Top

Published in:

01-12-2012 | Original article

Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer

Authors: E. Le Fur, J.P. Malhaire, D. Baverez, F. Delage, M.A. Perrouin-Verbe, F. Schlurmann, S. Guerif, G. Fournier, O. Pradier, A. Valeri

Published in: Strahlentherapie und Onkologie | Issue 12/2012

Abstract

Purpose

To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB).

Patients and methods

From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I¹²⁵ PPB as monotherapy with intraoperative planning. Patients were divided into three groups—P1 (n = 64), P2 (n = 45), P3 (n = 41)—according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation).

Results

We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10^− 5) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008).

Conclusion

We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters.

D’Amico AV, Whittington R, Malkowicz SB et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974CrossRef

Goldner G, Potter R, Battermann JJ et al (2012) Comparison of seed brachytherapy or external beam radiotherapy (70 Gy or 74 Gy) in 919 low-risk prostate cancer patients. Strahlenther Onkol 188:305–310PubMedCrossRef

Potters L, Klein EA, Kattan MW et al (2004) Monotherapy for stage T1-T2 prostate cancer: radical prostatectomy, external beam radiotherapy, or permanent seed implantation. Radiother Oncol 71:29–33PubMedCrossRef

Buron C, Le Vu B, Cosset JM et al (2007) Brachytherapy versus prostatectomy in localized prostate cancer: results of a French multicenter prospective medico-economic study. Int J Radiat Oncol Biol Phys 67:812–822PubMedCrossRef

Pinkawa M, Fischedick K, Piroth MD et al (2006) Health-related quality of life after permanent interstitial brachytherapy for prostate cancer: correlation with postimplant CT scan parameters. Strahlenther Onkol 182:660–665PubMedCrossRef

Schafer JW, Welzel G, Trojan L et al (2008) Long-term health-related quality-of-life outcomes after permanent prostate brachytherapy. Onkologie 31:599–603PubMedCrossRef

Ferlay J, Parkin DM, Steliarova-Foucher E (2010) Estimates of cancer incidence and mortality in Europe in 2008. Eur J Cancer 46:765–781PubMedCrossRef

Boyle P, Ferlay J (2005) Cancer incidence and mortality in Europe, 2004. Ann Oncol 16:481–488PubMedCrossRef

McVey GP, McPhail S, Fowler S et al (2010) Initial management of low-risk localized prostate cancer in the UK: analysis of the British Association of Urological Surgeons Cancer Registry. BJU Int 106:1161–1164PubMedCrossRef

10.

Guedea F, Hoskin P, Mazeron JJ et al (2009) Brachytherapy in the United Kingdom and Spain: a subset analysis of a European pattern of care survey. Clin Transl Oncol 11:534–538PubMedCrossRef

11.

Guedea F, Venselaar J, Hoskin P et al (2010) Patterns of care for brachytherapy in Europe: updated results. Radiother Oncol 97:514–520PubMedCrossRef

12.

Poortmans PM, Aarts MJ, Jobsen JJ et al (2011) A population-based study on the utilisation rate of primary radiotherapy for prostate cancer in 4 regions in the Netherlands, 1997–2008. Radiother Oncol 99:207–213PubMedCrossRef

13.

Stubinger SH, Wilhelm R, Kaufmann S et al (2008) Brachytherapy of the prostate cancer. Urologe A 47:284–290PubMedCrossRef

14.

Kaulich TW, Bamberg M (2010) Radiation protection of persons living close to patients with radioactive implants. Strahlenther Onkol 186:107–112PubMedCrossRef

15.

Goldner G, Sljivic S, Oismueller R et al (2011) Prostate cancer radiotherapy in Austria: overview on number of patients, intention to treat, and treatment techniques based on data from 2007. Strahlenther Onkol 187:279–283PubMedCrossRef

16.

Acher P, Popert R, Nichol J et al (2006) Permanent prostate brachytherapy: dosimetric results and analysis of a learning curve with a dynamic dose-feedback technique. Int J Radiat Oncol Biol Phys 65:694–698PubMedCrossRef

17.

Bladou F, Salem N, Simonian-Sauve M et al (2004) Permanent iodine 125 implant brachytherapy in localized prostate cancer: results of the first 4 years of experience. Prog Urol 14:345–352PubMed

18.

Hoinkis C, Hakenberg OW, Lehmann D et al (2004) Evaluation of dose-volume histograms after prostate seed implantation. 4-year experience. Strahlenther Onkol 180:550–556PubMedCrossRef

19.

Salem N, Simonian-Sauve M, Rosello R et al (2003) Predictive factors of acute urinary morbidity after iodine-125 brachytherapy for localised prostate cancer: a phase 2 study. Radiother Oncol 66:159–165PubMedCrossRef

20.

Schiefer H, Toggenburg F von, Seelentag W et al (2009) Exposure of treating physician to radiation during prostate brachytherapy using iodine-125 seeds: dose measurements on both hands with thermoluminescence dosimeters. Strahlenther Onkol 185:689–695PubMedCrossRef

21.

Wust P, Postrach J, Kahmann F et al (2008) Postimplantation analysis enables improvement of dose-volume histograms and reduction of toxicity for permanent seed implantation. Int J Radiat Oncol Biol Phys 71:28–35PubMedCrossRef

22.

Stock RG, Stone NN, Lo YC et al (2000) Postimplant dosimetry for (125)I prostate implants: definitions and factors affecting outcome. Int J Radiat Oncol Biol Phys 48:899–906PubMedCrossRef

23.

Stock RG, Stone NN, Wesson MF, DeWyngaert JK (1995) A modified technique allowing interactive ultrasound-guided three-dimensional transperineal prostate implantation. Int J Radiat Oncol Biol Phys 32:219–225PubMedCrossRef

24.

Rosenthal SA, Bittner NH, Beyer DC et al (2011) American Society for Radiation Oncology (ASTRO) and American College of Radiology (ACR) practice guideline for the transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys 79:335–341PubMedCrossRef

25.

Stock RG, Stone NN, Tabert A et al (1998) A dose-response study for I-125 prostate implants. Int J Radiat Oncol Biol Phys 41:101–108PubMedCrossRef

26.

Al-Qaisieh B, Ash D, Bottomley DM, Carey BM (2002) Impact of prostate volume evaluation by different observers on CT-based post-implant dosimetry. Radiother Oncol 62:267–273PubMedCrossRef

27.

Crook J, Milosevic M, Catton P et al (2002) Interobserver variation in postimplant computed tomography contouring affects quality assessment of prostate brachytherapy. Brachytherapy 1:66–73PubMedCrossRef

28.

Lee WR, Roach M 3rd, Michalski J et al (2002) Interobserver variability leads to significant differences in quantifiers of prostate implant adequacy. Int J Radiat Oncol Biol Phys 54:457–461PubMedCrossRef

29.

Simmat I, Georg P, Georg D et al (2012) Assessment of accuracy and efficiency of atlas-based autosegmentation for prostate radiotherapy in a variety of clinical conditions. Strahlenther Onkol

30.

Block T, Czempiel H, Zimmermann F (2006) Transperineal permanent seed implantation of “low-risk” prostate cancer: 5-year-experiences in 118 patients. Strahlenther Onkol 182:666–671PubMedCrossRef

31.

Moerland MA, Deursen MJ van, Elias SG et al (2009) Decline of dose coverage between intraoperative planning and post implant dosimetry for I-125 permanent prostate brachytherapy: comparison between loose and stranded seed implants. Radiother Oncol 91:202–206PubMedCrossRef

32.

Stone NN, Stock RG, Unger P (2005) Intermediate term biochemical-free progression and local control following 125iodine brachytherapy for prostate cancer. J Urol 173:803–807PubMedCrossRef

33.

Merrick GS, Grimm PD, Sylvester J et al (2007) Initial analysis of Pro-Qura: a multi-institutional database of prostate brachytherapy dosimetry. Brachytherapy 6:9–15PubMedCrossRef

34.

Salembier C, Lavagnini P, Nickers P et al (2007) Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol 83:3–10PubMedCrossRef

35.

Borchers H, Pinkawa M, Donner A et al (2009) Rectourethral fistula following LDR brachytherapy. Urol Int 82:365–366PubMedCrossRef

36.

Gelblum DY, Potters L (2000) Rectal complications associated with transperineal interstitial brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys 48:119–124PubMedCrossRef

37.

Stone NN, Cesaretti JA, Rosenstein B, Stock RG (2010) Do high radiation doses in locally advanced prostate cancer patients treated with 103Pd implant plus external beam irradiation cause increased urinary, rectal, and sexual morbidity? Brachytherapy 9:114–118PubMedCrossRef

38.

Stone NN, Stock RG (2007) Long-term urinary, sexual, and rectal morbidity in patients treated with iodine-125 prostate brachytherapy followed up for a minimum of 5 years. Urology 69:338–342PubMedCrossRef

39.

Tran A, Wallner K, Merrick G et al (2005) Rectal fistulas after prostate brachytherapy. Int J Radiat Oncol Biol Phys 63:150–154PubMedCrossRef

40.

Keyes M, Schellenberg D, Moravan V et al (2006) Decline in urinary retention incidence in 805 patients after prostate brachytherapy: the effect of learning curve? Int J Radiat Oncol Biol Phys 64:825–834PubMedCrossRef

41.

Murakami N, Itami J, Okuma K et al (2008) Urethral dose and increment of international prostate symptom score (IPSS) in transperineal permanent interstitial implant (TPI) of prostate cancer. Strahlenther Onkol 184:515–519PubMedCrossRef

42.

Pal RP, Bhatt JR, Khan MA et al (2011) Prostatic length predicts functional outcomes after iodine-125 prostate brachytherapy. Brachytherapy 10:107–116PubMedCrossRef

43.

Waterman FM, Dicker AP (1999) Effect of post-implant edema on the rectal dose in prostate brachytherapy. Int J Radiat Oncol Biol Phys 45:571–576PubMedCrossRef

44.

Pinkawa M, Gagel B, Piroth MD et al (2006) Changes of dose delivery distribution within the first month after permanent interstitial brachytherapy for prostate cancer. Strahlenther Onkol 182:525–530PubMedCrossRef

45.

Pinkawa M, Asadpour B, Gagel B et al (2007) Evaluation of source displacement and dose—volume changes after permanent prostate brachytherapy with stranded seeds. Radiother Oncol 84:190–196PubMedCrossRef

46.

Loiselle CR, Waheed M, Sylvester J et al (2009) Analysis of the Pro-Qura Database: rectal dose, implant quality, and brachytherapist’s experience. Brachytherapy 8:34–39PubMedCrossRef

47.

Patriciu A, Petrisor D, Muntener M et al (2007) Automatic brachytherapy seed placement under MRI guidance. IEEE Trans Biomed Eng 54:1499–1506PubMedCrossRef

48.

Song DY, Burdette EC, Fiene J et al (2011) Robotic needle guide for prostate brachytherapy: clinical testing of feasibility and performance. Brachytherapy 10:57–63PubMedCrossRef

49.

Nath R, Bice WS, Butler WM et al (2009) AAPM recommendations on dose prescription and reporting methods for permanent interstitial brachytherapy for prostate cancer: report of Task Group 137. Med Phys 36:5310–5322PubMedCrossRef

Title: Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer
Authors: E. Le Fur
J.P. Malhaire
D. Baverez
F. Delage
M.A. Perrouin-Verbe
F. Schlurmann
S. Guerif
G. Fournier
O. Pradier
A. Valeri
Publication date: 01-12-2012
Publisher: Springer-Verlag
Published in: Strahlentherapie und Onkologie / Issue 12/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-012-0242-9

At a glance: The STEP trials

Springer Medicine

Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer

Abstract

Purpose

Patients and methods

Results

Conclusion

At a glance: The STEP trials

Springer Medicine

Abstract

Purpose

Patients and methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 12/2012

Benign painful shoulder syndrome

Radikale Prostatektomie versus Zuwarten beim lokalisierten Prostatakarzinom

Radiation therapy for primary carcinoma of the eyelid: tumor control and visual function

Expander/implant breast reconstruction before radiotherapy

Prognostic factors and a survival score for patients with metastatic spinal cord compression from colorectal cancer

Impact of the adaptor protein GIPC1/Synectin on radioresistance and survival after irradiation of prostate cancer