Live implant dosimetry may be an effective replacement for postimplant computed tomography in localized prostate cancer patients receiving low dose rate brachytherapy |
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| Authors: | Davood Roshan Kieran Joyce Peter Woulfe Pradeep Reddy Gorakati Richard Stock Francis J. Sullivan |
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| Affiliation: | 1. School of Mathematics, Statistics and Applied Mathematics, National University of Ireland, Galway, Ireland;2. School of Medicine, National University of Ireland, Galway, Ireland;3. CÚRAM, SFI Research Centre for Medical Devices, Biomedical Sciences Building, National University of Ireland, Galway, Ireland;4. Department of Radiation Oncology, Galway Clinic, Ireland;5. School of Medicine & M.Sc Clinical Research, National University of Ireland, Galway, Ireland;6. School of Medicine, Mount Sinai, New York, NY;7. Prostate Cancer Institute, National University of Ireland, Galway, Ireland |
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| Abstract: | PurposeTo determine if Live Implant Dosimetry (LIDO) utilizing intraoperative transrectal ultrasound (TRUS) is equivalent to postimplant CT dosimetry (either day 0 or day 30) in patients with localized prostate cancer (PC) treated with low dose rate (LDR) prostate seed brachytherapy.Methods and MaterialsThe treated population consisted of 628 men with localized (T1-T2) PC. All d'Amico risk categories (low, intermediate, and high) were included, and 437 patients were treated with monotherapy (160 Gy) [low and low tier intermediate], and the remainder (191) [high tier intermediate and high risk] with an implant boost (106 Gy) post external beam radiation, to a volume including the prostate and seminal vesicles (46 Gy). LIDO with intraoperative TRUS, postimplant CT (day 0 and day 30) were performed in all cases. Prostate volumes (V), V100 (prostate) and dose (D) D90 (prostate), D30 (urethra), and Rectum D2cc, were recorded. No urinary catheter was used on Day 30 CT.ResultsMore than 91.33% of monotherapy patients reached the target D90 according to LIDO while only 82.99% of Day 0 CT and 92.82% of Day 30 CT achieved target D90. When considering V100, monotherapy patients recorded target dosimetry in 90.93%, 82.31%, and 92.02% of cases assessed by LIDO, Day 0 CT and Day 30 CT, respectively. Strong correlations are observed in D90, Rectum D2cc and Urethra D30 across imaging modalities but V100 and V150 were poorly correlated due to the relative quantification of this parameter and high degree of error in measurement. Of all monotherapy patients with satisfactory dosimetry on LIDO, 94.82% reached target D90 at day 30 CT and 94.19% reached target V100.ConclusionsLIDO and CT are both effective tools for assessing postimplant dosimetry. Patients with satisfactory LIDO dosimetry are highly likely to have equivalent dosimetry on CT at follow-up, indicating that postimplant CT may be eliminated in PC a patients implanted with this technique. |
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