Inverse planning for HDR prostate brachytherapy used to boost dominant intraprostatic lesions defined by magnetic resonance spectroscopy imaging

International Journal of Radiation Oncology, Biology, Physics
Jean PouliotJohn Kurhanewicz

Abstract

To dose escalate selected regions inside the prostate without compromising the dose coverage of the prostate and the protection to the urethra, rectum, and bladder for prostate cancer patients treated with high-dose-rate brachytherapy. Magnetic resonance imaging combined with magnetic resonance spectroscopy imaging was used to differentiate between normal and malignant prostate and define cancer-validated dominant intraprostatic lesions (DIL) on 10 patients. The DILs were then contoured on the planning scans (CT or MRI based, 5 patients each), and our inverse planning dose optimization algorithm (called IPSA) was used to generate dose distributions for 3 different boost levels. Dose-volume histograms of the target and each organ at risk were compared with optimized plans without DIL boost. Combined MRI/magnetic resonance spectroscopic imaging identified 2 DILs in 8/10 of the 10 patients studied and a single DIL in the remaining 2 patients. The average prostate dose coverage V100 was 97% (sigma = 1.0%). When the minimum DIL dose requested was 120% of the prescribed dose, the average DIL V120 was 97.1% (sigma = 1.8%). For a boost value of 150%, the average V150 ranged from 77.8% to 86.1%, depending on the upper limit of the dose ...Continue Reading

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