Use of contemporary prostate brachytherapy approaches in clinical trials

A Haworth,J Betts,D Murphy,D Wraith,C Mitchell,S Williams,Y Sun,M Ebert,B Parameswaran,H Reynolds

doi:10.1088/1742-6596/1154/1/012010

Abstract

A number of clinical trials are investigating the role of prostate focal brachytherapy as an alternative treatment to whole gland therapy, offering the opportunity for tumour dose escalation and/or reduced toxicity. Brachytherapy, either low dose rate or high dose rate, offers a treatment choice with both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines for treatment planning approaches along with many other technical issues when practicing focal brachy-therapy. Without consensus guidelines there is the potential for a diversity of practices to develop, leading to challenges in interpreting outcome data from multiple centres. We provide a quantitative framework for prostate focal brachytherapy that incorporates a personalized, biological approach that can be used as the foundation for future prostate focal brachytherapy trials.

Highlights

Prostate cancer (CaP) is globally the most commonly diagnosed cancer in men [1]
We hereby describe a framework for Biologically Optimised RadioTherapy (BiRT)
In contrast we suggest ods [8]. the use of computer aided detection (CAD) systems to delineate PCa from multiparametric MRI (mpMRI) [23,24] to improve consistency compared to manual delineation, which can suffer from inter-observer variability and low detection rates of satellite lesions [25]

Summary

Introduction

Prostate cancer (CaP) is globally the most commonly diagnosed cancer in men [1]. Randomised trials have demonstrated that radiotherapy is an effective form of treatment for localised CaP and that escalating the dose improves biochemical control [2,3,4,5]. Brachytherapy [BT] offers an opportunity to accurately deliver higher doses of radiation than can typically be delivered with external beam radiotherapy (EBRT) [6] This is due to the high dose gradients that surround the radioactive source creating an opportunity to tightly conform the radiation dose to the target volume whilst controlling radioactive source placement [7]. A number of studies have investigated “focal” or “focussed” approaches to BT treatments, whereby the aim is to deliver very high doses of radiation to only tumour bearing regions of the prostate, with lower doses delivered to the remainder of the gland in an effort to maximise tumour control and minimise side effects [10,11]. We hereby describe a framework for Biologically Optimised RadioTherapy (BiRT)

Methods

Findings

Conclusion