title: Impact of postimplant edema on V(100) and D(90) in prostate brachytherapy: can implant quality be predicted on day 0?
abstract: OBJECTIVE
  To determine the effect of edema on the dosimetric parameters V(100) (percentage of prostate volume that received a dose equal to or greater than the prescribed dose) and D(90) (minimal dose delivered to 90% of prostate volume) in 125I prostate brachytherapy and to determine whether the edema can be used to predict implant quality on the day of the implant (Day 0).
  
  
  METHODS
  Fifty consecutive patients treated with (125)I implants who had two postimplant CT scans were selected for this study. The mean interval between the studies was 46 +/- 23 days. The implants were preplanned to deliver 150 Gy to the prostate plus a 3-5-mm symmetric dose margin using peripherally loaded 0.4-0.6-mCi (NIST-99) (125)I seeds. A dose-volume histogram was compiled for each postimplant CT scan. The V(100) and D(90) from the first and second CT scans were compared to determine the effect of edema on these parameters. A multivariate regression analysis was performed to define the linear relationships for predicting the V(100) or D(90) at 30-60 days after implant from the magnitude of the edema and the values of V(100) and D(90) on Day 0.
  
  
  RESULTS
  V(100) and D(90) increased by 5% +/- 6% and 15% +/- 17%, respectively, during the interval between the first and second postimplant CT scans. The mean edema was 1.53 +/- 0.20. The increases in V(100) and D(90) were found to be proportional to the edema and the values of V(100) and D(90) on Day 0. The increase in V(100) was also found to depend on the width of the preplan dose margin. Linear relationships were derived that predict the V(100) and D(90) at 30-60 days after implant with a standard error of +/-4% and +/-24 Gy, respectively.
  
  
  CONCLUSIONS
  V(100) and D(90) increased by 5% +/- 6% and 15% +/- 17%, respectively, during the first 30-60 days after implant. The results of a multivariate linear regression analysis showed that the increases in V(100) and D(90) were proportional to both the magnitude of the edema and the values of these parameters on Day 0. The relationships derived by linear regression analysis predict V(100) and D(90) at 30-60 days after implant to within +/-4% and +/-24 Gy, respectively. However, predicting the 30-60-day V(100) and D(90) on Day 0 is a poor substitute for obtaining a 30-60-day CT scan, because the uncertainty in the predicted values is greater by a factor of > or =2. Nevertheless, on average, the predicted values should provide a more reliable estimate of the actual V(100) and D(90) than the Day 0 values that ignore the effect of edema altogether. The increase in V(100) was also found to depend on the width of the preplan dose margin; therefore, our results for V(100) are only valid for implants planned with a 3-5-mm margin.
authors.affiliation: Department of Radiation Oncology, Kimmel Cancer Center, Jefferson Medical College, Thomas Jefferson University, 111 S. 11th Street, Philadelphia, PA 19107, USA. frank.waterman@mail.tju.edu
authors.forename: Frank M
authors.initials: FM
authors.lastname: Waterman
authors.forename: Adam P
authors.initials: AP
authors.lastname: Dicker
mesh_terms: D000465:Algorithms; D001918:Brachytherapy / Q000009:adverse effects*; D004487:Edema / Q000150:complications* / Q000000981:diagnostic imaging; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011469:Prostatic Diseases / Q000150:complications* / Q000000981:diagnostic imaging; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D012044:Regression Analysis; D013997:Time Factors; D014057:Tomography, X-Ray Computed