Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility

Arun Elangovan, Siraj Husain, Philip McGeahy, Michael Roumeliotis, Che Hsuan David Wu, Nathan Wolfe, Tyler Meyer, Elizabeth Watt, Kevin Martell, Kundan Thind

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The purpose of the study was to describe our approach towards safe delivery of single-fraction high-dose-rate (HDR) brachytherapy (BT) boost in patients with prostate cancer in the setting of an unshielded operating room (OR). Methods and Materials: A total of 95 patients received 15 Gy HDR BT boost. The procedure involved transrectal ultrasound–based catheter insertion and planning in the OR, after which the patient was moved to a shielded treatment room for radiation. This required three vital components: (1) an OR table capable of transporting the patient in lithotomy position, (2) robust motion management checks to ensure reproducibility of prostate and catheter positions in the treatment room before radiation delivery, (3) remote monitoring of patient vitals while under anesthesia, during the radiation. Initial viability of this approach was confirmed by assessing acute toxicities using the Common Terminology Criteria for Adverse Events v4.0 and American Urologic Association symptom scores. Results: We found good stability in prostate and catheter position, with less than 1 mm shifts in each direction due to patient transfer. The median baseline American Urologic Association score was 7 (3–11), which increased to 12 (7–17) at 4 weeks and 9 (5–14) at 3 months (p = 0.003). Common Terminology Criteria for Adverse Events ≥ grade 2 genitourinary and gastrointestinal toxicities were experienced by 7% and 0% patients, respectively, at 3 months posttreatment completion. Conclusions: Single-fraction HDR prostate BT can be delivered safely in an unshielded OR facility with a distant shielded treatment room using rigorous motion management checks and supplementary procedural equipment.

Original languageEnglish (US)
Pages (from-to)58-65
Number of pages8
JournalBrachytherapy
Volume20
Issue number1
DOIs
StatePublished - Jan 1 2021
Externally publishedYes

Keywords

  • HDR brachytherapy
  • Motion management
  • Prostate cancer
  • Unshielded OR

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Fingerprint

Dive into the research topics of 'Implementation of high-dose-rate brachytherapy for prostatic carcinoma in an unshielded operating room facility'. Together they form a unique fingerprint.

Cite this