title: Dosimetric consequences of using a surrogate urethra to estimate urethral dose after brachytherapy for prostate cancer.
abstract: OBJECTIVE
  To assess the accuracy and dosimetric consequences of defining a surrogate urethra at the geometric center of the prostate in postimplant CT scans.
  
  
  METHODS
  Eighty postimplant CT scans were obtained with a Foley catheter in place at Day 0 and at 1 month for 40 patients who had undergone (125)I prostate brachytherapy. The percentage of urethral volume receiving at least 275% of the prescribed dose (uV(275)), uV(250), uV(200), uV(150), maximal dose received by 90% of urethral volume (uD(90)), uD(70), uD(30), and uD(1) were measured for the Foley catheter and surrogate urethra. The distance between the Foley catheter and surrogate urethra was measured at the base, middle, and apex of the prostate.
  
  
  RESULTS
  A statistically significant difference was found in all the above-listed dosimetric parameters between the Foley catheter and surrogate urethra at Day 0 (p <or= 0.001). At 1 month, the uD(90), uD(70), and uD(1) remained significantly different between the Foley catheter and surrogate urethra (p <or= 0.05). The difference in the uV(275) (p = 0.055) and uV(150) (p = 0.059) between the Foley catheter and surrogate urethra showed a trend toward statistical significance at 1 month. The uV(250), uV(200), and uD(30) were greater for the surrogate urethra than for the Foley catheter at 1 month, but were not significantly different statistically. The mean distance between the Foley catheter and the surrogate urethra was greatest at the base (1.2 cm) in the vertical axis at Day 0 and decreased substantially to 0.87 cm at 1 month (p = 0.0004).
  
  
  CONCLUSIONS
  Using a surrogate urethra at the geometric center of the prostate may significantly overestimate the urethral dose at Day 0 and certain dosimetric parameters at 1 month. An alternative position for a surrogate urethra accounting for the difference in the location of the Foley catheter near the base of the prostate at Day 0 and 1 month could be considered in future studies.
authors.affiliation: Department of Radiation Oncology, The University of Texas M. D. Anderson Cancer Center, Houston 77030, USA.
authors.forename: Hoon K
authors.initials: HK
authors.lastname: Lee
authors.forename: Warren D
authors.initials: WD
authors.lastname: D'Souza
authors.forename: Jose-Miguel J
authors.initials: JM
authors.lastname: Yamal
authors.forename: Alan
authors.initials: A
authors.lastname: Pollack
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Lee
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Palmer
authors.forename: Deborah A
authors.initials: DA
authors.lastname: Kuban
mesh_terms: D001918:Brachytherapy; D002404:Catheterization; D006801:Humans; D021621:Imaging, Three-Dimensional; D007457:Iodine Radioisotopes / Q000627:therapeutic use; D008297:Male; D011874:Radiometry / Q000379:methods*; D011879:Radiotherapy Dosage; D018709:Statistics, Nonparametric; D014057:Tomography, X-Ray Computed; D014521:Urethra / Q000033:anatomy & histology / Q000000981:diagnostic imaging*; D014546:Urinary Catheterization
chemical_list: D007457:Iodine Radioisotopes