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Feasibility of adequate dose coverage in permanent prostate brachytherapy using divergent needle insertion methods
Michiel R van den Bosch1, Irene M Lips, Vera Lagerburg
1Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands. M.R.vandenBosch@umcutrecht.nl
Summary
Divergent needle insertion methods are feasible for adequate dose coverage in permanent prostate brachytherapy, even with MRI-guided techniques. This approach helps overcome pubic arch interference for better treatment planning.
Area of Science:
- Radiation Oncology
- Medical Physics
- Prostate Cancer Treatment
Background:
- Permanent prostate brachytherapy is a treatment for prostate cancer.
- Magnetic resonance imaging (MRI)-guided brachytherapy can be hindered by pubic arch interference.
- Novel needle insertion techniques are needed to improve treatment delivery.
Purpose of the Study:
- To assess the feasibility of achieving adequate dose coverage using divergent needle insertion methods in permanent prostate brachytherapy.
- To evaluate divergent needle insertion techniques, particularly for MRI-guided procedures, to circumvent pubic arch interference.
- To compare dose coverage outcomes between divergent and parallel needle insertion methods.
Main Methods:
- MRI data from 10 T1-T2 prostate cancer patients were analyzed.
- An inverse planning algorithm (simulated annealing) optimized dose distribution for three needle insertion methods: divergent (single and double rotation points) and parallel.
- Dose constraints followed clinical criteria and ESTRO/EAU/EORTC recommendations.
Main Results:
- All methods achieved 99% mean PTV V(100) when PTV was intraprostatic.
- With a 3mm margin, mean PTV V(100) was 94-95% for divergent and parallel methods.
- Expanding seed tips 3mm beyond the prostate apex/base resulted in a 96% mean PTV V(100) for all methods.
Conclusions:
- Divergent needle insertion methods are feasible for achieving adequate dose coverage in permanent prostate brachytherapy.
- These techniques offer a viable solution for MRI-guided procedures facing anatomical challenges.
- The study supports the clinical utility of divergent needle insertion for optimizing prostate brachytherapy outcomes.
