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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Article Info
Publication History
Published online: March 22, 2022
Accepted:
January 29,
2022
Received in revised form:
December 3,
2021
Received:
May 27,
2021
Footnotes
Disclosures: There are no conflicts of interest involved in this work.
Identification
Copyright
© 2022 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.
