Pathology & Oncology Research

, Volume 16, Issue 4, pp 593–599 | Cite as

The Effect of Needle Number on the Quality of High-dose-rate Prostate Brachytherapy Implants

  • Georgina Fröhlich
  • Péter Ágoston
  • József Lövey
  • Csaba Polgár
  • Tibor Major


The aim of this study is to evaluate the effect of the number of needles on the quality of dose distributions in high-dose-rate (HDR) prostate implants regarding target coverage, dose homogeneity and dose to organs at risk. Treatment plans of 174 implants were evaluated using cumulative dose-volume histograms. The plans were divided into three groups according to the number of implanted needles: <15: LNG (low number group), 15–17: MNG (medium number group) and >17: HNG (high number group). Treatment planning was based on transrectal ultrasound imaging. Dose-volume parameters for target (V90, V100, V150, V200, D90, Dmin) and quality indices (DNR, DHI, CI, COIN) were calculated. Maximal dose in reference points and high dose volumes were determined for rectum and urethra. Nonparametric analysis of variance and correlation was used with regard to needle numbers. Between the groups differences were found only in the following parameters: Vp was larger when more needles were used with the values of 22.8 cm3, 28.0 cm3 and 30.9 cm3 for the three groups, and more needles were used when the central cross-section of the prostate was larger. V200 in MNG was lower than in LNG (12%, 14%). Dose to rectum was higher in MNG than in LNG (D2: 51%, 47%). Doses to the urethra were higher in HNG than in MNG (D1: 142%, 137%, and D0.1: 128%, 125%). There was no significant difference in other parameters. Different number of needles results significant differences in treatment plans. However, the optimal needle number depends on not only the size of the prostate, but also the individual anatomy of the patient. Based on our results, in most cases the use of 15–17 needles seems to provide a dosimetrically acceptable treatment plan in HDR prostate implants.


Dose-volume analysis High-dose-rate Prostate brachytherapy Number of needles Organs at risk Treatment planning 



three dimensional conformal radiotherapy




coverage index


conformal index


clinical target volume


dose homogeneity index


dose nonuniformity ratio


dose volume histogram


European Association of Urologists


Groupe Européen de Curiethérapie/European Society for Therapeutic Radiology and Oncology




organ at risk




planning target volume


reference dose






  1. 1.
    Akimoto T, Ito K, Saitoh JI et al (2005) Acute genitourinary toxicity after high-dose-rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity. Int J Radiat Oncol Biol Phys 63:463–471PubMedGoogle Scholar
  2. 2.
    Akimoto T, Katoh H, Noda SE et al (2005) Acute genitourinary toxicity after high-dose-rate (HDR) brachytherapy combined with hypofractionated external-beam radiation therapy for localized prostate cancer: second analysis to determine the correlation between the urethral dose in HDR brachytherapy and the severity of acute genitourinary toxicity. Int J Radiat Oncol Biol Phys 63:472–478PubMedGoogle Scholar
  3. 3.
    Demanes DJ, Rodriguez RR, Altieri GA (2000) High dose rate prostate brachytherapy: the California Endocurietherapy (CET) Method. Radiother Oncol 57:289–296CrossRefPubMedGoogle Scholar
  4. 4.
    Demanes DJ, Rodriguez RR, Schour LD et al (2005) High-dose-rate intensity-modulated brachytherapy with external beam radiotherapy for prostate cancer: California Endocurietherapy’s 10-year results. Int J Radiat Oncol Biol Phys 61:1306–1316PubMedGoogle Scholar
  5. 5.
    Hsu ICJ, Cabrera AR, Weinberg V et al (2005) Combined modality treatment with high-dose-rate brachytherapy boost for locally advanced prostate cancer. Brachytherapy 4:202–206CrossRefPubMedGoogle Scholar
  6. 6.
    Jo J, Hiratsuka J, Fujii T et al (2004) High-dose-rate Iridium-192 afterloading therapy combined with external beam radiotherapy for T1c-T3bN0M0 prostate cancer. Urology 64:556–560CrossRefPubMedGoogle Scholar
  7. 7.
    Kovács G, Melchert C, Sommerauer M et al (2007) Intensity modulated high-dose-rate brachytherapy boost complementary to external beam radiation for intermediate- and high-risk localized prostate cancer patients—How we do it in Lübeck/Germany. Brachytherapy 6:142–148CrossRefPubMedGoogle Scholar
  8. 8.
    Mate TP, Gottesman JE, Hatton J et al (1998) High-dose-rate afterloading 192-Iridium prostate brachytherapy: feasibility report. Int J Radiat Oncol Biol Phys 41:525–533CrossRefPubMedGoogle Scholar
  9. 9.
    Martin T, Hey-Koch S, Strassmann G et al (2000) 3D interstitial HDR brachytherapy combined with 3D external beam radiotherapy and androgen deprivation for prostate cancer. Strahlenther Onkol 176:361–367CrossRefPubMedGoogle Scholar
  10. 10.
    Pinkawa M, Fischedick K, Treusacher P et al (2006) Dose-volume impact in high-dose-rate Iridium-192 brachytherapy as a boost to external beam radiotherapy for localized prostate cancer—a phase II study. Radiother Oncol 78:41–46CrossRefPubMedGoogle Scholar
  11. 11.
    Vargas CE, Ghilezan M, Hollander M et al (2005) A new model using number of needles and androgen deprivation to predict chronic urinary toxicity for high or low dose rate prostate brachytherapy. J Urol 174:882–887CrossRefPubMedGoogle Scholar
  12. 12.
    Charra-Brunaud C, Hsu ICJ, Weinberg V et al (2003) Analysis of interaction between number of implant catheters and dose-volume histograms in prostate high-dose-rate brachytherapy using a computer model. Int J Radiat Oncol Biol Phys 56:586–591CrossRefPubMedGoogle Scholar
  13. 13.
    D’Amico AV, Whittington R, Malkowicz B et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974CrossRefPubMedGoogle Scholar
  14. 14.
    Baltas D, Kolotas C, Geramani K et al (1998) A conformal index (COIN) to evaluate implant quality and dose specification in brachytherapy. Int J Radiat Oncol Biol Phys 40:515–524PubMedGoogle Scholar
  15. 15.
    Hoskin PJ (2000) High-dose-rate brachytherapy boost treatment in radical radiotherapy for prostate cancer. Radiother Oncol 57:285–288CrossRefPubMedGoogle Scholar
  16. 16.
    Morton GC (2005) The emerging role of high-dose-rate brachytherapy for prostate cancer. Clin Oncol 17:219–227CrossRefGoogle Scholar
  17. 17.
    Sathya JR, Davis IR, Julian JA et al (2005) Randomized trial comparing Iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 23:1192–1199CrossRefPubMedGoogle Scholar
  18. 18.
    Stromberg J, Martinez A, Gonzalez J et al (1995) Ultrasound-guided high-dose-rate conformal brachytherapy boost in prostate cancer: treatment description and preliminary results of a phase I/II clinical trial. Int J Radiat Oncol Biol Phys 33:161–171PubMedGoogle Scholar
  19. 19.
    Martinez AA, Pataki I, Edmundson G et al (2001) Phase II prospective study of the use of conformal highdose-rate brachytherapy as monotherapy for the treatment of favourable stage prostate cancer: a feasibility report. Int J Radiat Oncol Biol Phys 49:61–69PubMedGoogle Scholar
  20. 20.
    Yoshioka Y, Nose T, Yoshida K et al (2003) High-dose-rate brachytherapy as monotherapy for localized prostate cancer: a retrospective analysis with special focus on tolerance and chronic toxicity. Int J Radiat Oncol Biol Phys 56:213–220PubMedGoogle Scholar
  21. 21.
    Edmundson GK, Rizzo NR, Teahan M et al (1993) Concurrent treatment planning for outpatient high-dose-rate prostate template implants. Int J Radiat Oncol Biol Phys 27:1215–1223PubMedGoogle Scholar
  22. 22.
    Jacob D, Raben A, Sarkar A et al (2008) Anatomy-based inverse planning simulated annealing optimization in high-dose-rate prostate brachytherapy: significant dosimetric advantage over other optimization techniques. Int J Radiat Oncol Biol Phys 72:820–827PubMedGoogle Scholar
  23. 23.
    Kolkman-Deurloo IKK, Deleye XGJ, Jansen PP et al (2004) Anatomy based inverse planning in HDR prostate brachytherapy. Radiother Oncol 73:73–77CrossRefPubMedGoogle Scholar
  24. 24.
    Nickers P, Lenaerts E, Thissen B et al (2005) Does inverse planning applied to Iridium192 high dose rate prostate brachytherapy improve the optimization of the dose afforded by the Paris system? Radiother Oncol 74:131–136CrossRefPubMedGoogle Scholar
  25. 25.
    Yoshioka Y, Nishimura T, Kamata M et al (2005) Evaluation of anatomy-based dwell position and inverse optimization in high-dose-rate brachytherapy of prostate cancer: a dosimetric comparison to a conventional cylindrical dwell position, geometric optimization, and dose-point optimization. Radiother Oncol 75:311–317CrossRefPubMedGoogle Scholar
  26. 26.
    Ash D, Flynn A, Battermann J et al (2000) ESTRO/EAU/EORTC recommendations on permanent seed implantation for localized prostate cancer. Radiother Oncol 57:315–321CrossRefPubMedGoogle Scholar
  27. 27.
    Nag S, Bice W, Dewyngaert K et al (2000) The American Brachytherapy Society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys 46:221–230CrossRefPubMedGoogle Scholar
  28. 28.
    Kovács G, Pötter R, Loch T et al (2005) GEC/ESTRO-EAU recommendations on temporary brachytherapy using stepping sources for localised prostate cancer. Radiother Oncol 74:37–148CrossRefGoogle Scholar
  29. 29.
    Edmundson GK, Yan D, Martinez AA (1995) Intraoperative optimization of needle placement and dwell times for conformal prostate brachytherapy. Int J Radiat Oncol Biol Phys 33:1257–1263PubMedGoogle Scholar
  30. 30.
    Khoo VS (2005) Radiotherapeutic techniques for prostate cancer, dose escalation and brachytherapy. Clin Oncol 17:560–571CrossRefGoogle Scholar
  31. 31.
    Lakosi F, Antal G, Vandulek C et al (2009) Technical feasibility of transperineal MR-guided prostate interventions in a low-field open MRI unit: canine study. Pathol Oncol Res 15(3):315–322CrossRefPubMedGoogle Scholar

Copyright information

© Arányi Lajos Foundation 2010

Authors and Affiliations

  • Georgina Fröhlich
    • 1
    • 2
  • Péter Ágoston
    • 2
  • József Lövey
    • 2
  • Csaba Polgár
    • 2
  • Tibor Major
    • 2
  1. 1.School of PhD StudiesSemmelweis UniversityBudapestHungary
  2. 2.Department of RadiotherapyNational Institute of OncologyBudapestHungary

Personalised recommendations