Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy

Purpose: The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy. Material and methods: Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans. Results: Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V-100, V-150, V-200, and OARs DVH-related parameters between the plans. Mean values of ECE V-100, V-150, and V-200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V-100, V-150, and V-200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively). Conclusions: TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.