High dose rate afterloading brachytherapy for prostate cancer: catheter and gland movement between fractions

Hoskin, Peter; Bownes, Peter; Ostler, Peter; Walker, Ken; Bryant, Linda

doi:10.1016/s0167-8140(03)00203-2

Cited by 127 publications

(69 citation statements)

References 5 publications

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“…In measuring catheter displacement between fractions, the 3‐mm CT slices used in the present study were comparable to the 3‐mm slices used in one study (11) and the 2‐mm and 5‐mm CT scans in another study (12) . The average catheter displacement was quite different: approximately 4 mm in our study as compared with approximately 10 mm in others.…”

Section: Discussionsupporting

confidence: 64%

“…They also reported a reduction in needle movement after the first day (to an average of 2 mm between the third and fourth fractions). Using a 5‐mm CT scan, Hoskin et al (11) reported that the average template movement was 1 mm and that catheter movement relative to the prostate was 9.7 mm between the first and second fractions (over a period of 18 – 24 hours). Mullokandov and Gejerman (12) reported that no displacement of catheters relative to the template occurred and that the mean consecutive catheter displacement was 2, 8, and 10 mm before the second, third, and fourth fractions.…”

Section: Discussionmentioning

confidence: 99%

“…Reports in the literature ( 11 , 12 ) that used axial CT images for treatment planning note dose variation attributable to catheter displacement during fractions: a median 9.7‐mm catheter displacement reduced the

D_{90}

(the dose received by 90% of the target volume) by 40%, (11) and a median 9‐mm catheter displacement caused 35% of change in the dose to 90% of the prostate volume (12) . In those studies, the dosimetric impact of catheter displacement was significant because the magnitude of catheter displacement was almost twice the spacing of the consecutive dwell positions (5 mm).…”

Section: Discussionmentioning

confidence: 99%

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Measurement of craniocaudal catheter displacement between fractions in computed tomography–based high dose rate brachytherapy of prostate cancer

Kim

Hsu

Pouliot

2007

J Applied Clin Med Phys

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The objective of the present work was to measure the craniocaudal displacement of catheters occurring between consecutive fractions of transrectal ultrasound (TRUS)‐guided high dose rate (HDR) prostate brachytherapy. Ten consecutive patients were treated with 2 fractions of 9.5‐Gy TRUS‐guided HDR brachytherapy, with dental putty being used for the fixation of catheters. For each patient, a computed tomography (CT) scan with 3‐mm slice thickness was acquired before each of the 2 fractions. Two different references were used to measure the catheter displacement between fractions: the ischial bone as a bony marker (BM) and the center of two gold markers (COGM) implanted in the prostate. Catheter displacement was calculated by multiplying the thickness of the CT slice by the difference in number of CT slices between the reference slice and the slice containing the tip of a catheter. The average magnitude of caudal catheter displacement was 2.7 mm (range: −6.0 mm to 13.5 mm) for the BM method and 5.4 mm (range: −3.75 mm to 18.0 mm) for the COGM method. The measurement data obtained from the BM and COGM methods verified that prostate movement and catheter displacement both occurred independently between fractions. The most anterior and medial two catheters (catheter positions 8 and 12) had the greatest tendency to be displaced in the caudal direction because they were located at the most distant position from the fulcrum, making them susceptible to rotation of the dental putty in the lateral plane because of the movement of the patients’ legs between fractions. In conclusion, the combination of the BM and COGM methods can demonstrate prostate and catheter movement relative to the BM between fractions. Our technique found a pattern of catheter displacement. Based on that finding, further improvement of our results may be possible by modification of our current technique.PACS number: 87.53.Jw

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Section: Discussionsupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

D_{90}

Section: Discussionmentioning

confidence: 99%

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Measurement of craniocaudal catheter displacement between fractions in computed tomography–based high dose rate brachytherapy of prostate cancer

Kim

Hsu

Pouliot

2007

J Applied Clin Med Phys

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“…The most conformal solutions can be designed in this way, allowing nonuniform dose distribution inside the CTV. When needles are left in tissues, local oedema heightened by the presence of a template can induce caudal displacements [6,14]. Mainly present the first 24 h, the latter were circumvented by loading the catheters on the next day.…”

Section: Discussionmentioning

confidence: 99%

192Ir low dose rate brachytherapy for boosting locally advanced prostate cancers after external beam radiotherapy: A phase II trial

Nickers¹,

Coppens

Leval

et al. 2006

Radiotherapy and Oncology

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Background and purpose: To evaluate on 201 locally advanced prostatic cancers prospectively treated in a phase II trial, the efficacy of a combination of external beam radiotherapy (39.6 Gy) and 192 Ir low dose rate brachytherapy (Bt) (40-45 Gy).Patients and methods: Sixty-four patients were included in the intermediate prognosis group with only one of the following adverse factors (PSAO10 ng/ml, Gleason scoreR7 or clinical stageRT2b) and 137 in the unfavourable group when at least two of these factors were present.Results: The actuarial 4 years biochemical no evidence of disease is 82.8% for the entire population. It is, respectively, 97 and 76% in the intermediate and unfavourable prognosis groups (P!0.0001). GradeR3 late urinary complications occurred in 13 patients (6.5%). Eight patients (4%) presented late grade 2 rectal complications but no grades 3-5 was observed.Conclusions: Even if an a/b of 1.5-3 Gy theoretically favours the use of a high dose rate mode of irradiation, the early results presented here are as good as those reported for similar groups of patients with high dose rate treatments. Late toxicity is identical but our urinary toxicity is within the less favourable and rectal toxicity within the most favourable results.We can postulate that while inducing very high hyperdosage regions (V150) mainly focused on the peripheral zone, most of the Bt techniques consist of a more ablative treatment. Many of the radiobiological studies on Bt did not in fact take into account the heterogeneity of irradiation inside the CTV. This study highlights the need to explore pulsed dose rate therapies, permanent implant and new available radioisotopes such as 169 Ytterbium that will offer the safety of low and lower dose rates. The actual late toxicity of the different Bt techniques is not yet inexistent indeed. q

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“…Although concern has been raised about the possible impact on dosimetry, given that fractionated treatment is given over two days, Kim et al 6 have analysed this and have not found it to be of real significance. Hoskin et al 7 have studied catheter movement between two fractions of HDR treatment and have found that although there is minimal change in prostate position between fractions, there is caudal migration of the catheters in relation to various landmarks, again due to the periprostatic oedema that develops. It is, therefore, important to able to quantify this movement over the period of treatment using appropriate imaging, and to be able to correct for it, thus maintaining an optimal plan.…”

Section: Rationale For Hdr Brachytherapymentioning

confidence: 99%

Challenge of dose escalation in locally advanced unfavourable prostate cancer using HDR brachytherapy

Al-Salihi

Mitra

Payne

2006

Prostate Cancer Prostatic Dis

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In men with locally advanced/high-risk prostate cancer, there is an ongoing challenge to achieve improved results. Dose escalation studies using three-dimensional conformal radiotherapy (3D-CRT) or intensity modulated radiation therapy (IMRT) have shown benefit particularly in the intermediate and poor risk groups of patients. Of concern, however, is the increase in documented rectal toxicity. High-dose rate brachytherapy (HDR-BT) as a boost in combination with external beam radiotherapy (EBRT) is an alternative strategy of dose escalation that can potentially achieve an even higher biological equivalent dose (BED) to the tumour. The results so far are very encouraging for men with poor prognosis disease. Moreover the technique is associated with very low rates of acute and late toxicity.

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High dose rate afterloading brachytherapy for prostate cancer: catheter and gland movement between fractions

Cited by 127 publications

References 5 publications

Measurement of craniocaudal catheter displacement between fractions in computed tomography–based high dose rate brachytherapy of prostate cancer

Measurement of craniocaudal catheter displacement between fractions in computed tomography–based high dose rate brachytherapy of prostate cancer

192Ir low dose rate brachytherapy for boosting locally advanced prostate cancers after external beam radiotherapy: A phase II trial

Challenge of dose escalation in locally advanced unfavourable prostate cancer using HDR brachytherapy

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