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Adaptive planning strategy for high dose rate prostate brachytherapy—a simulation study on needle positioning errors.

M Borot de Battisti, B Denis de Senneville, M Maenhout

Physics in Medicine and Biology

|February 25, 2016

Summary

This study introduces a dose plan adaptation strategy for MR-guided high dose rate (HDR) brachytherapy in prostate cancer. Real-time feedback on needle position improves the accuracy and clinical acceptability of radiation dose delivery during treatment.

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Area of Science:

Medical Physics
Oncology
Robotics

Background:

Magnetic resonance (MR)-guided high dose rate (HDR) brachytherapy is emerging for prostate cancer treatment, enabling precise, single-fraction dose delivery.
A novel MR-compatible robotic system is being developed for accurate needle placement within the confined space of a closed-bore MRI scanner.
Potential needle positioning errors during robot-assisted insertion can alter the planned radiation dose distribution.

Purpose of the Study:

To propose and evaluate a dose plan adaptation strategy for MR-guided HDR prostate brachytherapy using intra-operative feedback on needle position.
To assess the effectiveness of this strategy in compensating for needle positioning errors and improving treatment plan quality.

Main Methods:

A dose plan adaptation strategy was developed, involving plan updates after each needle insertion to correct for positioning errors.
The strategy was tested using simulated HDR brachytherapy procedures on eight patients, comparing outcomes with and without real-time feedback.
Simulations involved varying numbers of needle insertions (4 to 12) to assess robustness.

Main Results:

The feedback-based dose adaptation strategy resulted in a higher number of clinically acceptable treatment plans compared to procedures without feedback.
The computation time for plan adaptation between needle insertions was consistently under 100 seconds, suitable for intra-operative application.
The strategy demonstrated effectiveness in mitigating the impact of needle positioning errors on dose distribution.

Conclusions:

The proposed dose plan adaptation strategy enhances the reliability and clinical acceptability of MR-guided HDR prostate brachytherapy.
Real-time feedback and plan adaptation are crucial for accurate dose delivery in robot-assisted brachytherapy procedures.
This approach holds promise for improving treatment outcomes in prostate cancer patients undergoing brachytherapy.