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Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer

Bedeutung der Lernkurve und technischer Veränderungen für die Dosimetrie bei der Low-Dose-Brachytherapie des Prostatakarzinoms

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Abstract

Purpose

To assess the impact of experience and technical changes on peri- and postimplantation (1 month later) dosimetry for permanent prostate brachytherapy (PPB).

Patients and methods

From July 2003 to May 2010, 150 prostate cancer patients underwent low-dose, loose-seed I125 PPB as monotherapy with intraoperative planning. Patients were divided into three groups—P1 (n = 64), P2 (n = 45), P3 (n = 41)—according to the technical changes that occurred during the study period: use of an automatic stepper at the beginning of P2 and a high-frequency ultrasound probe in P3. Peri- and postimplantation dosimetric parameters (on day 30) were reported: D90 (dose received by 90% of prostate volume), V100 and V150 (prostate volume receiving, respectively, 100% and 150% of the prescribed dose), D2 cc and D0.1 cc (doses received by 2 cc and 0.1 cc of the rectum), R100 (rectum volume that received 100% of the prescribed dose), and D10 and D30 (doses received by 10% and 30% of the urethra, only during peri-implantation).

Results

We observed a decrease in the number of needles and seeds used over time. The mean peri-implantation D90 was 187.52 Gy without a significant difference between the three periods (p = 0.48). The postimplantation D90, V100, and V150 parameters were, respectively, 168.3 Gy, 91.9%, and 55% with no significant difference between the three periods. The peri-implantation and postimplantation D0.1 cc and R100 significantly decreased over time; on day 30: D0.1 cc P1 = 223.1 Gy vs. D0.1 cc P3 = 190.4 Gy (p = 8.10− 5) and R100 P1 = 1.06 cc vs. R100 P3 = 0.53 cc (p = 0.0008).

Conclusion

We observed a learning curve for the implantation parameters, which led to a significant decrease in the rectal doses without having any impact on the prostate dosimetric parameters.

Zusammenfassung

Ziel

Ziel war es, den Einfluss von Erfahrung und technischen Änderungen der Dosimetrie bei und nach Implantation einer Prostatabrachytherapie abzuschätzen.

Patienten und Methoden

Es wurden 150 Patienten mit Low-Dose-Rate-Brachytherapie der Prostata behandelt. Die Patienten wurden hisichtlich der technischen Veränderungen in 3 Perioden aufgeteilt (P1, P2, P3): Gebrauch eines automatischen „Steppers“ zu Beginn von P2 und Gebrauch einer Hochfrequenzsonde seit P3. Peri- und Postimplantationsdosimetriekriterien von Prostata, Rektum und Urethra wurden registriert: D90 (Dosis, die 90% der Prostata erhalten haben), V100 und V150 (Prostatavolumen, das 100% bzw. 150% der verordneten Dosis erhalten hat), D2 cm3 und D0,1 cm3 (Dosis pro 2 cm3 und 0,1 cm3 des Rektums), R100 (Rektalvolumen, das 100% der verordneten Dosis erhalten hat) und D10 und D30 (Dosis, die 10% bzw. 30% der Urethra erhalten haben, nur bei Implantation).

Ergebnisse

D90 bei Implantation betrug 187,52 Gy ohne signifikanten Unterschied in den 3 Perioden (p = 0,48). Die D0,1 cm3 und R100 bei und nach Implantation verringerten sich mit der Zeit signifikant von 170,5 Gy in P1 zu 147,7 Gy in P3 (p = 1,10− 5) und von 0,29 cm3 in P1 zu 0,05 cm3 in P3 (p = 4,10− 5). Die Werte für D90, V100 und V150 nach einem Monat betrugen 168,3 Gy, 91,9% und 55% ohne einen signifikanten Unterschied zwischen den 3 Perioden. Nach Implantation sank die rektale Dosis signifikant (D2 cm3 P1 = 129,8 Gy vs. D2 cm3 P3 = 113,5 Gy (p = 0,06), D0,1 cm3 P1 = 223,1 Gy vs. D0,1 cm3 P3 = 190,4 Gy (p = 8,10− 5), R100 P1 = 1,06 cm3 vs. R100 P3 = 0,53 cm3 (p = 0,0008).

Fazit

Wir konnten keine positive Lernkurve für D90 bei und nach Implantation beobachten. Allerdings stellten wir eine signifikante Verringerung der rektalen Dosis mit wachsender Erfahrung fest.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Urology Department, CHU Brest, 29200, Brest, France

    F. Delage, M.A. Perrouin-Verbe, G. Fournier & A. Valeri

  2. Radiation Therapy Department, CHU Brest, 5 avenue Foch, 29200, Brest, France

    E. Le Fur, J.P. Malhaire, D. Baverez, F. Schlurmann & O. Pradier

  3. Faculté de Médecine et des Sciences de la Santé, Université de Bretagne Occidentale, 29200, Brest, France

    E. Le Fur, G. Fournier, O. Pradier & A. Valeri

  4. Université Européenne de Bretagne, Rennes, France

    G. Fournier, O. Pradier & A. Valeri

  5. LaTIM, INSERM U650, CHU Brest, 29200, Brest, France

    O. Pradier

  6. Ce.Re.P.P, Hôpital Tenon, APHP, 75970, Paris, France

    G. Fournier & A. Valeri

  7. Radiation Therapy Department, University Hospital La Milétrie, 86021, Poitiers, France

    S. Guerif

  8. Université de Poitiers, 86021, Poitiers, France

    S. Guerif

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  1. E. Le Fur
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  2. J.P. Malhaire
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  3. D. Baverez
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  6. F. Schlurmann
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  7. S. Guerif
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  10. A. Valeri
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Correspondence to E. Le Fur.

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Le Fur, E., Malhaire, J., Baverez, D. et al. Impact of learning curve and technical changes on dosimetry in low-dose brachytherapy for prostate cancer. Strahlenther Onkol 188, 1091–1095 (2012). https://doi.org/10.1007/s00066-012-0242-9

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  • DOI: https://doi.org/10.1007/s00066-012-0242-9

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