American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy

Yamada, Yoshiya; Rogers, Leland; Demanes, D. Jeffrey; Morton, Gerard; Prestidge, Bradley R.; Pouliot, Jean; Cohen, Gilad; Zaider, Marco; Ghilezan, M.; Hsu, I‐Chow

doi:10.1016/j.brachy.2011.09.008

Cited by 265 publications

(196 citation statements)

References 72 publications

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“…Interpreting this information in a prostate implant, we can conclude that no relevant differences are found in the regions corresponding to the rectum and bladder, overall, when the volumes of the organs at risk are delineated 9 mm above and below the target volume (32) . Nevertheless, a dose underestimation for the zone corresponding to the penile bulb between 2% and 3% may be observed.…”

Section: Discussionmentioning

confidence: 78%

Brachytherapy treatment planning commissioning: effect of the election of proper bibliography and finite size of TG‐43 input data on standard treatments

Valdés

Piriz

Lozano

2015

J Applied Clin Med Phys

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The aim of this work is to evaluate the performance of a commercial brachytherapy treatment planning system (TPS) with TG‐43 Vendors Input Data (VID), analyze possible discrepancies with respect to a proper reference source and its implications for standard treatments, and judge the effectiveness of certain widespread recommended quality controls to find potential errors related with the interpolations of TG‐43 VID tables. The TPS evaluated was a BrachyVision 8.6 loaded with TG‐43 VID for a VariSource high‐dose‐rate 192Ir source (Vs2000). The reference data chosen were the TG‐43 data published in the literature. In the first step, we compared TG‐43 VID with respect to the chosen reference data. Next, we used percent dose‐rate differences in a point array matrix to compare the outcomes of the TPS on standard treatment setup with respect to an in‐house developed program (MATLAB R2009a‐based) loaded with the chosen full TG‐43 reference data. The cases with major discrepancies were evaluated using the gamma‐index analysis. The comparison with the reference data indicated a lack of sample in the angles between near to the tip (between 165<θ<180) and cable (0<θ<15) of the F(r,θ)VID, which causes a dose underestimation of approximately 17% in the investigated points due to inaccurate interpolations. The differences over 2% encompassed approximately 17% of the surrounding source volume. These results have special relevance in treatment using one applicator with a few dwell steps or in Fletcher treatments where 10% dose underestimates were identified within the tumor or in organs at risk, respectively. Our results suggest that the differences found in the TPS under study are created by a lack of information on the angles in high‐gradient zones in the F(r,θ)VID, which generates important differences in dosimetric results. In contrast, the gamma analysis shows very good results (between 90% and 100% of passed points) in the analyzed treatments (one dwell and Fletcher). Further studies are required to exclude the possibility of finding noticeable effects in the DVH of treatment plans caused by the discrepancies here described. To achieve more strict control over the TPS dose‐rate calculation, we recommend using QA test thinking in a source with nonaxial symmetry, adding a control point on the angles of the high‐dose gradient zones (e.g., between 0° and 15° and between 165° and 180°). More studies are required to achieve full understanding of the clinical implication of such discrepancies.PACS number: 87.55.Qr

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Section: Discussionmentioning

confidence: 78%

Brachytherapy treatment planning commissioning: effect of the election of proper bibliography and finite size of TG‐43 input data on standard treatments

Valdés

Piriz

Lozano

2015

J Applied Clin Med Phys

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“…It is not clear what dosimetric values best predict the risk of acute and/or late-term toxicity for the bladder, the rectum, or the risk of developing erectile dysfunction after HDR monotherapy. This was recently echoed by the American Brachytherapy Society prostate HDR guidelines, which state that ''given the extreme heterogeneity in dose fractionation schedules published in the literature, it is difficult to establish absolute dose guidelines for normal tissues'' (40). This limitation makes it challenging to estimate whether the dose reductions we found to OARs would be clinically meaningful.…”

Section: Discussionmentioning

confidence: 96%

Focal high-dose-rate brachytherapy: A dosimetric comparison of hemigland vs. conventional whole-gland treatment

et al. 2013

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PURPOSE: To determine the utility of focal high-dose-rate brachytherapy for localized prostate cancer, we investigated the impact on target coverage and dose to organs at risk (OARs) with hemigland (HG) compared with whole-gland (WG) treatment. METHODS AND MATERIALS:A total of 10 WG implants were used to generate 10 WG and 20 HG (left and right) treatment plans optimized with the inverse planning simulation annealing algorithm using Oncentra MasterPlan (Nucletron B.V., Veenendaal, The Netherlands). The standard distribution of 17e18 catheters designed for WG was used to generate HG plans. The same OARs namely bladder, rectum, and urethra contours and dose constraints were applied for HG and WG plans. The HG contour was a modification of the WG contour whereby the urethra divided the prostate into HGs.

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“…Oncologic outcomes for HDR monotherapy for low-and intermediate-risk patients demonstrate PSA control rates in the O90% range (11). The most common short-term morbidity is urethritis, which is temporary in the majority of men with only about 10% having some type of persistent severe urinary change (11).…”

Section: Discussionmentioning

confidence: 99%

“…Most studies suggest that these side effects are associated with urethritis as opposed to prostatitis or cystitis (11). Consistent reproducible doseevolume parameters associated with urinary toxicity for HDR prostate brachytherapy have not been established.…”

Section: Urinary Toxicitymentioning

confidence: 99%

From whole gland to hemigland to ultra-focal high-dose-rate prostate brachytherapy: A dosimetric analysis

et al. 2015

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PURPOSE: To assess the magnitude of dosimetric reductions of a focal and ultra-focal high-doserate (HDR) prostate brachytherapy treatment strategy relative to standard whole gland (WG) treatment. METHODS AND MATERIALS: HDR brachytherapy plans for five patients treated with WG HDR monotherapy were optimized to assess different treatment strategies. Plans were generated to treat the hemigland (HG), one-third gland (1/3G), and one-sixth gland (1/6G), as well as to assess treating the WG with a boost to one of those sub-volumes (WG þ HG, WG þ 1/3G, WG þ 1/6G). Dosimetric parameters analyzed included Target D90%, V100%, V150%, Bladder (B), Rectal (R), Urethral (U) D0.1, 1 and 2cc, Urethral V75%, and the V50% to the contralateral HG. Two-tailed t tests were used for comparison of means, and p-values less than 0.05 were considered statistically significant. RESULTS: Target objectives (D90 O 100% and V100 O 97%) were met in all cases. Significant organs at risk dose reductions were achieved for all approaches compared with WG plans. 1/6G vs WG plans resulted in the greatest reduction in dose with a mean bladder D2cc 24.7 vs 64.8%, rectal D2cc 32.8 vs 65.3%, urethral D1cc 52.1 vs 103.8%, and V75 14.5 vs 75% ( p ! 0.05 for all comparisons). CONCLUSION: Significant dose reductions to organs at risk can be achieved using HDR focal brachytherapy. The magnitude of the reductions achievable with treating progressively smaller sub-volumes suggests the potential to reduce morbidity, but the clinical impact on morbidity and tumor control remain to be investigated. Ó

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American Brachytherapy Society consensus guidelines for high-dose-rate prostate brachytherapy

Cited by 265 publications

References 72 publications

Brachytherapy treatment planning commissioning: effect of the election of proper bibliography and finite size of TG‐43 input data on standard treatments

Brachytherapy treatment planning commissioning: effect of the election of proper bibliography and finite size of TG‐43 input data on standard treatments

Focal high-dose-rate brachytherapy: A dosimetric comparison of hemigland vs. conventional whole-gland treatment

From whole gland to hemigland to ultra-focal high-dose-rate prostate brachytherapy: A dosimetric analysis

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