Search

Background We describe two patients who underwent low-dose-rate prostate brachytherapy after embolization for pelvic arteriovenous malformation. Case presentation Case 1: A 76-year-old man was referred for definitive treatment of intermediate-risk prostate cancer (prostate-specific antigen 8.667 ng/mL, cT2aN0M0, Gleason score 3 + 4 = 7). We planned low-dose-rate brachytherapy. However, magnetic resonance imaging and computed tomography demonstrated a large pelvic arteriovenous malformation. We performed embolization of the arteriovenous malformation before initiating treatment to lower the risk of rupture of the arteriovenous malformation during low-dose-rate brachytherapy. Case 2: A 69-year-old man was referred for the definitive treatment of high-risk prostate cancer (prostate-specific antigen 5.81 ng/mL, cT2aN0M0, Gleason score 4 + 4 = 8) with a pelvic arteriovenous malformation. Similar to Case 1, we performed embolization of the arteriovenous malformation before initiating treatment. In both cases, low-dose-rate brachytherapy could be performed without complications. Conclusions Low-dose-rate brachytherapy after transcatheter embolization of pelvic arteriovenous malformations can safely and effectively treat localized prostate cancer with pelvic arteriovenous malformations.

PURPOSE/OBJECTIVE(S) To report on rectal dosimetry and toxicity outcomes in men with prostate cancer (PCa) treated with I125 low-dose rate brachytherapy (LDR-BT) with or without hydrogel (HS) or hyaluronic acid (HA) rectal spacer (RS) insertion. The working hypothesis is the increased retroprostatic distance achieved from RS insertion results in reduced rectal dosimetry and subsequent reduction in rectal toxicity outcomes. MATERIALS/METHODS Seventy consecutive men treated with LDR-BT between December 2017 and July 2019 were included in this study, twenty-eight (40%) men had RS insertion according to the preference of the referring urologist, compared to a group of forty-two men (60%) without RS. Descriptive statistics were used to compare the RS safety, dosimetric effects on organs at risk (rectum and urethra), as well as gastrointestinal (GI) and genitourinary (GU) toxicities (assessed using the CTCAEv4) between the two groups. RESULTS The mean prostate-rectal separation with RS at mid prostate was 9.9mm (SD 2.8mm). There were no post-operative complications for RS insertion. There was significantly reduced rectal dosimetry in RS group vs non-RS group, the median RV100 was 0cc (IQR = 0-0.0cc) vs 0.4cc (IQR = 0.1-1.1cc) (P < 0.001) respectively. Mean rectal D1cc and D2cc were 52.4% vs 84.2% (P < 0.001) and 45.7% vs. 70.0% (P < 0.001) for RS and non-RS group respectively. There were no discernible differences in the mean urethral D20, D5, and D1. There were significantly less ≥ grade 1 acute and late GI toxicities in the RS group when compared to the non-RS group (0% vs 24% P = 0.004 for acute GI toxicity: 4% vs 33%, P = 0.003 for late GI toxicity). Strong association remained for RS with late GI toxicity (odds ratios < 0.2) even after accounting for the confounding effects of post-implant RV100, D1cc and D2cc. CONCLUSION Insertion of RS in men treated with LDR-BT is safe and results in significantly lower values in rectal dosimetry. The reduction in rectal dosimetry with RS insertion translates into significantly reduced rates of acute and late GI toxicities.

Purpose: To evaluate the feasibility and to report the early outcomes of focal treatment of prostate cancer using low- dose-rate brachytherapy (LDR-PB). Material and methods: Seventeen patients were screened with multi-parametric magnetic resonance imaging (mpMRI), 14 of whom proceeded to receive trans-perineal template mapping biopsy (TTMB). Focal LDR-PB was performed on five eligible patients using dual air kerma strength treatment plans based on planning target volumes derived from cancer locations and determined by TTMB. Patient follow-up includes prostate specific antigen (PSA) measurements, urinary and sexual function questionnaires, repeated imaging and TTMB at specific intervals post-treatment. Results: Feasibility of focal LDR-PB was shown and short-term outcomes are promising. While the detection rate of tumors, a majority of which were low grade GS 3 + 3, was found to be low on mpMRI (sensitivity of 37.5%), our results suggest the potential of mpMRI in detecting the presence of higher grade (GS ≥ 3 + 4), and bilateral disease indicating its usefulness as a screening tool for focal LDR-PB. Conclusions : Low-dose-rate brachytherapy is a favorable ablation option for focal treatment of prostate cancer, requiring minimal modification to the standard (whole gland) LDR-PB treatment, and appears to have a more favorable side effect profile. Further investigation, in the form of a larger study, is needed to assess the methods used and the long-term outcomes of focal LDR-PB.

Purpose Low-dose-rate (LDR) brachytherapy has been established as an effective and safe treatment option for men with low and intermediate risk prostate cancer. In this retrospective analysis, we sought to study the effect of body mass index (BMI) on post-implant dosimetric quality. Material and methods After institutional approval, records of patients with non-metastatic prostate cancer treated in Puerto Rico with LDR brachytherapy during 2008-2013 were reviewed. All patients were implanted with 125I seeds to a prescription dose of 145 Gy. Computed tomography (CT) based dosimetry was performed 1 month after implant. Patients with at least 1 year of prostate-specific antigen (PSA) follow-up were included. Factors predictive of adequate D90 coverage (≥ 140 Gy) were compared via the Pearson χ2 or Wilcoxon rank-sum test as appropriate. Results One-hundred and four patients were included in this study, with 53 (51%) patients having a D90 ≥ 140 Gy. The only factor associated with a dosimetric coverage detriment (D90 < 140 Gy) was BMI ≥ 25 kg/m2 (p = 0.03). Prostate volume (p = 0.26), initial PSA (p = 0.236), age (p = 0.49), hormone use (p = 0.93), percent of cores positive (p = 0.95), risk group (p = 0.24), tumor stage (p = 0.66), and Gleason score (p = 0.61) did not predict D90. Conclusions In this study we show that BMI is a significant pre-implant predictor of D90 (< 140 Gy vs. ≥ 140 Gy). Although other studies have reported that prostate volume also affects D90, our study did not find this correlation to be statistically significant, likely because all of our patients had a prostate volume < 50 cc. Our study suggests that in patients with higher BMI values, more rigorous peri-implant dosimetric parameters may need to be applied in order to achieve a target D90 > 140 Gy.

Purpose The aim of this analysis was to compare acute and late toxicities between low-dose-rate brachytherapy (LDR-BT) (110 Gy) in combination with 45 Gy in 25 fractions external beam radiation therapy (EBRT) and LDR-BT (160 Gy) alone for localized prostate cancer. Material and methods One hundred five consecutive patients with localized prostate cancer treated from May 2014 to May 2017 were included in this retrospective analysis. Sixty patients received combination therapy and 45 patients received BT monotherapy. The LDR-BT procedure was performed using 125I seeds. Results The median follow-up time was 28 months in both groups. Three-year effect rates were overall survival: 100% in both groups. The biochemical failure rate was 2.3% in the combination group and 0% in the monotherapy group (p = 0.373). No patients died during the study period. In both groups, almost all the patients experienced acute urethritis. There was a significant difference between the combination therapy group (8.3%) and BT monotherapy group (11.1%) in late genitourinary (GU) toxicities ≥ grade 2 (p = 0.035). Only 2 patients (3.3%) in the combination therapy group developed late ≥ grade 2 rectal hemorrhage. There were no significant differences between two groups in hematuria ≥ grade 2 (p = 0.068) or rectal hemorrhage ≥ grade 2 (p = 0.206). Conclusions To our knowledge, this is the first report to compare the GU and gastrointestinal toxicities between the combination therapy and BT monotherapy (160 Gy) for localized prostate cancer. Unexpectedly, there were more late GU toxicities (except for hematuria) in the BT monotherapy group.

Purpose: Post-implant dosimetry following prostate seed implantation (PSI) occasionally reveals suboptimal dosi- metric coverage of the gland. Published reports of re-implantation techniques have focused on earlier-generation tech- niques, including preplanned approaches and stranded seeds. The purpose of this case report is to describe a customizable approach to perform corrective re-implantation using loose seeds and intraoperative planning technique. Material and methods: This case report describes a 63-year-old male with favorable risk prostate adenocarcinoma receiving PSI. Thirty day post-implant dosimetric evaluation revealed suboptimal coverage of the base of the gland. Us- ing guidance from post-implant CT-images and real-time planning, the patient received a corrective re-implantation with intraoperative planning. Results: Post-implant dosimetry after re-implantation procedure with intraoperative planning yielded improved tar- get volume coverage that achieved standard dosimetric criteria. Conclusions: Re-implantation as a salvage treatment technique after sub-optimal PSI is a valid treatment option per- formed with intraoperative real-time planning. J Contemp Brachyther 2012; 4, 3: 176-181 DOI: 10.5114/jcb.2012.30684

Purpose To develop a consensus statement between the American Brachytherapy Society (ABS) and Groupe Europeen de Curietherapie/European Society for Therapeutic Radiation and Oncology (GEC-ESTRO) for the use of brachytherapy in the primary management of carcinoma of the penis. Methods and Materials The American Brachytherapy Society and Groupe Europeen de Curietherapie/European Society for Therapeutic Radiation and Oncology convened a group of expert practitioners and physicists to develop a statement for the use of 192Ir in low-dose-rate (LDR), pulse-dose-rate, and high-dose-rate (HDR) brachytherapy for penile cancer. Results Decades of brachytherapy experience with LDR 192Ir wire and pulse-dose-rate 192Ir sources for this rare malignancy indicate a penile preservation rate of 70% at 10 years postimplant. Chief morbidities remain stenosis of the urethral meatus and soft tissue ulceration at the primary site. Nonhealing ulceration can be successfully managed with various measures including hyperbaric oxygen treatment. HDR brachytherapy implant procedures are technically similar to LDR. The optimal HDR dose and fractionation schemes are being developed. Conclusions The good tumor control rates, acceptable morbidity, and functional organ preservation warrant recommendation of brachytherapy as the initial treatment for invasive T1, T2, and selected T3 penile cancers.