Multiparametric MRI-guided high-dose-rate prostate brachytherapy with focal dose boost to dominant intraprostatic lesions

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

doi:10.1117/12.2548152

28 February 2020 Multiparametric MRI-guided high-dose-rate prostate brachytherapy with focal dose boost to dominant intraprostatic lesions

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

Author Affiliations +

Proceedings Volume 11317, Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging; 1131724 (2020) https://doi.org/10.1117/12.2548152
Event: SPIE Medical Imaging, 2020, Houston, Texas, United States

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.

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Tonghe Wang, Matt Giles, Robert H. Press, Xianjin Dai, Ashesh B. Jani, Peter Rossi, Yang Lei, Walter J. Curran, Pretesh Patel, Tian Liu, and Xiaofeng Yang "Multiparametric MRI-guided high-dose-rate prostate brachytherapy with focal dose boost to dominant intraprostatic lesions", Proc. SPIE 11317, Medical Imaging 2020: Biomedical Applications in Molecular, Structural, and Functional Imaging, 1131724 (28 February 2020); https://doi.org/10.1117/12.2548152

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