Optimal source distribution for focal boosts using high dose rate (HDR) brachytherapy alone in prostate cancer

Pittaya Dankulchai, Roberto Alonzi, Gerry J Lowe, James Burnley, Anwar R Padhani, Peter J Hoskin

Research output: Contribution to journalArticlepeer-review


PURPOSE: To investigate the optimal distribution of sources using high dose rate brachytherapy to deliver a focal boost to a dominant lesion within the whole prostate gland based on multi-parametric magnetic resonance imaging (mpMRI).

METHODS: Sixteen patients with prostate cancer underwent mpMRI each of which demonstrated a dominant lesion. There were single lesions in 6 patients, two lesions in 4 and 3 lesions in 6 patients. Two dosimetric models and parameters were compared in each case. The first model used 10mm intervals between needles, and the second model used additional needles at 5 mm intervals between each needle in the boost area.

RESULTS: Three of thirty-two plans did not achieve the plan objectives. These three plans were in the first model. A higher median urethral volume was seen in the 'unsuccessful' group (2.7 cc, and 1.9 cc, respectively, p-value=0.12). Conformity indices of the second model were also better than the first model (COIN index; 0.716 and 0.643, respectively).

CONCLUSIONS: Focal monotherapy based on mpMRI achieves optimal dosimetry by individualizing the needle positions using 5mm spacing rather than 10mm spacing within the boost volume. A larger urethral volume may have an adverse effect on this distribution. Formal clinical evaluation of this approach is currently underway.

Original languageEnglish
Pages (from-to)121-125
Number of pages5
JournalRadiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology
Issue number1
Publication statusPublished - Oct 2014


  • Aged
  • Brachytherapy/instrumentation
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Needles
  • Prostatic Neoplasms/radiotherapy
  • Radiometry
  • Radiotherapy Dosage
  • Urethra/radiation effects

Research Beacons, Institutes and Platforms

  • Manchester Cancer Research Centre


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