Magnetic Resonance Imaging–Defined Treatment Margins in Iodine-125 Prostate Brachytherapy

Crook, Juanita; Patil, Nikhilesh; Ma, Clement; McLean, Michael; Borg, Jette

doi:10.1016/j.ijrobp.2009.06.040

Cited by 26 publications

(17 citation statements)

References 37 publications

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“…Within the recommended dose range of 140 to 180 Gy, local failures are extremely rare events. We previously reported MRIdefined treatment margins with this planning approach and demonstrated satisfactory coverage of a 3-mm margin around the MRI-defined prostate (38). It may be that those patients failing locally had disease extent beyond this margin, but it is more likely that they had either disease in a region of deficient margin or inherent radioresistance.…”

Section: Discussionmentioning

confidence: 93%

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

Crook

Borg

Evans

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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100

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Section: Discussionmentioning

confidence: 93%

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

Crook

Borg

Evans

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

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100

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“…However, studies correlating pathologic extent of extraprostatic spread suggest that in over 90% of cases, microscopic extracapsular extension is 3 mm or less and microscopic seminal vesicle spread is 1 cm or less [34,35]. When the procedure is modified to implant the base of the seminal vesicles, brachytherapy can technically address minimal extracapsular and seminal vesicle extension [36,37]. Further, IMRT to the prostate and seminal vesicles and prostate brachytherapy boost can address potential extracapsular extension while achieving high prostate biologically effective doses (BEDs).…”

Section: Prostate Brachytherapy Is An Organ Function-sparing Treatmenmentioning

confidence: 99%

Update on Prostate Brachytherapy: Long-term Outcomes and Treatment-related Morbidity

Kao

Cesaretti²,

Stone

et al. 2011

Curr Urol Rep

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Current research in prostate brachytherapy focuses on five key concepts covered in this review. Transrectal ultrasound-guided prostate brachytherapy assisted by intraoperative treatment planning is the most advanced form of image-guided radiation delivery. Prostate brachytherapy alone for low-risk prostate cancer achieves lower prostate-specific antigen (PSA) nadirs than intensity-modulated radiotherapy (IMRT) or protons while maintaining durable biochemical control in about 90% of patients without late failures seen in surgically treated patients. As an organ-conserving treatment option, seed implant results in a lower rate of erectile dysfunction and urinary incontinence than surgery that has been validated in several recent prospective studies. Combined IMRT and seed implant has emerged as a rational and highly effective approach to radiation-dose escalation for intermediate- and high-risk prostate cancer. Preliminary results suggest that seed implantation may play a role in improving outcomes for historically poor-prognosis locally advanced and recurrent prostate cancers.

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“…Previously, post-implant margins have been analyzed with respect to outcomes, but the results have been conflicting [30–32]. In some studies, larger post-implant whole prostate and anterior margins were associated with better biochemical outcomes [31, 32].…”

Section: Discussionmentioning

confidence: 99%

“…In some studies, larger post-implant whole prostate and anterior margins were associated with better biochemical outcomes [31, 32]. In another study, there was no association between post-implant margins and biochemical outcomes [30].…”

Section: Discussionmentioning

confidence: 99%

Pre-plan parameters predict post-implant D 90 ≥ 140 Gy for 125 I permanent prostate implants

Alexander

Weinberg

Gottschalk

et al. 2014

jcb

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PurposeTo find permanent prostate implant (PPI) pre-plan dosimetric parameters that predict post-implant D90 ≥ 140 Gy.Material and methodsPre-plans were evaluated for 504 patients undergoing PPI with 125I seeds for low or intermediate risk prostate cancer. Baseline patient and disease factors, numbers of seeds, ratios of number of seeds to available positions (occupancy proportion), and distances between the 100% isodose line and edge of the prostate (margin) planned for the whole prostate (WP), superior (S), inferior (I), anterior (A), and posterior (P) halves, SA, SP, IA, and IP quarters, and superior (ST), inferior (IT), and middle (MT) thirds, and anterior (AT) and posterior (PT) middle one-sixth segments were analyzed by post-implant D90 subset (≥ 140 Gy vs. < 140 Gy).Results20% had post-implant D90 < 140 Gy (mean: 128.0 Gy, range: 97.5-139.2) vs. ≥ 140 Gy (mean: 154.4 Gy, range: 140.0-193.5). The D90 ≥ 140 Gy subset had larger AT and IA segment mean numbers of seeds (p = 0.01, 0.046), larger WP, S, A, SA, ST, AT, and MT segment mean margins (p = 0.01, 0.01, 0.001, 0.0001, 0.03, 0.005, 0.02), and lower PT segment occupancy proportion (p = 0.004). On multivariate analysis, independent predictors of post-implant D90 ≥ 140 Gy were increased SA mean margin, no pre-implant 5-α-reductase inhibitor, higher pre-plan D90, decreased P occupancy proportion, no pre-implant hormone therapy, and decreased SP mean margin.ConclusionsHigher occupancy proportion and larger margins anteriorly and reduced occupancy proportion, and smaller margins posteriorly on PPI pre-plans predict post-implant D90 ≥ 140 Gy.

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Magnetic Resonance Imaging–Defined Treatment Margins in Iodine-125 Prostate Brachytherapy

Cited by 26 publications

References 37 publications

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

10-Year Experience With I-125 Prostate Brachytherapy at the Princess Margaret Hospital: Results for 1,100 Patients

Update on Prostate Brachytherapy: Long-term Outcomes and Treatment-related Morbidity

Pre-plan parameters predict post-implant D 90 ≥ 140 Gy for 125 I permanent prostate implants

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