A unified strategy to focal brachytherapy incorporating transperineal biopsy, image fusion, and real-time implantation with and without rectal spacer simulated in prostate phantoms

IF 1.1 4区 医学 Q4 ONCOLOGY Journal of Contemporary Brachytherapy Pub Date : 2024-04-30 DOI:10.5114/jcb.2024.139280
Ben G.L. Vanneste, Basile Skouteris, Luis Campos Pinheiro, Robert Voncken, Evert J. Van Limbergen, Ludy Lutgens, Valérie Fonteyne, Charles Van Praet, Nicolaas Lumen, Rendi Sheu, Richard Stock, Nelson N. Stone
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Abstract

Purpose:
To develop an approach to the diagnosis and treatment of prostate cancer using one platform for fusion biopsy, followed by focal gland ablation utilizing permanent prostate brachytherapy with and without a rectal spacer.

Material and methods:
Prostate phantoms containing multiparametric magnetic resonance imaging (mpMRI) regions of interest (ROI) underwent fusion biopsy, followed by image co-registration of positive sites to a treatment planning brachytherapy program. A partial hemi-ablation and both posterior lobes using a Mick applicator and linked stranded seeds were simulated. Dummy sources were modeled as iodine-125 (125I) with a prescribed dose of at least 210 Gy to gross tumor (GTV) and clinical target volume (CTV), as defined by mpMRI visible ROI and surrounding negative biopsy sites. Computer tomograms (CT) were performed post-implant prior to and after rectal spacer insertion. Different prostate and rectal constraints were compared with and without the spacer.

Results:
The intra-operative focal volumes of CTV ranged from 6.2 to 14.9 cc (mean, 11.3 cc), and the ratio of focal volume/whole prostate volume ranged between 0.19 and 0.42 (mean, 0.31). The intra- and post-operative mean focal D90 of GTV, CTV, and for the entire prostate gland was 265 Gy and 235 Gy, 214 Gy and 213 Gy, and 66.1 Gy and 57 Gy, respectively. On average, 13 mm separation was achieved between the prostate and the rectum (range, 12-14 mm) on post-operative CT. The mean doses in Gy to 2 cc of the rectum (D2cc) without spacer vs. with spacer were 39.8 Gy vs. 32.6 Gy, respectively.

Conclusions:
Doses above 200 Gy and the implantation of seeds in clinically significant region for focal therapy in phantoms are feasible. All rectal dosimetric parameters improved for the spacer implants, as compared with the non-spacer implants. Further validation of this concept is warranted in clinical trials.

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在前列腺模型中模拟经会阴活检、图像融合和有无直肠垫片的实时植入,从而实现病灶近距离放射治疗的统一策略
材料与方法:对包含多参数磁共振成像(mpMRI)感兴趣区(ROI)的前列腺模型进行融合活检,然后将阳性部位的图像联合注册到治疗规划近距离放射治疗程序中。模拟了使用米克涂抹器和链接串联种子进行部分半消融和两个后叶的治疗。假源被模拟为碘-125(125I),其规定剂量至少为 210 Gy,用于肿瘤总体积(GTV)和临床靶体积(CTV),由 mpMRI 可见 ROI 和周围阴性活检部位定义。在插入直肠间隔器之前和之后,分别进行了植入后计算机断层扫描(CT)。结果:术中 CTV 病灶体积介于 6.2 到 14.9 毫升(平均 11.3 毫升)之间,病灶体积/整个前列腺体积比介于 0.19 到 0.42 之间(平均 0.31)。GTV、CTV和整个前列腺的术中和术后平均病灶D90分别为265 Gy和235 Gy,214 Gy和213 Gy,66.1 Gy和57 Gy。术后 CT 显示,前列腺与直肠之间的平均距离为 13 毫米(范围为 12-14 毫米)。不使用间隔器与使用间隔器时,直肠2毫升(D2cc)的平均剂量(单位:Gy)分别为39.8 Gy和32.6 Gy。与无垫片植入物相比,垫片植入物的所有直肠剂量学参数都有所改善。这一概念需要在临床试验中进一步验证。
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来源期刊
Journal of Contemporary Brachytherapy
Journal of Contemporary Brachytherapy ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING
CiteScore
2.40
自引率
14.30%
发文量
54
审稿时长
16 weeks
期刊介绍: The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
期刊最新文献
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