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Cousins MM, Heckman P, Short E, Narayana V, Bryant AK, Evans C, Hixson G, Hurley P, McLaughlin PW. Rectal sparing in prostate radiotherapy with combination-brachytherapy and hydrogel spacer. Brachytherapy 2022; 21:300-307. [DOI: 10.1016/j.brachy.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/11/2021] [Accepted: 11/09/2021] [Indexed: 11/25/2022]
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2
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Wei G, Jiang P, Li C, Wei S, Jiang Y, Sun H, Wang J. A review on permanent implants for prostate brachytherapy with comparison between stranded and loose seeds. Jpn J Radiol 2021; 40:135-146. [PMID: 34480718 DOI: 10.1007/s11604-021-01189-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Accepted: 08/10/2021] [Indexed: 11/24/2022]
Abstract
A systematic literature review to validate the conclusions with regard to stranded seeds versus loose seeds. Published data for this review were identified by searching the PubMed databases. PD90, PV100, PV150, UD30, and RV100 acquired during the perioperative period and the postoperative period were analyzed by meta-analysis. Based on these studies, in addition to the reduction of migration and displacement, stranded seeds had some dosimetric advantages, especially in dose homogeneity and coverage of target area due to its connection characteristics. We also noticed implanted seeds usually excessive both in stranded seeds group and loose seed group. Intraoperatively built custom links will prolong operation time, with the proficiency of technology, the prolonged time gradually decreases.
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Affiliation(s)
- Guangchao Wei
- Institute of Medical Technology, Peking University Health Science Center, 38 Xueyuan Rd, Haidian District, 100191, Beijing, People's Republic of China.,Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Ping Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Chunxiao Li
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Shuhua Wei
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Yuliang Jiang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Haitao Sun
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China
| | - Junjie Wang
- Department of Radiation Oncology, Peking University Third Hospital, 49 North Garden Rd., Haidian District, 100191, Beijing, People's Republic of China.
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3
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Dhere VR, Fischer-Valuck BW, Goyal S, Liu Y, Morgan TM, Ghavidel E, Moghanaki DM, Hershatter BW, Patel PR, Jani AB, Godette KD, Rossi PJ, Patel SA. Patient-reported outcomes after Low-dose-rate versus High-dose-rate brachytherapy boost in combination with external beam radiation for intermediate and high risk prostate cancer. Brachytherapy 2021; 20:1130-1138. [PMID: 34417136 DOI: 10.1016/j.brachy.2021.07.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/24/2021] [Accepted: 07/14/2021] [Indexed: 02/07/2023]
Abstract
PURPOSE Addition of a brachytherapy boost to external beam radiation therapy (EBRT) reduces prostate cancer (PCa) recurrence at the expense of genitourinary (GU) toxicity. Whether brachytherapy boost technique, specifically low-dose-rate (LDR-BT) versus high-dose-rate (HDR-BT), impacts treatment-related toxicity is unclear. METHODS Between 2012-2018, 106 men with intermediate/high risk PCa underwent EBRT (37.5-45 Gy in 1.8-2.5 Gy/fraction) plus brachytherapy boost, either with LDR-BT (110 Gy I-125 or 100 Gy Pd-103; n = 51) or HDR-BT (15 Gy x1 Ir-192; n = 55). Patient-reported outcomes (PRO) were assessed by International Prostate Symptom Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC-CP) surveys at 3-6-month intervals for up to three years following treatment, with higher scores indicating more severe toxicity. Provider-reported GU and gastrointestinal (GI) toxicity was graded per CTCAE v5.0 at each follow-up. Linear mixed models comparing PROs between LDR-BT versus HDR-BT were fitted. Stepwise multivariable analysis (MVA) was performed to account for age, gland size, androgen deprivation therapy use, and alpha-blocker medication use. Incidence rates of grade 2+ GU/GI toxicity was compared using Fisher's exact test. RESULTS Use of LDR-BT was associated with greater change in IPSS (p=0.003) and EPIC-CP urinary irritative score (p = 0.002) compared with HDR-BT, but effect size diminished over time (LDR-BT versus HDR-BT: baseline to 6-/24-month mean IPSS change, +6.4/+1.4 versus +2.7/-3.0, respectively; mean EPIC-CP irritative/obstructive change, +2.5/+0.1 versus +0.9/+0.1, respectively). Results remained significant on MVA. Post-treatment grade 2+ GU toxicity was significantly higher in the LDR-BT group (67.5% versus 42.9% for LDR-BT and HDR-BT, respectively; p <0.001). There were no differences between groups in incontinence, bowel function, and erectile function, or grade 2+ GI toxicity. CONCLUSION Compared with LDR-BT, HDR-BT was associated with lower acute patient- and provider-reported GU toxicity.
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Affiliation(s)
- Vishal R Dhere
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | | | - Subir Goyal
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta GA
| | - Yuan Liu
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta GA
| | | | - Elizabeth Ghavidel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Drew M Moghanaki
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Bruce W Hershatter
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Pretesh R Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Ashesh B Jani
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Karen D Godette
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA
| | - Peter J Rossi
- Calaway Young Cancer Center, Valley View Hospital, Glenwood Springs CO
| | - Sagar A Patel
- Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta GA.
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4
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Shigeta K, Kikuchi E, Matsushima M, Ogihara K, Kosaka T, Mizuno R, Tanaka T, Shigematsu N, Oya M. Relationship between radiation doses and erectile function deterioration in patients with localized prostate cancer treated with permanent prostate brachytherapy. Int J Urol 2020; 27:1087-1093. [PMID: 32893378 DOI: 10.1111/iju.14358] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 07/20/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVES To investigate the relationship between radiation doses in prostate brachytherapy and deterioration of erectile function in patients with localized prostate cancer. METHODS A longitudinal survey study was carried out among 261 prostate cancer patients who received prostate brachytherapy. A total of 48 patients were potent at baseline and they did not receive any supplemental therapy preoperatively. Dosimetry parameters of the whole prostate gland, prostate apex, urethra and rectum were collected using the VariSeed 8.0 treatment planning system (Varian Medical Systems, Palo Alto, CA, USA). We carried out a logistic regression analysis to clarify the relationship between radiation doses and erectile function deterioration, which was assessed using the International Index of Erectile Function-15 questionnaire. RESULTS The median patient age was 66 years (range 53-70 years) with a median follow-up time of 44 months (36-71 months). The mean total International Index of Erectile Function-15 score decreased from 49.9 at baseline to 34.7 after 12 months (P < 0.001), but gradually plateaued within 36 months. Erectile function deterioration was noted in 32 (66.7%) patients 36 months after prostate brachytherapy. In an analysis of risk factors for erectile function deterioration after prostate brachytherapy, age ≥70 years (P = 0.029), prostate V100 ≥95% (P = 0.024), apex V100 ≥95% (P = 0.024), apex V150 ≥70% (P = 0.009) and apex D90 ≥150 Gy (P = 0.011) correlated with erectile function deterioration. A multivariate analysis identified an age of ≥70 years (odds ratio 7.91, P = 0.024) and apex V150 ≥70% (odds ratio 7.75, P = 0.007) as independent risk factors for erectile function deterioration after prostate brachytherapy. CONCLUSIONS An excessive radiation dose, particularly to the prostate apex area, and an advanced age might have a negative impact on the preservation of potency after prostate brachytherapy.
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Affiliation(s)
- Keisuke Shigeta
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Eiji Kikuchi
- Department of Urology, Keio University School of Medicine, Tokyo, Japan.,Department of Urology, St. Marianna University School of Medicine, Kanagawa, Japan
| | | | - Koichiro Ogihara
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Takeo Kosaka
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Ryuichi Mizuno
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
| | - Tomoki Tanaka
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Naoyuki Shigematsu
- Department of Radiology, Keio University School of Medicine, Tokyo, Japan
| | - Mototsugu Oya
- Department of Urology, Keio University School of Medicine, Tokyo, Japan
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5
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McLaughlin PW, Narayana V. Progress in Low Dose Rate Brachytherapy for Prostate Cancer. Semin Radiat Oncol 2020; 30:39-48. [DOI: 10.1016/j.semradonc.2019.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
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6
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Analysis of the relationship between prescribed dose and dosimetric advantage of real-time intraoperatively built custom-linked seeds in iodine-125 prostate brachytherapy. Radiat Oncol 2017; 12:192. [PMID: 29191234 PMCID: PMC5710060 DOI: 10.1186/s13014-017-0932-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2017] [Accepted: 11/24/2017] [Indexed: 11/13/2022] Open
Abstract
Background The purpose of this study was to investigate the differences in the dosimetric advantage of using intraoperatively built custom-linked (IBCL) seeds between permanent iodine-125 (I-125) seed implantation (PI) alone and PI followed by external-beam radiation therapy (EBRT) for prostate cancer. Methods We reviewed the records of 62 patients with localized prostate cancer who received transperineal interstitial brachytherapy with I-125 using free seeds or IBCL seeds. Twenty-four low- and intermediate-risk patients underwent PI alone with the prescribed dose of 160 Gy, and 39 high-risk patients underwent PI with 110 Gy, followed by EBRT with 45 Gy (PI + EBRT). Intraoperative and post-implant dosimetric parameters 1 month after implantation were collected and analyzed. Results The numbers of patients implanted with free seeds and IBCL seeds were 14 (58.3%) and 10 (41.7%), respectively, in the PI group and 25 (65.8%) and 13 (34.2%), respectively, in the PI + EBRT group. In the PI group, although there were significant differences in prostate V100 (p = 0.003) and D90 (p = 0.009) and rectum V100 (p = 0.026) on intraoperative dosimetry, these differences were not found on post-implant dosimetry. In the PI + EBRT group, the dosimetric parameters of IBCL seeds, such as prostate V200 (p = 0.013) and V250 (p = 0.010) and urethra D30 (p = 0.038), were better than those of free seeds on intraoperative dosimetry. Furthermore, even on post-implant dosimetry, prostate D90 (p = 0.004), V150 (p = 0.001), and homogeneity index (HI, p = 0.001), as well as V200 (p = 0.001) and V250 (p = 0.020), and urethra D5 (p = 0.008) as well as D30 (p = 0.003) had a better dosimetric quality in IBCL seeds than in free seeds. There was no significant difference in the operation time between free seeds and IBCL seeds in each PI and PI + EBRT group. Conclusions Our results reveal that greater dosimetric benefits could be obtained using IBCL seeds in the case of permanent implantation with a lower prescribed dose, such as PI + EBRT, rather than PI alone.
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7
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Cattani F, Vavassori A, Comi S, Gherardi F, Russo S, Orecchia R, Jereczek-Fossa BA. Can the Day 0 CT-scan predict the post-implant scanning? Results from 136 prostate cancer patients. Phys Med 2017; 40:66-71. [DOI: 10.1016/j.ejmp.2017.07.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2016] [Revised: 07/07/2017] [Accepted: 07/12/2017] [Indexed: 11/24/2022] Open
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8
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Steggerda MJ, van den Boom F, Witteveen T, Moonen LMF. Displacement patterns of stranded I-125 seeds after permanent brachytherapy of the prostate: Dosimetry in the operating room put into perspective. Radiother Oncol 2017. [PMID: 28633957 DOI: 10.1016/j.radonc.2017.05.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND AND PURPOSE The reliability of post-implant dosimetry in the OR depends on the geometrical variability of implant and anatomy after the procedure. The purpose was to gain detailed information on seed displacement patterns in different sectors of the prostate. MATERIALS AND METHODS Of 33 patients with stranded seed implants the seed geometry and the dose distribution were compared between the situation in the OR just after the procedure, based on ultrasound images, and the situation after 1month, based on registered CT and MR images. RESULTS There was a substantial displacement of ventral seeds of 3.8±2.5mm in caudal direction (p<0.001). Of these ventral seeds cranially located seeds moved more than caudally located seeds, 4.5±2.7mm and 2.9±2.6mm, respectively (p<0.001). The D90 in the dorsal-caudal and ventral-caudal sectors increased with respectively 44±20Gy and 29±28Gy (p<0.001) and decreased with 17±31Gy in the ventral-cranial sector (p=0.008). CONCLUSIONS There were substantial changes in dose distribution 1month after the procedure, mainly due to implant and prostate shrinkage and displacement of ventral seed strands in caudal direction. When performing dynamic dosimetry or dosimetry at the end of the procedure the effect of these phenomena has to be taken into account when using stranded seeds.
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Affiliation(s)
- Marcel J Steggerda
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
| | - Ferrie van den Boom
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Thelma Witteveen
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
| | - Luc M F Moonen
- Department of Radiation Oncology, The Netherlands Cancer Institute - Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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9
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Rose J, Liu D, Boychak O, Sloboda R, Pervez N, Murtha A, Yee D, Amanie J, Usmani N. Unexpected Seed Migration in Prostate Brachytherapy Implants Coincident with Change in Seed Stranding Product. Cureus 2017; 9:e1243. [PMID: 28620572 PMCID: PMC5467979 DOI: 10.7759/cureus.1243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Purpose: This study was undertaken to determine if significant seed migration occurred when our institution changed seed products by comparing patterns of seed migration in implants containing different stranding material. Methods and Materials: Day 0 and Day 30 CT scans were registered by the contoured prostate center of mass. An implant reconstruction program identified seeds on CT according to the pre-plan, enabling one-to-one correspondence between Day 0 and Day 30 seeds. Significant seed migration was defined by review of seeds that migrated > 2 cm outside the prostate or appearance in unexpected locations.
Results: Twenty-five (149, 16.8%) new strands displayed movement > 2 cm between Day 0 and Day 30 compared with just 2/118 (1.7%) of the standard strands. Six out of 26 (23%) patients with new strands displayed significant migration compared with 2/13 (14%) of patients with standard strands. In the six patients with new strands and significant migration, a mean of four strands (17%, range: 2-8 per patient) migrated significantly with 65% due to whole strand migration, 25% due to strand breakage, and 10% strand clumping. In the control group, only two strands (2%) migrated significantly, both due to strand breakage. Despite the greater seed movement with the new strands, Day 0 and Day 30 dosimetry was acceptable. Conclusion: In this short report, we identified that a change to a new strand type was associated with unexpected significant seed movement compared to our typical strands. Since seed movement can arise from unexpected causes, it is important to maintain quality assurance practices when a change in technique or infrastructure is instituted.
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Affiliation(s)
- Jim Rose
- Radiation Oncology, BC Cancer Agency - Abbotsford Centre
| | - Derek Liu
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | | | - Ron Sloboda
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Nadeem Pervez
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Albert Murtha
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - Don Yee
- Radiation Oncology, Cross Cancer Institute, University of Alberta
| | - John Amanie
- Radiation Oncology, Cross Cancer Institute, University of Alberta
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10
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Soni PD, Berlin A, Venkatesan AM, McLaughlin PW. Magnetic resonance imaging-guided functional anatomy approach to prostate brachytherapy. Brachytherapy 2016; 16:698-714. [PMID: 28040380 DOI: 10.1016/j.brachy.2016.11.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2016] [Revised: 11/17/2016] [Accepted: 11/18/2016] [Indexed: 01/18/2023]
Abstract
PURPOSE To provide an MRI based functional anatomy guide to prostate brachytherapy. METHODS AND MATERIALS We performed a narrative review of periprostatic functional anatomy and the significance of this anatomy in prostate brachytherapy treatment planning. RESULTS MRI has improved delineation of gross tumor and critical periprostatic structures that have been implicated in toxicity. Furthermore, MRI has revealed the significant anatomic variants and the dynamic nature of these structures that can have significant implications for treatment planning and dosimetry. CONCLUSIONS The MRI-based functional anatomy approach to prostate brachytherapy takes into account extent of disease, its relation to the patient's individual anatomy, and functional baseline to optimize the therapeutic ratio of prostate cancer treatment.
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Affiliation(s)
- Payal D Soni
- Department of Radiation Oncology, University of Michigan, Ann Arbor, MI
| | - Alejandro Berlin
- Department of Radiation Oncology, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Aradhana M Venkatesan
- Section of Abdominal Imaging, Department of Diagnostic Radiology, MD Anderson Cancer Center, Houston, TX
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11
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Davis BJ, Taira AV, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Showalter TN, Vapiwala N. ACR appropriateness criteria: Permanent source brachytherapy for prostate cancer. Brachytherapy 2016; 16:266-276. [PMID: 27964905 DOI: 10.1016/j.brachy.2016.10.002] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Accepted: 10/10/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To provide updated American College of Radiology (ACR) appropriateness criteria for transrectal ultrasound-guided transperineal interstitial permanent source brachytherapy. METHODS AND MATERIALS The ACR appropriateness criteria are evidence-based guidelines for specific clinical conditions that are reviewed every 3 years by a multidisciplinary expert panel. The guideline development and review include an extensive analysis of current medical literature from peer reviewed journals and the application of a well-established consensus methodology (modified Delphi) to rate the appropriateness of imaging and treatment procedures by the panel. In those instances where evidence is lacking or not definitive, expert opinion may be used to recommend imaging or treatment. RESULTS Permanent prostate brachytherapy (PPB) is a treatment option for appropriately selected patients with localized prostate cancer with low to very high risk disease. PPB monotherapy remains an appropriate and effective curative treatment for low-risk prostate cancer patients demonstrating excellent long-term cancer control and acceptable morbidity. PPB monotherapy can be considered for select intermediate-risk patients with multiparametric MRI useful in evaluation of such patients. High-risk patients treated with PPB should receive supplemental external beam radiotherapy (EBRT) along with androgen deprivation. Similarly, patients with involved pelvic lymph nodes may also be considered for such combined treatment but reported long-term outcomes are limited. Computed tomography-based postimplant dosimetry completed within 60 days of PPB is essential for quality assurance. PPB may be considered for treatment of local recurrence after EBRT but is associated with an increased risk of toxicity. CONCLUSIONS Updated appropriateness criteria for patient evaluation, selection, treatment, and postimplant dosimetry are given. These criteria are intended to be advisory only with the final responsibility for patient care residing with the treating clinicians.
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Affiliation(s)
- Brian J Davis
- Department of Radiation Oncology, Mayo Clinic, Rochester, MN.
| | - Al V Taira
- Dorothy Schneider Cancer Center, San Mateo, CA
| | - Paul L Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA
| | - Dean G Assimos
- Department of Urology, University of Alabama School of Medicine, Birmingham, AL; American Urological Association, Linthicum, MD
| | - Anthony V D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, MA; American Society of Clinical Oncology, Alexandria, VA
| | - Alexander R Gottschalk
- Department of Radiation Oncology, University of California San Francisco, San Francisco, CA
| | | | - Sameer R Keole
- Department of Radiation Oncology, Mayo Clinic Scottsdale, Phoenix, AZ
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, The University of Chicago Medical Center, Chicago, IL
| | - Shane Lloyd
- Department of Radiation Oncology, Huntsman Cancer Hospital, Salt Lake City, UT
| | | | - Benjamin Movsas
- Department of Radiation Oncology, Henry Ford Health System, Detroit, MI
| | | | - Timothy N Showalter
- Department of Radiation Oncology, University of Virginia, Charlottesville, VA
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA
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12
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Birckhead BJ, Fossum CC, Deufel CL, Furutani KM, Merrell KW, Schueler BA, Mynderse LA, Choo R, Davis BJ. Stranded seed displacement, migration, and loss after permanent prostate brachytherapy as estimated by Day 0 fluoroscopy and 4-month postimplant pelvic x-ray. Brachytherapy 2016; 15:714-721. [PMID: 27542893 DOI: 10.1016/j.brachy.2016.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 06/27/2016] [Accepted: 07/15/2016] [Indexed: 10/21/2022]
Abstract
PURPOSE The aim of the study was to determine the incidence of local displacement, distant seed migration to the chest, and seed loss after permanent prostate brachytherapy (PPB) with stranded seeds (SSs) using sequential two-dimensional fluoroscopic pelvic and chest x-rays. METHODS AND MATERIALS Between October 2010 and April 2014, a total of 137 patients underwent PPB and 4-month followup pelvic and chest x-ray imaging. All patients had exclusively SSs placed and an immediate postimplant fluoroscopic image of the seed cluster. Followup x-ray images were evaluated for the number, location, and displacement of seeds in comparison to Day 0 fluoroscopic images. Significant seed displacement was defined as seed displacement >1 cm from the seed cluster. Followup chest x-rays were evaluated for seed migration to the chest. RESULTS Seed migration to the chest occurred in 3 of the 137 patients (2%). Seed loss occurred in 38 of the 137 patients (28%), with median loss of one seed (range, 1-16), and total seeds loss of 104 of 10,088 (1.0%) implanted. Local seed displacement was seen in 12 of the 137 patients (8.8%), and total seeds displaced were 0.15% (15/10,088). CONCLUSIONS SS placement in PPB is associated with low rates of substantial seed loss, local displacement, or migration to the chest. Comparing immediate postimplant fluoroscopic images to followup plain x-ray images is a straightforward method to supplement quality assurance in PPB and was found to be useful in identifying cases where seed loss was potentially of clinical significance.
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Affiliation(s)
- B J Birckhead
- Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - C C Fossum
- Mayo Medical School, Mayo Clinic and Foundation, Rochester, MN
| | - C L Deufel
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - K M Furutani
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - K W Merrell
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - B A Schueler
- Department of Radiology, Mayo Clinic and Foundation, Rochester, MN
| | - L A Mynderse
- Department of Urology, Mayo Clinic and Foundation, Rochester, MN
| | - R Choo
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN
| | - B J Davis
- Department of Radiation Oncology, Mayo Clinic and Foundation, Rochester, MN.
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13
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Westendorp H, Nuver TT, Moerland MA, Minken AW. An automated, fast and accurate registration method to link stranded seeds in permanent prostate implants. Phys Med Biol 2015; 60:N391-403. [DOI: 10.1088/0031-9155/60/20/n391] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
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14
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Teye-Mensah R, Abdalla I, Dong L. The fixity of prostate seed implants: The impact of the strand surface on its ability to migrate inside oil and gel medium. Brachytherapy 2015; 14:686-91. [PMID: 26014645 DOI: 10.1016/j.brachy.2015.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2011] [Revised: 04/19/2015] [Accepted: 04/20/2015] [Indexed: 11/26/2022]
Abstract
PURPOSE Radioactive seed implants are widely used to treat cancer patients, most commonly those with prostate cancer. However, the seeds have a tendency to migrate after placement in patients, a phenomenon that can result in unfavorable outcomes. The ability of the seed strand to migrate was investigated by examining the impact of the strand surface on the velocity of its movement inside oil and gel media. METHODS AND MATERIALS We investigated the motion of smooth surface strands and strands with different grooved helical profiles after they were placed in oil and gel media. Three patterns of grooved helices were studied (60, 140, and 300 rotations per meter). The movement of the strands through a tube filled with the medium was recorded by the motion sensor, and the drag forces on the individual strands were calculated and compared for the oil and gel media. RESULTS The strands with 60, 140, and 300 rotations/meter grooved helical surfaces demonstrated less mobility in both oil and gel than the strands with a smooth surface. The strand with the highest number of helical grooves per meter recorded the largest drag force and moved more slowly in both media. CONCLUSIONS The differential in the motion of the smooth strand and the strands with grooved surfaces can be attributed to the increased surface area of the grooved strands. This finding is significant since it will impact, theoretically, the design, and thus the migration of seed implants that are used to treat cancer patients, particularly those with prostate cancer.
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Affiliation(s)
- Randy Teye-Mensah
- Department of Physics, Astronomy and Materials Science, Missouri State University, Springfield, MO
| | | | - Lifeng Dong
- Department of Physics, Astronomy and Materials Science, Missouri State University, Springfield, MO; Department of Physics, Hamline University, Saint Paul, MN.
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Gregory KJ, Pattison JE, Bibbo G. Measurement uncertainty analysis of low-dose-rate prostate seed brachytherapy: post-implant dosimetry. AUSTRALASIAN PHYSICAL & ENGINEERING SCIENCES IN MEDICINE 2015; 38:71-81. [DOI: 10.1007/s13246-014-0325-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/23/2014] [Accepted: 12/20/2014] [Indexed: 11/30/2022]
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Kovtun KA, Wolfsberger L, Niedermayr T, Sugar EN, Graham PL, Murciano-Goroff Y, Beard C, D'Amico AV, Martin NE, Orio PF, Nguyen PL. Dosimetric quality and evolution of edema after low-dose-rate brachytherapy for small prostates: implications for the use of newer isotopes. Brachytherapy 2013; 13:152-6. [PMID: 23911279 DOI: 10.1016/j.brachy.2013.05.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 05/07/2013] [Accepted: 05/31/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE To characterize prostate swelling and dosimetry in patients with small prostate volumes (PVs) undergoing brachytherapy. METHODS AND MATERIALS We studied 25 patients with PV <25 cc (range, 15.1-24.8) and 65 patients with PV ≥25 cc (range, 25.0-66.2) based on three-dimensional ultrasound contours who underwent brachytherapy monotherapy with intraoperative planning. Postoperative Days 1 and 30 dosimetry was done by CT-MRI fusion. RESULTS Small PVs had greater Day 1 swelling than large PVs (32.5% increase in volume vs. 23.7%, p = 0.04), but by Day 30, swelling was minimal and not significantly different (p = 0.44). Small PVs had greater seed and needle densities at implant (p < 0.001). Rectal and urethral doses were nearly identical by Day 30 (small PV rectum receiving 100% of the prescription dose [145 Gy] [V100] = 0.32 cc; large PV rectum V100 = 0.33 cc, p = 0.99; small PV urethra receiving 150% of the prescription dose [145 Gy] [V150] = 0.20, large PV urethra V150 = 0.20, p = 0.91). Swelling at Day 1 created some cool implants (rate dose that covers 90% of the prostate volume [D90 <140 Gy = 12.0% and 9.4% for the small and large PV groups, respectively, p = 0.71), but Day 30 planning target volume coverage was excellent (rate D90 <140 Gy = 0% for both groups). CONCLUSIONS Although smaller prostates have greater Day 1 swelling, good Day 30 dosimetry can be achieved, making them excellent candidates for (125)I seeds (half-life [t½] = 60 days). Smaller prostates may be suboptimal for shorter t½ sources such as (131)Cs (t½ = 9.7 days), in which the majority of the dose may be delivered to an edematous gland, unless the planning is adjusted to anticipate the edema.
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Affiliation(s)
- Konstantin A Kovtun
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Luciant Wolfsberger
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Thomas Niedermayr
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Emily N Sugar
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Powell L Graham
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Yonina Murciano-Goroff
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Clair Beard
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Anthony V D'Amico
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Neil E Martin
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Peter F Orio
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA
| | - Paul L Nguyen
- Department of Radiation Oncology, Dana-Farber Cancer Institute/Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
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Sarkar A, Donavanik V, Zhang I, Chen H, Koprowski C, Hanlon A, Mourtada F, Strasser J, Raben A. Prostate implant dosimetric outcomes and migration patterns between bio-absorbable coated and uncoated brachytherapy seeds. Brachytherapy 2013; 12:356-61. [PMID: 23477885 DOI: 10.1016/j.brachy.2013.01.163] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2012] [Revised: 12/21/2012] [Accepted: 01/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Abhirup Sarkar
- Department of Radiation Oncology, Helen F. Graham Cancer Center, Christiana Care Health System, Newark, DE
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Sylvester J, Grimm P, Naidoo D, Bilik J, Miller A, Wong J. First report on the use of a thinner 125I radioactive seed within 20-gauge needles for permanent radioactive seed prostate brachytherapy: Evaluation of postimplant dosimetry and acute toxicity. Brachytherapy 2013; 12:375-81. [DOI: 10.1016/j.brachy.2012.07.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/26/2012] [Accepted: 07/16/2012] [Indexed: 11/28/2022]
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Bowes D, Gaztañaga M, Araujo C, Kim D, Parker B, Batchelar D, Milette MP, Rajapakshe R, Petrik D, Halperin R, Crook JM. A randomized trial comparing seed displacement of coated seeds to regular loose seeds at 30 days postimplant. Brachytherapy 2013; 12:362-7. [DOI: 10.1016/j.brachy.2013.01.166] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2012] [Revised: 12/31/2012] [Accepted: 01/10/2013] [Indexed: 11/29/2022]
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Taira AV, Merrick GS, Grimm P, Butler WM, Lief JH, Morris M, Bennett A. Impact of small prostate size on postimplant prostate dosimetry: analysis of a large community database. Brachytherapy 2013; 12:222-7. [PMID: 23473916 DOI: 10.1016/j.brachy.2012.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 07/23/2012] [Accepted: 07/24/2012] [Indexed: 10/27/2022]
Abstract
PURPOSE Achieving high-quality permanent interstitial brachytherapy in smaller prostates is thought to be more difficult than in larger glands. This study evaluates 4547 implants in a large community database to test this hypothesis. METHODS AND MATERIALS From January 2003 to October 2010, 4547 prostate brachytherapy implants from a large community database were analyzed. The cohort was divided into three groups based on size, namely smaller (<30cm(3), n=1301), medium (30-40cm(3), n=1861), and large (>40cm(3), n=1385). Postimplant dosimetry, including D90, V100, and V100 by prostate sector, was performed for each implant. Comparison of mean V100 among small, medium, and larger prostate volume cohorts was performed using a one-way analysis of variance test. RESULTS For the overall cohort, the D90 was 105% and 104% for monotherapy and boost, respectively. Mean D90 for small prostates was 106% and 104% for monotherapy and boost, respectively. Mean V100 for small prostates was 91.1% and 90.0%, respectively. Coverage for small prostates was as good or slightly better than larger glands. V100 by prostate sector revealed that there were no sectors for which smaller glands had significantly inferior coverage compared with larger glands. CONCLUSION Although smaller prostates may in some respects be more technically difficult to implant than larger glands, a review of community-based brachytherapists reveals that with current implant techniques, good quality implants are readily achievable in men with smaller glands.
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Affiliation(s)
- Al V Taira
- Dorothy Schneider Cancer Center, Mills Peninsula Hospital, San Mateo, CA, USA
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21
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Three-dimensional visualization and dosimetry of stranded source migration following prostate seed implant. Pract Radiat Oncol 2012; 2:193-200. [DOI: 10.1016/j.prro.2011.09.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Revised: 09/25/2011] [Accepted: 09/30/2011] [Indexed: 11/22/2022]
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22
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Sloboda RS, Usmani N, Monajemi TT, Liu DMC. Impact of edema and seed movement on the dosimetry of prostate seed implants. J Med Phys 2012; 37:81-9. [PMID: 22557797 PMCID: PMC3339147 DOI: 10.4103/0971-6203.94742] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2011] [Revised: 02/16/2012] [Accepted: 02/16/2012] [Indexed: 11/04/2022] Open
Abstract
This article summarizes current knowledge concerning the characterization of prostatic edema and intra-prostatic seed movement as these relate to dosimetry of permanent prostate implants, and reports the initial application to clinical data of a new edema model used in calculating pre- and post-implant dose distributions. Published edema magnitude and half-life parameters span a broad range depending on implant technique and measurement uncertainty, hence clinically applicable values should be determined locally. Observed intra-prostatic seed movements appear to be associated with particular aspects of implant technique and could be minimized by technique modification. Using an extended AAPM TG-43 formalism incorporating the new edema model, relative dose error RE associated with neglecting edema was calculated for three I-125 seed implants (18.9 cc, 37.6 cc, 60.2 cc) performed at our center. Pre- and post-plan RE average values and ranges in a 50 × 50 × 50 mm(3) calculation volume were similar at ~2% and ~0-3.5%, respectively, for all three implants; however, the spatial distribution of RE varied for different seed configurations. Post-plan values of D90 and V100 for prostate were reduced by ~2% and ~1%, respectively. In cases where RE is not clinically negligible as a consequence of large edema magnitude and / or use of Pd-103 seeds, the dose calculation method demonstrated here can be applied to account for edema explicitly and there by improve the accuracy of clinical dose estimates.
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Affiliation(s)
- Ron S Sloboda
- Department of Medical Physics, Cross Cancer Institute, Alberta Health Services - Cancer Care and Department of Oncology, Faculty of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Whaley JT, Levy LB, Swanson DA, Pugh TJ, Kudchadker RJ, Bruno TL, Frank SJ. Sexual function and the use of medical devices or drugs to optimize potency after prostate brachytherapy. Int J Radiat Oncol Biol Phys 2012; 82:e765-71. [PMID: 22300559 DOI: 10.1016/j.ijrobp.2011.11.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 10/31/2011] [Accepted: 11/01/2011] [Indexed: 11/19/2022]
Abstract
PURPOSE Prospective evaluation of sexual outcomes after prostate brachytherapy with iodine-125 seeds as monotherapy at a tertiary cancer care center. METHODS AND MATERIALS Subjects were 129 men with prostate cancer with I-125 seed implants (prescribed dose, 145 Gy) without supplemental hormonal or external beam radiation therapy. Sexual function, potency, and bother were prospectively assessed at baseline and at 1, 4, 8, and 12 months using validated quality-of-life self-assessment surveys. Postimplant dosimetry values, including dose to 10% of the penile bulb (D10), D20, D33, D50, D75, D90, and penile volume receiving 100% of the prescribed dose (V100) were calculated. RESULTS At baseline, 56% of patients recorded having optimal erections; at 1 year, 62% of patients with baseline erectile function maintained optimal potency, 58% of whom with medically prescribed sexual aids or drugs. Variables associated with pretreatment-to-posttreatment decline in potency were time after implant (p = 0.04) and age (p = 0.01). Decline in urinary function may have been related to decline in potency. At 1 year, 69% of potent patients younger than 70 years maintained optimal potency, whereas 31% of patients older than 70 maintained optimal potency (p = 0.02). Diabetes was related to a decline in potency (p = 0.05), but neither smoking nor hypertension were. For patients with optimal potency at baseline, mean sexual bother scores had declined significantly at 1 year (p < 0.01). Sexual potency, sexual function, and sexual bother scores failed to correlate with any dosimetric variable tested. CONCLUSIONS Erections firm enough for intercourse can be achieved at 1 year after treatment, but most men will require medical aids to optimize potency. Although younger men were better able to maintain erections firm enough for intercourse than older men, there was no correlation between potency, sexual function, or sexual bother and penile bulb dosimetry.
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Affiliation(s)
- J Taylor Whaley
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
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24
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Usmani N, Chng N, Spadinger I, Morris WJ. Lack of significant intraprostatic migration of stranded iodine-125 sources in prostate brachytherapy implants. Brachytherapy 2011; 10:275-85. [DOI: 10.1016/j.brachy.2010.10.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2010] [Revised: 10/04/2010] [Accepted: 10/06/2010] [Indexed: 10/18/2022]
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25
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Crook J. The role of brachytherapy in the definitive management of prostate cancer. Cancer Radiother 2011; 15:230-7. [DOI: 10.1016/j.canrad.2011.01.004] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2010] [Revised: 12/22/2010] [Accepted: 01/12/2011] [Indexed: 10/18/2022]
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Vassiliev ON, Kudchadker RJ, Swanson DA, Bruno TL, van Vulpen M, Frank SJ. Displacement of periurethral stranded seeds and its dosimetric consequences in prostate brachytherapy. Brachytherapy 2011; 10:401-8. [PMID: 21306959 DOI: 10.1016/j.brachy.2011.01.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2010] [Revised: 11/19/2010] [Accepted: 01/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE The use of stranded seeds for prostate brachytherapy has raised concern that displacement of strands, particularly in the periurethral region, may result in inadequate coverage of the prostate. We sought here to evaluate the displacement of periurethral stranded seeds after a prostate brachytherapy implant (Day 0) and its dosimetric consequences 1 month later (Day 30). METHODS AND MATERIALS Subjects were 10 consecutive patients who underwent implantation with (125)I stranded seeds via a peripheral-loading technique. Computed tomography scanning was done on Days 0 and 30. Seeds were located and dose distributions calculated with a Variseed 7.2 treatment planning system (Varian Medical Systems). Images were registered by two methods, one using the penile bulb as reference and the other using the pubic bones for verification. Only seeds within the periurethral strands were analyzed. RESULTS The mean displacement of periurethral stranded seeds relative to the prostate did not exceed 1mm in any direction. Calculated displacements were not affected by the registration method used. The mean dose covering 90% of the prostate volume (D(90)) and prostate volume receiving 100% of the prescribed dose (V(100)) were 169Gy and 97% on Day 0 and 186.5Gy and 98.7% on Day 30 (p<0.001 for D(90)). CONCLUSIONS Displacement of periurethral stranded seeds 30 days after implantation was minimal and did not compromise dosimetric coverage of the prostate.
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Affiliation(s)
- Oleg N Vassiliev
- Department of Radiation Physics, The University of Texas M. D. Anderson Cancer Center, Houston, TX 77030, USA
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Chng N, Spadinger I, Morris WJ, Usmani N, Salcudean S. Prostate brachytherapy postimplant dosimetry: Automatic plan reconstruction of stranded implants. Med Phys 2010; 38:327-42. [DOI: 10.1118/1.3525839] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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28
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Liu HW, Malkoske K, Sasaki D, Bews J, Demers A, Nugent Z, Ong A, Bashir B, Dufan T, Cho P, Drachenberg D, Chowdhury A. The dosimetric quality of brachytherapy implants in patients with small prostate volume depends on the experience of the brachytherapy team. Brachytherapy 2010; 9:202-7. [DOI: 10.1016/j.brachy.2009.07.009] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2009] [Revised: 07/10/2009] [Accepted: 07/14/2009] [Indexed: 10/19/2022]
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29
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Loose seeds versus stranded seeds in I-125 prostate brachytherapy: Differences in clinical outcome. Radiother Oncol 2010; 96:30-3. [DOI: 10.1016/j.radonc.2010.02.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 01/08/2010] [Accepted: 02/13/2010] [Indexed: 11/21/2022]
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30
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Badwan HO, Shanahan AE, Adams MA, Shanahan TG, Mueller PW, Markwell SJ, Tarter TH. AnchorSeed for the reduction of source movement in prostate brachytherapy with the Mick applicator implant technique. Brachytherapy 2009; 9:23-6. [PMID: 19762286 DOI: 10.1016/j.brachy.2009.07.002] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2009] [Revised: 07/01/2009] [Accepted: 07/01/2009] [Indexed: 10/20/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the influence of potential contributing factors to the incidence of seed slippage and quality of prostate brachytherapy dosimetry comparing "coated" vs. "bare" seeds with a Mick applicator. METHODS AND MATERIALS Two consecutive groups of 89 patients were treated with (125)I prostate brachytherapy at a high treatment volume single institution. All the patients were evaluated with Day 0 plain films of the pelvis and CT-based dosimetry analysis. The incidence of seed slippage was quantified. The seed slippage outcome was evaluated with respect to source type (bare vs. coated). The Day 0 prostate V(100), V(150), D90%, rectal V(100), and urethra D(30) outcomes were evaluated with respect to source type. RESULTS A total of 13,512 seeds were placed in 178 patients. An average of 76 seeds and 16 needles were used for each patient. The bare seed group was significantly higher on fluoroscopy minutes (2.34 vs. 1.58 min), seed slippage (5 vs. 1.5 mm), volume of rectum receiving 100% of dose (0.05 vs. 0.0 cc), dose percentage received by 30% of urethra (119% vs. 113.64%), and volume of prostate receiving 100% of prescription dose (95.21% vs. 92.8%). No significant differences in volume of prostate receiving 150% of prescription dose, dose percentage received by 90% of prostate, vascular seed migration, or operating room procedure time were seen. No seed drift greater than 10mm outside the "packet" of other seeds was seen in the AnchorSeed (BrachySciences, a division of Biocompatibles, Inc. Oxford, CT) cohort. CONCLUSION The report is the first to show the unique "fixity" of AnchorSeed to remain in position after deployment from the Mick applicator. Minimizing seed drag can reduce dose to the penile bulb, and maximize radiation coverage to the apex of the gland.
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Affiliation(s)
- Hamzeh O Badwan
- Department of Radiation Oncology, Memorial Medical Center, 701 North First Street, Springfield, IL 62781-0001, USA
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31
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Moerland MA, van Deursen MJ, Elias SG, van Vulpen M, Jürgenliemk-Schulz IM, Battermann JJ. Decline of dose coverage between intraoperative planning and post implant dosimetry for I-125 permanent prostate brachytherapy: Comparison between loose and stranded seed implants. Radiother Oncol 2009; 91:202-6. [DOI: 10.1016/j.radonc.2008.09.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2008] [Revised: 09/05/2008] [Accepted: 09/07/2008] [Indexed: 10/21/2022]
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32
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Rectal dosimetry following prostate brachytherapy with stranded seeds – Comparison of transrectal ultrasound intra-operative planning (day 0) and computed tomography-postplanning (day 1 vs. day 30) with special focus on sources placed close to the rectal wall. Radiother Oncol 2009; 91:207-12. [DOI: 10.1016/j.radonc.2008.11.012] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2008] [Revised: 09/29/2008] [Accepted: 11/04/2008] [Indexed: 11/15/2022]
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Cormack RA. Quality assurance issues for computed tomography-, ultrasound-, and magnetic resonance imaging-guided brachytherapy. Int J Radiat Oncol Biol Phys 2008; 71:S136-41. [PMID: 18406913 DOI: 10.1016/j.ijrobp.2007.07.2389] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2007] [Revised: 07/09/2007] [Accepted: 07/15/2007] [Indexed: 11/25/2022]
Abstract
The requirements of quality assurance (QA) for both brachytherapy and imaging devices are well-defined, but image-guided brachytherapy has raised new issues. Image guidance in brachytherapy involves the transition from reference point dosimetry using films to volumetric imaging such as computed tomography, ultrasonography, and magnetic resonance imaging for treatment planning and guidance of applicator, needle, or seed placement. The QA of these devices might not reflect the conditions of use in brachytherapy or the requirements of brachytherapy treatment planning. Image interpretation becomes much more important with image-guided brachytherapy. The success of a procedure could depend on the interpretation of a single image in a calibration phase done under the time pressures of the operative setting. This change has implications at the level of treatment, the process, and the field of brachytherapy as a whole. The QA concerns arising from brachytherapy procedures using ultrasound, computed tomography, and magnetic resonance imaging guidance are discussed, as are the problems associated with using imaging in an interventional setting. This report was intended to indicate the QA concerns arising from the convergence of brachytherapy and imaging-highlighting areas in which technical improvements are needed.
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Affiliation(s)
- Robert A Cormack
- Department of Radiation Oncology, Dana Farber/Brigham and Women's Cancer Center, Boston, MA 02115, USA.
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Saibishkumar EP, Borg J, Yeung I, Cummins-Holder C, Landon A, Crook JM. Loose seeds vs. stranded seeds: A comparison of critical organ dosimetry and acute toxicity in 125I permanent implant for low-risk prostate cancer. Brachytherapy 2008; 7:200-5. [DOI: 10.1016/j.brachy.2007.12.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2007] [Revised: 12/11/2007] [Accepted: 12/28/2007] [Indexed: 11/27/2022]
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35
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Soto DE, McLaughlin PW. Combined Permanent Implant and External-Beam Radiation Therapy for Prostate Cancer. Semin Radiat Oncol 2008; 18:23-34. [DOI: 10.1016/j.semradonc.2007.09.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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36
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Reed DR, Wallner KE, Merrick GS, Arthurs S, Mueller A, Cavanagh W, Butler WB, Ford E, Sutlief SG. A prospective randomized comparison of stranded vs. loose 125I seeds for prostate brachytherapy. Brachytherapy 2007; 6:129-34. [PMID: 17434106 DOI: 10.1016/j.brachy.2007.01.003] [Citation(s) in RCA: 75] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2006] [Revised: 01/17/2007] [Accepted: 01/17/2007] [Indexed: 11/23/2022]
Abstract
PURPOSE To compare seed loss and dosimetric parameters between stranded and loose 125I seeds (LS) for prostate brachytherapy. METHODS AND MATERIALS Sixty-four patients with 1997 American Joint Commission on Cancer (AJCC) clinical stage T1c or T2a prostate carcinoma were prospectively randomized to brachytherapy (144Gy) with RAPID Strand 125I seeds (RS) vs. LS (Oncura, Plymouth Meeting, PA) The treatment plan for each patient was devised before randomization, and was not modified based on the randomization. Each patient underwent magnetic resonance, computed tomography, and plain film radiographs on the day of the implant (Day 0) and 30 days later (Day 30). RESULTS Overall, 21 of 62 patients (30%) experienced seed loss. Seed loss occurred in 15 of 32 of LS patients (47%) vs. 6 of 30 RS patients (23%; p=0.053). Mean seed loss was 1.09 in the LS patient vs. 0.43 in RS patients (p=0.062). Eight LS patients (25%) lost multiple seeds, compared to 3 stranded patients (10%). Despite the lesser degree of seed loss in patients who received stranded seeds, they had a paradoxical trend toward lower V100 and D90 values. CONCLUSION This prospective randomized trial showed a strong trend toward a decrease in postimplant seed loss with stranded seeds. Improved seed retention may be more advantageous in a setting of less generous periprostatic coverage. The lowered risk seed migration seen with stranded seeds would presumably also decrease the likelihood of lung or cardiac seed embolization.
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Affiliation(s)
- Daniel R Reed
- Scottsdale Radiation Oncology, Arizona Oncology Services, Phoenix, AZ 85260, USA.
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37
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Pinkawa M, Asadpour B, Gagel B, Piroth MD, Borchers H, Jakse G, Eble MJ. Evaluation of source displacement and dose–volume changes after permanent prostate brachytherapy with stranded seeds. Radiother Oncol 2007; 84:190-6. [PMID: 17706306 DOI: 10.1016/j.radonc.2007.07.014] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2007] [Revised: 06/14/2007] [Accepted: 07/13/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND PURPOSE The aim of the study was to analyze source displacements and dose-volume changes in the first month after a permanent implant. MATERIALS AND METHODS In 51 consecutive patients, CT scans were performed at the postoperative day (day 1) and one month (day 30) after an (125)I implant with stranded seeds. Seed positions were determined relative to pelvic bones for five seeds at the base and five seeds at the apex for each patient (n=510) and compared. To verify these results, treatment margins (TM=distance of prescription isodose to prostate) and displacements of the prostate surface (anterior/posterior/right/left/superior/inferior) relative to pelvic bones were measured. RESULTS Seed positions have moved significantly between day 1 and 30 in the posterior (mean 1.0mm; p<0.001) and inferior (mean 3.8mm; p<0.001) directions. TM increased particularly at the posterior (mean 2.2mm; p<0.001) and apical (median 3.0mm; p<0.001) prostate contour with decreasing oedema. With a stable apex position and a mean inward posterior surface displacement of 1.1mm (p<0.001) relative to pelvic bones, seed displacements could be well correlated with prescription isodose displacements (Pearson correlation coefficients >or=0.81; p<0.001). CONCLUSIONS Both changes of prostate volume and seed displacements need to be considered to explain dosimetric changes after permanent prostate brachytherapy.
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Affiliation(s)
- Michael Pinkawa
- Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany.
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Steggerda MJ, Moonen LMF, van der Poel HG, Schneider CJ. The influence of geometrical changes on the dose distribution after I-125 seed implantation of the prostate. Radiother Oncol 2007; 83:11-7. [PMID: 17349706 DOI: 10.1016/j.radonc.2007.02.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2006] [Revised: 02/02/2007] [Accepted: 02/08/2007] [Indexed: 10/23/2022]
Abstract
PURPOSE After prostate implantation, dose calculation is usually based on a single imaging session, assuming no geometrical changes occur during the months of dose accumulation. In this study, the effect of changes in anatomy and implant geometry on the dose distribution was investigated. MATERIALS AND METHODS One day, 1 month and 312 months after seed implantation, a combined TRUS-CT scan was made of 13 patients. Based on these scans changes in dose rate distribution were determined in prostate, urethra and bladder and a 'geometry corrected' dose distribution was estimated. RESULTS When based on the day-1 scan, parameters representing high dose volumes in prostate and urethra were largely underestimated: V150 of the prostate 18+/-10% and V120 of the urethra 47+/-32%. The dose to a 2cm(3) hotspot in the bladder wall (D2cc), however, was overestimated by 31+/-35%. Parameters based on scans 1 month post-implant or later were all within +/-5% of geometry corrected values. CONCLUSION Values meant to indicate the adequacy of dose coverage of the prostate, V100 and D90, were not influenced by geometrical changes and were independent of the post-implant scan date. Other parameters representing high dose volumes changed strongly within the first month after implantation.
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Affiliation(s)
- Marcel J Steggerda
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands.
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Lin K, Lee SP, Cho JS, Reiter RE, DeMarco JJ, Solberg TD. Improvements in prostate brachytherapy dosimetry due to seed stranding. Brachytherapy 2007; 6:44-8. [PMID: 17284385 DOI: 10.1016/j.brachy.2006.08.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2006] [Revised: 08/20/2006] [Accepted: 08/29/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE Prostate brachytherapy with suture embedded seeds has emerged as a popular technique to reduce seed migration and to improve dosimetry. Various trials have shown improved dosimetry with seed fixity, whereas others have shown no benefit and possible detriment to suture embedded seeds. In order to contribute to the understanding of whether seed stranding improves dosimetry, we present retrospective data from our institution. METHODS AND MATERIALS We analyzed 80 patients treated between April 29, 2001 and June 19, 2006, receiving I-125 monotherapy for prostate cancer. Brachytherapy patients at the University of California, Los Angeles (UCLA) were initially treated using a transperineal approach with loose seeds. Subsequent to October 26, 2002, all patients were implanted using suture embedded seeds. Dosimetric quantifiers were calculated based on a CT obtained 1-month postimplantation. RESULTS Dosimetry of patients treated with stranded seeds showed significant improvement. Specifically, the V100 (volume of the prostate receiving 100% of the prescribed dose) improved from 88% to 92% (p<0.05), and the D90 (maximum dose received by 90% of the prostate) improved from 143 to 155 Gy (p<0.05). CONCLUSIONS At UCLA, the use of suture embedded seeds resulted in a significant improvement in our dosimetric quantifiers. Based upon other published studies, this improvement in dosimetry may translate into improved patient outcomes.
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Affiliation(s)
- Kevin Lin
- Department of Radiation Oncology, University of California, Los Angeles, CA 90095, USA.
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Spadinger I, Hilts M, Keyes M, Smith C, Sidhu S, Morris WJ. Prostate brachytherapy postimplant dosimetry: A comparison of suture-embedded and loose seed implants. Brachytherapy 2006; 5:165-73. [PMID: 16864068 DOI: 10.1016/j.brachy.2006.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2006] [Revised: 05/16/2006] [Accepted: 05/19/2006] [Indexed: 11/26/2022]
Abstract
PURPOSE To compare postimplant dosimetry and seed embolization rates for prostate brachytherapy implants using suture-embedded and loose seeds. METHODS AND MATERIALS Dosimetric analysis of the whole prostate, prostate quadrants, rectum, and surrogate urethra was performed on 54 loose seed and 81 RAPIDStrand (RS) patients. Seed embolization rates were determined from chest radiographs. RESULTS Whole prostate V100 and D90 did not differ significantly for the loose seed (V100 = 90.5%, D90 =153.2 Gy) and RS groups (V100 = 91.5%, D90 = 151.6 Gy) (p = 0.43 and 0.65, respectively), but V150, V200, and contiguous V200 were higher (p < or = 0.003) for the RS group (59.9%, 28.3%, and 23.2%, respectively) than the loose seed group (52.5%, 22.8%, and 16.1%, respectively). Extraprostatic measures (conformity index and external index) were also different at the p < 0.05 level. The embolization rate was 40% in the loose seed group and 14% in the RS group. CONCLUSIONS The most significant difference between the two study groups was a decrease in the embolization rate. Although some statistically significant changes in postimplant dosimetry were observed, they were nevertheless small.
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Affiliation(s)
- Ingrid Spadinger
- Radiation Therapy Program, BC Cancer Agency, Vancouver, BC, Canada.
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