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J Biomed Opt 2011 Aug;16(8):080502

Brachytherapy is a form of radiation therapy commonly used in the treatment of prostate cancer wherein sustained radiation doses can be precisely targeted to the tumor area by the implantation of small radioactive seeds around the treatment area. Ultrasound is a popular imaging mode for seed implantation, but the seeds are difficult to distinguish from the tissue structure. In this work, we demonstrate the feasibility of photoacoustic imaging for identifying brachytherapy seeds in a tissue phantom, comparing the received intensity to endogenous contrast. Read More

Eur Rev Med Pharmacol Sci 2011 Jul;15(7):769-74

L.D. of Surgical Semeiotics, University of Parma, Parma, Italy.

Both low dose rate (LDR) permanent either 1251 or 103Pd seed implant and high dose rate (HDR) 1921r temporary implant are an excellent way to release high dose of ionizing radiations to cancerous lesions while significantly sparing the surrounding healthy tissues. Therefore, the radiation brachytherapy, among the established treatment options of organ-confined prostate carcinoma--interstitial radiofrequency, high intensity focused ultrasound, cryotherapy--has gained large acceptance in the last decades. The LDR permanent interstitial radioactive seed implantation is often used as monotherapy for low risk prostate carcinoma whereas the HDR temporary implant may useful to treat intermediate-to-high risk prostate tumors as a radiation boost to combined external beam radiation therapy (EBRT). Read More

Int J Radiat Oncol Biol Phys 2011 Sep 4;81(1):1-7. Epub 2011 Apr 4.

Radiation Oncology Medical College of Wisconsin, Milwaukee, WI 53226, USA.

Purpose: To evaluate the long-term effectiveness of transrectal ultrasound-guided permanent radioactive I125 implantation of the prostate for organ confined adenocarcinoma of the prostate compared with historical data of prostatectomy and external beam radiotherapy within a cooperative group setting.

Methods And Materials: Patients accrued to this study had histologically confirmed, locally confined adenocarcinoma of the prostate clinical stage T1b, T1c, or T2a; no nodal or metastatic disease; prostate-specific antigen level of ≤10 ng/ml; and a Gleason score of ≤6. All patients underwent transrectal ultrasound-guided radioactive I125 seed implantation into the prostate. Read More

Stud Health Technol Inform 2011 ;163:623-9

Worcester Polytechnic Institute, Worcester, MA 01609, USA.

This paper presents the design of a magnetic resonance imaging (MRI) compatible needle placement system actuated by piezoelectric actuators for prostate brachytherapy and biopsy. An MRI-compatible modular 3 degree-of-freedom (DOF) needle driver module coupled with a 3-DOF x-y-z stage is proposed as a slave robot to precisely deliver radioactive brachytherapy seeds under interactive MRI guidance. The needle driver module provides for needle cannula rotation, needle insertion and cannula retraction to enable the brachytherapy procedure with the preloaded needles. Read More

Cancer Gene Ther 2011 Mar 5;18(3):189-95. Epub 2010 Nov 5.

Division of Radiation Research, Department of Radiation Medicine, Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, DC 20057-1482, USA.

Brachytherapy (BRT) is used in the treatment of human cancers, including the cervix, breast, prostate and head and neck cancers. The primary advantage of BRT lies in the spatial conformation of the radiation deposition. Previously, we have shown that similar techniques (using hollow metallic cylinders) may be used to deliver gene-therapy vectors capable of expressing the radiation-sensitizing cytokine, tumor necrosis factor (TNF)-α, within a restricted volume of tissue. Read More

Panminerva Med 2010 Sep;52(3):183-8

Department of Urology, Rostock University, Rostock, Germany.

Permanent prostate brachytherapy by implantation of radioactive isotope seeds has become a widely accepted treatment modality for localized prostate cancer. Clinical outcome data are mature and show excellent long-term PSA recurrence-free survival over 10 years in patients with low risk tumours. Results are dependent on patient selection and implant quality. Read More

Cancer Radiother 2010 Oct 17;14(6-7):488-92. Epub 2010 Aug 17.

Département de radiothérapie, institut Gustave-Roussy, 39 rue Camille-Desmoulins, 94805 Villejuif, France.

Brachytherapy techniques by permanent implant of radioactive sources or by temporary high-dose-rate (HDR) fractions are nowadays extensively used for the treatment of prostatic carcinoma. Long-term results (at 20 years) concerning large amount of patients have been published by major centers confirming both in terms of efficacy and toxicities that permanent implant of radioactive iodine-125 seeds yields at least the same good results of surgery and of external beam irradiation when proposed to patients affected by low-risk disease. For intermediate to high-risk tumors, HDR temporary implants are proposed as a boost for dose escalation. Read More

Int J Clin Oncol 2009 Dec 5;14(6):502-6. Epub 2009 Dec 5.

Department of Urology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan.

Background: We aimed to calculate the frequency and features of the development of a prostate-specific antigen (PSA) bounce after prostate brachytherapy alone, to correlate the bounce with clinical and dosimetric factors and to identify factors that predict PSA bounce.

Methods: PSA bounce was evaluated in 86 patients with T1-T2 prostate cancer who underwent radioactive seed implantation using iodine-125 (I-125) without hormonal therapy or external-beam radiation therapy (EBRT) from September 2004 to December 2007. A PSA bounce was defined as a rise of at least 0. Read More

Radiother Oncol 2009 Nov 11;93(2):168-73. Epub 2009 Sep 11.

Department of Radiation Oncology, Academic Medical Center, University of Amsterdam, The Netherlands.

Background And Purpose: For the radiation treatment of prostate cancer high dose should be delivered for optimal biochemical control. Treatment can be given by dose-escalated external beam radiotherapy (EBRT) or external beam radiotherapy combined with a radioactive seed implantation (EBSeeds) or high-dose rate (HDR) brachytherapy (EBTI). Differences in outcome between the modalities were assessed by a systematic review. Read More

Phys Med Biol 2009 Sep 28;54(18):5595-611. Epub 2009 Aug 28.

Department of Radiation Oncology, University of Oklahoma Health Sciences Center, 825 NE 10th Street, OUPB 1430, Oklahoma City, OK 73104, USA.

This work investigates variation in the volume of the prostate measured at different stages through the prostate brachytherapy procedure for 30 patients treated with I-125 radioactive seeds. The implanted seeds were localized on post-implantation ultrasound (US) images and the effect of prostate enlargement due to edema on dose coverage for 15 patients was studied. The volume of the prostate was measured at four stages as follows: (a) 2-3 weeks prior to implantation using US imaging, (b) then at the start of the intra-operative prostate brachytherapy procedure on the day of the implant, (c) immediately post-implantation using US imaging in the operating room and (d) finally by CT imaging at nearly 4 weeks post-implantation. Read More

Am J Clin Oncol 2010 Feb;33(1):1-10

Division of General Internal Medicine, Department of Medicine, and Center for Clinical Effectiveness, Cincinnati, Ohio, USA.

Objectives: Multiple options with similar cure rates exist for men with localized adenocarcinoma of the prostate. Therefore, treatment-related morbidity is a major consideration for treatment selection. We present a descriptive, longitudinal analysis of genitourinary and bowel symptoms following treatment in a brachytherapy registry at the University of Cincinnati. Read More

IEEE Trans Med Imaging 2009 Dec 14;28(12):1955-68. Epub 2009 Jul 14.

Department of Electrical and Computer Engineering, Johns Hopkins University, Baltimore, MD 21218, USA.

Intraoperative dosimetry in prostate brachytherapy requires localization of the implanted radioactive seeds. A tomosynthesis-based seed reconstruction method is proposed. A three-dimensional volume is reconstructed from Gaussian-blurred projection images and candidate seed locations are computed from the reconstructed volume. Read More

Int J Urol 2009 Jun 12;16(6):558-60. Epub 2009 May 12.

Department of Urology, University of California, San Francisco, California, USA.

Objectives: We prospectively investigated risk factors for acute urinary retention (AUR) following transperineal radioactive seed implantation for prostate cancer.

Methods: A total of 273 consecutive patients underwent transperineal ultrasound-guided prostate brachytherapy for clinical T1c-T3b prostate cancer. Preoperative factors included age; International Prostate Symptom score; planimetric prostate and transition volumes (TZV) measured by transrectal ultrasound; peak flow rate; post-void residual urine; neoadjuvant hormone therapy; use of pelvic radiation; and T stage. Read More

BJU Int 2009 Sep 23;104(5):600-4. Epub 2009 Feb 23.

Department of Urology, University of California, San Francisco, CA 94117, USA.

Objective: To assess our experience with salvage permanent perineal radioactive-seed implantation (SPPI) as a possible therapeutic option for recurrent prostate adenocarcinoma, as salvage therapies for recurrences after definitive external beam radiotherapy (EBRT) for localized adenocarcinoma of the prostate are associated with significant morbidity and biochemical failure.

Patients And Methods: We retrospectively analysed on patients who had SPPI for localized recurrent prostate adenocarcinoma from 1996 to 2007 after primary treatment with EBRT. Excluded were patients who had other primary treatment or had no follow-up. Read More

J Acoust Soc Am 2008 Dec;124(6):EL347-52

Frederic L Lizzi Center for Biomedical Engineering, Riverside Research Institute, New York, NY 10038, USA.

Brachytherapy to treat prostate cancer uses transrectal ultrasound to guide implantation of titanium-shelled radioactive seeds. Transperitoneal implantation allows errors in placement that cause suboptimal dosimetry. Conventional ultrasound cannot reliably image implanted seeds; therefore, seed misplacements cannot be corrected in the operating room. Read More

Med Phys 2008 Dec;35(12):5841-50

Cliniques Universitaires Saint-Luc, Radiotherapy and Oncology Department, Catholic University of Louvain, Brussels, Belgium.

Permanent implantation of 125I (iodine) or 103Pd (palladium) sources is a popular treatment option in the management of early stage prostate cancer. New sources are being developed, some of which are being marketed for different clinical applications. A new technique of adjuvant stereotactic permanent seed breast implant, similar to that used in the treatment of prostate cancer, has been proposed by [N. Read More

IEEE Trans Inf Technol Biomed 2009 Mar 31;13(2):217-25. Epub 2008 Dec 31.

Department of Computer Science, University of North Carolina, Chapel Hill, NC 27599-3175, USA.

Minimally invasive medical procedures such as biopsies, anesthesia drug injections, and brachytherapy cancer treatments require inserting a needle to a specific target inside soft tissues. This is difficult because needle insertion displaces and deforms the surrounding soft tissues causing the target to move during the procedure. To facilitate physician training and preoperative planning for these procedures, we develop a needle insertion motion planning system based on an interactive simulation of needle insertion in deformable tissues and numerical optimization to reduce placement error. Read More

Med Image Comput Comput Assist Interv 2009 ;12(Pt 1):59-66

Department of Electrical and Computer Eng., Johns Hopkins University, USA

In prostate brachytherapy, x-ray fluoroscopy has been used for intra-operative dosimetry to provide qualitative assessment of implant quality. More recent developments have made possible 3D localization of the implanted radioactive seeds. This is usually modeled as an assignment problem and solved by resolving the correspondence of seeds. Read More

Crit Rev Biomed Eng 2009 ;37(1-2):59-106

Department of Medical Physics & Applied Radiation Sciences, McMaster University, Canada.

Recent applications of robotics in the field of prostate brachytherapy are seeding the future and could potentially lead to a fully automated prostate brachytherapy surgery. Currently, a typical prostate brachytherapy surgery involves the implantation of upwards of 100 radioactive I-125 seeds by a surgeon. This review supplies background information on prostate biology, brachytherapy of the prostate, robotic brachytherapy, and transrectal ultrasound. Read More

Zhonghua Yi Xue Za Zhi 2008 Oct;88(39):2739-42

Department of Radiology, Southwest Hospital, Third Military Medical University, Chongqing 400038, China.

Objective: To investigate the clinical value of CT guided radioactive seed (125)I implantation in treating bone metastasis.

Methods: 28 multiple bone metastatic tumor patients with 116 metastatic lesions totally, adenocarcinoma of lung in 6 cases, squamous cell carcinoma of lung, renal clear-cell carcinoma, and carcinoma of prostate in 4 cases each, hepatocellular carcinoma and colon carcinoma in 3 cases each, breast carcinoma in 2 cases, and malignant schwannoma and pancreatic cancer in 1 case each, 13 males and 15 females, aged 49.8, underwent CT guided radioactive seed (125)I implantation into bone metastatic lesions. Read More

Cancer 2008 Nov;113(9):2605-9

Department of Radiation Oncology, University Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio 45219, USA.

Background: Acute urinary retention is a potential complication of brachytherapy, with the literature estimating that 5% to 22% of patients require catheterization within 48 hours after implantation. In theory, postimplantation edema could be reduced by using intraoperative steroids. A prospective trial was conducted randomizing patients to a single intraoperative dose of dexamethasone versus no steroid use. Read More

J Acoust Soc Am 2008 Apr;123(4):2148-59

Frederic L. Lizzi Center for Biomedical Engineering, Riverside Research Institute, 156 William Street, 9th Floor, New York, New York 10038, USA.

Transrectal-ultrasound-guided brachytherapy uses small titanium-shelled radioactive seeds to locally treat prostate cancer. During the implantation procedure, needles inserted transperitoneally cause gland movement resulting in seed misplacement and suboptimal dosimetry. In a previous study, an algorithm based on singular spectrum analysis (SSA) applied to envelope-detected ultrasound signals was proposed to determine seed locations [J. Read More

Urol Oncol 2008 Mar-Apr;26(2):147-52. Epub 2007 Oct 29.

Department of Radiation Oncology, Brigham and Women's Hospital and Dana Farber Cancer Institute, Boston, MA 02115, USA.

Purpose: This study was performed to define the rectal dose constraint that would predict late rectal bleeding requiring argon plasma coagulation (APC) following prostate brachy mono-therapy.

Methods And Materials: Between February 1999 and April 2002, 91 patients with low risk prostate cancer underwent permanent I(125) radioactive seed implantation without the use of supplemental external beam radiation or androgen suppression therapy. Patients received both CT and MRI scans 6 weeks postimplant for evaluation of dosimetry. Read More

Med Image Comput Comput Assist Interv 2007 ;10(Pt 2):9-17

Johns Hopkins University, USA.

Intra-operative guidance in Transrectal Ultrasound (TRUS) guided prostate brachytherapy requires localization of inserted radioactive seeds relative to the prostate. Seeds were reconstructed using a typical C-arm, and exported to a commercial brachytherapy system for dosimetry analysis. Technical obstacles for 3D reconstruction on a non-isocentric C-arm included pose-dependent C-arm calibration; distortion correction; pose estimation of C-arm images; seed reconstruction; and C-arm to TRUS registration. Read More

Annu Int Conf IEEE Eng Med Biol Soc 2007 ;2007:1233-6

Department of Radiation Oncology, Jefferson Medical College of Thomas Jefferson University, Philadelphia, PA 19107, USA.

In contemporary prostate brachytherapy, precise placement of needle and accurate deliver of radioactive seed at planned location is challenging. In this paper, we present a multi-channel robotic system designed for permanent seed implant in prostate. Unlike a single-channel robotic system or conventional manual technique, the designed multi-channel robotic system is capable of inserting a large number of needles concurrently. Read More

Brachytherapy 2007 Oct-Dec;6(4):267-71. Epub 2007 Oct 23.

Department of Radiation Oncology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA 02215, USA.

Purpose: We examined whether prostate volume reduction after a short course of androgen deprivation (AD) lowered the risks of acute and chronic urinary morbidity related to radioactive seed implantation for low-risk prostate cancer.

Methods And Materials: Eighty-one patients received AD for cytoreduction before interstitial brachytherapy alone. Urinary morbidity was carefully assessed for all patients during a median followup of 53 (range, 23-78) months after treatment. Read More

Ugeskr Laeger 2007 May;169(20):1902-4

Herlev Hospital, Urologisk Afdeling H, Rigshospitalet, Urologisk Afdeling D.

The incidence of prostate cancer is increasing sharply in Denmark and an increasing proportion of patients have clinically localised disease at diagnosis. The therapeutic strategy encompasses intended curative therapy: radical prostatectomy with complete removal of the prostate gland and seminal vesicles performed as an open procedure or laparoscopically, external beam radiation therapy, or implantation of radioactive seeds into the prostate (brachytherapy). In older patients with good prognostic factors, active surveillance should be considered. Read More

Int J Med Robot 2006 Sep;2(3):256-61

TIMC Laboratory, Grenoble, France.

Background: Prostate brachytherapy consists in placing radioactive seeds for tumour destruction under transrectal ultrasound imaging (TRUS) control. It requires prostate delineation from the images for dose planning. Because ultrasound imaging is patient- and operator-dependent, we have proposed to fuse MRI data to TRUS data to make image processing more reliable. Read More

Ann Urol (Paris) 2007 Apr;41(2):68-79

Service d'urologie, hôpital Salvator, 249, boulevard de Sainte-Marguerite, BP51, 13274 Marseille, France.

Permanent seed brachytherapy as a monotherapy is an appropriate treatment in patients with low risk localized prostate cancer such as intraprostatic cancer, T1-2 stage, PSA less than 10 ng/mL, low tumour volume, well differentiated cancer (Gleason score less than 7), gland size less than 50 mL, no micturition symptoms that could decompensate after implantation. A brachytherapy program needs a specialized multidisciplinary team with the collaboration of urologists, radiotherapists (authorized person to manipulate radioactive elements), and physicists. The 10-year oncologic and morbidity results have been published in the literature and are comparable to those of other standard treatments of localized prostate cancer such as radical prostatectomy and external beam radiation therapy. Read More

J Acoust Soc Am 2007 Mar;121(3):1790-801

Frederic L. Lizzi Center for Biomedical Engineering, Riverside Research Institute, 156 William Street, New York, New York 10038, USA.

Ultrasound-guided brachytherapy using titanium-shelled radioactive seeds is a popular, effective means of treating prostate cancer. Unfortunately, implantation using needles inserted transperitoneally causes gland movement and distortion, which often results in seed misplacement and dosimetry errors. If actual seed locations could be determined in the operating room, then corrections to dosimetry errors could be made immediately. Read More