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MRI-guided neurovascular bundle avoidance in high dose rate prostate brachytherapy
Drew G Gerber1, Sean Dresser1, Xiaofeng Yang1
1Department of Radiation Oncology, Winship Cancer Institute, Emory University, Atlanta, GA.
Brachytherapy
|January 13, 2026
Summary
MRI-based treatment planning allows for neurovascular bundle (NVB)-sparing during high-dose-rate (HDR) prostate brachytherapy, preserving erectile function. This technique is feasible and warrants further investigation for improved patient outcomes.
Area of Science:
- Oncology
- Radiotherapy
- Urology
Background:
- Neurovascular bundles (NVBs) are crucial for erectile function.
- NVBs are poorly visualized with conventional imaging like ultrasound and CT.
- Effective sparing of NVBs during prostate radiotherapy is challenging.
Purpose of the Study:
- To investigate the feasibility of using treatment planning MRI to avoid NVBs during high-dose-rate (HDR) prostate brachytherapy.
- To compare dose distributions between standard HDR brachytherapy plans and NVB-sparing plans.
Main Methods:
- Retrospective review of 34 patients undergoing HDR prostate brachytherapy.
- Contouring of left and right NVBs on treatment planning MRI.
- Generation of standard and NVB-sparing treatment plans.
- Dosimetric comparison of target coverage and organs at risk (OARs) between plan types.
Main Results:
- NVB-sparing plans significantly reduced dose to the left and right NVBs (D0.01cc).
- Prostate coverage (D90, V100) was maintained with NVB-sparing plans.
- Slight reductions in prostate V150% and V200% were observed with NVB-sparing plans.
- Doses to bladder, rectum, and urethra remained similar between plan types.
Conclusions:
- MRI-based treatment planning enables feasible NVB-sparing during HDR prostate brachytherapy.
- This approach shows promise for preserving erectile function in prostate cancer patients.
- Further research is recommended to validate these findings.
