chemotherapy seems indicated in an attempt to prolong patient survival which is now limited by hematogenous metastases.

Shipley, W.U.; Nardi, G.L.; Cohen, A.M.; Ling, C.C.

1980-02-15

204

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

205

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

206

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

207

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

208

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

209

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

PubMed

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

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

2013-01-31

210

Equivalent Biochemical Control and Improved Prostate-Specific Antigen Nadir After Permanent Prostate Seed Implant Brachytherapy Versus High-Dose Three-Dimensional Conformal Radiotherapy and High-Dose Conformal Proton Beam Radiotherapy Boost  

Microsoft Academic Search

Purpose: Permanent prostate implant brachytherapy (PPI), three-dimensional conformal radiotherapy (3D-CRT), and conformal proton beam radiotherapy (CPBRT) are used in the treatment of localized prostate cancer, although no head-to-head trials have compared these modalities. We studied the biochemical control (biochemical no evidence of disease [bNED]) and prostate-specific antigen (PSA) nadir achieved with contemporary PPI, and evaluated it against 3D-CRT and CPBRT.

Siavash Jabbari; Vivian K. Weinberg; Katsuto Shinohara; Joycelyn L. Speight; Alexander R. Gottschalk; I.-Chow Hsu; Barby Pickett; Patrick W. McLaughlin; Howard M. Sandler; Mack Roach III

2010-01-01

211

Three-dimensional seed reconstruction for prostate brachytherapy using Hough trajectories.  

PubMed

In order to perform intra-operative or post-implant dosimetry in prostate brachytherapy, the 3D coordinates of the implanted radioactive seeds must be determined. Film or fluoroscopy based seed reconstruction techniques use back projection of x-ray data obtained at two or three x-ray positions. These methods, however, do not perform well when some of the seed images are undetected. To overcome this problem we have developed an alternate technique for 3D seed localization using the principle of Hough transform. The Hough method utilizes the fact that, for each seed coordinate in three dimensions, there exists a unique trajectory in Hough feature space. In this paper we present the Hough transform parametric equations to describe the path of the seed projections from one view to the next and a method to reconstruct the 3D seed coordinates. The results of simulation and phantom studies indicate that the Hough trajectory method can accurately determine the 3D seed positions even from an incomplete dataset. PMID:15005165

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

2004-02-21

212

Oxidative Stress Markers in Prostate Cancer Patients after HDR Brachytherapy Combined with External Beam Radiation  

PubMed Central

Assessment of oxidative stress markers was perfomed in prostate cancer (PCa) patients subjected to high-dose brachytherapy (HDR) with external beam radiotherapy (EBRT). Sixty men with PCa were subjected to combined two-fraction treatment with HDR (tot. 20?Gy) and EBRT (46?Gy). Blood samples were taken before treatment, immediately afterwards, after 1.53 months, and approx. 2 years. Control group consisted of 30 healthy men. Erythrocyte glutathione peroxidase activity in the patients was lower than in healthy subjects by 34% (P < 0.001), 50% (P < 0.001), 30% (P < 0.05), and 61% (P < 0.001), respectively, at all periods. No significant differences were found by comparing superoxide dismutase and catalase activity in PCa patients with that of the controls. After 2 years of the end of treatment, the activity of studied enzymes demonstrated a decreasing tendency versus before therapy. Blood plasma thiobarbituric acid reactive substances (TBARS) concentration was higher than in the controls at all periods, while erythrocyte TBARS decreased after 2 years to control levels. The results confirm that in the course of PCa, imbalance of oxidant-antioxidant processes occurs. The therapy did not alter the levels of oxidative stress markers, which may prove its applicability. Two years is too short a period to restore the oxidant-antioxidant balance.

Wozniak, Alina; Masiak, Rafal; Szpinda, Michal; Mila-Kierzenkowska, Celestyna; Wozniak, Bartosz; Makarewicz, Roman; Szpinda, Anna

2012-01-01

213

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

214

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

SciTech Connect

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

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

2006-02-01

215

Prostate Brachytherapy Seed Reconstruction with Gaussian Blurring and Optimal Coverage Cost  

PubMed Central

Intraoperative dosimetry in prostate brachytherapy requires localization of the implanted radioactive seeds. A tomosynthesis-based seed reconstruction method is proposed. A three-dimensional volume is reconstructed from Gaussian-blurred projection images and candidate seed locations are computed from the reconstructed volume. A false positive seed removal process, formulated as an optimal coverage problem, iteratively removes ghost seeds that are created by tomosynthesis reconstruction. In an effort to minimize pose errors that are common in conventional C-arms, initial pose parameter estimates are iteratively corrected by using the detected candidate seeds as fiducials, which automatically focuses the collected images and improves successive reconstructed volumes. Simulation results imply that the implanted seed locations can be estimated with a detection rate of ? 97.9% and ? 99.3% from three and four images, respectively, when the C-arm is calibrated and the pose of the C-arm is known. The algorithm was also validated on phantom data sets successfully localizing the implanted seeds from four or five images. In a Phase-1 clinical trial, we were able to localize the implanted seeds from five intraoperative fluoroscopy images with 98.8% (STD=1.6) overall detection rate.

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

2009-01-01

216

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

217

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

PubMed

Thermal therapy is an experimental treatment to destroy solid tumours by heating them to temperatures ranging from 55 degrees C to 90 degrees 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. PMID:12741500

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

2003-04-21

218

PSA Nadir of <0.5 ng/mL Following Brachytherapy for Early-Stage Prostate Adenocarcinoma is Associated With Freedom From Prostate-Specific Antigen Failure  

SciTech Connect

Purpose: Because limited information exists regarding whether the rate or magnitude of PSA decline following brachytherapy predicts long-term clinical outcomes, we evaluated whether achieving a prostate-specific antigen (PSA) nadir (nPSA) <0.5 ng/mL following brachytherapy is associated with decreased PSA failure and/or distant metastasis. Methods and Materials: We retrospectively analyzed our database of early-stage prostate adenocarcinoma patients who underwent brachytherapy, excluding those receiving androgen-deprivation therapy and those with <2 years follow-up. Median and mean pretreatment PSA were 6 ng/mL and 7.16 ng/mL, respectively. By clinical stage, 775 were low risk ({<=}T2a), 126 were intermediate risk (T2b), and 20 were high risk (>T2b). By Gleason score, 840 were low risk ({<=}6), 71 were intermediate risk (7), and 10 were high risk (>7). Patients were treated with brachytherapy only (I-125, n = 779, or Pd-103, n = 47), or brachytherapy + external-beam radiation therapy (n = 95). Median follow-up was 6.3 years. We noted whether nPSA <0.5 ng/mL was achieved and the time to achieve this nadir and tested for associations with pretreatment risk factors. We also determined whether this PSA endpoint was associated with decreased PSA failure or distant metastasis. Results: Absence of high-risk factors in clinical stage ({<=}T2b), Gleason score ({<=}7), and pretreatment PSA ({<=}20 ng/mL) was significantly associated with achieving nPSA <0.5 ng/mL. By Kaplan-Meier analysis, patients achieving nPSA <0.5 ng/mL had significantly higher long-term freedom from biochemical failure (FFBF) than nonresponders (5-year FFBF: 95.2 {+-} 0.8% vs. 71.5 {+-} 6.7%; p < 0.0005). Among responders, those who achieved nPSA <0.5 ng/mL in {<=}5 years had higher FFBF than those requiring >5 years (5-year FFBF: 96.7 {+-} 0.7% vs. 80.8 {+-} 4.6%; p < 0.0005). On multivariate analysis, patients who achieved nPSA <0.5 ng/mL in {<=}5 years had significantly higher FFBF than other patients. Conclusions: Pretreatment risk factors (clinical tumor stage, Gleason score, pretreatment PSA) strongly predict for patients achieving nPSA <0.5 ng/mL following brachytherapy, and this cohort had significantly higher long-term FFBF.

Ko, Eric C. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Stone, Nelson N. [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States); Department of Urology, Mount Sinai Medical Center, New York, NY (United States); Stock, Richard G., E-mail: Richard.Stock@mountsinai.org [Department of Radiation Oncology, Mount Sinai Medical Center, New York, NY (United States)

2012-06-01

219

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

220

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, Duanes model and the Army Material Systems Analysis Activity, i.e., Crows model, were applied. The MTBF was used as an important measure for assessing the systems 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 Duanes postulation as well as Crows postulation of reliability growth. The Laplace test index was ?3.82 (<0), indicating a significant trend in failure data, and the failure intervals lengthened gradually. The continuous increase in the failure occurrence interval suggested a trend toward improved reliability. The MTBF was 592 seeds, which implied that several prostate seed implantation cases would be possible without encountering any critical failure. The shape parameter for the MTBF was 0.3859 (<1), suggesting a positive reliability growth of this robotic system. At 95% confidence, the reliability for deposition of 65 seeds was more than 90%. Conclusions: Analyses of failure mode strongly indicated a gradual improvement of reliability of this autonomous robotic system. High MTBF implied that several prostate seed implant cases would be possible without encountering any critical failure.

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

2011-01-01

221

On the Need to Compensate for Edema-Induced Dose Reductions in Preplanned {sup 131}Cs Prostate Brachytherapy  

SciTech Connect

Purpose: Surgical trauma-induced edema and its protracted resolution can lead to significant dose reductions in preplanned {sup 131}Cs prostate brachytherapy. The purpose of this work was to examine whether these dose reductions should be actively compensated for and to estimate the magnitude of the additional irradiation needed for dose compensation. Methods and Materials: The quantitative edema resolution characteristics observed by Waterman et al. were used to examine the physical and radiobiologic effects of prostate edema in preplanned {sup 131}Cs implants. The need for dose compensation was assessed using the dose responses observed in {sup 125}I and {sup 103}Pd prostate implants. The biologically effective dose, calculated with full consideration of edema evolution, was used to estimate the additional irradiation needed for dose compensation. Results: We found that the edema-induced dose reduction in preplanned {sup 131}Cs implants could easily exceed 10% of the prescription dose for implants with moderate or large edema. These dose reductions could lead to a >10% reduction in the biochemical recurrence-free survival for individual patients if the effect of edema was ignored. For a prescribed dose of 120 Gy, the number of 2-Gy external beam fractions needed to compensate for a 5%, 10%, 15%, 20%, and 25% edema-induced dose reduction would be one, four, six, seven, and nine, respectively, for prostate cancer with a median potential doubling time of 42 days. The required additional irradiation increased for fast-growing tumors and/or those less efficient in sublethal damage repair. Conclusion: Compensation of edema-induced dose reductions in preplanned {sup 131}Cs prostate brachytherapy should be actively considered for those implants with moderate or large edema.

Chen, Z. Jay [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)], E-mail: zhe.chen@yale.edu; Deng Jun; Roberts, Kenneth; Nath, Ravinder [Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT (United States)

2008-01-01

222

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

223

Transperineal percutaneous I-125 implant of prostate.  

PubMed

Although Iodine-125 seeds for interstitial radiation of prostatic cancer via the retropubic route is an established method of treatment, the retropubic implant technique has disadvantages: inadequate space for proper placement of the needles, possible bleeding from the prostatic venous plexus by the insertion of needles through these veins, and possible wound infection due to inadvertent puncturing of the bladder and/or rectum by the needles. A technique is described whereby Iodine-125 seeds for interstitial radiation are placed into the prostate through the perineum allowing more accurate placement of the seeds, assuring homogenous dose distribution, and decreasing the risk of bleeding and of bacterial contamination. PMID:7210373

Kumar, P P; Bartone, F F

1981-03-01

224

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

225

[Lack of evidence of benefit - using the example of low dose rate brachytherapy for the treatment of localised prostate carcinoma].  

PubMed

The appraisal of new diagnostics or therapies performed by the Federal Joint Committee in Germany often reveals a dramatic lack of evidence of the benefit of such medical treatments. For example, the evaluation of low dose rate brachytherapy used to treat men with local prostate cancer demonstrates that controlled trials still need to be conducted to ensure evidence-based patient care. In Germany, legal incentives are missing to regularly assess the benefits of medical devices and operative techniques. For the sake of patient safety there is an urgent need for a change in law in order to initiate a systematic evaluation of these new medical technologies before their widespread use. PMID:20951960

Schmedders, Mechtild; Dettloff, Matthias

2010-08-14

226

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

SciTech Connect

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

Mosleh-Shirazi, M. A.; Hadad, K.; Faghihi, R.; Baradaran-Ghahfarokhi, M.; Naghshnezhad, Z.; Meigooni, A. S. [Center for Research in Medical Physics and Biomedical Engineering and Physics Unit, Radiotherapy Department, Shiraz University of Medical Sciences, Shiraz 71936-13311 (Iran, Islamic Republic of); Radiation Research Center and Medical Radiation Department, School of Engineering, Shiraz University, Shiraz 71936-13311 (Iran, Islamic Republic of); Comprehensive Cancer Center of Nevada, Las Vegas, Nevada 89169 (United States)

2012-08-15

227

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

228

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

229

A preliminary analysis of health-related quality of life in the first year after permanent source interstitial brachytherapy (PIB) for clinically localized prostate cancer  

Microsoft Academic Search

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after permanent source interstitial brachytherapy (PIB).Methods and Materials: Thirty-one men treated with PIB between September 1997 and March 1998 completed a quality of life (functional assessment of cancer therapy-prostate: FACT-P) and a urinary symptom questionnaire (international prostate symptom score: IPSS) prior to

W. Robert Lee; Richard P McQuellon; Kesha Harris-Henderson; L. Doug Case; David L McCullough

2000-01-01

230

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

Microsoft Academic Search

Purpose: To present preliminary outcomes of pulsed dose rate brachytherapy (PDR-BT), external beam radiotherapy (EBRT), and hormonal manipulation, for prostate cancer. Patients and Methods: Between December 1999 and January 2005, 165 consecutive patients with Stage T1-T3, N0, M0 prostate cancer were treated. Hormones were used in every patient. Median follow-up was 36 months. Risk groups were low (either Stage {<=}T2a,

Michael A.. Izard; Richard L. Haddad; Gerald B. Fogarty; Adrian Rinks; Timothy Dobbins; Philip Katelaris

2006-01-01

231

MRI-based sector analysis enhances prostate palladium-103 brachytherapy quality assurance in a phase II prospective trial of men with intermediate-risk localized prostate cancer.  

PubMed

PURPOSE: Palladium-103 ((103)Pd) may be superior to other isotopes in brachytherapy for localized intermediate-risk prostate cancer because of its relatively short half-life, higher initial dose rate, and greater dose heterogeneity within the target volume; these properties also underscore the need for accurate target delineation and postimplant quality assurance. We assessed the use of prostate sector analysis based on MRI for quality assurance after (103)Pd monotherapy. METHODS AND MATERIALS: Fifty men with intermediate-risk prostate cancer underwent (103)Pd monotherapy in a prospective phase II trial at MD Anderson Cancer Center. Dosimetric analyses on day 30 after the implant were done using both CT and fused CT/MRI scans. Dosimetric variables were assessed for the entire prostate and for each of three or six sectors. Volumes and dosimetric variables were compared with paired t tests. RESULTS: Postimplant dosimetric variables for the entire prostate were significantly different on CT vs. CT/MRI (p= 0.019 for V100 and p < 0.01 for D90). Prostate volumes were smaller on the CT/MRI scans (p < 0.00001). The base sector contributed the greatest difference, with doses based on CT/MRI lower than those based on CT (p < 0.01 for V100 and D90). To date, these lower base doses have not affected biochemical outcomes for patients with disease in prostate base biopsy samples. CONCLUSIONS: CT/MRI is more precise than CT for prostate volume delineation and dosimetric quality assessment and thus provides superior heterogeneity control assessment after (103)Pd monotherapy implants. PMID:23669149

Takiar, Vinita; Pugh, Thomas J; Swanson, David; Kudchadker, Rajat J; Bruno, Teresa L; McAvoy, Sarah; Mahmood, Usama; Frank, Steven J

2013-05-11

232

Seed localization in ultrasound and registration to C-arm fluoroscopy using matched needle tracks for prostate brachytherapy.  

PubMed

We propose a novel fiducial-free approach for the registration of C-arm fluoroscopy to 3-D ultrasound images of prostate brachytherapy implants to enable dosimetry. The approach involves the reliable detection of a subset of radioactive seeds from 3-D ultrasound, and the use of needle tracks in both ultrasound and fluoroscopy for registration. Seed detection in ultrasound is achieved through template matching in 3-D radio frequency ultrasound signals, followed by thresholding and spatial filtering. The resulting subset of seeds is registered to the complete reconstruction of the brachytherapy implant from multiple C-arm fluoroscopy views. To compensate for the deformation caused by the ultrasound probe, simulated warping is applied to the seed cloud from fluoroscopy. The magnitude of the applied warping is optimized within the registration process. The registration is performed in two stages. First, the needle track projections from fluoroscopy and ultrasound are matched. Only the seeds in the matched needles are then used as fiducials for point-based registration. We report results from a physical phantom with a realistic implant (average postregistration seed distance of 1.6 1.2 mm) and from five clinical patient datasets (average error: 2.8 1.5 mm over 128 detected seeds). We conclude that it is feasible to use RF ultrasound data, template matching, and spatial filtering to detect a reliable subset of brachytherapy seeds from ultrasound to enable registration to fluoroscopy for dosimetry. PMID:22759435

Moradi, Mehdi; Mahdavi, S Sara; Dehghan, Ehsan; Lobo, Julio R; Deshmukh, Sanchit; Morris, William James; Fichtinger, Gabor; Salcudean, Septimiu Tim E

2012-06-29

233

High dose-rate brachytherapy of prostate cancer utilising Iridium-192 after-loading technique: technical and methodological aspects.  

PubMed

The aim of this study was to focus on certain characteristic problems associated with Iridium-192 high dose-rate brachytherapy (Ir-192 HDR-BT) in combination with external beam radiation therapy (EBRT) in the treatment of patients with localised prostate cancer. Over a period of 16 years, >2,000 patients with prostate cancer have been treated in Sweden with a combination of two fractions of 10 Gy Ir-192 HDR-BT and 50 Gy of fractionated EBRT. Although this treatment is usually well tolerated, there are biological and technical factors to be considered before and during the treatment of the patient to avoid side effects or under-treatment of the target volume. Some of the problems facing the doctors are transducer stability, needle deviation, target definition, target motion, pubic arch interference, concomitant diseases and tolerance doses for different organs at risk. These problems are discussed and possible solutions are presented in this study. PMID:17088991

Edgren, M; Ekelund, A M; Albertsson, P; Lundberg, L M; Ullen, A; Levitt, S; Nilsson, S; Lennerns, B

2006-12-01

234

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 512512192 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

235

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

236

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

237

A study of a pretreatment method to predict the number of I-125 seeds required for prostate brachytherapy  

SciTech Connect

Purpose: Prediction of the number of iodine seeds (I-125) required for prostate implantation is an important tool to reduce the number of unused seeds for brachytherapy. This study was designed to investigate the relationship between the number of seeds implanted vs. prostate volume. This can produce a tool to accurately estimate the number of seeds required for a given target volume. In addition, total cost of treatment, personal radiation risks during storage and handling, and errors in accounting for seeds can be reduced. Methods and Materials: Data from two groups of patients who had I-125 seed prostate implants (Oncura/Amersham RAPIDStrand model 6711 I-125) have been separately analyzed: (A) The relationship between prostate volume vs. number of seeds implanted was based on 401 patients treated between 1999 and 2002 who were implanted with seeds of air kerma strength (AKS) of 0.459 {mu}Gyh{sup -1} at 1 m per seed. (B) The relationship between prostate volume vs. total seed AKS was analyzed. This was based on 628 patients treated between 1999 and 2002 who were implanted with a range of seed strengths from 0.381 to 0.521 U. Both patient groups were subdivided into integer prostate volume bins. For each bin, the mean and 95% confidence intervals (CI) for the implanted number of seeds or total AKS implanted were calculated. The upper 95% CI was used to investigate the relationship between the number of seeds implanted and total AKS implanted vs. prostate volume. Results: The new method of predicting the number of seeds shows valid and accurate results. The required number of seeds can be predicted, which helps to reduce the number of leftover seeds to 3% of the total number of seeds ordered. Conclusion: The number of I-125 seeds or the total activity that is required to deliver the prescribed dose for the target volume can be predicted. This could reduce the overall treatment cost by accurate seed ordering before implantation.

Al-Qaisieh, Bashar [Medical Physics Department, Cookridge Hospital, Leeds (United Kingdom)]. E-mail: bashar@medphysics.leeds.ac.uk; Brearley, Elizabeth [Medical Physics Department, Cookridge Hospital, Leeds (United Kingdom); St Clair, Shaun [Medical Physics Department, Cookridge Hospital, Leeds (United Kingdom); Flynn, Anthony [Medical Physics Department, Cookridge Hospital, Leeds (United Kingdom)

2006-05-01

238

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

239

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

240

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

241

Acute genitourinary toxicity after high dose rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: Second analysis to determine the correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity  

Microsoft Academic Search

Purpose: We have been treating localized prostate cancer with high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiation therapy (EBRT) at our institution. We recently reported the existence of a correlation between the severity of acute genitourinary (GU) toxicity and the urethral radiation dose in HDR brachytherapy by using different fractionation schema. The purpose of this study was to evaluate

Tetsuo. Akimoto; Hiroyuki Katoh; Shin-ei Noda; Kazuto Ito; Takumi Yamamoto; Bunzo Kashiwagi; Takashi Nakano

2005-01-01

242

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

243

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

244

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.

2011-02-01

245

PSA kinetics after prostate brachytherapy: PSA bounce phenomenon and its implications for PSA doubling time  

SciTech Connect

Purpose: To analyze prostate-specific antigen (PSA) kinetics in patients treated with prostate brachytherapy (PI) with a minimum of 5 years of PSA follow-up. Methods and Materials: The records of 162 patients treated with PI for localized prostate cancer with a minimum of 5 years of PSA follow-up were reviewed. A variety of pretreatment and posttreatment variables were examined. Patients were coded as having a PSA bounce if their PSA achieved a nadir, elevated at least 0.2 ng/mL greater than that nadir, and decreased to, or below, the initial nadir. Two definitions of biochemical failure (bF) or biochemical relapse-free survival (bRFS) were used: the classic American Society for Therapeutic Radiology and Oncology consensus definition of three consecutive rises (bF3) and the nadir plus 2 ng/mL definition (bFn+2). Associations between a PSA bounce and the various pre- and posttreatment factors were assessed with logistic regression analysis, and the association between a PSA bounce and bF was examined with the log-rank test. The Mann-Whitney U test was applied to test for differences in the PSA doubling time (PSADT) and the time to a PSA rise between the PSA bounce patients and the bF patients. PSADT was calculated from the nadir to the time of the first PSA rise, because this point is known first in the clinical setting. Results: The 5-year overall bRFS rate was 87% for the bF3 definition and 96% for the bFn+2 definition. A PSA bounce was experienced by 75 patients (46.3%). Patients who experienced a PSA bounce were less likely to have a bF, regardless of the bRFS definition used (bF3: p = 0.0015; bFn+2: p = 0.0040). Among the pre- and posttreatment factors, only younger age predicted for a PSA bounce on multivariate analysis (p = 0.0018). The use of androgen deprivation had no effect on PSA bounce. No difference was found in the PSADT between patients who had a PSA bounce and those with bF. The median PSADT for those with a PSA bounce was 8.3 months vs. 10.3 months using the bF3 definition and 8.8 months using the bFn+2 definition. However, a significant difference was found in the time to the first rise in PSA after PI for patients with a PSA bounce vs. patients with bF. The median time to the first rise in PSA after nadir for those with a PSA bounce was 15.1 months vs. 30.0 months using the bF3 definition (p = 0.001) and 22.3 months using the bFn+2 definition (p = 0.013). Conclusion: Patients experiencing a PSA bounce are more likely to be younger and will have a better bRFS. The PSADT cannot differentiate a PSA bounce from bF. The time to the initial PSA rise after nadir is an excellent discriminator of bF from PSA bounce. The time of the PSA rise after nadir occurs far sooner for a PSA bounce than for bF. This factor should be considered when assessing a patient with a rising PSA level after PI before a patient is administered salvage therapy.

Ciezki, Jay P. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States)]. E-mail: ciezkij@ccf.org; Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Garcia, Jorge [Department of Medical Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Angermeier, Kenneth [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Ulchaker, James [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Mahadevan, Arul [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Chehade, Nabil [Department of Urology, Kaiser Permanente Medical Group, Cleveland, OH (United States); Altman, Andrew [Department of Urology, Kaiser Permanente Medical Group, Cleveland, OH (United States); Klein, Eric A. [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States)

2006-02-01

246

Dosimetric quality endpoints for low-dose-rate prostate brachytherapy using biological effective dose (bed) vs. conventional dose  

SciTech Connect

The purpose of this study was to compare conventional low-dose-rate prostate brachytherapy dosimetric quality parameters with their biological effective dose (BED) counterparts. To validate a model for transformation from conventional dose to BED, the postimplant plans of 31 prostate brachytherapy patients were evaluated using conventional dose-volume histogram (DVH) quality endpoints and analogous BED-DVH endpoints. Based on CT scans obtained 4 weeks after implantation, DVHs were computed and standard dosimetric endpoints V100 (volume receiving 100% of the prescribed dose), V150, V200, HI (1-[V150/V100]), and D90 (dose that 90% of the target volume received) were obtained for quality analysis. Using known and reported transformations, dose grids were transformed to BED-early ({alpha}/{beta} = 10 Gy) and BED-late ({alpha}/{beta} = 3 Gy) grids, and the same dosimetric endpoints were analyzed. For conventional, BED-early and BED-late DVHs, no differences in V100 were seen (0.896, 0.893, and 0.894, respectively). However, V150 and V200 were significantly higher for both BED-early (0.582 and 0.316) and BED-late (0.595 and 0.337), compared with the conventional (0.539 and 0.255) DVHs. D90 was significantly lower for the BED-early (103.1 Gy) and BED-late transformations (106.9 Gy) as compared with the conventional (119.5 Gy) DVHs. The conventional prescription parameter V100 is the same for the corresponding BED-early and BED-late transformed DVHs. The toxicity parameters V150 and V200 are slightly higher using the BED transformations, suggesting that the BED doses are somewhat higher than predicted using conventional DVHs. The prescription/quality parameter D90 is slightly lower, implying that target coverage is lower than predicted using conventional DVHs. This methodology can be applied to analyze BED dosimetric endpoints to improve clinical outcome and reduce complications of prostate brachytherapy.

Singh, Rachana; Al-Hallaq, Hania; Pelizzari, Charles A.; Zagaja, Gregory P.; Chen, Andrew; Jani, Ashesh B

2003-12-31

247

Automatic shape-based level set segmentation for needle tracking in 3-D TRUS-guided prostate brachytherapy.  

PubMed

Prostate brachytherapy is an effective treatment for early prostate cancer. The success depends critically on the correct needle implant positions. We have devised an automatic shape-based level set segmentation tool for needle tracking in 3-D transrectal ultrasound (TRUS) images, which uses the shape information and level set technique to localize the needle position and estimate the endpoint of needle in real-time. The 3-D TRUS images used in the evaluation of our tools were obtained using a 2-D TRUS transducer from Ultrasonix (Richmond, BC, Canada) and a computer-controlled stepper motor system from Thorlabs (Newton, NJ, USA). The accuracy and feedback mechanism had been validated using prostate phantoms and compared with 3-D positions of these needles derived from experts' readings. The experts' segmentation of needles from 3-D computed tomography images was the ground truth in this study. The difference between automatic and expert segmentations are within 0.1 mm for 17 of 19 implanted needles. The mean errors of automatic segmentations by comparing with the ground truth are within 0.25 mm. Our automated method allows real-time TRUS-based needle placement difference within one pixel compared with manual expert segmentation. PMID:22763006

Yan, Ping; Cheeseborough, John C; Chao, K S Clifford

2012-07-03

248

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

249

Multi-Parametric MRI-Directed Focal Salvage Permanent Interstitial Brachytherapy for Locally Recurrent Adenocarcinoma of the Prostate: A Novel Approach  

PubMed Central

Even with the technological advances of dose-escalated IMRT with the addition of the latest image guidance technologies, local failures still occur. The combination of MRI-based imaging techniques can yield quantitative information that reflects on the biological properties of prostatic tissues. These techniques provide unique information that can be used for tumor detection in the treated gland. With the advent of these improved imaging modalities, it has become possible to more effectively image local recurrences within the prostate gland. With better imaging, these focal recurrences can be differentially targeted with salvage brachytherapy minimizing rectal and bladder toxicity. Here we report a novel use of MRI-directed focal brachytherapy after local recurrence. This technique offers a unique opportunity to safely and successfully treat recurrent prostate cancer, previously treated with definitive radiation therapy. The use of multi-parametric MRI-directed focal salvage permanent interstitial brachytherapy for locally recurrent adenocarcinoma of the prostate is a promising strategy to avoid more aggressive and expensive treatments that are associated with increased morbidity, potentially improving survival at potentially lower costs.

Wallace, T.; Avital, I.; Stojadinovic, A.; Brucher, B.L.D.M.; Cote, E.; Yu, J.

2013-01-01

250

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

251

A Genetically Determined Dose-Volume Histogram Predicts for Rectal Bleeding among Patients Treated With Prostate Brachytherapy  

SciTech Connect

Purpose: To examine whether possession of genetic alterations in the ATM (ataxia telangiectasia) gene is associated with rectal bleeding in a dose-dependent and volume-dependent manner. Methods and Materials: One hundred eight prostate cancer patients who underwent brachytherapy using either an {sup 125}I implant, a {sup 103}Pd implant, or the combination of external beam radiotherapy with a {sup 103}Pd implant and had a minimum of 1 year follow-up were screened for DNA sequence variations in the 62 coding exons of the ATM gene using denaturing high-performance liquid chromatography. Rectal dose was reported as the volume (in cubic centimeters) of rectum receiving the brachytherapy prescription dose. The two-sided Fisher exact test was used to compare differences in proportions. Results: A significant correlation between the presence of any ATM sequence alteration and Grade 1 to 2 proctitis was obtained when the radiation dose to rectal tissue was quantified. Rectal bleeding occurred in 4 of 13 patients (31%) with a variant versus 1 of 23 (4%) without a genetic alteration for patients who had <0.7 cm{sup 3} of rectal tissue receiving the implant prescription dose (p = 0.05). Of patients in whom 0.7-1.4 cm{sup 3} of the rectum received the implant prescription, 4 of 11 (36%) with an ATM alteration exhibited Grade 1 to 2 proctitis, whereas 1 of 21 (5%) without a variant (p = 0.04) developed this radiation-induced late effect. Conclusions: The possession of genetic variants in the ATM gene is associated with the development of radiation-induced proctitis after prostate cancer radiotherapy for patients who receive the full prescription dose to either a low or a moderate volume of rectal tissue.

Cesaretti, Jamie A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States)]. E-mail: jamie.cesaretti@msnyuhealth.org; Stock, Richard G. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Atencio, David P. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Peters, Sheila A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Peters, Christopher A. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Burri, Ryan J. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Stone, Nelson N. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Rosenstein, Barry S. [Department of Radiation Oncology, Mount Sinai School of Medicine, New York, NY (United States); Department of Community and Preventive Medicine, Mount Sinai School of Medicine, New York, NY (United States); Department of Dermatology, Mount Sinai School of Medicine, New York, NY (United States); Department of Radiation Oncology, New York University School of Medicine, New York, NY (United States)

2007-08-01

252

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

253

Dosimetric Comparison of High-Dose-Rate Brachytherapy and Intensity-Modulated Radiation Therapy as a Boost to the Prostate  

SciTech Connect

Purpose: We compared the dose conformity of two radiation modalities: high-dose-rate brachytherapy (HDR BT) and intensity-modulated radiation therapy (IMRT) to deliver a boost to the prostate after external beam radiotherapy (EBRT). Methods and Materials: Ten successive patients with prostate adenocarcinoma treated with a single 10-Gy HDR BT boost after EBRT were investigated. Four theoretical IMRT plans were computed: (a) 32.85 Gy IMRT and (b) 26 Gy IMRT with CTV-PTV expansions, doses corresponding to the equivalent dose in 2-Gy fractions (EQD2) of one 10-Gy fraction calculated with a prostate alpha/beta ratio of respectively 1.5 and 3 Gy; and (c) 32.85 Gy IMRT and (d) 26 Gy IMRT without CTV-PTV expansions. The dose-volume histogram values converted in EQD2 with an alpha/beta ratio of 3 Gy for the organs at risk were compared. Results: The HDR BT plan delivered higher mean doses to the PTV compared with IMRT plans. In all, 33% of the rectal volume received a mean dose of 5.32 +- 0.65 Gy and 20% of bladder volume received 4.61 +- 1.24 Gy with HDR BT. In comparison, doses delivered with IMRT were respectively 13.4 +- 1.49 Gy and 10.81 +- 4 Gy, even if only 26 Gy was prescribed to the PTV with no CTV-PTV expansion (p < 0.0001). The hot spots inside the urethra were greater with HDR BT but acceptable. Conclusions: Use of HDR BT produced a more conformal plan for the boost to the prostate than IMRT even without CTV-PTV expansions.

Hermesse, Johanne, E-mail: jhermesse@chu.ulg.ac.b [Department of Radiation Oncology, Liege University Hospital, Liege (Belgium); Biver, Sylvie; Jansen, Nicolas [Department of Radiation Oncology, Liege University Hospital, Liege (Belgium); Lenaerts, Eric [Department of Medical Physics, Liege University Hospital, Liege (Belgium); Nickers, Philippe [Department of Radiation Oncology, Oscar Lambret Center, Lille (France)

2010-01-15

254

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

255

Failure-free survival following brachytherapy alone or external beam irradiation alone for T12 prostate tumors in 2222 patients: results from a single practice  

Microsoft Academic Search

Purpose: To evaluate failure-free survival (FFS) for brachytherapy (BT) alone compared to external beam radiotherapy (EBRT) alone for Stage T12 Nx-No Mo patients over the same time period by a single community-based practice in the prostate-specific antigen (PSA) era.Materials and Methods: The database of Arizona Oncology Services (a multiphysician radiation oncology practice in the Phoenix metropolitan area) was reviewed for

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

2000-01-01

256

High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapys 10-year results  

Microsoft Academic Search

Purpose: To present the long-term outcome and morbidity of high-dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) for localized prostate cancer. Methods and Materials: Between September 1991 and December 1998, 209 consecutive patients with no prior androgen suppression were treated with HDR-BT plus EBRT. The median follow-up was 7.25 years (range, 5-12 years). The patients were stratified into three

D. Jeffrey. Demanes; Rodney R. Rodriguez; Lionel Schour; David Brandt; Gillian Altieri

2005-01-01

257

Needle Displacement during High-Dose-Rate Afterloading Brachytherapy Boost and Conventional External Beam Radiation Therapy for Initial and Local Advanced Prostate Cancer  

Microsoft Academic Search

Purpose: To determine the displacement of needles (ND) and its impact in the outcome of initial and locally advanced prostate cancer treated with conventional external beam radiation therapy (EBRT) and fractionated transrectal ultrasound-guided high-dose-rate afterloading brachytherapy (HDR-BT) as a boost. Methods and Materials: From 03\\/97 to 08\\/98 a total of 47 patients were eligible for study entry. Patients with 1992

A. C. A. Pellizzon; J. V. Salvajoli; P. E. R. S. Novaes; M. A. C. Maia; R. Ferigno; R. C. Fogaroli

2003-01-01

258

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; Joo Vitor Salvajoli; Ricardo Cesar Fogaroli; Paulo Eduardo R. S Novaes; Maria Aparecida Conte Maia; Robson Ferrigno

2003-01-01

259

Prophylactic tamsulosin (Flomax) in patients undergoing prostate {sup 125}I brachytherapy for prostate carcinoma: Final report of a double-blind placebo-controlled randomized study  

SciTech Connect

Purpose: To evaluate the effectiveness of prophylactic tamsulosin (Flomax) in reducing the urinary symptoms in patients undergoing {sup 125}I prostate implantation (PI) for prostate adenocarcinoma. Methods and materials: This is a single-institution, double-blind, placebo-controlled, randomized trial for patients undergoing PI for prostate adenocarcinoma comparing prophylactic tamsulosin versus placebo. Eligibility criteria included patients not taking tamsulosin or other {alpha}-blockers treated with PI. The patients were randomly assigned to either tamsulosin (0.8 mg, orally once a day) or matched placebo. All patients started the medication 4 days before PI and continued for 60 days. The American Urologic Association (AUA) symptom index questionnaire was used to assess urinary symptoms. The AUA questionnaire was administered before PI for a baseline score and weekly for 8 weeks after PI. Patients were taken off the study if they developed urinary retention, had intolerable urinary symptoms, or wished to discontinue with the trial. Results: One hundred twenty-six patients were enrolled in this study from November 2001 to January 2003 (118 were evaluable: 58 in the tamsulosin arm and 60 in the placebo group). Pretreatment and treatment characteristics were comparably matched between the two groups. The urinary retention rate was 17% (10 patients) in the placebo group compared with 10% (6 patients) in the tamsulosin group (p = 0.3161). Eighty-eight percent (14 patients) of those who developed urinary retention experienced it within 2 weeks after the PI. Intolerable urinary symptoms were reported equally (10 patients in each group) with 70% occurring in the first 2 weeks after PI. There was a significant difference in mean AUA score in favor of tamsulosin at Week 5 after PI (p = 0.03). Conclusions: Prophylactic tamsulosin (0.8 mg/day) before prostate brachytherapy did not significantly affect urinary retention rates, but had a positive effect on urinary morbidity at Week 5 after PI.

Elshaikh, Mohamed A. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Ulchaker, James C. [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Reddy, Chandana A. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States); Angermeier, Kenneth W. [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Klein, Eric A. [Glickman Urologic Institute, Cleveland Clinic Foundation, Cleveland, OH (United States); Chehade, Nabil [Department of Urology, Kaiser Permanente, Cleveland, OH (United States); Altman, Andrew [Department of Urology, Kaiser Permanente, Cleveland, OH (United States); Ciezki, Jay P. [Department of Radiation Oncology, Cleveland Clinic Foundation, Cleveland, OH (United States)]. E-mail: ciezkj@ccf.org

2005-05-01

260

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

261

Gold marker displacement due to needle insertion during HDR-brachytherapy for treatment of prostate cancer: A prospective cone beam computed tomography and kilovoltage on-board imaging (kV-OBI) study  

PubMed Central

Purpose To evaluate gold marker displacement due to needle insertion during HDR-brachytherapy for therapy of prostate cancer. Patients and methods 18 patients entered into this prospective evaluation. Three gold markers were implanted into the prostate during the first HDR-brachytherapy procedure after the irradiation was administered. Three days after marker implantation all patients had a CT-scan for planning purpose of the percutaneous irradiation. Marker localization was defined on the digitally-reconstructed-radiographs (DRR) for daily (VMAT technique) or weekly (IMRT) set-up error correction. Percutaneous therapy started one week after first HDR-brachytherapy. After the second HDR-brachytherapy, two weeks after first HDR-brachtherapy, a cone-beam CT-scan was done to evaluate marker displacement due to needle insertion. In case of marker displacement, the actual positions of the gold markers were adjusted on the DRR. Results The value of the gold marker displacement due to the second HDR-brachytherapy was analyzed in all patients and for each gold marker by comparison of the marker positions in the prostate after soft tissue registration of the prostate of the CT-scans prior the first and second HDR-brachytherapy. The maximum deviation was 5 mm, 7 mm and 12 mm for the anterior-posterior, lateral and superior-inferior direction. At least one marker in each patient showed a significant displacement and therefore new marker positions were adjusted on the DRRs for the ongoing percutaneous therapy. Conclusions Needle insertion in the prostate due to HDR-brachytherapy can lead to gold marker displacements. Therefore, it is necessary to verify the actual position of markers after the second HDR-brachytherapy. In case of significant deviations, a new DRR with the adjusted marker positions should be generated for precise positioning during the ongoing percutaneous irradiation.

2012-01-01

262

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

263

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

SciTech Connect

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

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

2012-03-15

264

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

265

Radiation safety aspects of brachytherapy for prostate cancer using permanently implanted sources. A report of ICRP Publication 98.  

PubMed

The use of permanent radioactive implants (125I or 103Pd seeds) to treat selected localised prostate cancer patients has been increasing rapidly all over the world for the last 15 years. It is estimated that more than 50,000 patients are treated this way every year in the world, and this number is anticipated to increase in the near future. Although no accidents or adverse effects involving medical staff and/or members of the patient's family have been reported to date, this brachytherapy technique raises a number of radiation safety issues that need specific recommendations from the ICRP. All data concerning the dose received by people approaching patients after implantation have been reviewed. Those doses have been either been measured directly or calculated. The available data show that, in the vast majority of cases, the dose to comforters and carers remains well below the recommended limit of 1 mSv/year. Only the (rare) case where the patient's partner is pregnant at the time of implantation may need specific precautions. Expulsion of sources through urine, semen, or the gastro-intestinal tract is rare. Specific recommendations should be given to patients to allow them to deal adequately with this event. Of note, due to the low activity of an isolated seed and its low photon energy, no incident/accident linked to seed loss has ever been recorded. When performed in the first few months after implantation, cremation of bodies (frequent in some countries) raises several issues related to: (1) the activity that remains in the patient's ashes; and (2) the airborne dose, potentially inhaled by crematorium staff or members of the public. Review of available data shows that cremation can be allowed if 12 months have elapsed since implantation with 125I (3 months for 103Pd). If the patient dies before this delay has elapsed, specific measures must be undertaken. Specific recommendations have to be given to the patient to warn his surgeon in case of subsequent pelvic or abdominal surgery. A 'wallet card' with all relevant information about the implant is useful. In most cases, brachytherapy does make the patient infertile. However, although the therapy-related modifications of the semen reduce fertility, patients must be aware of the possibility of fathering children after such a permanent implantation, with a limited risk of genetic effects for the child. Patients with permanent implants must be aware of the possibility of triggering certain types of security radiation monitors. The 'wallet card' including the main information about the implant (see above) may prove to be helpful in such a case. Considering the available experience after brachytherapy and external irradiation of prostate cancer, the risk of radio-induced secondary tumours appears to be extremely low. The demonstrated benefit of brachytherapy clearly outweighs, by far, the very limited (mainly theoretical)increase in the radiation-induced cancer risk. PMID:16330284

2005-01-01

266

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

Microsoft Academic Search

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

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

2004-01-01

267

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

268

High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California endocurietherapy's 10-year results  

SciTech Connect

Purpose: To present the long-term outcome and morbidity of high-dose-rate brachytherapy (HDR-BT) combined with external beam radiotherapy (EBRT) for localized prostate cancer. Methods and Materials: Between September 1991 and December 1998, 209 consecutive patients with no prior androgen suppression were treated with HDR-BT plus EBRT. The median follow-up was 7.25 years (range, 5-12 years). The patients were stratified into three risk groups: low (Stage T2a or less, Gleason score {<=}6, and prostate-specific antigen [PSA] level {<=}10 ng/mL), intermediate (Stage T2b,c, Gleason score 7, and PSA level 10-20 ng/mL), and high (Stage T3, Gleason score 8-10, and PSA level >20). Four definitions of PSA progression were compared with the general clinical failure outcome: the American Society for Therapeutic Radiology and Oncology (ASTRO) definition, nadir plus 2.0 ng/mL, two consecutive rises {>=}0.5 ng/mL, and PSA level >0.2 ng/mL. Morbidity was scored using Radiation Therapy Oncology Group criteria. Results: The general clinical control rate was 90% (188 of 209), and the general clinical failure rate was 10% (21 of 209). The overall survival rate was 79%, and the cause-specific survival rate was 97%. The PSA progression-free survival (ASTRO definition) rate was 90%, 87%, and 69% for the low-, intermediate-, and high-risk groups, respectively. The nadir plus 2 ng/mL and two rises {>=}0.5 definitions correlated better with the actual clinical outcome than did the ASTRO and PSA >0.2 ng/mL definitions. The rate of Grade 3 and 4 late urinary morbidity was 6.7% and 1%, respectively, mostly occurring in patients who had undergone post-RT transurethral prostate resection. No late Grade 3 or 4 rectal morbidity developed. The sexual potency preservation rate was 67%. Conclusion: Our 10-year results have demonstrated HDR-BT plus EBRT is a proven treatment for all stages of localized prostate cancer. The morbidity was low, but post-RT transurethral resection should be avoided.

Demanes, D. Jeffrey [California Endocurietherapy Cancer Center, Oakland, CA (United States)]. E-mail: jdemanes@cetmc.com; Rodriguez, Rodney R. [California Endocurietherapy Cancer Center, Oakland, CA (United States); Schour, Lionel [California Endocurietherapy Cancer Center, Oakland, CA (United States); Brandt, David [California Endocurietherapy Cancer Center, Oakland, CA (United States); Altieri, Gillian [California Endocurietherapy Cancer Center, Oakland, CA (United States)

2005-04-01

269

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

270

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

271

Can extraprostatic extension be treated by prostate brachytherapy? An analysis based on postimplant dosimetry  

Microsoft Academic Search

Purpose: To determine whether extraprostatic extension (EPE) can be treated by Pd-103 prostate implants.Methods and Materials: The postimplant dosimetry of 22 consecutive Pd-103 prostate implants was analyzed to determine whether potential EPE was adequately treated. The implants were peripherally loaded and planned with a 35-mm dose margin at midgland. Seeds were not implanted outside of the capsule except at the

Deborah Butzbach; Frank M. Waterman; Adam P. Dicker

2001-01-01

272

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

SciTech Connect

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

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

1983-05-01

273

Iodine-125 implant and external beam irradiation in patients with localized pancreatic carcinoma: a comparative study to surgical resection.  

PubMed

Twelve patients with biopsy-proven clinically localized ductal pancreatic cancers (less than 7 cm in greatest diameter) judged unsuitable for resection were treated by bypass surgery, an Iodine-125 implant (20-39 mCi), and postoperative irradiation (4000-4500 rads). The potential problems of significant bleeding, pancreatic fistula, or pancreatitis were not experienced. A local recurrence developed in one patient and two recurred in regional lymph nodes. The projected median survival of the group is 11 months with four of the 12 patients still surviving. For purposes of comparison all patients with pancreatic ductal carcinoma treated by radical resection during a similar time were evaluated. All ten have died with a median survival of six months. Twelve of 22 (55%) of the combined implanted and resected groups have developed distant metastasis. Further pursuit of intraoperative techniques of irradiation in combination with adjuvant multidrug chemotherapy seems indicated in an attempt to prolong patient survival which is now limited by hematogenous metastases. PMID:6244074

Shipley, W U; Nardi, G L; Cohen, A M; Ling, C C

1980-02-15

274

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

275

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

276

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

PubMed Central

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

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

2013-01-01

277

Radiation dose to the internal pudendal arteries from permanent-seed prostate brachytherapy as determined by time-of-flight MR angiography  

SciTech Connect

Purpose: To determine the feasibility of time-of-flight magnetic resonance (MR) angiography to visualize the internal pudendal arteries (IPAs) in potent men undergoing permanent-seed prostate brachytherapy and to calculate the radiation dose received by these arteries. Methods and Materials: Prostate brachytherapy is performed at the University Health Network/Princess Margaret Hospital by use of transrectal ultrasound (TRUS) preplanning and preloaded needles. All patients received {sup 125}I, with a mean seed activity of 0.32 mCi/seed (0.41 U). Postplan evaluation is performed at 1 month by magnetic resonance-computed tomography fusion. Twenty consecutive potent men had time-of-flight MR angiography as part of their postplan evaluation. Results: The mean V100 was 96.5%, and the mean D90 was171.5 Gy. The IPAs were easily visualized for 18 of the 20 men. The mean peak dose received by the IPA was 17 Gy. The highest peak dose received by any patient was 38.2 Gy, with only 1 other patient receiving a peak dose greater than 30 Gy. Eleven of 18 had a measurable portion of at least 1 IPA that received 10% of the prescribed dose (V10 = 14.5 Gy). Only 2 patients had nonzero values for V25. The distal third of the IPA received the highest dose for 16 of the 18 patients. Conclusions: The IPAs can be well visualized in the majority of potent men by use of time-of-flight MR angiography 1 month after brachytherapy. The IPAs receive a low but calculable dose from permanent-seed {sup 125}I brachytherapy. Further research is needed to determine if this outcome has any correlation with subsequent potency.

Gillan, Caitlin [Department of Radiation Medicine, University Health Network, Princess Margaret Hospital, Toronto (Canada); Kirilova, Anna [Department of Radiation Physics, University Health Network, Princess Margaret Hospital, Toronto (Canada); Landon, Angela [Department of Radiation Medicine, University Health Network, Princess Margaret Hospital, Toronto (Canada); Yeung, Ivan [Department of Radiation Physics, University Health Network, Princess Margaret Hospital, Toronto (Canada); Pond, Gregory [Department of Biostatistics, University Health Network, Princess Margaret Hospital, Toronto (Canada); Crook, Juanita [Department of Radiation Oncology, University Health Network, Princess Margaret Hospital, Toronto (Canada)]. E-mail: juanita.crook@rmp.uhn.on.ca

2006-07-01

278

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

279

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

280

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

281

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

282

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

283

Transperineal percutaneous iridium-192 implant of the prostate  

Microsoft Academic Search

Interstitial implantation of radioisotopes has become an increasingly popular modality for the management of localized adenocarcinoma of the prostate. Despite the recognized disadvantages, including technical difficulties of accurate seed placement, uncorrectable dose, inhomogeneities in implant volume, limitations in the range of irradiation, and radiation exposure to personnel handling active sources, permanent implantation of either iodine-125 or gold-198 seeds has been

Kutub Khan; E. David Crawford; Edward L. Johnson

1983-01-01

284

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

SciTech Connect

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 modalities. Methods and Materials: A total of 2376 patients with clinical stage T1-T3 N0 M0 prostate cancer were treated with conventional dose (median, 66.6 Gy) EBRT (n = 1201), high-dose (median, 75.6 Gy) adaptive radiation therapy (n = 465), EBRT + high-dose-rate brachytherapy boost (n 416), or brachytherapy alone (n = 294) between 1987 and 2003. A total of 496 patients (21%) received neoadjuvant AD with radiation therapy. There were 21924 posttreatment prostate-specific antigen (PSA) measurements. Multiple BF definitions were tested for their sensitivity, specificity, positive predictive value (+PV), and negative PV (-PV) in predicting subsequent clinical failure (CF) (any local failure or distant metastasis), overall survival (OS), and cause-specific survival (CSS). Median follow-up was 4.5 years. The date of BF was the date BF criteria were met (e.g., date of third rise). Results: A total of 290 patients (12%) experienced CF at a median interval of 3.6 years (range, 0.2-15.2 years). The 5- and 10-year CF rates were 12% and 26%, respectively. Three consecutive rises yielded a 46% sensitivity and 84% specificity for predicting CF. The 10-year CF for those 475 patients who experienced three rises (BF) was 37% vs. 17% for those patients who did not meet these criteria (biochemically controlled [BC]). For all patients, the following definitions were superior to three rises for predicting CF for both +PV, and -PV: n + 1 ({>=}1 ng/mL above nadir), n + 2, n + 3, threshold 2 (any PSA {>=}2.0 ng/mL at or after nadir), threshold 3, threshold 4, and threshold 5. For the subset of patients treated with EBRT alone, the n + k definitions and threshold k definitions maintained superior predictive capacity. However, the threshold k definitions seemed to maintain a slightly greater separation in 10-year CF rates (43% for BF vs. 13% for BC = 30% difference for threshold 3). Surprisingly, all definitions generally had better predictive capacity for those patients who received brachytherapy or neoadjuvant AD vs. EBRT alone. The endpoints appeared similar for n + 1 vs. threshold 3 and n + 2 vs. threshold 4 in EBRT alone patients, but for brachytherapy or neoadjuvant AD patients, there were similarities for n + 2 vs. threshold 3 and n + 3 vs. threshold 4. This may be a reflection of the lower nadir levels in patients receiving AD (median <0.1 ng/mL vs. 0.2 ng/mL for brachytherapy vs. 0.8 ng/mL for EBRT alone, p < 0.01). When examining CF correlation for the various classes of BF definitions, the threshold k definitions clearly demonstrated the greatest area under the receiver operating characteristic curve, followed by the n + k definitions. For OS, the threshold k definitions again demonstrated the greatest area under the curve, followed by definitions based on specific nadir cutoffs (nadir {>=}k ng/mL). Conclusions: Biochemical failure definitions applying a PSA threshold at or after the nadir (e.g., threshold 3) demonstrated the highest association with CF, OS, and CSS for all assessed treatment modalities. Definitions incorporating a PSA increase above the nadir value (e.g., nadir + 2 ng/mL) were also superior for all modalities. In general, BF definitions have greater predictive capacity for clinical outcome with brachytherapy or neoadjuvant AD than EBRT alone, possibly because of less 'noise' from production of background PSA.

Fitch, Dwight L. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); McGrath, Samuel [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Martinez, Alvaro A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Vicini, Frank A. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States); Kestin, Larry L. [Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI (United States)]. E-mail: lkestin@beaumont.edu

2006-12-01

285

Automated localization of implanted seeds in 3D TRUS images used for prostate brachytherapy  

SciTech Connect

An algorithm has been developed in this paper to localize implanted radioactive seeds in 3D ultrasound images for a dynamic intraoperative brachytherapy procedure. Segmentation of the seeds is difficult, due to their small size in relatively low quality of transrectal ultrasound (TRUS) images. In this paper, intraoperative seed segmentation in 3D TRUS images is achieved by performing a subtraction of the image before the needle has been inserted, and the image after the seeds have been implanted. The seeds are searched in a 'local' space determined by the needle position and orientation information, which are obtained from a needle segmentation algorithm. To test this approach, 3D TRUS images of the agar and chicken tissue phantoms were obtained. Within these phantoms, dummy seeds were implanted. The seed locations determined by the seed segmentation algorithm were compared with those obtained from a volumetric cone-beam flat-panel micro-CT scanner and human observers. Evaluation of the algorithm showed that the rms error in determining the seed locations using the seed segmentation algorithm was 0.98 mm in agar phantoms and 1.02 mm in chicken phantoms.

Wei Zhouping; Gardi, Lori; Downey, Donal B.; Fenster, Aaron [Imaging Research Laboratories, Robarts Research Institute, London, ON N6A 5K8 (Canada) and Biomedical Engineering Graduate Program, University of Western Ontario, London, ON N6A 5B9 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, ON N6A 5K8 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, ON N6A 5K8 (Canada) and Medical Imaging Department, Royal Island Hospital, Kamloops, BC V2C 2T1 (Canada); Imaging Research Laboratories, Robarts Research Institute, London, ON N6A 5K8 (Canada); Biomedical Engineering Graduate Program, University of Western Ontario, London, ON N6A 5B9 (Canada) and Department of Radiology and Nuclear Medicine, University of Western Ontario, London, ON N6A 5A5 (Canada)

2006-07-15

286

Selecting Patients for Exclusive Permanent Implant Prostate Brachytherapy: The Experience of the Paris Institut Curie/Cochin Hospital/Necker Hospital Group on 809 Patients  

SciTech Connect

Purpose: The aim of this study was to analyze overall and relapse-free survival in a cohort of 809 patients, 34% of whom corresponded to a higher-risk group than American Brachytherapy Society (ABS) criteria. Methods and Materials: Between January 1999 and September 2004, 809 patients were treated with permanent loose 125 iodine seed implantation (IsoSeed Bebig, Eckert and Ziegler) by the Paris Institut Curie, Cochin Hospital, and Necker Hospital group. Of these 809 patients, 533 (65.9%) corresponded exactly to ABS criteria. Two hundred and seventy-six patients (34.1%) had a prostate-specific antigen (PSA) level between 10 and 15, or a Gleason score of 7, or both (non-ABS group). Results: Overall 5-year survival was 98%, with no difference between the ABS group and the non-ABS patient subgroups (p 0.62).Five-year relapse-free survival was 97% in the ABS group; it was significantly lower (p = 0.001) in the non-ABS group but remained satisfactory at 94%. On subgroup analysis, the results appeared to be better for the subgroup of patients with PSA 10-15 than for the subgroup with a Gleason score of 7. Conclusions: Our results suggest that selected patients in the intermediate-risk group of localized prostate cancers can be safely proposed as recipients of permanent implant brachytherapy as monotherapy.

Cosset, Jean-Marc [Institut Curie, Paris (France)], E-mail: jean-marc.cosset@curie.net; Flam, Thierry [Cochin Hospital, Paris (France); Thiounn, Nicolas [Necker Hospital, Paris (France); Gomme, Stephanie; Rosenwald, Jean-Claude; Asselain, Bernard; Pontvert, Dominique; Henni, Mehdi [Institut Curie, Paris (France); Debre, Bernard [Cochin Hospital, Paris (France); Chauveinc, Laurent [Institut Curie, Paris (France)

2008-07-15

287

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

SciTech Connect

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

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

2006-03-01

288

High-Risk Prostate Cancer With Gleason Score 8-10 and PSA Level {<=}15 ng/ mL Treated With Permanent Interstitial Brachytherapy  

SciTech Connect

Purpose: With widespread prostate-specific antigen (PSA) screening, there has been an increase in men diagnosed with high-risk prostate cancer defined by a Gleason score (GS) {>=}8 coupled with a relatively low PSA level. The optimal management of these patients has not been defined. Cause-specific survival (CSS), biochemical progression-free survival (bPFS), and overall survival (OS) were evaluated in brachytherapy patients with a GS {>=}8 and a PSA level {<=}15 ng/mL with or without androgen-deprivation therapy (ADT). Methods and Materials: From April 1995 to October 2005, 174 patients with GS {>=}8 and a PSA level {<=}15 ng/mL underwent permanent interstitial brachytherapy. Of the patients, 159 (91%) received supplemental external beam radiation, and 113 (64.9%) received ADT. The median follow-up was 6.6 years. The median postimplant Day 0 minimum percentage of the dose covering 90% of the target volume was 121.1% of prescription dose. Biochemical control was defined as a PSA level {<=}0.40 ng/mL after nadir. Multiple parameters were evaluated for impact on survival. Results: Ten-year outcomes for patients without and with ADT were 95.2% and 92.5%, respectively, for CSS (p = 0.562); 86.5% and 92.6%, respectively, for bPFS (p = 0.204); and 75.2% and 66.0%, respectively, for OS (p = 0.179). The median post-treatment PSA level for biochemically controlled patients was <0.02 ng/mL. Multivariate analysis failed to identify any predictors for CSS, whereas bPFS and OS were most closely related to patient age. Conclusions: Patients with GS {>=}8 and PSA level {<=}15 ng/mL have excellent bPFS and CSS after brachytherapy with supplemental external beam radiotherapy. The use of ADT did not significantly impact bPFS, CSS, or OS.

Fang, L. Christine [Department of Radiation Oncology, University of Washington, Seattle, WA (United States); Merrick, Gregory S., E-mail: gmerrick@urologicresearchinstitute.org [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Butler, Wayne M.; Galbreath, Robert W.; Murray, Brian C.; Reed, Joshua L. [Schiffler Cancer Center, Wheeling Jesuit University, Wheeling, WV (United States); Adamovich, Edward [Department of Pathology, Wheeling Hospital, Wheeling, WV (United States); Wallner, Kent E. [Puget Sound Veterans Affairs Hospital, Seattle, WA (United States)

2011-11-15

289

A Pilot Study of Catheter-Based Ultrasound Hyperthermia with HDR Brachytherapy for Treatment of Locally Advanced Cancer of the Prostate and Cervix  

NASA Astrophysics Data System (ADS)

Interstitial and endocavity ultrasound devices have been developed specifically for applying hyperthermia within temporary HDR brachytherapy implants during radiation therapy. 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. 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 length180 deg and 3-4 cm360 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 x 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 four 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.

2011-09-01

290

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

SciTech Connect

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

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

2007-09-01

291

Hypofractionated Boost With High-Dose-Rate Brachytherapy and Open Magnetic Resonance Imaging-Guided Implants for Locally Aggressive Prostate Cancer: A Sequential Dose-Escalation Pilot Study  

SciTech Connect

Purpose: To evaluate the feasibility, tolerance, and preliminary outcome of an open MRI-guided prostate partial-volume high-dose-rate brachytherapy (HDR-BT) schedule in a group of selected patients with nonmetastatic, locally aggressive prostatic tumors. Methods and Materials: After conventional fractionated three-dimensional conformal external radiotherapy to 64-64.4 Gy, 77 patients with nonmetastatic, locally aggressive (e.g., perineural invasion and/or Gleason score 8-10) prostate cancer were treated from June 2000 to August 2004, with HDR-BT using temporary open MRI-guided {sup 192}Ir implants, to escalate the dose in the boost region. Nineteen, 21, and 37 patients were sequentially treated with 2 fractions of 6 Gy, 7 Gy, and 8 Gy each, respectively. Neoadjuvant androgen deprivation was given to 62 patients for 6-24 months. Acute and late toxicity were scored according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scoring system. Results: All 77 patients completed treatment as planned. Only 2 patients presented with Grade >=3 acute urinary toxicity. The 3-year probability of Grade >=2 late urinary and low gastrointestinal toxicity-free survival was 91.4% +- 3.4% and 94.4% +- 2.7%, respectively. Rates of 3-year biochemical disease-free survival (bDFS) and disease-specific survival were 87.1% +- 4.1% and 100%, respectively. Conclusions: Boosting a partial volume of the prostate with hypofractionated HDR-BT for aggressive prostate cancer was feasible and showed limited long-term toxicity, which compared favorably with other dose-escalation methods in the literature. Preliminary bDFS was encouraging if one considers the negatively selected population of high-risk patients in this study.

Ares, Carmen; Popowski, Youri [Department of Radiation Oncology, University Hospital of Geneva, Geneva (Switzerland); Pampallona, Sandro [Med, Services for Medical Research, Evolene (Switzerland); Nouet, Philippe; Dipasquale, Giovanna [Department of Radiation Oncology, University Hospital of Geneva, Geneva (Switzerland); Bieri, Sabine; Ozsoy, Orhan [Department of Radiation Oncology, Regional Hospital of Valais, Hospital of Sion (Switzerland); Rouzaud, Michel [Department of Radiation Oncology, University Hospital of Geneva, Geneva (Switzerland); Khan, Haleem [Institut de Radiologie Jean Violette, Geneva (Switzerland); Miralbell, Raymond, E-mail: Raymond.Miralbell@hcuge.c [Department of Radiation Oncology, University Hospital of Geneva, Geneva (Switzerland)

2009-11-01

292

Treatment Results of PDR Brachytherapy Combined With External Beam Radiotherapy in 106 Patients With Intermediate- to High-Risk Prostate Cancer  

SciTech Connect

Purpose: To evaluate treatment outcome of pulsed dose-rate brachytherapy (PDR) combined with external-beam radiotherapy (EBRT) for the treatment of prostate cancer. Methods and Materials: Between 2002 and 2007, 106 patients were treated by EBRT combined with PDR and followed prospectively. Two, 38, and 66 patients were classified as low-, intermediate-, and high-risk disease respectively according to the National Comprehensive Cancer Network criteria. EBRT dose was 46 Gy in 2.0-Gy fractions. PDR dose was increased stepwise from 24.96 to 28.80 Gy. Biochemical disease free survival and overall survival were determined by the Kaplan-Meier method. Cumulative incidence of late gastrointestinal (GI) and genitourinary (GU) toxicity were scored, according to the Common Terminology Criteria for Adverse Events. Results: The 3- and 5-year biochemical nonevidence of disease (bNED) were 92.8% (95% confidence interval [CI], 87.1-98.5) and 89.5% (95% CI, 85.2-93.8), respectively. Overall survival at 3 and 5 years was 99% (95% CI, 96-100) and 96% (95% CI, 90-100), respectively. The 3- and 5-year Grade 2 GI toxicity was 5.3% (95% CI, 0-10.6) and 12.0% (95% CI, 1.4-22.6), respectively. No Grade 3 or higher GI toxicity was observed. The 3- and 5-year Grade 2 or higher GU toxicity was 18.7% (95% CI, 10.3-27.1) and 26.9% (95% CI, 15.1-38.7), respectively. Conclusion: Results on tumor control and late toxicity of EBRT combined with PDR are good and comparable to results obtained with EBRT combined with high-dose-rate brachytherapy for the treatment of prostate cancer.

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

2011-03-15

293

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

SciTech Connect

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

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

2006-09-01

294

Health-Related Quality of Life After Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Prostate Cancer  

SciTech Connect

Purpose: To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change. Methods and Materials: Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months. Results: By 24 months, 23% had Grade 2 urinary toxicity and only 5% had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53%, 51%, 45%, and 40% at 12 months and 57%, 65%, 51%, and 30% at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38%, 36%, 24%, and 20% at 12 months and 46%, 48%, 19%, and 8% at 24 months, respectively. On multivariate analysis, the dose to 10% of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose to 10% of the urethra cutpoint for urinary health-related quality of life was 120% of the prescription dose. Conclusion: EPIC was a more sensitive tool for detecting the effects on function and bother than were the generic toxicity scales. The urethral dose had the strongest association with a deteriorating urinary quality of life.

Morton, Gerard C., E-mail: gerard.morton@sunnybrook.ca [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Loblaw, D. Andrew; Chung, Hans [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Tsang, Gail [Premion, Wesley Medical Centre, Brisbane, Queensland (Australia); Sankreacha, Raxa [Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Deabreu, Andrea; Zhang Liying; Mamedov, Alexandre [Department of Clinical Trials and Epidemiology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Cheung, Patrick [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Batchelar, Deidre [Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada); Danjoux, Cyril; Szumacher, Ewa [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto, ON (Canada)

2011-08-01

295

MRS-guided HDR brachytherapy boost to the dominant intraprostatic lesion in high risk localised prostate cancer  

Microsoft Academic Search

BACKGROUND: It is known that the vast majority of prostate cancers are multifocal. However radical radiotherapy historically treats the whole gland rather than individual cancer foci. Magnetic resonance spectroscopy (MRS) can be used to non-invasively locate individual cancerous tumours in prostate. Thus an intentionally non-uniform dose distribution treating the dominant intraprostatic lesion to different dose levels than the remaining prostate

Aleksandra Kazi; Guy Godwin; John Simpson; Giuseppe Sasso

2010-01-01

296

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

Microsoft Academic Search

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

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

1987-01-01

297

[Cancer of the prostate: technics of curietherapy. Review of the literature and experience at the Institut Gustave-Roussy].  

PubMed

Pasteau and Degrais in Paris used radium to treat prostatic cancer in 1907, radium was further used with different techniques including radium needles and radon seeds during twenty years. In 1951, Flock advocated colloidal radioactive gold with interesting palliative results. Permanent gold seeds implant was also used. But until 1970 with the appearance of Iodine 125 grain, brachytherapy was not widely employed. Hilaris and Whitmore treated almost 1000 cases until now, with few immediate complications. Survivals at 5 years are T1 96%, T2 76%, T3 69%. Conservation of potency and absence of late complications are the main benefits. However, the technique is a somewhat complex surgical procedure and the cases have to be carefully selected. Many others centers used iodine technique and Holm recently proposed an ingenious per-operative echography to improve the safety and accuracy of the permanent implantation. Removable implants with 192Ir wire (or nylon ribbon seeds) are obviously simpler and safer to implant through perineal route. For us, flexible plastic tubes is the technique of choice. In ten cases irradiated at 70 Gy level, no recurrences and no complications except one pulmonary embolism, but the patients were highly selected. For Syed rigid needles through perineal template is the technique of choice. External radiation is added after the implant, which delivered a dose of about 30 Gy. The results are satisfactory in the first 100 cases, but with a high level of complication. Comparative series and more follow-up are evidently requested, to know the exact place of brachytherapy in the treatment of prostatic adenocarcinoma. PMID:4092108

Chassagne, D; Court, B; Gerbaulet, A; Perrin, J L; Haie, C

1985-01-01

298

Pubic arch detection in transrectal ultrasound guided prostate cancer therapy  

Microsoft Academic Search

New biopsy techniques, increased life expectancy, and prostate-specific antigen (PSA) screening have contributed to an increase in the reported incidence of prostate cancer. Among several treatment options available to the patients, transperineal prostate brachytherapy has emerged as a medically successful, cost-effective outpatient procedure for treating localized prostate cancer. Transperineal prostate brachytherapy employs transrectal ultrasound (TRUS) as the primary imaging modality

Sayan D. Pathak; Peter D. Grimm; Vikram Chalana; Yongmin Kim

1998-01-01

299

Enhanced Ultrasound Visualization of Brachytherapy Seeds by a Novel Magnetically Induced Motion Imaging Method.  

National Technical Information Service (NTIS)

We have devised a method called Magnetically Induced Motion Imaging (MIMI) for identifying brachytherapy seeds in ultrasound images. Ultrasound guided brachytherapy is a common treatment for prostate cancer. The overall goal of this project is the unambig...

S. McAleavey

2009-01-01

300

Acute genitourinary toxicity after high dose rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: Second analysis to determine the correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity  

SciTech Connect

Purpose: We have been treating localized prostate cancer with high-dose-rate (HDR) brachytherapy combined with hypofractionated external beam radiation therapy (EBRT) at our institution. We recently reported the existence of a correlation between the severity of acute genitourinary (GU) toxicity and the urethral radiation dose in HDR brachytherapy by using different fractionation schema. The purpose of this study was to evaluate the role of the urethral dose in the development of acute GU toxicity more closely than in previous studies. For this purpose, we conducted an analysis of patients who had undergone HDR brachytherapy with a fixed fractionation schema combined with hypofractionated EBRT. Methods and Materials: Among the patients with localized prostate cancer who were treated by 192-iridium HDR brachytherapy combined with hypofractionated EBRT at Gunma University Hospital between August 2000 and November 2004, we analyzed 67 patients who were treated by HDR brachytherapy with the fractionation schema of 9 Gy x two times combined with hypofractionated EBRT. Hypofractionated EBRT was administered at a fraction dose of 3 Gy three times weekly, and a total dose of 51 Gy was delivered to the prostate gland and seminal vesicles using the four-field technique. No elective pelvic irradiation was performed. After the completion of EBRT, all the patients additionally received transrectal ultrasonography-guided HDR brachytherapy. The planning target volume was defined as the prostate gland with a 5-mm margin all around, and the planning was conducted based on computed tomography images. The tumor stage was T1c in 13 patients, T2 in 31 patients, and T3 in 23 patients. The Gleason score was 2-6 in 12 patients, 7 in 34 patients, and 8-10 in 21 patients. Androgen ablation was performed in all the patients. The median follow-up duration was 11 months (range 3-24 months). The toxicities were graded based on the Radiation Therapy Oncology Group and the European Organization for Research and Treatment of Cancer toxicity criteria. Results: The main symptoms of acute GU toxicity were dysuria and increase in the urinary frequency or nocturia. The grade distribution of acute GU toxicity in the patients was as follows: Grade 0-1, 42 patients (63%); Grade 2-3, 25 patients (37%). The urethral dose in HDR brachytherapy was determined using the following dose-volume histogram (DVH) parameters: V30 (percentage of the urethral volume receiving 30% of the prescribed radiation dose), V80, V90, V100, V110, V120, V130, and V150. In addition, the D5 (dose covering 5% of the urethral volume), D10, D20, and D50 of the urethra were also estimated. The V30-V150 values in the patients with Grade 2-3 acute GU toxicity were significantly higher than those in patients with Grade 0-1 toxicity. The D10 and D20, but not D5 and D50, values were also significantly higher in the patients with Grade 2-3 acute GU toxicity than in those with Grade 0-1 toxicity. Regarding the influence of the number of needles implanted, there was no correlation between the number of needles implanted and the severity of acute GU toxicity or the V30-V150 values and D5-D50 values. Conclusions: It was concluded that HDR brachytherapy combined with hypofractionated EBRT is feasible for localized prostate cancer, when considered from the viewpoint of acute toxicity. However, because the urethral dose was closely associated with the grade of severity of the acute GU toxicity, the urethral dose in HDR brachytherapy must be kept low to reduce the severity of acute GU toxicity.

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); Noda, Shin-ei [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Ito, Kazuto [Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Yamamoto, Takumi [Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Kashiwagi, Bunzo [Department of Urology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan); Nakano, Takashi [Department of Radiation Oncology, Gunma University Graduate School of Medicine, Maebashi, Gunma (Japan)

2005-10-01

301

Advances in Brachytherapy  

PubMed Central

During the past 15 years, permanent seed brachytherapy for prostate cancer has advanced significantly in all areas, including patient selection, treatment planning, technique, and technology (eg, seeds stranded in Vicryl suture). These improvements have made transperineal seed implantation an accurate and practical treatment option for men with low-, intermediate-, and high-risk disease. Because of the evidence that the various treatment options for prostate cancer are likely to be equally successful in terms of long-term cancer control, continuing efforts focus on enhancing the quality of life of implant patients.

Grimm, Peter; Sylvester, John

2004-01-01

302

Correlation Between Dosimetric Parameters and Late Rectal and Urinary Toxicities in Patients Treated With High-Dose-Rate Brachytherapy Used as Monotherapy for Prostate Cancer  

SciTech Connect

Purpose: To evaluate the correlation between dosimetric parameters and late rectal and urinary toxicities in high-dose-rate brachytherapy (HDR-BT) used as monotherapy for prostate cancer. Methods and Materials: The data of 83 patients treated with HDR-BT alone for prostate cancer from 2001 through 2005 at Osaka University Hospital were analyzed. Median follow-up time was 36 months (range, 18-70). The total prescribed dose was 54 Gy in nine fractions over 5 days. Correlation between dosimetric parameters and late toxicities was examined. Results: The means of V30, V40, V50, V60, V70, D1cc, D2cc, D5cc, and D10cc of the rectum were significantly higher in 18 patients who presented with late rectal toxicity (Grades 1-3 rectal bleeding) than in the other 65 patients who did not. A significant difference was observed for D1cc-10cc but not for D5-90. The statistically most significant difference was observed for V40 and D5cc. Late rectal toxicity rate was significantly higher for patients with rectal V40 >= 8 cc than those with the rectal V40 < 8 cc (42% vs. 8%; p < 0.001), as well as for patients with rectal D5cc >= 27 Gy compared with those with rectal D5cc < 27 Gy (50% vs. 11%; p < 0.001). Dosimetric parameters of the urethra of 15 patients with late urinary toxicity were not significantly different from the 68 patients without toxicity. Conclusion: Rectal V40 < 8 cc and D5cc < 27 Gy may be dose-volume constraints in HDR-BT used as monotherapy for prostate cancer.

Konishi, Koji [Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan); Yoshioka, Yasuo, E-mail: yoshioka@radonc.med.osaka-u.ac.j [Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan); Isohashi, Fumiaki; Sumida, Iori; Kawaguchi, Yoshifumi; Kotsuma, Tadayuki; Adachi, Kana; Morimoto, Masahiro; Fukuda, Shoichi; Inoue, Takehiro [Department of Radiation Oncology, Osaka University Graduate School of Medicine, 2-2 Yamadaoka, Suita, Osaka 565-0871 (Japan)

2009-11-15

303

Clinical outcome in patients with prostate cancer treated with external beam radiotherapy and high dose-rate iridium 192 brachytherapy boost: a 6-year follow-up.  

PubMed

To report the long-term results for treatment of localized carcinoma of the prostate using high dose rate (HDR) brachytherapy, conformal external beam radiotherapy (3D EBRT) and neo-adjuvant hormonal therapy (TAB). From 1998 through 1999, 154 patients with localized prostate cancer were entered in the trial. Biologically no evidence of disease (bNED) was defined at PSA levels < 2 microg/l. In order to compare the results of this treatment with other treatment modalities, the patient's pre-treatment data were used to calculate the estimated 5-year PSA relapse free survival using Kattan's nomograms for radical prostatectomy (RP) and 3D EBRT. After 6 years of follow-up, 129 patients remain alive. The actual 5-year relapse-free survival is 84%. None of the patients demonstrated clinical signs of local recurrence. The median PSA at follow-up among the relapse-free patients was 0.05 microg/l. Among the 80 patients who presented with clinical stage T3 tumours, 55 (68%) were relapse-free. The expected 5-year relapse-free survival using nomograms for RP and 3D EBRT was 54% and 70%, respectively. Late rectal toxicity RTOG grade 3 occurred in 1% of the patients. Late urinary tract toxicity RTOG grade 3 developed in 4% of the patients. Combined treatment, utilizing HDR, 3D EBRT and TAB, produces good clinical results. Rectal toxicity is acceptable. Urinary tract toxicity, most likely can be explained by the fact that during the first years of this treatment, no effort was made to localize the urethra, which was assumed to be in the middle of the prostate. PMID:17917823

Klkner, Karl Mikael; Wahlgren, Thomas; Ryberg, Marianne; Cohn-Cedermark, Gabriella; Castellanos, Enrique; Zimmerman, Rolf; Nilsson, Josef; Lundell, Marie; Fowler, Jack; Levitt, Seymour; Hellstrm, Magnus; Nilsson, Sten

2007-01-01

304

High-dose irradiation for prostate cancer via a high-dose-rate brachytherapy boost: Results of a phase I to II study  

SciTech Connect

Objective: To evaluate outcomes of intermediate- and high-risk prostate cancer patients on a prospective dose-escalation study of pelvic external-beam radiation therapy (EBRT) combined with high-dose-rate (HDR) brachytherapy boost. Methods: From November 1991 to April 2003, 197 patients were treated for intermediate- and high-risk disease features. All patients had prostate-specific antigen >10 ng/ml, Gleason score {>=}7, or clinical stage {>=}T2b, and all received pelvic EBRT (46 Gy) while receiving either two or three HDR boost treatments. HDR dose fractionation increased progressively and was divided into two dose levels. The mean prostate biologic equivalency dose was 88.2 Gy for the low-dose group and 116.8 Gy for the high-dose group ({alpha}/{beta} = 1.2). Clinical failure was either local failure or distant metastasis; clinical event-free survival (cEFS) was defined as patients who lived free of clinical failure. Results: Median follow-up was 4.9 years. The 5-year rates were as follows: biologic failure (BF), 18.6%, clinical failure (CF), 9.8%, cEFS 84.8%, cause-specific survival (CSS), 98.3%, and overall survival (OS), 92.9%. Five-year biochemical failure (68.7% vs. 86%, p < 0.001), CF (6.1% vs. 15.6%, p = 0.04), cEFS (75.5% vs. 91.7%, p = 0.003), CSS (95.4% vs. 100%, p = 0.02), and OS (86.2% vs. 97.8%, p = 0.002) were significantly better for the high-dose group. Multivariate analysis showed that high-dose group (p = 0.01, HR 0.35) and Gleason score (p = 0.01, HR 1.84) were significant variables for cEFS. Multivariate analysis showed that high-dose group (p = 0.01, HR 0.14) and age (p = 0.03, HR 1.09 per year) were significant variables for overall survival. Conclusion: There is a strong dose-response relationship for intermediate- to high-risk prostate cancer patients. Improved locoregional control with higher radiation doses alone can significantly decrease biochemical and clinical failures.

Vargas, Carlos E. [Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI (United States); Martinez, Alvaro A. [Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI (United States)]. E-mail: amartinez@beaumont.edu; Boike, Thomas P. [Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI (United States); Spencer, William [Urology Department, William Beaumont Hospital, Royal Oak, MI (United States); Goldstein, Neal [Pathology Department, William Beaumont Hospital, Royal Oak, MI (United States); Gustafson, Gary S. [Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI (United States); Krauss, Daniel J. [Radiation Oncology Department, William Beaumont Hospital, Royal Oak, MI (United States); Gonzalez, Jose [Urology Department, William Beaumont Hospital, Royal Oak, MI (United States)

2006-10-01

305

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

SciTech Connect

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

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

2007-11-01

306

Long-Term (10-Year) Gastrointestinal and Genitourinary Toxicity after Treatment with External Beam Radiotherapy, Radical Prostatectomy, or Brachytherapy for Prostate Cancer  

PubMed Central

Objective.To examine gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated in 1999 with external beam radiotherapy (RT), prostate interstitial brachytherapy (PI) or radical prostatectomy (RP). Methods. TThe records of 525 patients treated in 1999 were reviewed to evaluate toxicity. Late GI and GU morbidities were graded according to the RTOG late morbidity criteria. Other factors examined were patient age, BMI, smoking history, and medical co-morbidities. Due to the low event rate for late GU and GI toxicities, a competing risk regression (CRR) analysis was done with death as the competing event. Results. Median follow-up time was 8.5 years. On CRR univariate analysis, only the presence of DM was significantly associated with GU toxicity grade >2 (P = 0.43, HR 2.35, 95% Cl = 1.035.39). On univariate analysis, RT and DM were significantly associated with late GI toxicity. On multivariable analysis, both variables remained significant (RT: P = 0.038, HR = 4.71, CI = 1.0920.3; DM: P = 0.008, HR = 3.81, 95% Cl = 1.4210.2). Conclusions. Late effects occur with all treatment modalities. The presence of DM at the time of treatment was significantly associated with worse late GI and GU toxicity. RT was significantly associated with worse late GI toxicity compared to PI and RP.

Hunter, Grant K.; Reddy, Chandana A.; Klein, Eric A.; Kupelian, Patrick; Angermeier, Kenneth; Ulchaker, James; Chehade, Nabil; Altman, Andrew; Ciezki, Jay P.

2012-01-01

307

Encapsulated iodine-125 in radiation oncology. I. Study of the relative biological effectiveness (RBE) using low dose rate irradiation of mammalian cell cultures.  

PubMed

The use of encapsulated iodine-125 seeds has increased considerably since 1965, due largely to their physical characteristics. The 28 keV x-ray emission offers improved radiation protection and rapid fall-off of dose outside the treatment volume. The Relative Biological Effectiveness (RBE) of the low energy I-125 x-rays has not been adequately assessed. The limited studies have found a wide range of values, but most are between 1.2-1.5 relative to hard x-rays. We used C3H/10T1/2 mouse embryo cells in contact inhibited plateau phase to assess the RBE of I-125 seed x-rays relative to Cs-137 gamma rays (660 keV) using low dose rate continuous irradiation. Replicate experiments found the RBE to be 1.2. This did not vary with dose rate over the range of 10-76 cGy/hour. Calculations made from our cell survival data suggest that, in the case of permanent I-125 implants, where the dose is administered over a considerable period of time, the resultant surviving fraction of tumor cells is dictated largely by the length of the cell cycle. It is suggested that, for this reason, permanent I-125 implants may be less suitable for rapidly growing tumors, such as glioblastomas, than temporary I-125 implants, which are calculated to be virtually independent of the cell cycle duration. PMID:6528858

Marchese, M J; Hall, E J; Hilaris, B S

1984-12-01

308

Encapsulated iodine-125 in radiation oncology. I. Study of the Relative Biological Effectiveness (RBE) using low dose rate irradiation of mammalian cell cultures  

SciTech Connect

The use of encapsulated iodine-125 seeds has increased considerably since 1965, due largely to their physical characteristics. The 28 keV x-ray emission offers improved radiation protection and rapid fall-off of dose outside the treatment volume. The Relative Biological Effectiveness (RBE) of the low energy I-125 x-rays has not been adequately assessed. The limited studies have found a wide range of values, but most are between 1.2-1.5 relative to hard x-rays. C3H/10T1/2 mouse embryo cells were used in contact inhibited plateau phase to assess the RBE of I-125 seed x-rays relative to Cs-137 gamma rays (660 keV) using low dose rate continuous irradiation. Replicate experiments found the RBE to be 1.2. This did not vary with dose rate over the range of 10-76 cGy/hour. Calculations made from cell survival data suggest that, in the case of permanent I-125 implants, where the dose is administered over a considerable period of time, the resultant surviving fraction of tumor cells is dictated largely by the length of the cell cycle. It is suggested that, for this reason, permanent I-125 implants may be less suitable for rapidly growing tumors, such as glioblastomas, than temporary I-125 implants, which are calculated to be virtually independent of the cell cycle duration.

Marchese, M.J.; Hall, E.J.; Hilaris, B.S.

1984-12-01

309

Multicatheter Device for Brachytherapy Treatment  

NASA Astrophysics Data System (ADS)

Low dose rate brachytherapy treatment for prostate cancer encompasses the delivery of capsules containing radioactive material into the prostate's cancerous tissue via injection through needles. High dose rate brachytherapy treatment for prostate cancer follows the same concept with the difference that the radioactive source has a higher activity and it is placed temporarily into the patient. For this reason, the source is driven by an afterloading device that moves the source into the catheters and back into a shielded container. From both HDR and LDR brachytherapy, two issues remain unaddressed: homogeneity and localization. Sources not being homogeneous result in a delivered dose that does not correspond to the treatment plan. In the case of HDR, the afterloader not always places the source where it should within the catheter. This results in undertreatment of the cancerous tissue as well as damage to healthy tissue. To address both issues we have placed scintillating fiber into brachytherapy needles. If placed geometrically around the radioactive seeds we are able to check for homogeneity in the sources. At the same time, by analyzing the detected signals we are trying to determine the exact physical position of the seeds within the catheter. Using a radioactive source, we have taken measurements to calibrate the device and measurements under water to simulate living tissue environment. Results are discussed.

Velasco, Carlos; Gueye, Paul; Keppel, Cynthia

2007-03-01

310

Fifteen-Year Biochemical Relapse-Free Survival, Cause-Specific Survival, and Overall Survival Following I{sup 125} Prostate Brachytherapy in Clinically Localized Prostate Cancer: Seattle Experience  

SciTech Connect

Purpose: To report 15-year biochemical relapse-free survival (BRFS), cause-specific survival (CSS), and overall survival (OS) outcomes of patients treated with I{sup 125} brachytherapy monotherapy for clinically localized prostate cancer early in the Seattle experience. Methods and Materials: Two hundred fifteen patients with clinically localized prostate cancer were consecutively treated from 1988 to 1992 with I{sup 125} monotherapy. They were prospectively followed as a tight cohort. They were evaluated for BRFS, CSS, and OS. Multivariate analysis was used to evaluate outcomes by pretreatment clinical prognostic factors. BRFS was analyzed by the Phoenix (nadir + 2 ng/mL) definition. CSS and OS were evaluated by chart review, death certificates, and referring physician follow-up notes. Gleason scoring was performed by general pathologists at a community hospital in Seattle. Time to biochemical failure (BF) was calculated and compared by Kaplan-Meier plots. Results: Fifteen-year BRFS for the entire cohort was 80.4%. BRFS by D'Amico risk group classification cohort analysis was 85.9%, 79.9%, and 62.2% for low, intermediate, and high-risk patients, respectively. Follow-up ranged from 3.6 to 18.4 years; median follow-up was 15.4 years for biochemically free of disease patients. Overall median follow-up was 11.7 years. The median time to BF in those who failed was 5.1 years. CSS was 84%. OS was 37.1%. Average age at time of treatment was 70 years. There was no significant difference in BRFS between low and intermediate risk groups. Conclusion: I{sup 125} monotherapy results in excellent 15-year BRFS and CSS, especially when taking into account the era of treatment effect.

Sylvester, John E., E-mail: js@drjohnsylvester.com [Lakewood Ranch Oncology, Lakewood Ranch, FL (United States); Prostate Cancer Treatment Center, Seattle, WA (United States); Grimm, Peter D. [Lakewood Ranch Oncology, Lakewood Ranch, FL (United States); Wong, Jason [University California, Irvine, CA (United States); Galbreath, Robert W. [Ohio University Eastern, St. Clairsville, OH (United States); Merrick, Gregory [Schiffler Cancer Center and Wheeling Jesuit University, Wheeling, WV (United States); Blasko, John C.

2011-10-01

311

Prostatitis  

PubMed Central

The laboratory diagnosis of acute bacterial prostatitis is straightforward and easily accomplished in clinical laboratories. Chronic bacterial prostatitis, and especially chronic idiopathic prostatitis (most often referred to as abacterial prostatitis), presents a real challenge to the clinician and clinical microbiologist. Clinically, the diagnosis of chronic idiopathic prostatitis is differentiated from that of acute prostatitis by a lack of prostatic inflammation and no significant (controversial) leukocytes or bacteria in the expressed prostatic secretions. Despite these diagnostic criteria, the etiology of chronic idiopathic prostatitis is unknown. While this review covers the entire spectrum of microbially caused acute prostatitis (including common and uncommon bacteria, viruses, fungi, and parasites) and microbially associated chronic prostatitis, a special focus has been given to chronic idiopathic prostatitis. The idiopathic syndrome is commonly diagnosed in men but is poorly treated. Recent data convincingly suggests a possible bacterial etiology for the condition. Provocative molecular studies have been published reporting the presence of 16S rRNA bacterial sequences in prostate biopsy tissue that is negative for ordinary bacteria by routine culture in men with chronic idiopathic prostatitis. Additionally, special culture methods have indicated that difficult-to-culture coryneforms and coagulase-negative staphylococci are present in expressed prostatic secretions found to be negative by routine culture techniques. Treatment failures are not uncommon in chronic prostatitis. Literature reports suggest that antimicrobial treatment failures in chronic idiopathic prostatitis caused by organisms producing extracellular slime might result from the virulent properties of coagulase-negative staphylococci or other bacteria. While it is difficult to definitively extrapolate from animal models, antibiotic pharmokinetic studies with a murine model have suggested that treatment failures in chronic prostatitis are probably a result of the local microenvironment surrounding the persistent focal and well-protected small bacterial biofilms buried within the prostate gland. These conclusions support the molecular and culture data implicating bacteria as a cause of chronic idiopathic prostatitis.

Domingue, Gerald J.; Hellstrom, Wayne J. G.

1998-01-01

312

[Brachytherapy training].  

PubMed

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

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

2013-02-09

313

Results of stereotactic brachytherapy used in the initial management of patients with glioblastoma  

SciTech Connect

Recent studies have shown a survival benefit for patients with recurrent glioblastomas treated with stereotactic brachytherapy. On the basis of these encouraging results, we began a prospective study in 1987 to evaluate the use of brachytherapy in patients with newly diagnosed glioblastoma. Patients were considered eligible for this study if they met the following criteria: Karnofsky performance status 70% or greater; tumor size not greater than 5 cm in any dimension; a radiographically well delineated, supratentorial lesion not involving the ependymal surfaces; and pathologically confirmed glioblastoma. We treated 35 such patients between 1987 and 1990 with stereotactic brachytherapy as part of their initial therapy. The treatment protocol involved surgery, partial brain external-beam radiotherapy, and stereotactic brachytherapy with temporary high-activity iodine 125 sources giving an additional 50 Gy to the tumor bed. Chemotherapy was not used in the initial management of these 35 patients. To compare our results with those obtained in a matched control group, we identified 40 patients with glioblastoma treated with surgery and external radiotherapy, with or without chemotherapy, between 1977 and 1986 at our institution. These patients had clinical and radiographic characteristics that would have made them eligible for the brachytherapy protocol. Survival rates at 1 and 2 years after diagnosis were 87% and 57%, respectively, for patients receiving brachytherapy versus 40% and 12.5%, respectively, for the controls (P less than .001). We conclude that stereotactic brachytherapy improves the survival of patients with glioblastoma when it can be incorporated into the initial treatment approach. Unfortunately, only about one in four patients with glioblastoma are suitable candidates for brachytherapy at the time of initial presentation.

Loeffler, J.S.; Alexander, E. 3d.; Wen, P.Y.; Shea, W.M.; Coleman, C.N.; Kooy, H.M.; Fine, H.A.; Nedzi, L.A.; Silver, B.; Riese, N.E. (Joint Center for Radiation Therapy, Boston, MA (USA))

1990-12-19

314

Single-Fraction High-Dose-Rate Brachytherapy and Hypofractionated External Beam Radiotherapy for Men With Intermediate-Risk Prostate Cancer: Analysis of Short- and Medium-Term Toxicity and Quality of Life  

SciTech Connect

Purpose: To determine the short- and medium-term effects of a single high-dose-rate brachytherapy fraction of 15Gy and hypofractionated external beam radiation therapy for prostate cancer. Methods and Materials: Eligible patients had localized prostate cancer with a Gleason score of 7 and a prostate-specific antigen (PSA) concentration of <20 ng/ml or a Gleason score of 6 with a PSA concentration of 10 to 20 ng/ml. Patients received high-dose-rate brachytherapy as a single 15-Gy dose, followed by external beam radiation therapy at 37.5Gy in 15 fractions, and were followed prospectively for toxicity (using Common Terminology Criteria for Adverse Events version 3.0), urinary symptoms (using the International Prostate Symptom Score [IPSS]), erectile function (with the International Index of Erectile Function [IIEF]), and health-related quality of life (with the Expanded Prostate Cancer Index Composite [EPIC]). Clinical examinations and PSA measurements were performed at every visit, and prostate biopsies were repeated at 2 years. The trial accrued 125 patients, with a median follow-up of 1.14 years. Results: Acute grade 2 and 3 genitourinary toxicity occurred in 62% and 1.6% of patients, respectively, and acute grade 2 gastrointestinal toxicity occurred in 6.5% of patients. No grade 3 late toxicity has occurred: 47% of patients had grade 2 genitourinary and 10% of patients had grade 2 gastrointestinal toxicity. Median IPSSs rose from 5 at baseline to 12 at 1 month and returned to 7 at 3 months. Of the total number of patients who were initially potent (IIEF, >21), 8% of patients developed mild to moderate dysfunction, and 27% of patients developed severe erectile dysfunction. Baseline EPIC bowel, urinary, and sexual bother scores decreased by 9, 7, and 19 points, respectively, at 1 year. No patient has experienced biochemical failure, and 16 of the first 17 biopsy results showed no malignancy. Conclusions: Treatment is well tolerated in the short and medium term, with low toxicity and encouraging early indicators of disease control.

Morton, Gerard C., E-mail: gerard.morton@sunnybrook.c [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto (Canada); Loblaw, D. Andrew [Department of Radiation Oncology, Odette Cancer Centre, University of Toronto, Toronto (Canada); Department of Clinical Trials and Epidemiology, Odette Cancer Centre, Toronto (Canada); Sankreacha, Raxa [Department of Medical Physics, Odette Cancer Centre, University of Toronto, Toronto (Canada)

2010-07-01

315

Permanent implants in treatment of prostate cancer  

Microsoft Academic Search

SUMMARY : Low-dose rate brachytherapy (LDR - BT) is one of the radiation methods that is known for several years in treatment of localized prostate cancer. The main idea of this method is to implant small radioac- tive seeds as a source of radiation, directly into the prostate gland. LDR brachytherapy is applied as a monotherapy and also used along

Marek KANIKOWSKI; Janusz SKOWRONEK; Magda KUBASZEWSKA; Adam CHICHE?; Piotr MILECKI

2008-01-01

316

Antitumor effects of 32P-chromic-poly (L-lactide) brachytherapy in nude mice with human prostate cancer  

PubMed Central

The aim of the present study was to investigate the antitumor effects and tissue distribution of 32P-chromic-poly (L-lactide) (32P-CP-PLLA) in nude mice with human prostate cancer. Tumor models were obtained by transplantation of PC-3M tumor cells into male BALB/c nude mice. Animals were randomly divided into control, 32P-chromic phosphate (32P-CP) colloid and 32P-CP-PLLA groups (all n=20). A series of indices were investigated, including apoptosis of tumor cells, rate of apoptosis, expression of caspase 3 and 8, biodistribution and intratumoral concentration of 32P-CP-PLLA, intensity of radioactivity, tumor volume and microvessel density (MVD). Highly concentrated radioactivity of 32P-CP-PLLA in the tumor mass was detected by single photon emission computed tomography (SPECT) scanning. The residual activities of the 32P-CP-PLLA and 32P-CP colloid groups were 3.020.32 and 1.760.31 MBq, respectively, on day 14 following treatment. The tumor inhibition rates were 67.243.55 and 55.927.65%, respectively (P<0.01). Necrotic changes, in conjunction with apoptosis, were observed in the treatment group. MVD values for the 32P-CP-PLLA and 32P-CP colloid groups were 28.2410.07 and 36.1511.06, respectively. 32P-CP-PLLA showed an excellent capacity for killing tumor cells, inducing apoptosis and inhibiting angiogenesis.

SUN, LIUJING; ZHU, XISHAN; XU, LONGBAO; WANG, ZIZHENG; SHAO, GUOQIANG; ZHAO, JUN

2013-01-01

317

External-Beam Radiation Therapy and High-Dose Rate Brachytherapy Combined With Long-Term Androgen Deprivation Therapy in High and Very High Prostate Cancer: Preliminary Data on Clinical Outcome  

SciTech Connect

Purpose: To determine the feasibility of combined long-term androgen deprivation therapy (ADT) and dose escalation with high-dose-rate (HDR) brachytherapy. Methods and Materials: Between 2001 and 2007, 200 patients with high-risk prostate cancer (32.5%) or very high-risk prostate cancer (67.5%) were prospectively enrolled in this Phase II trial. Tumor characteristics included a median pretreatment prostate-specific antigen of 15.2 ng/mL, a clinical stage of T2c, and a Gleason score of 7. Treatment consisted of 54 Gy of external irradiation (three-dimensional conformal radiotherapy [3DCRT]) followed by 19 Gy of HDR brachytherapy in four twice-daily treatments. ADT started 0-3 months before 3DCRT and continued for 2 years. Results: One hundred and ninety patients (95%) received 2 years of ADT. After a median follow-up of 3.7 years (range, 2-9), late Grade {>=}2 urinary toxicity was observed in 18% of the patients and Grade {>=}3 was observed in 5%. Prior transurethral resection of the prostate (p = 0.013) and bladder D{sub 50} {>=}1.19 Gy (p = 0.014) were associated with increased Grade {>=}2 urinary complications; age {>=}70 (p = 0.05) was associated with Grade {>=}3 urinary complications. Late Grade {>=}2 gastrointestinal toxicity was observed in 9% of the patients and Grade {>=}3 in 1.5%. CTV size {>=}35.8 cc (p = 0.007) and D{sub 100} {>=}3.05 Gy (p = 0.01) were significant for increased Grade {>=}2 complications. The 5-year and 9-year biochemical relapse-free survival (nadir + 2) rates were 85.1% and 75.7%, respectively. Patients with Gleason score of 7-10 had a decreased biochemical relapse-free survival (p = 0.007). Conclusions: Intermediate-term results at the 5-year time point indicate a favorable outcome without an increase in the rate of late complications.

Martinez-Monge, Rafael, E-mail: rmartinezm@unav.es [Department of Radiation Oncology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain); Moreno, Marta; Ciervide, Raquel; Cambeiro, Mauricio [Department of Radiation Oncology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain); Perez-Gracia, Jose Luis; Gil-Bazo, Ignacio [Department of Medical Oncology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain); Gaztanaga, Miren; Arbea, Leire [Department of Radiation Oncology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain); Pascual, Ignacio [Department of Urology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain); Aristu, Javier [Department of Radiation Oncology, Clinica Universitaria de Navarra, University of Navarra, Pamplona, Navarre (Spain)

2012-03-01

318

Thermobrachytherapy for Recurrent Prostate Cancer.  

National Technical Information Service (NTIS)

The principal objective of this research is the development of the combination of hyperthermia (HT) and high dose rate (HDR) brachytherapy as a therapy for locally advanced, recurrent prostate cancer after failure using front line external beam definitive...

P. M. Corry

2003-01-01

319

Prostatitis  

MedlinePLUS

... topics for this letter X X-ray Y Yeast Infections Z no topics for this letter Prostatitis ( ... An illness caused by harmful bacteria, viruses or yeast growing in the urinary tract. urination: The passing ...

320

Prostatitis  

MedlinePLUS

... Having a pelvic trauma, such as injury from bicycling or horseback riding Not drinking enough fluids (dehydration) ... cushion to ease pressure on the prostate. Avoid bicycling, or wear padded shorts and adjust your bicycle ...

321

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

Microsoft Academic Search

Purpose: To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after 3 different treatments for clinically localized prostate cancer.Methods and Materials: Ninety men with T1T2 adenocarcinoma of the prostate were treated with curative intent between May 1998 and June 1999 and completed a quality-of-life Functional Assessment of Cancer Therapy-Prostate (FACT-P) questionnaire before

W. Robert Lee; M. Craig Hall; Richard P McQuellon; L. Douglas Case; David L McCullough

2001-01-01

322

Monte Carlo calculated doses to treatment volumes and organs at risk for permanent implant lung brachytherapy  

NASA Astrophysics Data System (ADS)

Iodine-125 (125I) and Caesium-131 (131Cs) brachytherapy have been used with sublobar resection to treat stage I non-small cell lung cancer and other radionuclides, 169Yb and 103Pd, are considered for these treatments. This work investigates the dosimetry of permanent implant lung brachytherapy for a range of source energies and various implant sites in the lung. Monte Carlo calculated doses are calculated in a patient CT-derived computational phantom using the EGsnrc user-code BrachyDose. Calculations are performed for 103Pd, 125I, 131Cs seeds and 50 and 100 keV point sources for 17 implant positions. Doses to treatment volumes, ipsilateral lung, aorta, and heart are determined and compared to those determined using the TG-43 approach. Considerable variation with source energy and differences between model-based and TG-43 doses are found for both treatment volumes and organs. Doses to the heart and aorta generally increase with increasing source energy. TG-43 underestimates the dose to the heart and aorta for all implants except those nearest to these organs where the dose is overestimated. Results suggest that model-based dose calculations are crucial for selecting prescription doses, comparing clinical endpoints, and studying radiobiological effects for permanent implant lung brachytherapy.

Sutherland, J. G. H.; Furutani, K. M.; Thomson, R. M.

2013-10-01

323

Monte Carlo calculated doses to treatment volumes and organs at risk for permanent implant lung brachytherapy.  

PubMed

Iodine-125 ((125)I) and Caesium-131 ((131)Cs) brachytherapy have been used with sublobar resection to treat stage I non-small cell lung cancer and other radionuclides, (169)Yb and (103)Pd, are considered for these treatments. This work investigates the dosimetry of permanent implant lung brachytherapy for a range of source energies and various implant sites in the lung. Monte Carlo calculated doses are calculated in a patient CT-derived computational phantom using the EGsnrc user-code BrachyDose. Calculations are performed for (103)Pd, (125)I, (131)Cs seeds and 50 and 100keV point sources for 17 implant positions. Doses to treatment volumes, ipsilateral lung, aorta, and heart are determined and compared to those determined using the TG-43 approach. Considerable variation with source energy and differences between model-based and TG-43 doses are found for both treatment volumes and organs. Doses to the heart and aorta generally increase with increasing source energy. TG-43 underestimates the dose to the heart and aorta for all implants except those nearest to these organs where the dose is overestimated. Results suggest that model-based dose calculations are crucial for selecting prescription doses, comparing clinical endpoints, and studying radiobiological effects for permanent implant lung brachytherapy. PMID:24051987

Sutherland, J G H; Furutani, K M; Thomson, R M

2013-09-20

324

Prostate Cancer  

Microsoft Academic Search

\\u000a Salvage radiotherapy for locally recurrent prostate cancer after primary radiation is generally performed by brachytherapy.\\u000a Only a limited amount of small studies has been performed, all retrospective. In these studies the rate of severe toxicity\\u000a was high and outcome was disappointing, and therefore, salvage treatments are not popular. Furthermore, it is unclear whether\\u000a salvage treatment will improve disease-specific or overall

Marco van Vulpen

325

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

SciTech Connect

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

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

1987-02-01

326

Image guided, adaptive, accelerated, high dose brachytherapy as model for advanced small volume radiotherapy.  

PubMed

Brachytherapy has consistently provided a very conformal radiation therapy modality. Over the last two decades this has been associated with significant improvements in imaging for brachytherapy applications (prostate, gynecology), resulting in many positive advances in treatment planning, application techniques and clinical outcome. This is emphasized by the increased use of brachytherapy in Europe with gynecology as continuous basis and prostate and breast as more recently growing fields. Image guidance enables exact knowledge of the applicator together with improved visualization of tumor and target volumes as well as of organs at risk providing the basis for very individualized 3D and 4D treatment planning. In this commentary the most important recent developments in prostate, gynecological and breast brachytherapy are reviewed, with a focus on European recent and current research aiming at the definition of areas for important future research. Moreover the positive impact of GEC-ESTRO recommendations and the highlights of brachytherapy physics are discussed what altogether presents a full overview of modern image guided brachytherapy. An overview is finally provided on past and current international brachytherapy publications focusing on "Radiotherapy and Oncology". These data show tremendous increase in almost all research areas over the last three decades strongly influenced recently by translational research in regard to imaging and technology. In order to provide high level clinical evidence for future brachytherapy practice the strong need for comprehensive prospective clinical research addressing brachytherapy issues is high-lighted. PMID:21963284

Haie-Meder, Christine; Siebert, Frank-Andr; Ptter, Richard

2011-09-30

327

Interstitially implanted I125 for prostate cancer using transrectal ultrasound  

SciTech Connect

Prostate cancer is the third leading cause of death from cancer among men in the United States. Traditional treatments for prostate cancer are prostatectomy, external beam irradiation, and interstitial implantation of Iodine125 (I125) via laparotomy. These treatments are associated with significant morbidity and limitations. Based on experience with I125 interstitial implantation by transrectal ultrasound guidance for early-stage prostate cancer, it seems that this newer method of treatment has greater accuracy of placement and distribution of the isotope and has had few reported complications. The need for a surgical incision has been eliminated. Hospitalization time also has been decreased, creating the need for ambulatory and inpatient nurses to understand the importance of their respective roles in providing coordinated quality care for these patients. Nurses in these departments must have knowledge of the procedure, radiation safety, and common side effects related to the implant.

Greenburg, S.; Petersen, J.; Hansen-Peters, I.; Baylinson, W. (Northwest Tumor Institute, Seattle, WA (USA))

1990-11-01

328

Coregistered photoacoustic-ultrasound imaging applied to brachytherapy  

NASA Astrophysics Data System (ADS)

Brachytherapy is a form of radiation therapy commonly used in the treatment of prostate cancer wherein sustained radiation doses can be precisely targeted to the tumor area by the implantation of small radioactive seeds around the treatment area. Ultrasound is a popular imaging mode for seed implantation, but the seeds are difficult to distinguish from the tissue structure. In this work, we demonstrate the feasibility of photoacoustic imaging for identifying brachytherapy seeds in a tissue phantom, comparing the received intensity to endogenous contrast. We have found that photoacoustic imaging at 1064 nm can identify brachytherapy seeds uniquely at laser penetration depths of 5 cm in biological tissue at the ANSI limit for human exposure with a contrast-to-noise ratio of 26.5 dB. Our realtime combined photoacoustic-ultrasound imaging approach may be suitable for brachytherapy seed placement and post-placement verification, potentially allowing for realtime dosimetry assessment during implantation.

Harrison, Tyler; Zemp, Roger J.

2011-08-01

329

ATM SEQUENCE VARIANTS ARE PREDICTIVE OF ADVERSE RADIOTHERAPY RESPONSE AMONG PATIENTS TREATED FOR PROSTATE CANCER  

Microsoft Academic Search

Purpose: To examine whether the presence of sequence variants in the ATM (mutated in ataxia-telangiectasia) gene is predictive for the development of radiation-induced adverse responses resulting from 125I prostate brachytherapy for early-stage prostate cancer. Materials and Methods: Thirty-seven patients with a minimum of 1-year follow-up who underwent 125I prostate brachytherapy of early-stage prostate cancer were screened for DNA sequence variations

JAMIE A. CESARETTI; RICHARD G. STOCK; STEVEN LEHRER; DAVID A. ATENCIO; JONINE L. BERNSTEIN; NELSON N. STONE; SYLVAN WALLENSTEIN; SHERYL GREEN; KAREN LOEB; MARISA KOLLMEIER; MICHAEL SMITH; BARRY S. ROSENSTEIN

2005-01-01

330

Value of perioperative brachytherapy in the management of non-oat cell carcinoma of the lung  

SciTech Connect

Nearly one-half of all patients with non-oat cell carcinoma of the lung are found to have mediastinal lymph node metastases at the time of initial presentation. There is no consensus today on what constitutes best treatment in patients whose disease is confined to the chest and in whom mediastinal lymph node metastases are the only evident site of tumor spread. The overall survival of these patients is so low that the majority have been either excluded from therapy or have been treated palliatively by external radiation therapy. In an attempt to improve the control of mediastinal lymph node metastases in the operable patients, a pilot study was begun in 1977 at Memorial Hospital to determine the value of perioperative brachytherapy (permanent Iodine-125 implantation of primary lung and a temporary Iridium-192 implantation of the mediastinum) with or without resection followed by a moderate dose of postoperative external beam irradiation. This pilot study has demonstrated that the combination of surgery, perioperative brachytherapy and external beam irradiation in non-oat cell carcinoma of the lung, metastatic to mediastinal lymph nodes, can improve the locoregional control and prolong survival with minimal early or late morbidity.

Hilaris, B.S.; Nori, D.; Beattie, E.J. Jr.; Martini, N.

1983-08-01

331

Stereotactic interstitial brachytherapy of malignant astrocytomas with remarks on postimplantation computed tomographic appearance  

SciTech Connect

Seventeen patients were treated with stereotactically implanted high activity iodine-125 seeds, 12 patients for recurrent malignant astrocytomas (Protocol I) and 5 patients for newly diagnosed glioblastomas (Protocol II). Total radiation dosage to the recurrent tumors in Protocol I, including prior external beam irradiation, averaged 13,500 cGy. In the follow-up period of 6 to 50 months, the survival rate was 93% at 6 months, 60% at 12 months, 50% at 18 months, and 38% at 24 months after implantation. In Protocol II, brachytherapy was used as an interstitial radiation boost to the conventional treatment of newly diagnosed glioblastomas. External beam therapy and interstitial brachytherapy provided 11,000 cGy to these tumors. In the follow-up period of 15 to 27 months, there was a 100% survival at 12 months, 75% at 18 months, and 25% at 24 months after implantation. Eight of our 17 patients required reoperation for persistent or recurrent mass lesions at 6 to 15 months postimplantation; 7 were found to harbor masses of radionecrosis containing nests of anaplastic astrocytes; 1 had frank tumor recurrence. Median survival in this group of patients requiring reoperation was 18.7 months postimplantation. In a review of postimplantation computed tomographic scans, significant mass effect and crossover of hypodensity or enhancement into the corpus callosum or opposite hemisphere were found to have prognostic significance; persistent areas of contrast enhancement and excessive peritumoral hypodensity did not.

Willis, B.K.; Heilbrun, M.P.; Sapozink, M.D.; McDonald, P.R.

1988-09-01

332

Design and optimization of a brachytherapy robot  

NASA Astrophysics Data System (ADS)

Trans-rectal ultrasound guided (TRUS) low dose rate (LDR) interstitial brachytherapy has become a popular procedure for the treatment of prostate cancer, the most common type of non-skin cancer among men. The current TRUS technique of LDR implantation may result in less than ideal coverage of the tumor with increased risk of negative response such as rectal toxicity and urinary retention. This technique is limited by the skill of the physician performing the implant, the accuracy of needle localization, and the inherent weaknesses of the procedure itself. The treatment may require 100 or more sources and 25 needles, compounding the inaccuracy of the needle localization procedure. A robot designed for prostate brachytherapy may increase the accuracy of needle placement while minimizing the effect of physician technique in the TRUS procedure. Furthermore, a robot may improve associated toxicities by utilizing angled insertions and freeing implantations from constraints applied by the 0.5 cm-spaced template used in the TRUS method. Within our group, Lin et al. have designed a new type of LDR source. The "directional" source is a seed designed to be partially shielded. Thus, a directional, or anisotropic, source does not emit radiation in all directions. The source can be oriented to irradiate cancerous tissues while sparing normal ones. This type of source necessitates a new, highly accurate method for localization in 6 degrees of freedom. A robot is the best way to accomplish this task accurately. The following presentation of work describes the invention and optimization of a new prostate brachytherapy robot that fulfills these goals. Furthermore, some research has been dedicated to the use of the robot to perform needle insertion tasks (brachytherapy, biopsy, RF ablation, etc.) in nearly any other soft tissue in the body. This can be accomplished with the robot combined with automatic, magnetic tracking.

Meltsner, Michael A.

333

Combined surgery, intraoperative brachytherapy, and postoperative external radiation in stage III non-small cell lung cancer.  

PubMed

From March 1977 to December 1980, 318 patients with Stage III non-small cell lung cancer underwent thoracotomy at Memorial Sloan-Kettering Cancer Center. One hundred of these patients, considered for this study, were treated by a multimodality approach consisting of resection and/or intraoperative brachytherapy followed by postoperative external irradiation. The criteria for utilizing intraoperative brachytherapy and postoperative external irradiation were either the presence of residual gross disease (47%) or close resection margins suspected to be involved by the tumor (53%). The intraoperative brachytherapy consisted of a temporary iridium 192 implant for subclinical disease in the mediastinum (median dose, 30 Gy in 3-5 days) and a permanent iodine 125 implant for residual gross disease usually at the primary site (median dose, 160 Gy). All patients received postoperative external beam irradiation consisting of 30 to 40 Gy in 2 to 4 weeks. Seven patients (7%) experienced mild to severe complications after these treatments. The local control, when all gross disease had been removed, was influenced by the presence or absence of tumor at the margins of resection (53% and 89%, respectively). The local control in the patients with gross residual disease treated by brachytherapy and postoperative external irradiation, (40 Gy in 4 weeks) was 72%. The actuarial overall 5-year survival was 22%. The 5-year survival was better in patients who had all gross disease removed as compared with patients who had gross residual disease (30% versus 13%). The disease-free survival in these two groups was 27% and 12%, respectively. This review shows that complete resection and moderate doses of postoperative external irradiation achieves a satisfactory local control and improves survival. When all gross disease cannot be removed, then brachytherapy and postoperative external irradiation may achieve similar local control. Distant metastases still remain a major problem in these patients. PMID:2982474

Hilaris, B S; Gomez, J; Nori, D; Anderson, L L; Martini, N

1985-03-15

334

A new endoscopic ultrasonography image processing method to evaluate the prognosis for pancreatic cancer treated with interstitial brachytherapy  

PubMed Central

AIM: To develop a fuzzy classification method to score the texture features of pancreatic cancer in endoscopic ultrasonography (EUS) images and evaluate its utility in making prognosis judgments for patients with unresectable pancreatic cancer treated by EUS-guided interstitial brachytherapy. METHODS: EUS images from our retrospective database were analyzed. The regions of interest were drawn, and texture features were extracted, selected, and scored with a fuzzy classification method using a C++ program. Then, patients with unresectable pancreatic cancer were enrolled to receive EUS-guided iodine 125 radioactive seed implantation. Their fuzzy classification scores, tumor volumes, and carbohydrate antigen 199 (CA199) levels before and after the brachytherapy were recorded. The association between the changes in these parameters and overall survival was analyzed statistically. RESULTS: EUS images of 153 patients with pancreatic cancer and 63 non-cancer patients were analyzed. A total of 25 consecutive patients were enrolled, and they tolerated the brachytherapy well without any complications. There was a correlation between the change in the fuzzy classification score and overall survival (Spearman test, r = 0.616, P = 0.001), whereas no correlation was found to be significant between the change in tumor volume (P = 0.663), CA199 level (P = 0.659), and overall survival. There were 15 patients with a decrease in their fuzzy classification score after brachytherapy, whereas the fuzzy classification score increased in another 10 patients. There was a significant difference in overall survival between the two groups (67 d vs 151 d, P = 0.001), but not in the change of tumor volume and CA199 level. CONCLUSION: Using the fuzzy classification method to analyze EUS images of pancreatic cancer is feasible, and the method can be used to make prognosis judgments for patients with unresectable pancreatic cancer treated by interstitial brachytherapy.

Xu, Wei; Liu, Yan; Lu, Zheng; Jin, Zhen-Dong; Hu, Yu-Hong; Yu, Jian-Guo; Li, Zhao-Shen

2013-01-01

335

Improving photoacoustic imaging contrast of brachytherapy seeds  

NASA Astrophysics Data System (ADS)

Prostate brachytherapy is a form of radiotherapy for treating prostate cancer where the radiation sources are seeds inserted into the prostate. Accurate localization of seeds during prostate brachytherapy is essential to the success of intraoperative treatment planning. The current standard modality used in intraoperative seeds localization is transrectal ultrasound. Transrectal ultrasound, however, suffers in image quality due to several factors such speckle, shadowing, and off-axis seed orientation. Photoacoustic imaging, based on the photoacoustic phenomenon, is an emerging imaging modality. The contrast generating mechanism in photoacoustic imaging is optical absorption that is fundamentally different from conventional B-mode ultrasound which depicts changes in acoustic impedance. A photoacoustic imaging system is developed using a commercial ultrasound system. To improve imaging contrast and depth penetration, absorption enhancing coating is applied to the seeds. In comparison to bare seeds, approximately 18.5 dB increase in signal-to-noise ratio as well as a doubling of imaging depth are achieved. Our results demonstrate that the coating of the seeds can further improve the discernibility of the seeds.

Pan, Leo; Baghani, Ali; Rohling, Robert; Abolmaesumi, Purang; Salcudean, Septimiu; Tang, Shuo

2013-03-01

336

Fractionation and protraction for radiotherapy of prostate carcinoma  

Microsoft Academic Search

Purpose: To investigate whether current fractionation and brachytherapy protraction schemes for the treatment of prostatic cancer with radiation are optimal, or could be improved.Methods and Materials: We analyzed two mature data sets on radiotherapeutic tumor control for prostate cancer, one using EBRT and the other permanent seed implants, to extract the sensitivity to changes in fractionation of prostatic tumors. The

David J Brenner; Eric J Hall

1999-01-01

337

FRACTIONATION AND PROTRACTION FOR RADIOTHERAPY OF PROSTATE CARCINOMA  

Microsoft Academic Search

Purpose: To investigate whether current fractionation and brachytherapy protraction schemes for the treatment of prostatic cancer with radiation are optimal, or could be improved. Methods and Materials: We analyzed two mature data sets on radiotherapeutic tumor control for prostate cancer, one using EBRT and the other permanent seed implants, to extract the sensitivity to changes in fractionation of prostatic tumors.

DAVID J. BRENNER; D. SC; ERIC J. HALL

1999-01-01

338

Brachytherapy needle deflection evaluation and correction  

SciTech Connect

In prostate brachytherapy, an 18-gauge needle is used to implant radioactive seeds. This thin needle can be deflected from the preplanned trajectory in the prostate, potentially resulting in a suboptimum dose pattern and at times requiring repeated needle insertion to achieve optimal dosimetry. In this paper, we report on the evaluation of brachytherapy needle deflection and bending in test phantoms and two approaches to overcome the problem. First we tested the relationship between needle deflection and insertion depth as well as whether needle bending occurred. Targeting accuracy was tested by inserting a brachytherapy needle to target 16 points in chicken tissue phantoms. By implanting dummy seeds into chicken tissue phantoms under 3D ultrasound guidance, the overall accuracy of seed implantation was determined. We evaluated methods to overcome brachytherapy needle deflection with three different insertion methods: constant orientation, constant rotation, and orientation reversal at half of the insertion depth. Our results showed that needle deflection is linear with needle insertion depth, and that no noticeable bending occurs with needle insertion into the tissue and agar phantoms. A 3D principal component analysis was performed to obtain the population distribution of needle tip and seed position relative to the target positions. Our results showed that with the constant orientation insertion method, the mean needle targeting error was 2.8 mm and the mean seed implantation error was 2.9 mm. Using the constant rotation and orientation reversal at half insertion depth methods, the deflection error was reduced. The mean needle targeting errors were 0.8 and 1.2 mm for the constant rotation and orientation reversal methods, respectively, and the seed implantation errors were 0.9 and 1.5 mm for constant rotation insertion and orientation reversal methods, respectively.

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

2005-04-01

339

Comparison of Prophylactic Naftopidil, Tamsulosin, and Silodosin for {sup 125}I Brachytherapy-Induced Lower Urinary Tract Symptoms in Patients With Prostate Cancer: Randomized Controlled Trial  

SciTech Connect

Purpose: To compare the efficacy of three {alpha}{sub 1A}/{alpha}{sub 1D}-adrenoceptor (AR) antagonists-naftopidil, tamsulosin, and silodosin-that have differing affinities for the {alpha}{sub 1}-AR subtypes in treating urinary morbidities in Japanese men with {sup 125}I prostate implantation (PI) for prostate cancer. Methods and Materials: This single-institution prospective randomized controlled trial compared naftopidil, tamsulosin, and silodosin in patients undergoing PI. Patients were randomized and received either naftopidil, tamsulosin, or silodosin. Treatment began 1 day after PI and continued for 1 year. The primary efficacy variables were the changes in total International Prostate Symptom Score (IPSS) and postvoid residual urine (PVR). The secondary efficacy variables were changes in IPSS storage score and IPSS voiding score from baseline to set points during the study (1, 3, 6, and 12 months). Results: Two hundred twelve patients were evaluated in this study between June 2006 and February 2009: 71, 70, and 71 patients in the naftopidil, tamsulosin, and silodosin groups, respectively. With respect to the primary efficacy variables, the mean changes in the total IPSS at 1 month after PI in the naftopidil, tamsulosin, and silodosin groups were +10.3, +8.9, and +7.5, respectively. There were significantly greater decreases with silodosin than naftopidil at 1 month in the total IPSS. The mean changes in the PVR at 6 months were +14.6, +23.7, and +5.7 mL in the naftopidil, tamsulosin, and silodosin groups, respectively; silodosin showed a significant improvement in the PVR at 6 months vs. tamsulosin. With respect to the secondary efficacy variables, the mean changes in the IPSS voiding score at 1 month in the naftopidil, tamsulosin, and silodosin groups were +6.5, +5.6, and +4.5, respectively; silodosin showed a significant improvement in the IPSS voiding score at 1 month vs. naftopidil. Conclusions: Silodosin has a greater impact on improving PI-induced lower urinary tract symptoms than the other two agents.

Tsumura, Hideyasu, E-mail: sugan@pd5.so-net.ne.jp [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Satoh, Takefumi [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Ishiyama, Hiromichi [Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Tabata, Ken-ichi [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Kotani, Shouko [Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Minamida, Satoru; Kimura, Masaki; Fujita, Tetsuo; Matsumoto, Kazumasa [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Kitano, Masashi; Hayakawa, Kazushige [Department of Radiation Oncology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan); Baba, Shiro [Department of Urology, Kitasato University School of Medicine, Sagamihara, Kanagawa (Japan)

2011-11-15

340

Treatment Choices and Outcomes in Early Prostate Cancer.  

National Technical Information Service (NTIS)

Prostate cancer is usually localized at diagnosis. Aggressive local therapy - external beam radiation therapy (EBRT), radical prostatectomy (RP), or brachytherapy (BT) - risks permanent urinary, bowel and sexual dysfunction, while observation for goes a c...

J. Talcott

2003-01-01