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MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL)

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Abstract

Objectives

The aim of the study was to establish the setup and workflow for delivering focal MRI-guided high-dose-rate (HDR) brachytherapy for prostate cancer (PCA) and to assess patient comfort and safety aspects of MRI-guided single-fraction HDR.

Methods

Patients with histologically proven focal low- to intermediate-risk PCA with a single PIRADS 4/5 lesion were treated with percutaneous interstitial HDR brachytherapy in a single fraction with a minimum dose for the gross tumor volume of 20 Gy while sparing the organ at risk (OAR). Using a 3T-MRI, brachytherapy catheters were placed transgluteal in freehand technique. No antibiotic therapy or general analgesics were administered. Patient data, procedure time, patient discomfort, and complications were recorded. Quarterly PSA controls, biannual follow-up imaging, and annual re-biopsy were planned.

Results

So far, 9 patients were successfully treated and followed for 6 months. Mean intervention time was 34 min. Using the VAS scale, the pain reported for the intervention ranged from 2 to 3. Short-term follow-up showed no acute genitourinary or gastrointestinal toxicity so far. None of the patients displayed signs of infection. PSA levels in all patients decreased significantly. On follow up no residual PCA was detected treated region so far. PSA levels in all patients decreased significantly. On follow-up, no residual PCA was detected so far.

Conclusions

MR-guided single-fraction focal HDR brachytherapy for localized PCA is feasible as well as safe for the individual patient. Catheters can be placed accurately and maximum therapeutic dose distribution can be restricted to the tumor. Countersigning the minimally invasive character of the procedure, no general anesthesia or antibiosis is necessary.

Key Points

• MR-guided focal HDR brachytherapy allows an accurate placement of catheters with maximum therapeutic dose distribution restricted to the tumor.

• No major anesthesia or antibiosis is necessary emphasizing the minimal invasive character of the procedure.

• Patients with low- and intermediate-risk prostate carcinoma in particular may benefit to halt disease progression whereas treatment-related morbidity is reduced compared with radical therapy.

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Abbreviations

ACR:

American College of Radiology

AS:

Active surveillance

EBRT:

External beam radiation therapy

GTV:

Gross tumor volume

HDR:

High-dose-rate brachytherapy

HIFU:

High-focused ultrasound

LDR :

Low-dose rate brachytherapy

OAR:

Organs at risk

PCA :

Prostate cancer

PSA :

Prostate-specific antigen

PTV:

Planning target volume

RT:

Percutaneous radiotherapy

VAS:

Virtual analog scale

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Funding

The authors state that this work has not received any funding.

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Authors and Affiliations

  1. Department of Radiology, Otto von Guericke University, Medical School, Leipziger Str. 44, 39120, Magdeburg, Germany

    Frank Fischbach, Philipp Genseke, Lisa Geisendorf, Maciej Pech & Katharina Fischbach

  2. Department of Radiotherapy, Otto von Guericke University, Medical School, Magdeburg, Germany

    Peter Hass & Thomas Brunner

  3. Department of Urology, Otto von Guericke University, Medical School, Magdeburg, Germany

    Daniel Schindele & Martin Schostak

  4. Philips Healthcare, Philips Medical Systems, Hamburg, Germany

    Christian Stehning

Authors
  1. Frank Fischbach
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  2. Peter Hass
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  3. Daniel Schindele
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  4. Philipp Genseke
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  5. Lisa Geisendorf
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  6. Christian Stehning
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  7. Martin Schostak
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  8. Thomas Brunner
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  9. Maciej Pech
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  10. Katharina Fischbach
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Corresponding author

Correspondence to Frank Fischbach.

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Guarantor

The scientific guarantor of this publication is Frank Fischbach.

Conflict of interest

The co-author, Christian Stehning, is a staff of the company Philips Healthcare.

All other authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

Institutional Review Board approval was obtained.

Methodology

• Prospective

• Observational

• Performed at one institution

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Fischbach, F., Hass, P., Schindele, D. et al. MRI targeted single fraction HDR Brachytherapy for localized Prostate Carcinoma: a feasibility study of focal radiation therapy (ProFocAL). Eur Radiol 30, 2072–2081 (2020). https://doi.org/10.1007/s00330-019-06505-0

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