Impact of a dominant intraprostatic lesion (DIL) boost defined by sextant biopsy in permanent I-125 prostate implants on biochemical disease free survival (bDFS) and toxicity outcomes

Guimond, Elizabeth; Lavallée, Marie-Claude; Foster, William; Vigneault, Éric; Guay, Karolann; Martin, André‐Guy

doi:10.1016/j.radonc.2018.12.027

Cited by 15 publications

(19 citation statements)

References 36 publications

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“…Of note, in the present study the median V150 and V200 (93.9% and 57.8%) were similar to those outlined by Gaudet et al (95.7% and 51.3% respectively) [29]. Furthermore, these results are similar to the recent publication by Guimond et al (91.2% and 55.6% respectively) which provides an update to the data presented by Gaudet et al [38]. Given that the dose distribution in the present study was based solely on clinical impression at the time of implant, this result is reassuring and suggests that this method of dose painting can lead to acceptable dosimetric results.…”

Section: Discussionsupporting

confidence: 92%

“…In unplanned analyses (not included in results) this effect was maintained examining patients with DILs limited to anywhere in the gland outside the base vs those without DIL (7yFFBF 84% vs 69%; p ¼ 0.40). This is consistent with the report of Guimond et al [38]. However, the overall estimated 7-year FFBF in the present study (82%) was relatively lower than the bDFS reported by Guimond et al (89-96)% despite both cohorts being comprised exclusively of patients with IR-PCa [38].…”

Section: Discussionsupporting

confidence: 92%

“…This is consistent with the report of Guimond et al [38]. However, the overall estimated 7-year FFBF in the present study (82%) was relatively lower than the bDFS reported by Guimond et al (89-96)% despite both cohorts being comprised exclusively of patients with IR-PCa [38]. Similar dose constraints and the same treatment delivery system (the SPOT Pro system from Nucletron) were used in both studies.…”

Section: Discussionsupporting

confidence: 91%

“…No difference in biochemical control was found in either the present or the Guimond et al study [38]. Despite this, it is difficult to infer whether one should aim to achieve dose escalation to the areas of pathological involvement at the time of LDR-BT when a DIL is present.…”

Section: Discussioncontrasting

confidence: 67%

“…Similar dose constraints and the same treatment delivery system (the SPOT Pro system from Nucletron) were used in both studies. This difference could be explained by a difference in baseline patient characteristics including a higher proportion of Gleason 6 PCa and lower baseline PSA being observed in the report by Guimond et al [38]. Independent of this difference, both studies report outcomes consistent with previous reports analyzing intermediate risk patients [7,46,47].…”

Section: Discussionsupporting

confidence: 59%

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Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy

Martell

Roy

Meyer

et al. 2020

Heliyon

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To compare the outcomes of patients with intermediate risk prostate cancer (IR-PCa) treated with lowdose rate I-125 seed brachytherapy (LDR-BT) and targeted dose painting of a histologic dominant intra-epithelial lesion (DIL) to those without a DIL. Methods: 455 patients with IR-PCa were treated at a single center with intra-operatively planned LDR-BT, each following the same in-house dose constraints. Patients with a DIL on pathology had hot spots localized to that region but no specific contouring during the procedure. Results: 396 (87%) patients had a DIL. Baseline tumor characteristics and overall prostate dosimetry were similar between patients with and without DIL except the median number of biopsy cores taken: 10 (10-12) vs 12 (10-12) (p ¼ 0.002). 19 (5%) and 18 (5%) of patients with and 1 (2%) and 0 (0%) of those without DIL experienced CTCAE grade 2 and 3 toxicity respectively. Overall, toxicity grade did not significantly correlate with presence of DIL (p ¼ 0.10). Estimated 7-year freedom from biochemical failure (FFBF) was 84% (95% confidence interval: 79-89) and 70% (54-89) in patients with and without a DIL (log-rank p ¼ 0.315). In DIL patients, cox regression revealed location of DIL ("Base" vs "Apex" HR: 1.03; 1.00-1.06; p ¼ 0.03) and older age (70 vs 60 HR: 1.62; 1.06-2.49; p ¼ 0.03) was associated with poor FFBF. Conclusions: Targeting DIL through dose painting during intraoperatively planned LDR-BT provided no statistically significant change in FFBF. Patients with DILs in the prostate base had slightly lower FFBF despite DIL boost.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 91%

Section: Discussioncontrasting

confidence: 67%

Section: Discussionsupporting

confidence: 59%

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Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy

Martell

Roy

Meyer

et al. 2020

Heliyon

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Prostate cancer detection and segmentation on MRI using non‐local mask R‐CNN with histopathological ground truth

et al. 2023

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BackgroundAutomatic detection and segmentation of intraprostatic lesions (ILs) on preoperative multiparametric‐magnetic resonance images (mp‐MRI) can improve clinical workflow efficiency and enhance the diagnostic accuracy of prostate cancer and is an essential step in dominant intraprostatic lesion boost.PurposeThe goal is to improve the detection and segmentation accuracy of 3D ILs in MRI by a proposed a deep learning (DL)‐based algorithm with histopathological ground truth.MethodsThis retrospective study included 262 patients with in vivo prostate biparametric MRI (bp‐MRI) scans and were divided into three cohorts based on their data analysis and annotation. Histopathological ground truth was established by using histopathology images as delineation reference standard on cohort 1, which consisted of 64 patients and was randomly split into 20 training, 12 validation, and 32 testing patients. Cohort 2 consisted of 158 patients with bp‐MRI based lesion delineation, and was randomly split into 104 training, 15 validation, and 39 testing patients. Cohort 3 consisted of 40 unannotated patients, used in semi‐supervised learning. We proposed a non‐local Mask R‐CNN and boosted its performance by applying different training techniques. The performance of non‐local Mask R‐CNN was compared with baseline Mask R‐CNN, 3D U‐Net and an experienced radiologist's delineation and was evaluated by detection rate, dice similarity coefficient (DSC), sensitivity, and Hausdorff Distance (HD).ResultsThe independent testing set consists of 32 patients with histopathological ground truth. With the training technique maximizing detection rate, the non‐local Mask R‐CNN achieved 80.5% and 94.7% detection rate; 0.548 and 0.604 DSC; 5.72 and 6.36 95 HD (mm); 0.613 and 0.580 sensitivity for ILs of all Gleason Grade groups (GGGs) and clinically significant ILs (GGG > 2), which outperformed baseline Mask R‐CNN and 3D U‐Net. For clinically significant ILs, the model segmentation accuracy was significantly higher than that of the experienced radiologist involved in the study, who achieved 0.512 DSC (p = 0.04), 8.21 (p = 0.041) 95 HD (mm), and 0.398 (p = 0.001) sensitivity.ConclusionThe proposed DL model achieved state‐of‐art performance and has the potential to help improve radiotherapy treatment planning and noninvasive prostate cancer diagnosis.

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Curvilinear catheter implantation in HDR prostate brachytherapy: feasibility study

Padasdao,

Imanaka,

Podder

et al. 2024

Medical Physics

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BackgroundHigh‐dose‐rate (HDR) brachytherapy (BT) has been acknowledged as a widely utilized treatment for patients with intermediate‐ and high‐risk prostate cancer, despite its side effects such as edema, incontinence, and impotence. Nevertheless, the treatment is consistently limited by the potential danger of excessive irradiation to organs‐at‐risk (OARs) like the urethra, bladder, and rectum.PurposeThis study aims to introduce curvilinear catheter implantation in the prostate gland for HDR treatment. The objective is to improve the radiation dose distribution by offering access channels conformal to the prostate anatomy. This approach seeks to minimize toxicity to nearby OARs while utilizing a reduced number of needles, potentially leading to improved clinical outcomes.MethodsCurvilinear catheters were first pre‐planned for an anonymized patient using Oncentra treatment planning system (TPS) and hybrid inverse planning optimization (HIPO) algorithm. The trajectories of the catheters were then analyzed using MATLAB to extract their radius of curvature. Tendon‐driven active needles were then used to implant curvilinear catheters inside an anthropomorphic phantom.ResultsProposed curvilinear catheter implantation resulted in significant improvement in terms of dosimetric constraints to the OARs and coverage to the prostate. Tendon‐driven active needles were shown to be capable of realizing the required pre‐planned curvatures inside prostate. It was shown that the active needle can realize a desired radius of curvature and a desired trajectory with an average accuracy of 9.1 ± 8.6 and 1.27 ± 0.50 mm in air and inside a tissue‐mimicking phantom, respectively.ConclusionThis work demonstrates the feasibility of using tendon‐driven active curvilinear catheter implantation in prostate to improve the outcomes of HDR‐BT via improved radiation dose distribution to the prostate and reduced toxicity to the OARs.

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Impact of a dominant intraprostatic lesion (DIL) boost defined by sextant biopsy in permanent I-125 prostate implants on biochemical disease free survival (bDFS) and toxicity outcomes

Cited by 15 publications

References 36 publications

Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy

Analysis of outcomes after non-contour-based dose painting of dominant intra-epithelial lesion in intra-operative low-dose rate brachytherapy

Prostate cancer detection and segmentation on MRI using non‐local mask R‐CNN with histopathological ground truth

Curvilinear catheter implantation in HDR prostate brachytherapy: feasibility study

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