A cold spot compensation technique using a combination of trans-rectal ultrasonography and intraoperative computed tomography for interstitial permanent prostate brachytherapy: a single-arm prospective trial

PURPOSE: To evaluate the efficacy of a cold spot compensation technique using a combination of trans-rectal ultrasonography (TRUS) and computed tomography (CT) for permanent interstitial prostate brachytherapy. MATERIAL AND METHODS: Sixty-five patients were treated with the cold spot compensation technique using TRUS-CT fusion. The prescribed dose was set at 145 Gy. The dose to 90% of prostate volume (D(90)) was planned to be within 195 Gy (134%) and 205 Gy (141%). After implantation using the conventional technique, additional seeds were implanted if cold spots were detected on TRUS-CT fusion images. RESULTS: Cold spots were detected in 32 of 65 patients (49%) and were compensated by additional seeds. Median number of additional seeds was 3 (range, 1-5). A CT scan 1 month later revealed that the percentage of patients receiving an undesirably low D(90) (160-180 Gy) was significantly reduced in the examination arm compared to historical controls. However, mean operation time was significantly longer in the examination arm (64 min) than in historical controls (49 min, p < 0.001). With median follow-up of 18 months (range, 9-24 months), no grade 3 or worse toxicity was encountered. CONCLUSION: The cold spot compensation technique using TRUS-CT fusion appears effective for patients receiving permanent interstitial prostate brachytherapy.