PURPOSE: Brachytherapy is an effective single treatment modality for low- and intermediate-risk prostate cancer.
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In this study, we defined a clinical target volume (CTV) and evaluated its dosimetry 1 month after the low-dose-rate brachytherapy procedure.
METHODS AND MATERIALS: One hundred ninety-eight consecutive patients treated for prostate cancer by iodine-125 seed brachytherapy were assessed. Prostate dosimetry was stratified according to British Columbia Cancer Agency criteria, with good implants having both V100 (percentage of target volume that receives 100% of the prescribed dose) > 85% and D90 (percentage of the prescribed dose received by 90% of the target volume) > 90%, suboptimal implants with V100 of 75-85%, or D90 80-90%, whereas poor implants were defined as those with V100 < 75 or D90 < 80%. CTV dosimetry stratification was performed according to the same dose coverage criteria, albeit to the CTV.
RESULTS: One hundred ninety-two patients (97%) had good prostate radiation coverage, whereas only 165 patients (83%) had good postimplant CTV dosimetry. Patients with suboptimal vs. good CTV dosimetry had prostate edema of 7.8 ± 0.2% vs. 0.2 ± 0.1%, respectively (p = 0.001).
CONCLUSIONS: Prostate seed implants with optimal dosimetry to prostate may still have suboptimal D90 and V100 for the CTV, especially in the presence of postimplant edema. A consensus is needed for definition and evaluation of CTV in postimplant setting for low-dose-rate prostate brachytherapy.
Nasser NJ, Sappiatzer J, Wang Y, Borg J, Saibishkumar EP. Are you the author?
Department of Radiation Oncology, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada; Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Radiation Physics, Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, Ontario, Canada.
Reference: Brachytherapy. 2014 Oct 7. pii: S1538-4721(14)00633-3.