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In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy
BACKGROUND: To assess brachytherapy catheter positioning accuracy and to evaluate the effects of prolonged irradiation time on the tolerance dose of normal liver parenchyma following single-fraction irradiation with (192 )Ir. MATERIALS AND METHODS: Fifty patients with 76 malignant liver tumors treat...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BioMed Central
2011
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179944/ https://www.ncbi.nlm.nih.gov/pubmed/21892943 http://dx.doi.org/10.1186/1748-717X-6-107 |
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author | Lüdemann, Lutz Wybranski, Christian Seidensticker, Max Mohnike, Konrad Kropf, Siegfried Wust, Peter Ricke, Jens |
author_facet | Lüdemann, Lutz Wybranski, Christian Seidensticker, Max Mohnike, Konrad Kropf, Siegfried Wust, Peter Ricke, Jens |
author_sort | Lüdemann, Lutz |
collection | PubMed |
description | BACKGROUND: To assess brachytherapy catheter positioning accuracy and to evaluate the effects of prolonged irradiation time on the tolerance dose of normal liver parenchyma following single-fraction irradiation with (192 )Ir. MATERIALS AND METHODS: Fifty patients with 76 malignant liver tumors treated by computed tomography (CT)-guided high-dose-rate brachytherapy (HDR-BT) were included in the study. The prescribed radiation dose was delivered by 1 - 11 catheters with exposure times in the range of 844 - 4432 seconds. Magnetic resonance imaging (MRI) datasets for assessing irradiation effects on normal liver tissue, edema, and hepatocyte dysfunction, obtained 6 and 12 weeks after HDR-BT, were merged with 3D dosimetry data. The isodose of the treatment plan covering the same volume as the irradiation effect was taken as a surrogate for the liver tissue tolerance dose. Catheter positioning accuracy was assessed by calculating the shift between the 3D center coordinates of the irradiation effect volume and the tolerance dose volume for 38 irradiation effects in 30 patients induced by catheters implanted in nearly parallel arrangement. Effects of prolonged irradiation were assessed in areas where the irradiation effect volume and tolerance dose volume did not overlap (mismatch areas) by using a catheter contribution index. This index was calculated for 48 irradiation effects induced by at least two catheters in 44 patients. RESULTS: Positioning accuracy of the brachytherapy catheters was 5-6 mm. The orthogonal and axial shifts between the center coordinates of the irradiation effect volume and the tolerance dose volume in relation to the direction vector of catheter implantation were highly correlated and in first approximation identically in the T1-w and T2-w MRI sequences (p = 0.003 and p < 0.001, respectively), as were the shifts between 6 and 12 weeks examinations (p = 0.001 and p = 0.004, respectively). There was a significant shift of the irradiation effect towards the catheter entry site compared with the planned dose distribution (p < 0.005). Prolonged treatment time increases the normal tissue tolerance dose. Here, the catheter contribution indices indicated a lower tolerance dose of the liver parenchyma in areas with prolonged irradiation (p < 0.005). CONCLUSIONS: Positioning accuracy of brachytherapy catheters is sufficient for clinical practice. Reduced tolerance dose in areas exposed to prolonged irradiation is contradictory to results published in the current literature. Effects of prolonged dose administration on the liver tolerance dose for treatment times of up to 60 minutes per HDR-BT session are not pronounced compared to effects of positioning accuracy of the brachytherapy catheters and are therefore of minor importance in treatment planning. |
format | Online Article Text |
id | pubmed-3179944 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2011 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-31799442011-09-27 In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy Lüdemann, Lutz Wybranski, Christian Seidensticker, Max Mohnike, Konrad Kropf, Siegfried Wust, Peter Ricke, Jens Radiat Oncol Research BACKGROUND: To assess brachytherapy catheter positioning accuracy and to evaluate the effects of prolonged irradiation time on the tolerance dose of normal liver parenchyma following single-fraction irradiation with (192 )Ir. MATERIALS AND METHODS: Fifty patients with 76 malignant liver tumors treated by computed tomography (CT)-guided high-dose-rate brachytherapy (HDR-BT) were included in the study. The prescribed radiation dose was delivered by 1 - 11 catheters with exposure times in the range of 844 - 4432 seconds. Magnetic resonance imaging (MRI) datasets for assessing irradiation effects on normal liver tissue, edema, and hepatocyte dysfunction, obtained 6 and 12 weeks after HDR-BT, were merged with 3D dosimetry data. The isodose of the treatment plan covering the same volume as the irradiation effect was taken as a surrogate for the liver tissue tolerance dose. Catheter positioning accuracy was assessed by calculating the shift between the 3D center coordinates of the irradiation effect volume and the tolerance dose volume for 38 irradiation effects in 30 patients induced by catheters implanted in nearly parallel arrangement. Effects of prolonged irradiation were assessed in areas where the irradiation effect volume and tolerance dose volume did not overlap (mismatch areas) by using a catheter contribution index. This index was calculated for 48 irradiation effects induced by at least two catheters in 44 patients. RESULTS: Positioning accuracy of the brachytherapy catheters was 5-6 mm. The orthogonal and axial shifts between the center coordinates of the irradiation effect volume and the tolerance dose volume in relation to the direction vector of catheter implantation were highly correlated and in first approximation identically in the T1-w and T2-w MRI sequences (p = 0.003 and p < 0.001, respectively), as were the shifts between 6 and 12 weeks examinations (p = 0.001 and p = 0.004, respectively). There was a significant shift of the irradiation effect towards the catheter entry site compared with the planned dose distribution (p < 0.005). Prolonged treatment time increases the normal tissue tolerance dose. Here, the catheter contribution indices indicated a lower tolerance dose of the liver parenchyma in areas with prolonged irradiation (p < 0.005). CONCLUSIONS: Positioning accuracy of brachytherapy catheters is sufficient for clinical practice. Reduced tolerance dose in areas exposed to prolonged irradiation is contradictory to results published in the current literature. Effects of prolonged dose administration on the liver tolerance dose for treatment times of up to 60 minutes per HDR-BT session are not pronounced compared to effects of positioning accuracy of the brachytherapy catheters and are therefore of minor importance in treatment planning. BioMed Central 2011-09-05 /pmc/articles/PMC3179944/ /pubmed/21892943 http://dx.doi.org/10.1186/1748-717X-6-107 Text en Copyright ©2011 Lüdemann et al; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Lüdemann, Lutz Wybranski, Christian Seidensticker, Max Mohnike, Konrad Kropf, Siegfried Wust, Peter Ricke, Jens In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title | In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title_full | In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title_fullStr | In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title_full_unstemmed | In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title_short | In vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)Ir high-dose-rate brachytherapy |
title_sort | in vivo assessment of catheter positioning accuracy and prolonged irradiation time on liver tolerance dose after single-fraction (192)ir high-dose-rate brachytherapy |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3179944/ https://www.ncbi.nlm.nih.gov/pubmed/21892943 http://dx.doi.org/10.1186/1748-717X-6-107 |
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