Transitioning From a Low-Dose-Rate to a High-Dose-Rate Prostate Brachytherapy Program: Comparing Initial Dosimetry...

Area of Science:

• Oncology
• Radiation Oncology
• Medical Physics

Background:

• Prostate brachytherapy is a key treatment for localized prostate cancer.
• Transitioning from low-dose-rate (LDR) to high-dose-rate (HDR) brachytherapy offers potential advantages in treatment delivery and patient management.
• Developing a robust HDR program requires careful planning, dosimetry comparison, and workflow optimization.

Purpose of the Study:

• To describe the development and implementation of a prostate HDR brachytherapy program.
• To compare dosimetry outcomes between established LDR and newly developed HDR prostate brachytherapy.
• To identify and evaluate the impact of workflow interventions on HDR treatment efficiency.

Main Methods:

• A retrospective cohort study comparing 51 patients treated with LDR and 71 patients treated with HDR prostate brachytherapy.
• Dosimetric parameters (D90, V100, V95, V200, V150, rectal V100, D1cc) were analyzed.
• Linear mixed-effects models were used to assess changes in implant procedure and treatment planning durations over 18 months, alongside targeted workflow interventions.

Main Results:

• Mean D90 was similar between LDR and HDR groups (P = .28).
• HDR demonstrated improved coverage (higher V100, V95) and reduced dose to organs at risk (lower V200, V150, rectal V100, D1cc) compared to LDR.
• HDR implant procedure time decreased (60 to 54 minutes, P = .02), and treatment planning time significantly improved from 3.7 to 2.0 hours (P < .0001) with interventions.

Conclusions:

• A prostate HDR brachytherapy program was successfully established with dosimetry comparable to historical LDR treatments.
• Targeted workflow interventions were effective in enhancing the efficiency of HDR treatment planning.
• The experience and interventions detailed may serve as a valuable guide for other institutions establishing HDR programs.