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Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy: Feasibility and Initial Experiences Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy

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Pathology & Oncology Research

Abstract

The aim of our pilot study was to demonstrate the feasibility and dosimetric quality of MR-guided HDR prostate brachytherapy in a low-field 0.35T open MRI scanner and to present our initial clinical experiences. 16 patiets with intermediate- to high-risk localized prostate cancer were treated with 46–60 Gy of external beam radiotherapy preceded and/or followed by an 8 Gy MR-guided HDR boost. For interventions an MR compatible custom-made system, coaxial needles and plastic catheters were used. Template reconstruction, trajectory planning, image guidance, contouring and treatment planning were exclusively based on MR images. For treatment planning, dose-point- and anatomy-based inverse planning optimization was used. Image quality was found to be good to excellent in almost all cases. The mean catheter placement accuracy modeled by Rayleigh distribution was 2.9 mm with a sigma value of 2.3 mm. The mean and standard deviation (SD) of the dosimetric results for the target volume were the following: V100: 94.2 ± 4.3%, V150: 43.9 ± 6.8%, V200: 18.5 ± 5.9%. The mean D0.1, D1 and D1 values for the intraprostatic urethra were 117.6 ± 12.5%, 98.5 ± 19.9% and 122.3 ± 16.4%, respectively. Regarding the rectal wall the mean D0.1, D1 and D2 values were 77.3 ± 7.2%, 64.8 ± 7.5%, and 53.2 ± 9.1%, respectively. The mean maximum dose for the inner rectal surface was 53.5 ± 9.2%. No RTOG Grade 3 or worse acute toxicities were observed. Our method seems to be a promising approach for performing feasible, accurate and high-quality MR-guided HDR prostate brachytherapy. To determine the long term side effects and outcome higher number of patients, additional follow-up is needed.

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Abbreviations

BT:

Brachytherapy

BW:

Pixel bandwidth

COIN:

Conformality index

CTV:

Clinical target volume

Du1:

Dose to volume of the most exposed 1% of the urethra

D90:

Minimum dose with which 90% of the PTV was irradiated

DHI:

Dose Homogeneity Index

Drmax :

Maximal point dose of the rectal inner surface

DNR:

Dose Nonuniformity Ratio

Dr0.1 Dr1, Dr2 :

Dose to volume of the most exposed 0.1, 1 and 2 cm3 of the rectal wall

Du0.1,Du1 :

Dose to volume of the most exposed 0.1 and 1 cm3of the urethra

EBRT:

External-beam radiotherapy

FA:

Flip angle

FOV:

Field of view

FSPGR:

Fast spoiled gradient-echo

Gy:

Gray

HDR:

High-dose-rate

HRPC:

High-risk prostate cancer

IPO:

Inverse planning optimization

IRPC:

Intermediate-risk prostate cancer

MRI:

Magnetic resonance imaging

NEX:

Number of excitations

OARs:

Organs at risk

Prs:

Procedures

Pts:

Patients

SV:

Seminal vesicles

T:

Tesla

T1W:

T1-weighted

T2W:

T2-weighted

TE:

Echo-time

TR:

Repetition time

TRUS:

Transrectal ultrasound

V100,V150,V200:

The volume in the PTV receiving 100% 150% or 200% of the prescribed dose or greater

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Acknowledgements

The authors thank Andras Bucsek for the development of the custom made system, Georgina Fröhlich for her help in the statistical analysis and the Urologic and Anesthesiologic team at the Kaposi Mor Teaching Hospital for their input and support.

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Authors and Affiliations

  1. Health Center, University of Kaposvar, Guba Sandor Street 40, Kaposvar, 7400, Hungary

    Ferenc Lakosi, Gergely Antal, Csaba Vandulek, Arpad Kovacs, Gabor L. Toller, Gabor Bajzik, Janaki Hadjiev, Peter Bogner & Imre Repa

  2. Department of Urology, Kaposi Mor Teaching Hospital, Tallian Gyula Street 20-32, Kaposvar, 7400, Hungary

    Istvan Rakasz

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  1. Ferenc Lakosi
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  2. Gergely Antal
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  3. Csaba Vandulek
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  4. Arpad Kovacs
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Correspondence to Arpad Kovacs.

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Lakosi, F., Antal, G., Vandulek, C. et al. Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy: Feasibility and Initial Experiences Open MR-Guided High-Dose-Rate (HDR) Prostate Brachytherapy. Pathol. Oncol. Res. 17, 315–324 (2011). https://doi.org/10.1007/s12253-010-9319-x

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  • DOI: https://doi.org/10.1007/s12253-010-9319-x

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