PubMed Health⌕ Search
Home/Archive/PubMed

PubMed · 8066206

Optimization of interstitial volume implants.

I K Kolkman-Deurloo·A G Visser·C G Niël·N Driver·P C Levendag
View original source ↗Export metadata ↓

Abstract

For interstitial applications of high dose rate (HDR) afterloading brachytherapy, generally a single stepping iridium-192 source is used, enabling optimization of the dose distribution by optimization of the relative time (dwell time) that the source remains at a certain position (dwell position). We analysed the effects of geometric optimization in a regular volume implant, with strictly parallel catheters, and in an irregular volume implant, such as an implant for tumours of the base of the tongue characterized by a non-parallel geometry and varying catheter separations. In both examples the reference dose is specified at 85% of the mean central dose (as is done in the Paris system for dose specification) in the non-optimized as well as the optimized plan. The irradiated volume, the dose uniformity, and the choice of the reference dose of optimized and non-optimized dose distributions were compared. This was done by isodose plots for representative planes, volume dose histograms (distributed, contiguous, and natural), and dose non-uniformity ratios (DNRs). For the regular implant, optimization results in a 28% increase in the treated volume with a similar increase in the overdosed volumes. In order to keep the treated volume comparable with the non-optimized dose distribution, 90-95% of the mean central dose should be chosen as a reference dose or the range of active dwell positions should be shortened in case of optimization. In the case of the irregular volume implant at the base of the tongue, the method for dose specification should be kept unchanged after geometric optimization as the volume enclosed by the reference isodose does not increase. It is clear from the volume-dose histograms that there is a reduction of the overdosed volume due to optimization. This is accompanied by an increase in the uniformity index and a decrease of the DNR. In conclusion, geometric optimization appears to be an effective tool to improve the dose distribution of interstitial volume implants. Contiguous and natural volume dose histograms appear, apart from planar dose plots, valuable methods for evaluating the dose distribution of an implant.

Explore related subjects

BrachytherapyHumansModels, BiologicalRadiation MonitoringRadiation ToleranceRadiotherapy DosageRadiotherapy, High-EnergyTongueJournal Article

Keep this discovery

Explore connections, maps & timelines

BibTeXRIS

I K Kolkman-Deurloo, A G Visser, C G Niël, N Driver, P C Levendag. 1994. Optimization of interstitial volume implants.. https://doi.org/10.1016/0167-8140(94)90428-6

Cite the original work for its findings. Save a collection to share your selection of sources.

KEEP EXPLORING

Related citations

PubMed2007

CT-based postimplant dosimetry of prostate brachytherapy: comparison of 1-mm and 5-mm section CT.

PURPOSE: The aim of this study was to compare the outcomes between 1-mm and 5-mm section computed tomography (CT)-based postimplant dosimetry. MATERIALS AND METHODS: A series of 21 consecutive patients underwent permanent prostate brachytherapy. The postimplant prostate volume was calculated using 1-mm and 5-mm section CT. One radiation oncologist contoured the prostate on CT images to obtain the reconstructed prostate volume (pVol), prostate V(100) (percent of the prostate volume receiving at least the full prescribed dose), and prostate D(90) (mean dose delivered to 90% of the prostate gland). The same radiation oncologist performed the contouring three times to evaluate intraobserver variation and subjectively scored the quality of the CT images. RESULTS: The mean +/-1 SD postimplant pVol was 20.17 +/- 6.66 cc by 1-mm section CT and 22.24 +/- 8.48 cc by 5-mm section CT; the difference in the mean values was 2.06 cc (P < 0.01). The mean postimplant prostate V(100) was 80.44% +/- 7.06% by 1-mm section CT and 77.33% +/- 10.22% by 5-mm section CT. The mean postimplant prostate D(90) was 83.28% +/- 10.81% by 1-mm section CT and 78.60% +/- 15.75% by 5-mm section CT. In the evaluation of image quality, 5-mm section CT was assigned significantly higher scores than 1-mm section CT. In regard to intraobserver variation, 5-mm section CT revealed less intraobserver variation than 1-mm section CT. CONCLUSION: Our current results suggested that the outcomes of postimplant dosimetry using 1-mm section CT did not improved the results over those obtained using 5-mm section CT in terms of the quality of the CT image or reproducibility.

Brachytherapy↗
PubMed2007

Long-term results of breast cancer irradiation treatment with low-dose-rate external irradiation.

PURPOSE: The aim of this study was to assess beam therapy with low-dose-rate (LDR) external irradiation in a group of patients with breast cancer. METHODS AND MATERIALS: This trial compared, from 1986 to 1989, patients with advanced breast cancer treated either by conventional fractionation or low-dose-rate (LDR) external radiotherapy (dose-rate 15 mGy/min, 5 sessions of 9 Gy delivered on 5 consecutive days). RESULTS: A total of 21 patients were included in the fractionated therapy arm. At follow-up 15 years after treatment, 7 local recurrences had occurred, 3 patients had died of cancer, 18 patients were alive, 10 were without evidence of disease, and 6 had evidence of disease. A total of 22 patients had been included in the LDR arm of the study. Of these, 11 had received a dose of 45 Gy; thereafter, in view of severe local reactions, the dose was reduced to 35 Gy. There was no local recurrence in patients who had received 45 Gy, although there were 2 local recurrences among the 11 patients after 35 Gy. The sequelae were severe in patients who received 45 Gy but were comparable to those observed in patients treated by fractionated radiotherapy who received 35 Gy. The higher efficacy of tumor control in patients treated by LDR irradiation as well as the lower tolerance of normal tissue are probably related to the lack of repopulation. CONCLUSION: Although the patient numbers in this study are limited, based on our study results we conclude that the data for LDR irradiation are encouraging and that further investigation is warranted.

Brachytherapy↗
PubMed2007

Five-year outcome of intraoperative conformal permanent I-125 interstitial implantation for patients with clinically localized prostate cancer.

PURPOSE: To report the 5-year tumor control and toxicity outcomes for patients with localized prostate treated with I-125 permanent implantation using an intraoperative real-time conformal planning technique. METHODS AND MATERIALS: Between January 1998 and June 2002, 367 patients with prostate cancer were treated with I-125 permanent interstitial implantation using a transrectal ultrasound-guided approach. Real-time intraoperative treatment planning which incorporated inverse planning optimization was used. The median follow-up time was 63 months. RESULTS: The median V100 and D90 were 96% and 173 Gy, respectively. In 96% of cases a D90 of >140 Gy was achieved. The median urethral and rectal doses were 100% and 33% of the prescription doses, respectively. The 5-year PSA relapse-free survival outcomes for favorable and intermediate risk patients according to the ASTRO definition were 96% and 89%, respectively. In these patients no dosimetric parameter was identified which influenced the biochemical outcome. Of 38% who developed acute Grade 2 urinary symptoms, 63% had resolution of their symptoms within a median time of 6 months. The incidence of late rectal and urinary Grade 3 or higher toxicities were 1% and 4%, respectively. Seven percent (n = 27) developed late rectal bleeding (Grade 2) and 19% experienced late Grade 2 urinary symptoms. CONCLUSION: Real-time intraoperative planning consistently achieved optimal coverage of the prostate with the prescription dose with concomitant low doses delivered to the urethra and rectum. Biochemical control outcomes were excellent at 5 years and late toxicity was unusual. These data demonstrate that real-time planning methods can consistently and reliably deliver the intended dose distribution to achieve an optimal therapeutic ratio between the target and normal tissue structures.

Brachytherapy↗