A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: A radiobiological modeling study

M. Fatyga, J. F. Williamson, N. Dogan, D. Todor, J. V. Siebers, R. George, I. Barani, M. Hagan

Research output: Contribution to journalArticle

15 Scopus citations

Abstract

A course of one to three large fractions of high dose rate (HDR) interstitial brachytherapy is an attractive alternative to intensity modulated radiation therapy (IMRT) for delivering boost doses to the prostate in combination with additional external beam irradiation for intermediate risk disease. The purpose of this work is to quantitatively compare single-fraction HDR boosts to biologically equivalent fractionated IMRT boosts, assuming idealized image guided delivery (igIMRT) and conventional delivery (cIMRT). For nine prostate patients, both seven-field IMRT and HDR boosts were planned. The linear-quadratic model was used to compute biologically equivalent dose prescriptions. The cIMRT plan was evaluated as a static plan and with simulated random and setup errors. The authors conclude that HDR delivery produces a therapeutic ratio which is significantly better than the conventional IMRT and comparable to or better than the igIMRT delivery. For the HDR, the rectal gBEUD analysis is strongly influenced by high dose DVH tails. A saturation BED, beyond which no further injury can occur, must be assumed. Modeling of organ motion uncertainties yields mean outcomes similar to static plan outcomes.

Original languageEnglish (US)
Pages (from-to)3995-4006
Number of pages12
JournalMedical physics
Volume36
Issue number9
DOIs
StatePublished - 2009

Keywords

  • Biological outcomes
  • Biologically equivalent dose (BED)
  • Generalized equivalent uniform dose (gEUD)
  • High dose rate brachytherapy (HDR)
  • Intensity modulated radiotherapy (IMRT)
  • Prostate cancer

ASJC Scopus subject areas

  • Biophysics
  • Radiology Nuclear Medicine and imaging

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    Fatyga, M., Williamson, J. F., Dogan, N., Todor, D., Siebers, J. V., George, R., Barani, I., & Hagan, M. (2009). A comparison of HDR brachytherapy and IMRT techniques for dose escalation in prostate cancer: A radiobiological modeling study. Medical physics, 36(9), 3995-4006. https://doi.org/10.1118/1.3187224