eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 12
Original paper

Biological dose summation of intensity-modulated arc therapy and image-guided high-dose-rate interstitial brachytherapy in intermediate- and high-risk prostate cancer

Georgina Fröhlich
1, 2
Péter Ágoston
1, 3
Kliton Jorgo
1, 3
Csaba Polgár
1, 3
Tibor Major
1, 3

Centre of Radiotherapy, National Institute of Oncology, Budapest, Hungary
Faculty of Science, Eötvös Loránd University, Budapest, Hungary
Department of Oncology, Faculty of Medicine, Semmelweis University, Budapest, Hungary
J Contemp Brachytherapy 2020; 12, 3: 260–266
Online publish date: 2020/06/30
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To present an alternative method for summing biologically effective doses of intensity-modulated arc therapy (IMAT) as teletherapy (TT), with interstitial high-dose-rate (HDR) brachytherapy (BT) boost in prostate cancer. Total doses using IMAT boost was compared with BT boost using our method.

Material and methods
Initially, 25 IMAT TT plus interstitial HDR-BT plans were included, and additional plans using IMAT TT boost were created. The prescribed dose was 2/44 Gy to the whole pelvis, 2/60 Gy to the prostate and seminal vesicles, and 1 × 10 Gy BT or 2/18 Gy IMAT TT to the prostate. Teletherapy computed tomography (CT) was registered with ultrasound (US) of BT, and the most exposed volume of critical organs in BT were identified on these CT images. The minimal dose of these from IMAT TT was summed with their BT dose, and these EQD2 doses were compared using BT vs. IMAT TT boost. This method was compared with uniform dose conception (UDC).

D90 of the prostate was significantly higher with BT than with IMAT TT boost: 99.3 Gy vs. 77.9 Gy, p = 0.0034. The D2 to rectum, bladder, and hips were 50.3 Gy vs. 76.8 Gy (p = 0.0117), 64.7 Gy vs. 78.3 Gy (p = 0.0117), and 41.9 Gy vs. 50.6 Gy (p = 0.0044), while D0.1 to urethra was 96.1 Gy vs. 79.3 Gy (p = 0.0180), respectively. UDC overestimated D2 (rectum) by 37% (p = 0.0117), D2 (bladder) by 5% (p = 0.0214), and underestimated D0.1 (urethra) by 1% (p = 0.0277).

Based on our biological dose summation method, the total dose of prostate is higher using BT boost than the IMAT. BT boost yields lower rectum, bladder, and hips doses, but higher dose to urethra. UDC overestimates rectum and bladder dose and underestimates the dose to urethra.


prostate cancer, dose summation, integrated biological doses, intensity-modulated arc therapy, interstitial brachytherapy

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