Computed tomography versus magnetic resonance imaging in high-dose-rate prostate brachytherapy planning: The impact on patient-reported health-related quality of life

Abstract

High-dose-rate (HDR) prostate brachytherapy uses volumetric imaging for treatment planning. Our institution transitioned from computed tomography (CT)-based planning to MRIbased planning with the hypothesis that improved visualization could reduce treatment-related toxicity. This study aimed to compare the patient-reported health-related quality of life (hrQOL) and physician-graded toxicity outcomes of CT-based and MRI-based HDR prostate brachytherapy. METHODS: From 2016 to 2019, 122 patients with low-or intermediate-risk prostate cancer were treated with HDR brachytherapy as monotherapy. Patients underwent CT only or CT and MRI imaging for treatment planning and were grouped per treatment planning imaging modality. Patientreported hrQOL in the genitourinary (GU), gastrointestinal (GI), and sexual domains was assessed using International Prostate Symptom Score and Expanded Prostate Cancer Index Composite Short Form-26 questionnaires. Baseline characteristics, changes in hrQOL scores, and physician-graded toxicities were compared between groups. RESULTS: The median follow-up was 18 months. Patient-reported GU, GI, and sexual scores worsened after treatment but returned toward baseline over time. The CT cohort had a lower baseline mean International Prostate Symptom Score (5.8 vs. 7.8, p 5 0.03). The other patient-reported GU and GI scores did not differ between groups. Overall, sexual scores were similar between the CT and MRI cohorts ( p 5 0.08) but favored the MRI cohort at later follow-up with a smaller decrease in Expanded Prostate Cancer Index Composite Short Form-26 sexual score from baseline at 18 months (4.9 vs. 19.8, p 5 0.05). Maximum physician-graded GU, GI, and sexual toxicity rates of grade $2 were 68%, 3%, and 53%, respectively, with no difference between the cohorts ( p 5 0.31). CONCLUSION: Our study shows that CT-and MRI-based HDR brachytherapy results in similar rates of GU and GI toxicity. MRI-based planning may result in improved erectile function recovery compared with CT-based planning. Published by Elsevier Inc. on behalf of American Brachytherapy Society.

Prostate segmentation accuracy using synthetic MRI for high-dose-rate prostate brachytherapy treatment planning

“…The major difference between two MRI scanners was the body coil. Signa HDxt had a body array coil (anterior and posterior components) with a maximum of eight independent receive channels and Signa Artist had a geometry embracing method (GEM) anterior array and a GEM posterior array in a table with a maximum of 36 independent receive channels (Harris et al 2021). In the 58 MRI datasets used for training, 25 scans were acquired using Signa HDxt and 33 scans were acquired using Signa Artist.…”

First implementation of an innovative infra‐red camera system integrated into a mobile CBCT scanner for applicator tracking in brachytherapy—Initial performance characterization

“…Since the introduction of three-dimensional (3D) imaging for brachytherapy in the late 20th century, 1,2 modalities such as computed tomography (CT) and cone-beam CT (CBCT) have been established as an essential part of many treatment workflows. [1][2][3][4][5][6] The cross-sectional visualization of the patient's anatomy enables not only the delineation of diseases but also a pre-planning of interventional procedures. 1,2,[7][8][9][10] The implantation of brachytherapy applicators is commonly performed based on imaging.…”