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Targeting prostate lesions on multiparametric MRI with HDR brachytherapy: Optimal planning margins determined using whole-mount digital histology

  • Christopher W. Smith
    Affiliations
    Baines Imaging Research Laboratory, London, Ontario, Canada

    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Biophysics, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
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  • Taylor Marcus
    Affiliations
    Department of Medical Biophysics, Western University, London, Ontario, Canada
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  • Douglas Hoover
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Biophysics, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
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  • Kathleen Surry
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Biophysics, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
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  • David D'Souza
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
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  • Derek Cool
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Imaging, Western University, London, Ontario, Canada
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  • Zahra Kassam
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Imaging, Western University, London, Ontario, Canada
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  • Matthew Bastian-Jordan
    Affiliations
    University of Queensland, Queensland, Australia
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  • José A. Gómez
    Affiliations
    Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
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  • Madeleine Moussa
    Affiliations
    Department of Pathology and Laboratory Medicine, Western University, London, Ontario, Canada
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  • Joseph L. Chin
    Affiliations
    Department of Surgery, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada
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  • Stephen Pautler
    Affiliations
    Department of Surgery, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada
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  • Glenn S. Bauman
    Affiliations
    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Biophysics, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
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  • Aaron D. Ward
    Correspondence
    Corresponding author. Department of Medical Biophysics, 1151 Richmond Street N, London, ON N6A 5C1, Canada. Tel.: 519 685 8500x56846.
    Affiliations
    Baines Imaging Research Laboratory, London, Ontario, Canada

    Lawson Health Research Institute, London, Ontario, Canada

    Department of Medical Biophysics, Western University, London, Ontario, Canada

    Department of Oncology, Western University, London, Ontario, Canada

    London Regional Cancer Program, London, Ontario, Canada
    Search for articles by this author

      Abstract

      PURPOSE

      Multiparametric magnetic resonance imaging (mpMRI) has demonstrated the ability to localize intraprostatic lesions. It is our goal to determine how to optimally target the underlying histopathological cancer within the setting of high-dose-rate brachytherapy (HDR-BT).

      METHODS AND MATERIALS

      Ten prostatectomy patients had pathologist-annotated mid-gland histology registered to pre-procedural mpMRI, which were interpreted by four different observers. Simulated HDR-BT plans with realistic catheter placements were generated by registering the mpMRI lesions and corresponding histology annotations to previously performed clinical HDR-BT implants. Inverse treatment planning was used to generate treatment plans that treated the entire gland to a single dose of 15 Gy, as well as focally targeted plans that aimed to escalate dose to the mpMRI lesions to 20.25 Gy. Three margins to the lesion were explored: 0 mm, 1 mm, and 2 mm. The analysis compared the dose that would have been delivered to the corresponding histologically-defined cancer with the different treatment planning techniques.

      RESULTS

      mpMRI-targeted plans delivered a significantly higher dose to the histologically-defined cancer (p < 0.001), in comparison to the standard treatment plans. Additionally, adding a 1 mm margin resulted in significantly higher D98, and D90 to the histologically-defined cancer in comparison to the 0 mm margin targeted plans (p = 0.019 & p = 0.0026). There was no significant difference between plans using 1 mm and 2 mm margins.

      CONCLUSIONS

      Adding a 1 mm margin to intraprostatic mpMRI lesions significantly increased the dose to histologically-defined cancer, in comparison applying no margin. No significant effect was observed by further expanding the margins.

      Keywords

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