Karius A, Lotter M, Kreppner S, Schaller V, Lubgan D, Grigo J, Fietkau R, Strnad V, Bert C (2022)
Publication Type: Journal article
Publication year: 2022
Book Volume: 21
Pages Range: 635-646
Journal Issue: 5
DOI: 10.1016/j.brachy.2022.04.007
PURPOSE: Seed brachytherapy is a well-established treatment modality for prostate cancer. However, there is still a lack of profound characterizations of seed motions within the prostate. We assessed these dynamics between day 0 and day 30 of brachytherapy. METHODS: We considered 45 patients with 2408 implanted seeds, and performed a 1:1 assignment between their positions on post-plan CT (nominal day 30) and intraoperative ultrasound (day 0). Geometric seed arrangement changes were measured for each patient and the entire collective. The impact of seed strand-lengths and implant regions was investigated. Correlations with patient characteristics were evaluated. We determined corresponding dosimetric effects by calculating common dose metrics. RESULTS: We found a median seed displacement of 4.3 mm [interquartile range: 3.1–6.9 mm], occurring preferentially in superior-inferior direction. Single and double strands moved significantly stronger than strands of higher lengths. Seed dynamics was more pronounced in base (5.6 mm [3.7–10.7 mm]) and apex (6.5 mm [4.1–15.0 mm]) than in the mid-gland (3.8 mm [2.7–5.0 mm]), and less pronounced in peripheral (4.3 mm [3.0–6.7 mm]) than in urethra-near (5.5 mm [3.5–10.7 mm]) regions. Correlations of seed dynamics with prostate volume changes and the number of implanted seeds and needles were found. D90 (dose that 90% of the prostate receives) varied by a median of 3 Gy [-6 to 15 Gy] between treatment plan and post-plan, but >40 Gy for individual patients. CONCLUSIONS: Reducing seed dynamics is important to ensure a high treatment quality. For this, strands containing ≥3 seeds may be useful, implantations in base-, apex-, and urethra-near zone should be avoided, and the number of needles and seeds may be minimized where possible.
APA:
Karius, A., Lotter, M., Kreppner, S., Schaller, V., Lubgan, D., Grigo, J.,... Bert, C. (2022). Permanent LDR prostate brachytherapy: Comprehensive characterization of seed-dynamics within the prostate on a seed-only level. Brachytherapy, 21(5), 635-646. https://doi.org/10.1016/j.brachy.2022.04.007
MLA:
Karius, Andre, et al. "Permanent LDR prostate brachytherapy: Comprehensive characterization of seed-dynamics within the prostate on a seed-only level." Brachytherapy 21.5 (2022): 635-646.
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