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The impact of activating source dwell positions outside the CTV on the dose to treated normal tissue volumes in TRUS guided 3D conformal interstitial HDR brachytherapy of prostate cancer
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-8351-3367
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Oncology, Örebro University Hospital, Örebro, Sweden.
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Örebro University Hospital. Department of Medical Physics, Örebro University Hospital, Örebro, Sweden.
2014 (English)In: Journal of Contemporary Brachytherapy, ISSN 1689-832X, E-ISSN 2081-2841, Vol. 6, no 3, p. 282-288Article in journal (Refereed) Published
Abstract [en]

Purpose: Dose coverage is crucial for successful treatment in mono-brachytherapy. Since few and very high dose fractions are used, there is an important balance between dwell positioning outside the clinical target volume (CTV) and possible damage on adjacent normal tissue. The purpose of this study was to evaluate the possibility of having dwell positions close to the CTV surface, while maintaining an acceptable dose distribution, and to investigate the robustness in terms of known geometrical uncertainties of the implant.

Material and methods: This study included 37 patients who had received brachytherapy for prostate cancer as a monotherapy with the following schedules: 2 x 14 Gy or 3 x 11 Gy, each fraction separated by two weeks. The source dwell positions were activated 5 mm outside CTV. New optimizations were simulated for dwell positions at 3, 2, 1, and 0 mm. Inverse and graphical optimization were applied according to the relative dose constraints: V-100 CTV >= 97%, D-max,D- urethra <= 110%, and D-10 rectal mucosa <= 65%. The V-100 normal tissue outside CTV was used to evaluate dose variations caused by different dwell positions. Prostate geometries and dose distributions for the different dwell positions outside the CTV were used to investigate the impact on the CTV dose distribution due to geometrical uncertainties.

Results: Both V-100,V- CTV, and V-100,V- normal tissue decreased, 98.6% to 92.2%, and 17 cm(3) to 9.0 cm(3), for dwell activation from 5 rum to 0 mm. The evaluation of both simulated longitudinal geometrical uncertainties and different source dwell activations implied that V-100,V- CTV ranged from 98.6% to 86.3%.

Conclusions: It is possible to reduce the V-100,V- normal tissue by decreasing the source dwell positions outside the CTV from 5 to 3 mm, while maintaining dose constraints. In combination with the estimated geometrical uncertainties, however, the source dwell positions need to be 5 mm from the surface in order to maintain a robust implant.

Place, publisher, year, edition, pages
Termedia Publishing House , 2014. Vol. 6, no 3, p. 282-288
Keywords [en]
brachytherapy, margins, optimization, prostate cancer
National Category
Cancer and Oncology
Research subject
Oncology
Identifiers
URN: urn:nbn:se:oru:diva-39464DOI: 10.5114/jcb.2014.45586ISI: 000344200000006PubMedID: 25337130Scopus ID: 2-s2.0-84907706206OAI: oai:DiVA.org:oru-39464DiVA, id: diva2:770245
Available from: 2014-12-10 Created: 2014-12-10 Last updated: 2018-06-14Bibliographically approved

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Karlsson, LeifThunberg, PerJohansson, BengtPersliden, Jan

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