Dosimetric benefits and preclinical performance of steerable needles in HDR prostate brachytherapy

IF 1.7 4区医学 Q3 ENGINEERING, BIOMEDICAL

Medical Engineering & Physics Pub Date : 2024-05-07 DOI:10.1016/j.medengphy.2024.104177

M. de Vries , M.E.M.C. Christianen , L. Luthart , K.C. de Vries , I.K.K. Kolkman-Deurloo , J.J. van den Dobbelsteen

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引用次数: 0

Abstract

Prostate cancer patients with an enlarged prostate and/or excessive pubic arch interference (PAI) are generally considered non-eligible for high-dose-rate (HDR) brachytherapy (BT). Steerable needles have been developed to make these patients eligible again. This study aims to validate the dosimetric impact and performance of steerable needles within the conventional clinical setting.

HDR BT treatment plans were generated, needle implantations were performed in a prostate phantom, with prostate volume > 55 cm³ and excessive PAI of 10 mm, and pre- and post-implant dosimetry were compared considering the dosimetric constraints: prostate V₁₀₀ > 95 % (13.50 Gy), urethra D_0.1cm³ < 115 % (15.53 Gy) and rectum D_1cm³ < 75 % (10.13 Gy).

The inclusion of steerable needles resulted in a notable enhancement of the dose distribution and prostate V₁₀₀ compared to treatment plans exclusively employing rigid needles to address PAI. Furthermore, the steerable needle plan demonstrated better agreement between pre- and post-implant dosimetry (prostate V₁₀₀: 96.24 % vs. 93.74 %) compared to the rigid needle plans (79.13 % vs. 72.86 % and 87.70 % vs. 81.76 %), with no major changes in the clinical workflow and no changes in the clinical set-up.

The steerable needle approach allows for more flexibility in needle positioning, ensuring a highly conformal dose distribution, and hence, HDR BT is a feasible treatment option again for prostate cancer patients with an enlarged prostate and/or excessive PAI.

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可转向针在 HDR 前列腺近距离放射治疗中的剂量学优势和临床前性能

前列腺增生和/或耻骨弓过度干扰（PAI）的前列腺癌患者通常被认为不符合高剂量率近距离放射治疗（HDR）的条件。为了让这些患者重新获得治疗资格，人们开发了可转向针。本研究旨在验证可转向针在传统临床环境中的剂量学影响和性能。研究人员生成了 HDR BT 治疗计划，在前列腺体积为 55 立方厘米、PAI 过大 10 毫米的前列腺模型中进行了针植入，并比较了植入前和植入后的剂量学，其中考虑到了剂量学限制：前列腺 V100 > 95 % (13. 50 Gy)、尿道 V100 > 95 % (13. 50 Gy)、前列腺 V100 > 95 % (13. 50 Gy)、尿道 V100 > 95 % (13. 50 Gy)、前列腺 V100 > 95 % (13. 50 Gy)。与完全采用刚性针头处理 PAI 的治疗计划相比，采用可转向针头可显著改善剂量分布和前列腺 V100。此外，与刚性针计划（79.13% 对 72.86% 和 87.70% 对 81.76%）相比，可转向针计划显示出植入前后剂量测定（前列腺 V100：96.24% 对 93.74%）之间更好的一致性，临床工作流程和临床设置均无重大变化。可转向穿刺针方法使穿刺针定位更加灵活，确保了高度适形的剂量分布，因此，对于前列腺增生和/或 PAI 过高的前列腺癌患者来说，HDR BT 又是一种可行的治疗方案。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Medical Engineering & Physics 工程技术-工程：生物医学

CiteScore

4.30

自引率

4.50%

发文量

172

审稿时长

3.0 months

期刊介绍： Medical Engineering & Physics provides a forum for the publication of the latest developments in biomedical engineering, and reflects the essential multidisciplinary nature of the subject. The journal publishes in-depth critical reviews, scientific papers and technical notes. Our focus encompasses the application of the basic principles of physics and engineering to the development of medical devices and technology, with the ultimate aim of producing improvements in the quality of health care.Topics covered include biomechanics, biomaterials, mechanobiology, rehabilitation engineering, biomedical signal processing and medical device development. Medical Engineering & Physics aims to keep both engineers and clinicians abreast of the latest applications of technology to health care.