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MRI-assisted radiosurgery: A quality assurance nomogram for palladium-103 and iodine-125 prostate brachytherapy.

Abstract：

PURPOSE:We sought to develop an activity nomogram for magnetic resonance (MR)-planned permanent seed prostate brachytherapy to improve quality assurance through a secondary dosimetric check. METHODS AND MATERIALS:Patients undergoing MRI-assisted radiosurgery (MARS), whereby MRI is used for preoperative planning and postimplant dosimetry, were reviewed from May 2016 to September 2018. Planned activity (U) was fitted by MR-prostate volume (cc) via simple linear regression. Resulting monotherapy nomograms were compared with institutional nomograms from an ultrasound-planned cohort. Dosimetric coverage and external urinary sphincter (EUS) dose were also assessed for MR-planned patients. RESULTS:We identified 183 patients treated with MARS: 146 patients received palladium-103 (103Pd; 102 monotherapy and 44 boost), and 37 received iodine-125 (125I) monotherapy. Median prostate volume was 28 cc (interquartile range: 22-35). Lines of best fit for implant activity were U = 4.344 × (vol) + 54.13 (R2: 95%) for 103Pd monotherapy, U = 3.202 (vol) + 39.72 (R2: 96%) for 103Pd boost and U = 0.684 (vol) + 13.38 (R2: 96%) for 125I monotherapy. Compared with ultrasound, MR-planned nomograms had lower activity per volume (p < 0.05) for both 103Pd monotherapy (∼6%) and 125I monotherapy (∼11%), given a median size (30 cc) prostate. Across all MARS implants, postimplant dosimetry revealed a median V100% of 94% (interquartile range: 92-96%). Median EUS V125 was <1 cc for all patients, regardless of isotope. CONCLUSIONS:We developed a quality assurance nomogram for MR-planned prostate brachytherapy. When compared with ultrasound-planned, MR-planned monotherapy resulted in a lower activity-to-volume ratio while maintaining dosimetric coverage, likely secondary to EUS-sparing and reduced planning target margins.

journal_name

Brachytherapy

journal_title

Brachytherapy

authors

Hanania AN,Kudchadker RJ,Bruno TL,Tang C,Anscher MS,Frank SJ

doi

10.1016/j.brachy.2019.10.002

subject

Has Abstract

pub_date

2020-01-01 00:00:00

pages

38-42

issue

1

eissn

1538-4721

issn

1873-1449

pii

S1538-4721(19)30612-9

journal_volume

19

pub_type

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