Practical considerations for prostate HDR brachytherapy

Abstract

Purpose A process for prostate high-dose-rate (HDR) brachytherapy was developed and implemented successfully in the community hospital setting. The practical aspects of the program are reviewed and may serve as a foundation for clinics interested in offering this clinical service. Methods and Materials A generic needle distribution geometry was established to accommodate target volumes of variable size. A system to identify and assign treatment channels to each implant needle was devised. The computerized tomography (CT)–based treatment planning was used with dose constraints defined for sensitive structures and target uniformity. Implant needle stability was promoted by supporting the patient on a CT compatible padded sliding board. A process that aligns dwell position to CT imaging without the use of radiographic markers was followed. Graphical optimization of dwell times was used to generate the treatment dose distributions. Results Prostate HDR brachytherapy as a boost or as monotherapy has been offered in a program that has evolved over the past 8 years. Practical aspects of the program promote its feasibility and precision. Collaboration with commercial entities has also led to the development of products that support the technique. Conclusions Prostate HDR brachytherapy offers a relatively high degree of dose distribution control in comparison with other prostate radiotherapy modalities. The practical aspects described offer assurance to achieve that goal.