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Proceedings Paper

Multiparametric MRI-guided high-dose-rate prostate brachytherapy with focal dose boost to dominant intraprostatic lesions
Author(s): Tonghe Wang; Matt Giles; Robert H. Press; Xianjin Dai; Ashesh B. Jani; Peter Rossi; Yang Lei; Walter J. Curran; Pretesh Patel; Tian Liu; Xiaofeng Yang
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Paper Abstract

The use of multiparametric MRI (mp-MRI) can reliably identify dominant intra-prostatic lesions (DILs) within prostate cancer. Dose escalation to DILs using high-dose-rate (HDR) brachytherapy may improve tumor control probability. In this study, we retrospectively investigated a total of 17 patients treated by HDR prostate brachytherapy, each of whom has mp-MRI and CT images acquired pre-treatment. 21 DILs were contoured based on mp-MRI and propagated to CT images after registration using a newly developed 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 in order to simulate mp-MRI guided needle placement. Both plans were optimized to maximize DIL V150 coverage while meeting OAR sparing constraints. DIL V150, prostate coverage, and OAR sparing were compared with original plan results. Overall, optimized boost plans significantly escalate 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. These results strongly indicate that the proposed mp-MRI guided DIL boost in HDR brachytherapy is feasible without violating OAR constraints. This retrospective study suggests the use of mp-MRI-defined DIL to optimize needle placement through the deformable MRI-ultrasound registration in the operating room may represent a strategy to personalize treatment delivery and improve tumor control.

Paper Details

Date Published: 28 February 2020
PDF: 7 pages
Proc. SPIE 11317, Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging, 1131724 (28 February 2020); doi: 10.1117/12.2548152
Show Author Affiliations
Tonghe Wang, Emory Univ. (United States)
Matt Giles, Emory Univ. (United States)
Robert H. Press, Emory Univ. (United States)
Xianjin Dai, Emory Univ. (United States)
Ashesh B. Jani, Emory Univ. (United States)
Peter Rossi, Emory Univ. (United States)
Yang Lei, Emory Univ. (United States)
Walter J. Curran, Emory Univ. (United States)
Pretesh Patel, Emory Univ. (United States)
Tian Liu, Emory Univ. (United States)
Xiaofeng Yang, Emory Univ. (United States)

Published in SPIE Proceedings Vol. 11317:
Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging
Andrzej Krol; Barjor S. Gimi, Editor(s)

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