Juanita Crook1, Ana Ots2, Miren Gaztañaga2, Matt Schmid3, Cynthia Araujo3, Michelle Hilts3, Deidre Batchelar3, Brent Parker3, François Bachand2, Marie-Pierre Milette2. 1. Radiation Oncology, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, BC, Canada. Electronic address: jcrook@bccancer.bc.ca. 2. Radiation Oncology, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, BC, Canada. 3. Medical Physics, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, BC, Canada.
Abstract
PURPOSE: To demonstrate the feasibility of using high-dose-rate (HDR) brachytherapy to deliver 125% of the prescription dose to the dominant intraprostatic lesion (DIL) as defined on multiparametric MRI while respecting critical organ dose constraints. METHODS AND MATERIALS: Twenty-six patients with biopsy-proven predominantly unilateral prostate cancer consented to a university ethics-approved Phase 2 study of selective dose escalation. Combined information from endorectal T2 MRI sequences, dynamic contrast enhancement, and apparent diffusion coefficient maps was used to contour the DIL and prostate. Images were fused to intraoperative transrectal ultrasound for transposition of the DIL. Treatment consisted of two fractions of 10 Gy HDR brachytherapy to the entire prostate with 12.5 Gy to the DIL, combined with 46 Gy in 23 fractions of external beam radiotherapy. RESULTS: All patients had intermediate- or high-risk disease; 25 of 26 had a visible DIL (mean volume, 2.9 cm(3); SD, 1.8). Mean percentage of prostate receiving prescription dose (V100) was 98.1% (SD, 1.2). Mean dose to 90% of the DIL was 13.4 Gy (SD, 1.0). The coverage of the DIL was excellent with a mean of 95.7% (SD, 5.0) receiving the planned escalation of 25%. Established dose constraints to rectum and urethra were respected in all cases; where DIL coverage was limited by proximity to urethra or rectum, a mean dose to 90% of the DIL of 12.3 Gy was achieved. CONCLUSIONS: Modest dose escalation to the DIL (25-30%) using ultrasound-planned HDR brachytherapy is feasible for selected intermediate- and high-risk patients while respecting critical organ constraints and is achievable within the practice setting of a community cancer center.
PURPOSE: To demonstrate the feasibility of using high-dose-rate (HDR) brachytherapy to deliver 125% of the prescription dose to the dominant intraprostatic lesion (DIL) as defined on multiparametric MRI while respecting critical organ dose constraints. METHODS AND MATERIALS: Twenty-six patients with biopsy-proven predominantly unilateral prostate cancer consented to a university ethics-approved Phase 2 study of selective dose escalation. Combined information from endorectal T2 MRI sequences, dynamic contrast enhancement, and apparent diffusion coefficient maps was used to contour the DIL and prostate. Images were fused to intraoperative transrectal ultrasound for transposition of the DIL. Treatment consisted of two fractions of 10 Gy HDR brachytherapy to the entire prostate with 12.5 Gy to the DIL, combined with 46 Gy in 23 fractions of external beam radiotherapy. RESULTS: All patients had intermediate- or high-risk disease; 25 of 26 had a visible DIL (mean volume, 2.9 cm(3); SD, 1.8). Mean percentage of prostate receiving prescription dose (V100) was 98.1% (SD, 1.2). Mean dose to 90% of the DIL was 13.4 Gy (SD, 1.0). The coverage of the DIL was excellent with a mean of 95.7% (SD, 5.0) receiving the planned escalation of 25%. Established dose constraints to rectum and urethra were respected in all cases; where DIL coverage was limited by proximity to urethra or rectum, a mean dose to 90% of the DIL of 12.3 Gy was achieved. CONCLUSIONS: Modest dose escalation to the DIL (25-30%) using ultrasound-planned HDR brachytherapy is feasible for selected intermediate- and high-risk patients while respecting critical organ constraints and is achievable within the practice setting of a community cancer center.
Authors: Almudena Zapatero; Maria Roch; Pablo Castro Tejero; David Büchser; Carmen Martin de Vidales; Saturnino González; Pablo Rodríguez; Luis Alberto San Jose; Guillermo Celada; Maria Teresa Murillo Journal: Br J Radiol Date: 2021-09-19 Impact factor: 3.039
Authors: Martin T King; Nicola J Nasser; Nitin Mathur; Gil'ad N Cohen; Marisa A Kollmeier; Jasper Yuen; Hebert A Vargas; Xin Pei; Yoshiya Yamada; Kristen L Zakian; Marco Zaider; Michael J Zelefsky Journal: Brachytherapy Date: 2016-04-20 Impact factor: 2.362
Authors: Robert H Press; Hui-Kuo G Shu; Hyunsuk Shim; James M Mountz; Brenda F Kurland; Richard L Wahl; Ella F Jones; Nola M Hylton; Elizabeth R Gerstner; Robert J Nordstrom; Lori Henderson; Karen A Kurdziel; Bhadrasain Vikram; Michael A Jacobs; Matthias Holdhoff; Edward Taylor; David A Jaffray; Lawrence H Schwartz; David A Mankoff; Paul E Kinahan; Hannah M Linden; Philippe Lambin; Thomas J Dilling; Daniel L Rubin; Lubomir Hadjiiski; John M Buatti Journal: Int J Radiat Oncol Biol Phys Date: 2018-06-30 Impact factor: 7.038
Authors: Christopher W Smith; Ryan Alfano; Douglas Hoover; Kathleen Surry; David D'Souza; Jonathan Thiessen; Irina Rachinsky; John Butler; Jose A Gomez; Mena Gaed; Madeleine Moussa; Joseph Chin; Stephen Pautler; Glenn S Bauman; Aaron D Ward Journal: Phys Imaging Radiat Oncol Date: 2021-07-30
Authors: Christopher H Chapman; Steve E Braunstein; Jean Pouliot; Susan M Noworolski; Vivian Weinberg; Adam Cunha; John Kurhanewicz; Alexander R Gottschalk; Mack Iii Roach; I-Chow Hsu Journal: J Contemp Brachytherapy Date: 2018-06-29
Authors: Kevin Martell; Soumyajit Roy; Tyler Meyer; Jordan Stosky; Will Jiang; Kundan Thind; Michael Roumeliotis; John Bosch; Steve Angyalfi; Harvey Quon; Siraj Husain Journal: Heliyon Date: 2020-06-07