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• W2109302471 abstract "Purpose/Objective(s)Standard templates used in permanent prostate brachytherapy allow for needles to be placed at 5mm intervals. A number of brachytherapy robots are currently either under development or in clinical use; although designs and features vary, one feature in common is the ability to vary spacing of needles at non-fixed intervals. The dosimetric benefits of this feature have not been determined. We sought to ascertain the potential for reducing dose to urethra and rectum by utilizing variable needle spacing.Materials/Methods108 treatment plans were created independently by 3 experienced planners using prostate ultrasound images from 9 patients (volumes 13 to 53cc). Each planner created 4 plan variations per patient: fixed spacing Pd103, variable spacing Pd103, fixed spacing I125, and variable spacing I125 (total 27 plans per variation). Treatment planning was performed on Variseed® 8.0. Source activities were 0.5U for I-125 and 2.5U for Pd-103. Plans utilized only intraprostatic sources, with no needles passing through urethra; all needles were parallel to each other and orthogonal to the plane of a standard template. Primary objectives were to achieve prostate V100 of 100% while minimizing dose to urethra and rectum. Dosimetric variables assessed were: urethral max dose (Umax), mean dose (U mean), D30, and D5, as well as rectal max dose (Rmax) and mean dose (Rmean). Secondary objectives were to minimize number of needles and number of sources.ResultsResults combined for the 3 planners revealed statistically significant differences in all urethral and rectal dosimetric variables (both isotopes) for variable spacing compared to fixed spacing. For all patients and planners combined, mean values for variable vs. fixed spacing for Pd-103 plans were: Umax 137% (SD 18) vs. 185% (SD 65), Umean 106% (SD 5) vs. 114% (SD 9), urethra D30 114% (SD 6) vs. 122% (SD 11), urethra D5 124% (SD 9) vs. 140% (SD 17), Rmax 94% (SD 20) vs. 100% (SD 21), Rmean 43% (SD 9) vs. 45% (SD 10). For I-125 plans, mean values for variable vs. fixed spacing were Umax 136% (SD 15) vs. 153% (SD 30), Umean 114% (SD 9) vs. 118% (SD 9), urethral D30 121% (SD 6) vs. 126% (SD 6), urethral D5 127% (SD 7) vs. 134% (SD 8), Rmax 97% (SD 15) vs. 107% (SD 24), Rmean 56% (SD 9) vs. 57% (SD 9). Small but statistically significant differences were observed in number of needles for Pd-103 plans (34 vs. 36, variable vs. fixed) and number of sources for I-125 plans (66 vs. 67, variable vs. fixed).ConclusionsThe use of variable spacing allows for reductions in both urethral and rectal doses while maintaining prostate dose coverage. Dosimetric advantages with potentially significant clinical benefits may be derived from the use of variable needle spacing as facilitated by the use of robotics. Purpose/Objective(s)Standard templates used in permanent prostate brachytherapy allow for needles to be placed at 5mm intervals. A number of brachytherapy robots are currently either under development or in clinical use; although designs and features vary, one feature in common is the ability to vary spacing of needles at non-fixed intervals. The dosimetric benefits of this feature have not been determined. We sought to ascertain the potential for reducing dose to urethra and rectum by utilizing variable needle spacing. Standard templates used in permanent prostate brachytherapy allow for needles to be placed at 5mm intervals. A number of brachytherapy robots are currently either under development or in clinical use; although designs and features vary, one feature in common is the ability to vary spacing of needles at non-fixed intervals. The dosimetric benefits of this feature have not been determined. We sought to ascertain the potential for reducing dose to urethra and rectum by utilizing variable needle spacing. Materials/Methods108 treatment plans were created independently by 3 experienced planners using prostate ultrasound images from 9 patients (volumes 13 to 53cc). Each planner created 4 plan variations per patient: fixed spacing Pd103, variable spacing Pd103, fixed spacing I125, and variable spacing I125 (total 27 plans per variation). Treatment planning was performed on Variseed® 8.0. Source activities were 0.5U for I-125 and 2.5U for Pd-103. Plans utilized only intraprostatic sources, with no needles passing through urethra; all needles were parallel to each other and orthogonal to the plane of a standard template. Primary objectives were to achieve prostate V100 of 100% while minimizing dose to urethra and rectum. Dosimetric variables assessed were: urethral max dose (Umax), mean dose (U mean), D30, and D5, as well as rectal max dose (Rmax) and mean dose (Rmean). Secondary objectives were to minimize number of needles and number of sources. 108 treatment plans were created independently by 3 experienced planners using prostate ultrasound images from 9 patients (volumes 13 to 53cc). Each planner created 4 plan variations per patient: fixed spacing Pd103, variable spacing Pd103, fixed spacing I125, and variable spacing I125 (total 27 plans per variation). Treatment planning was performed on Variseed® 8.0. Source activities were 0.5U for I-125 and 2.5U for Pd-103. Plans utilized only intraprostatic sources, with no needles passing through urethra; all needles were parallel to each other and orthogonal to the plane of a standard template. Primary objectives were to achieve prostate V100 of 100% while minimizing dose to urethra and rectum. Dosimetric variables assessed were: urethral max dose (Umax), mean dose (U mean), D30, and D5, as well as rectal max dose (Rmax) and mean dose (Rmean). Secondary objectives were to minimize number of needles and number of sources. ResultsResults combined for the 3 planners revealed statistically significant differences in all urethral and rectal dosimetric variables (both isotopes) for variable spacing compared to fixed spacing. For all patients and planners combined, mean values for variable vs. fixed spacing for Pd-103 plans were: Umax 137% (SD 18) vs. 185% (SD 65), Umean 106% (SD 5) vs. 114% (SD 9), urethra D30 114% (SD 6) vs. 122% (SD 11), urethra D5 124% (SD 9) vs. 140% (SD 17), Rmax 94% (SD 20) vs. 100% (SD 21), Rmean 43% (SD 9) vs. 45% (SD 10). For I-125 plans, mean values for variable vs. fixed spacing were Umax 136% (SD 15) vs. 153% (SD 30), Umean 114% (SD 9) vs. 118% (SD 9), urethral D30 121% (SD 6) vs. 126% (SD 6), urethral D5 127% (SD 7) vs. 134% (SD 8), Rmax 97% (SD 15) vs. 107% (SD 24), Rmean 56% (SD 9) vs. 57% (SD 9). Small but statistically significant differences were observed in number of needles for Pd-103 plans (34 vs. 36, variable vs. fixed) and number of sources for I-125 plans (66 vs. 67, variable vs. fixed). Results combined for the 3 planners revealed statistically significant differences in all urethral and rectal dosimetric variables (both isotopes) for variable spacing compared to fixed spacing. For all patients and planners combined, mean values for variable vs. fixed spacing for Pd-103 plans were: Umax 137% (SD 18) vs. 185% (SD 65), Umean 106% (SD 5) vs. 114% (SD 9), urethra D30 114% (SD 6) vs. 122% (SD 11), urethra D5 124% (SD 9) vs. 140% (SD 17), Rmax 94% (SD 20) vs. 100% (SD 21), Rmean 43% (SD 9) vs. 45% (SD 10). For I-125 plans, mean values for variable vs. fixed spacing were Umax 136% (SD 15) vs. 153% (SD 30), Umean 114% (SD 9) vs. 118% (SD 9), urethral D30 121% (SD 6) vs. 126% (SD 6), urethral D5 127% (SD 7) vs. 134% (SD 8), Rmax 97% (SD 15) vs. 107% (SD 24), Rmean 56% (SD 9) vs. 57% (SD 9). Small but statistically significant differences were observed in number of needles for Pd-103 plans (34 vs. 36, variable vs. fixed) and number of sources for I-125 plans (66 vs. 67, variable vs. fixed). ConclusionsThe use of variable spacing allows for reductions in both urethral and rectal doses while maintaining prostate dose coverage. Dosimetric advantages with potentially significant clinical benefits may be derived from the use of variable needle spacing as facilitated by the use of robotics. The use of variable spacing allows for reductions in both urethral and rectal doses while maintaining prostate dose coverage. Dosimetric advantages with potentially significant clinical benefits may be derived from the use of variable needle spacing as facilitated by the use of robotics." @default.
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• W2109302471 title "Reduced Dose to Urethra and Rectum with the use of Variable Needle Spacing in Prostate Brachytherapy: A Potential Advantage of Robotic Brachytherapy" @default.
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