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Comparing CTVs for permanent prostate brachytherapy

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Abstract

Background and purpose

To delineate the clinical target volume (CTV) in low dose rate (LDR) brachytherapy for prostate cancer, American Brachytherapy Society (ABS) recommends a CTV = prostate. ESTRO advocates a CTV = prostate + 3 mm excluding rectum and many authors use and recommend other different CTVs. This study aims to: (1) evaluate the appropriateness of these recommendations and (2) test the applicability of seed distributions on the different CTVs and contrast the dosimetric differences.

Materials and methods

Ninety-eight patients treated with 125I seeds (dose 145 Gy; CTV = prostate) were studied. We established for every patient: (1) risk of extraprostatic extension (EPE), (2) adequacy of original plan to an extended CTV with 3 mm-margin (3) a new planning and seed distribution for this CTV and (4) comparison of dosimetry of both plans.

Results

Mean risk of EPE was 28.46 %. Original plan, when applied to the extended CTV, resulted in unsatisfactory dosimetry. A plan was generated for the 98 extended CTVs meeting all dosimetric specifications.

Conclusions

The risk of EPE is high enough to consider a 3 mm-margin around prostate necessary for all cases. A CTV = prostate + 3 mm except rectum as ESTRO recommends is feasible and would adjust planning to the most probable extension of the tumor.

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References

  1. Nag S, Beyer D, Friedland J, Grimm P, Nath R. American Brachytherapy Society (ABS) recommendations for transperineal permanent brachytherapy of the prostate cancer. Int J Radiat Oncol Biol Phys. 1999;44(4):789–99.

    Article  CAS  PubMed  Google Scholar 

  2. Nath R, Anderson LL, Luxton G, Weaver KA, Williamson JF, Meigooni AS. Dosimetry of interstitial brachytherapy sources: recommendations of the AAPM Radiation Therapy Committee Task Group No. 43. American Association of Physicists in Medicine. Med Phys. 1995;22(2):209–34.

    Article  CAS  PubMed  Google Scholar 

  3. Rosenthal S, Bittner N, Beyer D, Demanes D, Goldsmith B, Horwitz E, et al. American Society for Radiation Oncology and American College of Radiology practice guideline for the transperineal permanent brachytherapy of prostate cancer. Int J Radiat Oncol Biol Phys. 2011;79(2):335–41.

    Article  PubMed  Google Scholar 

  4. Davis B, Horwitz E, Lee W, Crook J, Stock R, Merrick G, et al. American Brachytherapy Society consensus guidelines for transrectal brachytherapy. Brachytherapy. 2012;11(1):6–19.

    Article  PubMed  Google Scholar 

  5. Hoskin PJ, Venselaar J, Group GEB, Group GEP. Prostate brachytherapy in Europe: growth, practice and guidelines. Radiother Oncol. 2007;83(1):1–2.

    Article  Google Scholar 

  6. Salembier C, Lavagnini P, Nickers P, Mangili P, Rijnders A, Polo A, et al. Tumour and target volumes in permanent prostate brachytherapy: a supplement to the ESTRO/EAU/EORTC recommendations on prostate brachytherapy. Radiother Oncol. 2007;83(1):3–10.

    Article  PubMed  Google Scholar 

  7. Partin AW, Kattan MW, Subong EN, Walsh PC, Wojno KJ, Oesterling JE, et al. Combination of prostate-specific antigen, clinical stage, and Gleason score to predict pathological stage of localized prostate cancer: a multi-institutional update. JAMA. 1997;277(18):1445–51.

    Article  CAS  PubMed  Google Scholar 

  8. Partin AW, Mangold LA, Lamm DM, Walsh PC, Epstein JI, Pearson JD. Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology. 2001;58(6):843–8.

    Article  CAS  PubMed  Google Scholar 

  9. Partin AW, Yoo J, Carter HB, Pearson JD, Cha DV, Epstein JI, et al. The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 1993;150(1):110–4.

    CAS  PubMed  Google Scholar 

  10. Davis B, Pisansky T, Wilson T, Rothenberg H, Pacelli A, Hillman D, et al. The radial distance of extraprostatic extension of prostate carcinoma: implications for prostate brachytherapy. Cancer. 1999;85(12):2630–7.

    Article  CAS  PubMed  Google Scholar 

  11. Schwartz DJ, Sengupta S, Hillman DW, Sargent DJ, Cheville JC, Wilson TM, et al. Prediction of radial distance of extraprostatic extension from pretherapy factors. Int J Radiat Oncol Biol Phys. 2007;69(2):411–8.

    Article  PubMed  Google Scholar 

  12. Chao K, Goldstein N, Yan D, Vargas C, Ghilezan M, Korman H, et al. Clinicopathologic analysis of extracapsular extension in prostate cancer: should the clinical target volume be expanded posterolaterally to account for microscopic extension? Int J Radiat Oncol Biol Phys. 2006;65(4):999–1007.

    Article  PubMed  Google Scholar 

  13. Davis B, Pisansky T, Wilson T, Rothenberg H, Pacelli A, Hillman D, et al. The radial distance of extraprostatic extension of prostate carcinoma: implications for prostate brachytherapy. Cancer. 1999;85(12):2630–7.

    Article  CAS  PubMed  Google Scholar 

  14. Teh B, Bastasch M, Mai W, Butler E, Wheeler T. Predictors of extracapsular extension and its radial distance in prostate cancer: implications for prostate IMRT, brachytherapy, and surgery. Cancer J. 2003;9(6):454–60.

    Article  PubMed  Google Scholar 

  15. Villers A, McNeal J, Freiha F, Boccon-Gibod L, Stamey T. Invasion of Denonvilliers’ fascia in radical prostatectomy specimens. J Urol. 1993;149(4):793–8.

    CAS  PubMed  Google Scholar 

  16. Edge S, Byrd D, Compton C. AJCC Cancer staging manual, 7th ed. 2010; p. 457–468.

  17. Hsiao W, Moses K, Goodman M, Jani A, Rossi P, Master V. Stage IV prostate cancer: survival differences in clinical T4, nodal and metastatic disease. J Urol. 2010;184(2):512–8.

    Article  PubMed  Google Scholar 

  18. Pierorazio P, Epstein J, Humphreys E, Han M, Walsh P, Partin A. The significance of a positive bladder neck margin after radical prostatectomy: the American Joint Committee on Cancer Pathological Stage T4 designation is not warranted. J Urol. 2010;183(1):151–7.

    Article  PubMed  Google Scholar 

  19. Ploussard G, Rotondo S, Salomon L. The prognostic significance of bladder neck invasion in prostate cancer: is microscopic involvement truly a T4 disease? BJU Int. 2010;105(6):776–91.

    Article  PubMed  Google Scholar 

  20. Stone N, Stock R, Cesaretti J, Unger P. Local control following permanent prostate brachytherapy: effect of high biologically effective dose on biopsy results and oncologic outcomes. Int J Radiat Oncol Biol Phys. 2010;76(2):355–60.

    Article  PubMed  Google Scholar 

  21. Forsythe K, Burri R, Stone N, Stock R. Predictors of metastatic disease after prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2012;83(2):645–52.

    Article  PubMed  Google Scholar 

  22. Burri R, Stone N, Unger P, Stock R. Long-term outcome and toxicity of salvage brachytherapy for local failure after initial radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;77(5):1338–44.

    Article  PubMed  Google Scholar 

  23. Burri R, Ho A, Forsythe K, Cesaretti J, Stone N, Stock R. Young men have equivalent biochemical outcomes compared with older men after treatment with brachytherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2010;77(5):1315–21.

    Article  PubMed  Google Scholar 

  24. Forsythe K, Blacksburg S, Stone N, Stock R. Intensity-modulated radiotherapy causes fewer side effects than three-dimensional conformal radiotherapy when used in combination with brachytherapy for the treatment of prostate cancer. Int J Radiat Oncol Biol Phys. 2012;83(2):630–5.

    Article  PubMed  Google Scholar 

  25. Goldner G, Pötter R, Battermann J, Kirisits C, Schmid M, Sljivic S, et al. Comparison between external beam radiotherapy (70 Gy/74 Gy) and permanent interstitial brachytherapy in 890 intermediate risk prostate cancer patients. Radiother Oncol. 2012;103(2):223–7.

    Article  PubMed  Google Scholar 

  26. Stock R, Buckstein M, Liu J, Stone N. The relative importance of hormonal therapy and biological effective dose in optimizing prostate brachytherapy treatment outcomes. BJU Int. 2013;112(2):44–50.

    Article  Google Scholar 

  27. Roeloffze E, Lips I, van Gellekom M, van Roermund J, Frank S, Battermann J, et al. Health-related quality of life up to six years after (125)I brachytherapy for early-stage prostate cancer. Int J Radiat Oncol Biol Phys. 2010;76(4):1054–60.

    Article  Google Scholar 

  28. Keyes M, Crook J, Morris W, Morton G, Pickles T, Usmani N, et al. Canadian prostate brachytherapy in 2012. Can Urol Assoc J. 2013;7(1–2):51–8.

    PubMed Central  PubMed  Google Scholar 

  29. Crook J, Patil N, Ma C, McLean M, Borg J. Magnetic resonance imaging-defined treatment margins in iodine-125 prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2010;77(4):1079–84.

    Article  PubMed  Google Scholar 

  30. Lawton C, Hunt D, Lee W, Gomella L, Grignon D, Gillin M, et al. Long-term results of a phase II trial of ultrasound-guided radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (RTOG 98-05). Int J Radiat Oncol Biol Phys. 2011;81(1):1–7.

    Article  PubMed Central  PubMed  Google Scholar 

  31. Lawton C, DeSilvio M, Lee W, Gomella L, Grignon D, Gillin M, et al. Results of a phase II trial of transrectal ultrasound-guided permanent radioactive implantation of the prostate for definitive management of localized adenocarcinoma of the prostate (radiation therapy oncology group 98-05). Int J Radiat Oncol Biol Phys. 2007;67(1):39–47.

    Article  PubMed  Google Scholar 

  32. Gleason DF. Histological Grading and Clinical Staging of Prostatic Carcinoma. In: Tannenbaum M, editor. Urologic pathology: the prostate. Philadelphia: Lea & Feibiger; 1977. p. 171–98.

    Google Scholar 

  33. Nag S, Bice W, DeWyngaert K, Prestidge B, Stock R, Yu Y. The American Brachytherapy Society recommendations for permanent prostate brachytherapy postimplant dosimetric analysis. Int J Radiat Oncol Biol Phys. 2000;46(1):221–30.

    Article  CAS  PubMed  Google Scholar 

  34. Johnny K, Nelson N, Stone MD, Amir L, Vishruta D, Cesaretti JA, et al. I125 monotherapy using D90 implant doses of 180 Gy or greater. Int J Radiat Oncol Biol Phys. 2008;70(1):96–101.

    Article  Google Scholar 

  35. Taira A, Merrick G, Galbreath R, Butler W, Adamovich E, Wallner K. Prognostic importance of small prostate size in men receiving definitive prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2012;84(2):396–401.

    Article  PubMed  Google Scholar 

  36. Fuks Z, Leibel SA, Wallner KE, Begg CB, Fair WR, Anderson LL, et al. The effect of local control on metastatic dissemination in carcinoma of the prostate: long-term results in patients treated with 125I implantation. Int J Radiat Oncol Biol Phys. 1991;21(3):537–47.

    Article  CAS  PubMed  Google Scholar 

  37. Zelefsky M, Withmore W. Long-term result of retropubic permanent 125 iodine implantation of the prostate for clinically localized prostatic cancer. J Urol. 1997;158:23–30.

    Article  CAS  PubMed  Google Scholar 

  38. Nag S, Baird M, Blasko J. American brachytherapy society (ABS) survey of current clinical practice for permanent brachytherapy of prostate cancer. J Brachytherapy Int. 1997;13:243–51.

    Google Scholar 

  39. Stone N, Potters L, Davis B, Ciezki J, Zelefsky M, Roach M, et al. Customized dose prescription for permanent prostate brachytherapy: insights from a multicenter analysis of dosimetry outcomes. Int J Radiat Oncol Biol Phys. 2007;69(5):1472–7.

    Article  PubMed  Google Scholar 

  40. Otón C, Otón L. Brachytherapy doses for prostate cancer customized to risk factors: is it more important “how much” or “where”? In regard to Stone et al. Int J Radiat Oncol Biol Phys. 2008;71(3):962–3.

    Article  PubMed  Google Scholar 

  41. ICRU Report 50. Prescribing, Recording and reporting photon beam therapy. In: ICRU report 50. Bethesda, USA: ICRU; 1993. p. 5–27.

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Conflict of interest

All authors declared no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiation Oncology, University of La Laguna Tenerife, Santa Cruz de Tenerife, Spain

    C. A. Oton, L. Blanco, L. F. Oton & S. Moral

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  1. C. A. Oton
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  2. L. Blanco
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  3. L. F. Oton
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  4. S. Moral
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Correspondence to C. A. Oton.

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Oton, C.A., Blanco, L., Oton, L.F. et al. Comparing CTVs for permanent prostate brachytherapy. Clin Transl Oncol 17, 393–397 (2015). https://doi.org/10.1007/s12094-014-1245-z

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  • DOI: https://doi.org/10.1007/s12094-014-1245-z

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