Emma Fitzgerald
Epworth Radiation Oncology
Radiation Therapist

Bing Wei
Radiation Therapist
Epworth Radiation Oncology

Thang Nguyen
Radiation Therapist
Epworth Radiation Oncology

Background: Traditionally Low Dose Rate (LDR) Brachytherapy has been utilised for early staged, localised Prostate cancers. Prostate Brachytherapy allows for the delivery of high therapeutic doses of radiation to the prostate whilst significantly decreasing the exposure to surrounding normal tissue(1). Recently, a new technique has been developed that allows men to undergo Brachytherapy implantation via one surgical procedure and utilisation of their diagnostic MRI. This innovative technique is called 4D Brachytherapy and was developed by specialists at the Royal Surrey County Hospital in the United Kingdom(2).

Purpose: The aim of this pilot study is to present a comparison and analysis of the dosimetric viability of implementing 4D Brachytherapy within the scope of our radiation therapy department’s guidelines.

Methods: The current clinical process for LDR Brachytherapy is for the patient to undergo a volume study where ultrasound images of the prostate are captured for offline planning. The patient then returns approximately one month later for implantation of the radioactive seeds. Both these procedures are performed under a general anaesthetic in theatre. A retrospective comparative analysis reviewed 3 LDR patients that had undergone a standard Brachytherapy implantation against a 4D Brachytherapy plan. 4D Brachytherapy plans were created by taking height, width and length measurements from the patient’s diagnostic MRI and entering the effective prostate volume into the nomogram planning system(2).

Results: Plan suitability was reviewed in a quantitative manner looking at standard LDR Brachytherapy DVH measurements (D100Gy, V100%, V150% and V200%). Plans were also compared in regards to overall activity, number of needles and seeds required for implantation.

Conclusions: Initial results from this pilot study have demonstrated that clinically acceptable LDR Brachytherapy plans can be created utilising the prostate volume from diagnostic MRIs. These resultant 4D Brachytherapy plans have demonstrated similar DVH results, as well as, similar initial seed locations. Overall, 4D Brachytherapy could be a comparable option for early stage prostate cancer patients.

References:

1. Soares, R., Uribe-Lewis, S., Uribe, J. and Langley, S. (2017). Brachytherapy for Prostate Cancer - Surgical Procedures for Core Urology Trainees. (pp. 87-98). Springer, Cham.

2. Langley, S. and Laing, R. (2012). 4D Brachytherapy, a novel real-time prostate brachytherapy technique using stranded and loose seeds. BJU International (LDR Brachytherapy: Latest Advances in Prostate Cancer Treatment, 109(s1), 1-6.


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