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

Banerjee, Robyn; Park, Sang-June; Anderson, Erik S.; Demanes, D. Jeffrey; Wang, Jason; Kamrava, Mitchell

doi:10.1016/j.brachy.2014.12.007

Cited by 19 publications

(15 citation statements)

References 26 publications

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“…Banerjee et al [28] have shown that a significant reduction in dosage to the organs at risk (OARs) was achieved using high-dose-rate focal brachytherapy, compared to whole gland and hemi-gland treatment. However, none of the previous studies on prostate cancer focal therapy included radiomics based detection of cancer lesions for therapy planning.…”

Section: Introductionmentioning

confidence: 99%

Radiomics based targeted radiotherapy planning (Rad-TRaP): a computational framework for prostate cancer treatment planning with MRI

et al. 2016

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BackgroundRadiomics or computer – extracted texture features have been shown to achieve superior performance than multiparametric MRI (mpMRI) signal intensities alone in targeting prostate cancer (PCa) lesions. Radiomics along with deformable co-registration tools can be used to develop a framework to generate targeted focal radiotherapy treatment plans.MethodsThe Rad-TRaP framework comprises three distinct modules. Firstly, a module for radiomics based detection of PCa lesions on mpMRI via a feature enabled machine learning classifier. The second module comprises a multi-modal deformable co-registration scheme to map tissue, organ, and delineated target volumes from MRI onto CT. Finally, the third module involves generation of a radiomics based dose plan on MRI for brachytherapy and on CT for EBRT using the target delineations transferred from the MRI to the CT.ResultsRad-TRaP framework was evaluated using a retrospective cohort of 23 patient studies from two different institutions. 11 patients from the first institution were used to train a radiomics classifier, which was used to detect tumor regions in 12 patients from the second institution. The ground truth cancer delineations for training the machine learning classifier were made by an experienced radiation oncologist using mpMRI, knowledge of biopsy location and radiology reports. The detected tumor regions were used to generate treatment plans for brachytherapy using mpMRI, and tumor regions mapped from MRI to CT to generate corresponding treatment plans for EBRT. For each of EBRT and brachytherapy, 3 dose plans were generated - whole gland homogeneous () which is the current clinical standard, radiomics based focal (), and whole gland with a radiomics based focal boost (). Comparison of against conventional revealed that targeted focal brachytherapy would result in a marked reduction in dosage to the OARs while ensuring that the prescribed dose is delivered to the lesions. resulted in only a marginal increase in dosage to the OARs compared to . A similar trend was observed in case of EBRT with and compared to .ConclusionsA radiotherapy planning framework to generate targeted focal treatment plans has been presented. The focal treatment plans generated using the framework showed reduction in dosage to the organs at risk and a boosted dose delivered to the cancerous lesions.

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Section: Introductionmentioning

confidence: 99%

Radiomics based targeted radiotherapy planning (Rad-TRaP): a computational framework for prostate cancer treatment planning with MRI

et al. 2016

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“…The incidences of these toxicities with HDR as a boost to EBRT are w5.2%-12.7%, 17%-38%, 21%-26% 68,126 and 20%-50%, respectively. 127,128 Although new or worsening sexual dysfunction is very common after prostate BT, no consistent patterns have emerged demonstrating what structures might be spared to ameliorate this effect.…”

Section: Oculocutaneous Diseasementioning

confidence: 99%

“…126,129 Lower urinary tract symptoms share a positive association with bladder D 1cc , 130,131 with similar findings for rectal toxicities and hotspots. 127 IMBT studies have therefore focused on decreasing the dose to OARs, especially the urethra and periapical urethra, instead of increasing the prescription dose, given the relatively good prognosis for patients receiving standard doses.…”

Section: Oculocutaneous Diseasementioning

confidence: 99%

Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

Callaghan

Adams

Flynn

et al. 2019

International Journal of Radiation Oncology*Biology*Physics

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Purpose: To systematically review scientific literature on the use of intensity-modulated brachytherapy (IMBT), including static and dynamic shielding approaches, to enhance therapeutic ratio. Studies were evaluated for technique, disease site, dosimetry, applicators, dosimetric calculations, and planning algorithms. Comparisons with standard-of-care brachytherapy techniques, alternative IMBT methods, or both were performed for dose-to-target volumes, organs at risk (OARs), and treatment planning or delivery times. Methods and Materials: Inclusion criteria were any peer-reviewed journal articles on IMBT published from January 1, 1980, to January 1, 2019, on PubMed, Google Scholar, Cochrane Library, and EBSCO databases. Two independent investigators reviewed each article for inclusion and exclusion criteria and scope. Data collected on each study included technique, source or shield material, disease site, n of study (n Z number of simulated plans/treated patients), doseto-target/OARs, and planning or delivery times. This review adhered to the Preferred Reporting Items for Systemic reviews and Meta Analyses (PRISMA). Results: Database queries yielded 1734 results, which were reduced to 436 after exclusion criteria and 78 peer-reviewed journal articles after evaluation of scope. Studies per disease site were 31 for cervical; 16 for rectal; 10 for oculocutaneous; 7 for breast; 6 for prostate; and 8 for other, multiple, or no specific disease site. Eighteen studies demonstrated a significant decrease in dose to OARs (5.1%-68.2%), 11 improved treatment planning or delivery times (7.6%-99.7%), and 6 increased target coverage (18.6%-71.6%) relative to standard-of-care or alternative IMBT technique. IMBT consistently decreased dose to OAR compared with the standard of care at the cost of increased planning or delivery times. Innovations in dose calculation or planning algorithms and applicators were capable of ameliorating prolonged treatment intervals.

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“…According to the recent reports, the incidence of grade ≥ 2 genitourinary toxicity after HDR brachytherapy for prostate cancer is around 9-10% [ 3 , 10 ], and reaches 12-19% in some publications [ 12 , 13 ]. Therefore, in patients with low risk localized (stage T1-T2a) PCa, the research have been directed toward different methods of focal prostate brachytherapy, which can varied from hemigland irradiation to focal therapy directly to the tumor foci [ 11 , 14 ]. Considering the high incidence of multifocal pattern of prostate involvement, in our Institute we abounded classic focal HDR brachytherapy for patients with PCa.…”

Section: Purposementioning

confidence: 99%

Template guided transperineal saturation biopsy of the prostate: lessons for focal and urethra-sparing high-dose-rate brachytherapy for localized prostate cancer

Новиков¹,

Kanaev²,

Novikov³

et al. 2016

jcb

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PurposeThe aim of this work is to evaluate results of prostate transperineal saturation biopsy as a guide for focal high-dose-rate brachytherapy in patients with prostate cancer (PCa).Material and methodsTemplate guided saturation biopsy was performed in 67 primary patients with suspicion for prostate cancer. Biopsy was performed under ultrasonography (US) control with the help of brachytherapy grid and 5 mm distance between samples. We put special attention for accurate sampling of prostate in periurethral region. The number of cores varied from 17 to 81 (average 36 cores). Finally, in 40 patients with confirmed prostate cancer results of biopsy were used for brachytherapy planning.ResultsSaturation biopsy revealed prostate cancer in 40 of 67 evaluated patients. The extent of biopsy core involvement varied from 5% to 100% (average: 57%). Focal nature of PCa (single unilateral tumor nodule) was diagnosed in 10 (25%), multifocal – in another 30 (75%) patients. Hemigland invasion was mentioned in 12 (30%) cases. Saturation biopsy detected PCa in periurethral cores in 27 (67.5%) of 40 evaluated patients. In 10 patients, the extent of involvement in periurethral cores varied between 10% and 50%; in another, 17 observations exceeded 50%. According to results obtained on saturation biopsy, we performed HDR brachytherapy with “urethra low dose tunnel” (D10ur ≤ 80-90%) in 13 patients with noninvolved periurethral cores. Theoretically, hemigland brachytherapy was possible in 12 of 40 evaluated patients with PCa.ConclusionsIn low risk patients with PCa results of template guided saturation biopsy indicates high frequency (75%) of multifocal disease and high probability (67.5%) of periurethral invasion. Suitable candidates for focal HDR brachytherapy or irradiation with additional sparing of urethra can be effectively determined with the help of saturation biopsy.

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

Cited by 19 publications

References 26 publications

Radiomics based targeted radiotherapy planning (Rad-TRaP): a computational framework for prostate cancer treatment planning with MRI

Radiomics based targeted radiotherapy planning (Rad-TRaP): a computational framework for prostate cancer treatment planning with MRI

Systematic Review of Intensity-Modulated Brachytherapy (IMBT): Static and Dynamic Techniques

Template guided transperineal saturation biopsy of the prostate: lessons for focal and urethra-sparing high-dose-rate brachytherapy for localized prostate cancer

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