High dose rate prostate brachytherapy: the California Endocurietherapy (CET) method

Area of Science:

• Oncology
• Radiation Oncology
• Urology

Background:

• Prostate cancer treatment requires precise radiation delivery.
• High dose rate brachytherapy (HDR-BT) offers a targeted approach.
• A non-fixed template technique may enhance treatment flexibility.

Purpose of the Study:

• To detail the rationale, protocol, and procedure for prostate cancer treatment using HDR-BT.
• To evaluate the efficacy of a non-fixed template technique in HDR-BT.
• To assess treatment outcomes in patients with varying prostate gland characteristics.

Main Methods:

• 491 prostate cancer patients treated with HDR-BT and a non-fixed template technique (July 1991-Dec 1998).
• Inclusion criteria: AJCC stages T(1C)-T(3B), prior transurethral resection of the prostate (TURP), and gland volumes >60 cm³.
• Procedure involved 17 flexiguides, dosimetry via localization films, and two implants with four HDR fractions (6 Gy/fraction).

Main Results:

• Satisfactory treatment achieved in patients with large glands (>60 cm³), narrow pubic arches, and TURP defects.
• Transient urinary irritation symptoms resolved within 2 weeks.
• No high-grade chronic rectal morbidity reported; minimal chronic urinary incontinence.

Conclusions:

• The non-fixed template technique provided flexibility for precise flexiguide placement.
• Accommodated large glands, extracapsular extension, and seminal vesicle involvement effectively.
• Ensured complete prostate treatment volume coverage, overcoming challenges like small pubic arches and TURP defects.