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. 2019 May;92(1097):20190089.
doi: 10.1259/bjr.20190089. Epub 2019 Apr 9.

Multiparametric MRI-guided dose boost to dominant intraprostatic lesions in CT-based High-dose-rate prostate brachytherapy

Tonghe Wang  1 , Robert H Press  1 , Matt Giles  1 , Ashesh B Jani  1 , Peter Rossi  1 , Yang Lei  1 , Walter J Curran  1 , Pretesh Patel  1 , Tian Liu  1 , Xiaofeng Yang  1
Affiliations

Multiparametric MRI-guided dose boost to dominant intraprostatic lesions in CT-based High-dose-rate prostate brachytherapy

Tonghe Wang et al. Br J Radiol. 2019 May.

Abstract

Objective: The purpose of this study is to investigate the dosimetric feasibility of delivering focal dose to multiparametric (mp) MRI-defined DILs in CT-based high-dose-rate (HDR) prostate brachytherapy with MR/CT registration and estimate its clinical benefit.

Methods: We retrospectively investigated a total of 17 patients with mp-MRI and CT images acquired pre-treatment and treated by HDR prostate brachytherapy. 21 dominant intraprostatic lesions (DILs) were contoured on mp-MRI and propagated to CT images using a deformable image registration method. A boost plan was created for each patient and optimized on the original needle pattern. In addition, separate plans were generated using a virtually implanted needle around the DIL to mimic mp-MRI guided needle placement. DIL dose coverage and organ-at-rick (OAR) sparing were compared with original plan results. Tumor control probability (TCP) was estimated to further evaluate the clinical impact on the boost plans.

Results: Overall, optimized boost plans significantly escalated dose to DILs while meeting OAR constraints. The addition of mp-MRI guided virtual needles facilitate increased coverage of DIL volumes, achieving a V150 > 90% in 85 % of DILs compared with 57 % of boost plan without an additional needle. Compared with original plan, TCP models estimated improvement in DIL control by 28 % for patients with external-beam treatment and by 8 % for monotherapy patients.

Conclusion: With MR/CT registration, the proposed mp-MRI guided DIL boost in CT-based HDR brachytherapy is feasible without violating OAR constraints, and indicates significant clinical benefit in improving TCP of DIL. It may represent a strategy to personalize treatment delivery and improve tumor control.

Advances in knowledge: This study investigated the feasibility of mp-MRI guided DIL boost in HDR prostate brachytherapy with CT-based treatment planning, and estimated its clinical impact by TCP and NTCP estimation.

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Figures

Figure 1.
Figure 1.
Example of DIL delineation on T 2 weighted MRI (left) and ADC map (right).
Figure 2.
Figure 2.
Dose distributions of “Original”, “Original Boost” and “Additional Boost” plans. Prostate and DIL are indicated by red and blue contours. The original needle pattern is marked by blue dots in top left. The additional needle is marked as white cross-in bottom right.
Figure 3.
Figure 3.
The DVHs of patient in Figure 1 of “Original”, “Original Boost” and “Additional Boost” plans. Prostate-DIL = Prostate with DIL cropped.
Figure 4.
Figure 4.
Percentage of DILs receiving different dose coverage in different plans.
See this image and copyright information in PMC

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