Conformal prostate brachytherapy guided by realtime dynamic dose calculations using permanent 125iodine implants: technical description and preliminary experience

Prada, Pedro J.; Juan, Germán; Fernández, José M.; González-Suárez, Herminio; Martínez, Álvaro; González, José; Alonso, Ana

doi:10.4321/s0004-06142006000900021

Cited by 8 publications

(8 citation statements)

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“…The technique used in the implantation was based on intra-operative planning with real-time dynamic dose calculation with peripheral loading. The implantation technique has been previously described ( 10 , 11 ).…”

Section: Methodsmentioning

confidence: 99%

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

et al. 2016

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Objectives We analyzed the long-term oncologic outcome for patients with prostate cancer and transurethral resection who were treated using low-dose-rate (LDR) prostate brachytherapy.Methods and Materials From January 2001 to December 2005, 57 consecutive patients were treated with clinically localized prostate cancer. No patients received external beam radiation. All of them underwent LDR prostate brachytherapy. Biochemical failure was defined according to the “Phoenix consensus”. Patients were stratified as low and intermediate risk based on The Memorial Sloan Kettering group definition.Results The median follow-up time for these 57 patients was 104 months. The overall survival according to Kaplan-Meier estimates was 88% (±6%) at 5 years and 77% (±6%) at 12 years. The 5 and 10 years for failure in tumour-free survival (TFS) was 96% and respectively (±2%), whereas for biochemical control was 94% and respectively (±3%) at 5 and 10 years, 98% (±1%) of patients being free of local recurrence. A patient reported incontinence after treatment (1.7%). The chronic genitourinary complains grade I were 7% and grade II, 10%. At six months 94% of patients reported no change in bowel function.Conclusions The excellent long-term results and low morbidity presented, as well as the many advantages of prostate brachytherapy over other treatments, demonstrates that brachytherapy is an effective treatment for patients with transurethral resection and clinical organ-confined prostate cancer.

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Section: Methodsmentioning

confidence: 99%

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

et al. 2016

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“…The technique used for implantation was based on intraoperative planning with real‐time dynamic dose calculation. The implantation technique was described previously [5,9].…”

Section: Methodsmentioning

confidence: 99%

“…In 1999 we performed our first interstitial implant procedure with 125 I seeds [5]; currently, 300 patients are treated annually, with a total of 1400 recorded. The objective of the present study was to report the clinical outcome, side‐effects and complications after permanent implantation of 125 I seeds for early prostate cancer in 734 patients treated with a follow‐up of ≥30 months.…”

Section: Introductionmentioning

confidence: 99%

Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent ¹²⁵iodine implants

et al. 2010

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Study Type – Therapy (case series) Level of Evidence 4 OBJECTIVE To report our analysis of the oncological outcome, side‐effects and complications after 125I‐brachytherapy, based on 10 years of experience, as low dose‐rate (LDR) prostate brachytherapy is an accepted, effective and safe therapy for localized prostate cancer. PATIENTS AND METHODS Between April 1999 and December 2006, 734 consecutive patients were treated with clinically localized prostate cancer with a follow‐up of ≥30 months. No patients received external beam radiotherapy and 43% received hormonal therapy before brachytherapy; this therapy was given for 3–4 months. All patients had LDR prostate brachytherapy administered by one radiation oncologist. Biochemical failure was defined according to the ‘Phoenix consensus’. RESULTS The median follow‐up for the 734 patients was 55 months; 26 had a clinical relapse and 11 died from prostate cancer; 20 patients died from other illnesses. The 10‐year actuarial biochemical control was 92%, 84% and 65%, respectively (P < 0.001) for the low‐, intermediate‐ and high‐risk groups. Multivariate Cox regression analyses identified Gleason score and prostate‐specific antigen (PSA) level as independent prognostic factors for biochemical failure. The actuarial biochemical control with Gleason score was 88%, 76% and 67% for patients with a Gleason score of ≤6, 7 and >7, respectively (P < 0.001). The biochemical control was 90%, 80% and 42% for patients with a PSA level of ≤10, 10.1–20 and >20 ng/mL, respectively (P < 0.001). No patients reported incontinence after treatment. There was acute urinary retention in 22 (2.9%) patients. Logistic regression showed that the most significant factors correlating with the probability of catheterization were the pretreatment prostate volume and hormonal therapy. CONCLUSIONS The excellent long‐term results and low morbidity, and the many advantages of prostate brachytherapy over other treatments, show that brachytherapy is an effective treatment for clinically organ‐confined prostate cancer.

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“…LDR real-time dosimetry followed later, with one of the first reports being published by Stock and Stone (2000) [13] on a small cohort of 10 consecutive patients. Prada and colleagues [2] reported on a real-time dynamic intra-operative dose calculation technique which has replaced, in their practice, the need for post implant dosimetry. In order to avoid the challenges encountered during prostate delineation on post implant CT images, the group has implemented an interactive intra-operative dose calculation method whereby the treatment plan is designed on the spot according to anatomical specificities and limitations, with needles being positioned where considered most adequate, and not at given coordinates.…”

Section: Discussionmentioning

confidence: 99%

“…This challenge was possibly caused by several factors, such as: (1) changes in patient’s anatomy between the two scans; (2) changes in patient positioning on the operating couch. Thus the delivered seed dosimetry was likely to be significantly different from the initially planned one [2]. To eliminate this problem and, at the same time, to optimise treatment flow, the quality of the implant and hence treatment outcome, it was decided to move to a one step live planning technique.…”

Section: Introductionmentioning

confidence: 99%

Assessment of I-125 seed implant accuracy when using the live-planning technique for low dose rate prostate brachytherapy

2012

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BackgroundLow risk prostate cancers are commonly treated with low dose rate (LDR) brachytherapy involving I-125 seeds. The implementation of a ‘live-planning’ technique at the Royal Adelaide Hospital (RAH) in 2007 enabled the completion of the whole procedure (i.e. scanning, planning and implant) in one sitting. ‘Live-planning’ has the advantage of a more reliable delivery of the planned treatment compared to the ‘traditional pre-plan’ technique (where patient is scanned and planned in the weeks prior to implant). During live planning, the actual implanted needle positions are updated real-time on the treatment planning system and the dosimetry is automatically recalculated. The aim of this investigation was to assess the differences and clinical relevance between the planned dosimetry and the updated real-time implant dosimetry.MethodsA number of 162 patients were included in this dosimetric study. A paired t-test was performed on the D90, V100, V150 and V200 target parameters and the differences between the planned and implanted dose distributions were analysed. Similarly, dosimetric differences for the organs at risk (OAR) were also evaluated.ResultsSmall differences between the primary dosimetric parameters for the target were found. Still, the incidence of hotspots was increased with approximately 20% for V200. Statistically significant increases were observed in the doses delivered to the OAR between the planned and implanted data; however, these increases were consistently below 3% thus probably without clinical consequences.ConclusionsThe current study assessed the accuracy of prostate implants with I-125 seeds when compared to initial plans. The results confirmed the precision of the implant technique which RAH has in place. Nevertheless, geographical misses, anatomical restrictions and needle displacements during implant can have repercussions for centres without live-planning option if dosimetric changes are not taken into consideration.

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Conformal prostate brachytherapy guided by realtime dynamic dose calculations using permanent 125iodine implants: technical description and preliminary experience

Cited by 8 publications

References 18 publications

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent ¹²⁵iodine implants

Assessment of I-125 seed implant accuracy when using the live-planning technique for low dose rate prostate brachytherapy

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Conformal prostate brachytherapy guided by realtime dynamic dose calculations using permanent 125iodine implants: technical description and preliminary experience

Cited by 8 publications

References 18 publications

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

Low-dose-rate brachytherapy for patients with transurethral resection before implantation in prostate cancer. Long-term results

Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent 125iodine implants

Assessment of I-125 seed implant accuracy when using the live-planning technique for low dose rate prostate brachytherapy

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Prostate‐specific antigen relapse‐free survival and side‐effects in 734 patients with up to 10 years of follow‐up with localized prostate cancer treated by permanent ¹²⁵iodine implants