eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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1/2021
vol. 13
 
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abstract:
Original paper

An audit of high dose-rate prostate brachytherapy treatment planning at six Swedish clinics

Frida Dohlmar
1
,
Sakarias Johansson
2
,
Torbjörn Larsson
3
,
Michael Sandborg
1, 4
,
Åsa Carlsson Tedgren
1, 4, 5, 6

1.
Medical Radiation Physics, Department of Health, Medicine and Caring Sciences, Linköping University, Linköping, Sweden
2.
Department of Oncology, Karolinska University Hospital, Stockholm, Sweden
3.
Department of Mathematics, Linköping University, Linköping, Sweden
4.
Center for Medical Image Science and Visualization, CMIV, Linköping University, Linköping, Sweden
5.
Department of Medical Radiation Physics and Nuclear Medicine, Karolinska University Hospital, Stockholm, Sweden
6.
Department of Oncology Pathology, Karolinska Institute, Stockholm, Sweden
J Contemp Brachytherapy 2021; 13, 1: 59–71
Online publish date: 2021/02/18
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Introduction
High dose-rate prostate brachytherapy has been implemented in Sweden in the late 1980s and early 1990s in six clinics using the same schedule: 20 Gy in two fractions combined with 50 Gy in 25 fractions with external beam radiation therapy. Thirty years have passed and during these years, various aspects of the treatment process have developed, such as ultrasound-guided imaging and treatment planning system. An audit was conducted, including a questionnaire and treatment planning, which aimed to gather knowledge about treatment planning methods in Swedish clinics.

Material and methods
A questionnaire and a treatment planning case (non-anatomical images) were sent to six Swedish clinics, in which high-dose-rate prostate brachytherapy is performed. Treatment plans were compared using dosimetric indices and equivalent 2 Gy doses (EQD2). Treatment planning system report was used to compare dwell positions and dwell times.

Results
For all the clinics, the planning aim for the target was 10.0 Gy, but the volume to receive the dose differed from 95% to 100%. Dose constraints for organs at risk varied with up to 2 Gy. The dose to 90% of target volume ranged from 10.0 Gy to 11.1 Gy, equivalent to 26.0 Gy EQD2 and 31.3 Gy EQD2, respectively. Dose non-homogeneity ratio differed from 0.18 to 0.32 for clinical target volume (CTV) in treatment plans and conformity index ranged from 0.52 to 0.59 for CTV.

Conclusions
Dose constraints for the organs at risk are showing a larger variation than that reflected in compared treatments plans. In all treatment plans in our audit, at least 10 Gy was administered giving a total treatment of 102 Gy EQD2, which is in the upper part of the prescription doses published in the GEC/ESTRO recommendations.

keywords:

brachytherapy, audit, dosimetric indices

 
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