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Multi-parametric MRI-guided focal tumor boost using HDR prostate brachytherapy: a feasibility study.
Josh Mason1, Bashar Al-Qaisieh2, Peter Bownes2
1Medical Physics, St James's Institute of Oncology, Leeds Teaching Hospitals NHS Trust; Division of Medical Physics, University of Leeds.
Brachytherapy
|November 26, 2013
Summary
This study shows that MRI-guided high-dose-rate prostate brachytherapy can safely deliver a focal boost dose to identified tumor regions. This technique is feasible even after hormone therapy, improving treatment precision.
Area of Science:
- Oncology
- Radiotherapy
- Medical Imaging
Background:
- High-dose-rate (HDR) brachytherapy is a key treatment for prostate cancer.
- Accurate tumor targeting is crucial for effective dose escalation and minimizing side effects.
- Multi-parametric MRI offers detailed visualization of tumorous regions within the prostate.
Purpose of the Study:
- To assess the feasibility of delivering a focal boost dose to tumor regions identified by multi-parametric MRI in HDR prostate brachytherapy.
- To evaluate the ability to precisely target these regions while adhering to dose constraints for organs at risk.
Main Methods:
- Retrospective analysis of 15 patients undergoing HDR prostate brachytherapy.
- Acquisition of T2-weighted, diffusion-weighted, and dynamic-contrast-enhanced MRI before treatment.
- Delineation of tumor on MRI, registration to transrectal ultrasound, and creation of a focal boost planning target volume (F-PTV) with margins accounting for uncertainties.
- Comparison of delivered plans with optimized focal boost plans.
Main Results:
- Tumors were successfully delineated in all patients, with volumes ranging from 0.4-23.0cc.
- A margin of 4.5 mm was estimated for delineation and registration uncertainties.
- Focal boost plans significantly increased the median D90 from 17.6 to 20.9 Gy and median V150 from 27.3% to 75.9% for the F-PTV.
Conclusions:
- MRI-guided HDR prostate brachytherapy with a focal tumor boost is feasible.
- Tumor regions are identifiable using multi-parametric MRI, even in patients who have undergone hormone therapy.
- Focal boost dose escalation is achievable without compromising urethral and rectal dose constraints.
