Real-time brachytherapy for prostate cancer - implant analysis

Background In HDR brachytherapy precision of catheter implantation is crucial for conformal treatment planning as a starting point for better optimization process. Aim The aim was to investigate differences between virtual and real needle position and the effect of needle displacement on dosimetric parameters as a function of prostate volume for better evaluation of "real" implant with respect to final dose distribution. Materials/Methods Thirty treatment plans calculated by Nucletron SWIFT (TM) were randomly selected. Dosimetric data including V100 for prostate gland and D10 for urethra were analyzed as a function of prostate volume and needle displacement. Needle displacement was determined by measuring the distance between virtual and real positions of respective needles in three sectional images: at the base, apex of the prostate gland and reference image. Dosimetric parameters were determined for consecutive computer plans: virtual (before implantation), live (after implantation and renewed optimization). For the purpose of this study a new parameter, VD (Volume-Dose), was created. Results VD indicates the quality of "real" dose distribution with respect to "virtual" treatment plan. In order to realize the assumption of virtual plan (VD<1) for a given prostate volume, mean values of needle displacement r should not exceed r(acceptable) according to the formula: r(acceptable) (V-p) proportional to Vp(2). For larger glands (above 30cc) final dose distribution is less dependent on needle displacement than smaller ones. Conclusions The experiment determined maximum values of needle displacement for a given Vp parameter, allowing one to take advantage of optimization algorithms and to improve the final dose distribution.