title: Impact of intraoperative MRI/TRUS fusion on dosimetric parameters in cT3a prostate cancer patients treated with high-dose-rate real-time brachytherapy.
abstract: OBJECTIVE
  The purpose of this study was to evaluate the impact of intraoperative MRI/TRUS fusion procedure in cT3a prostate cancer patients treated with high-dose-rate (HDR) real-time brachytherapy.
  
  
  METHODS
  Prostate gland, dominant intraprostatic lesions (DILs), and extracapsular extension (ECE) were delineated in the pre-brachytherapy magnetic resonance images (MRI) of 9 consecutive patients. The pre-implant P-CTVUS (prostate clinical target volume) was defined as the prostate seen in the transrectal ultrasound (TRUS) images. The CTVMR includedthe prostate with the ECE image (ECE-CTV) as defined on the MRI. Two virtual treatment plans were performed based on the MRI/TRUS fusion images, the first one prescribing 100% of the dose to the P-PTVUS, and the second prescribing to the PTVMR. The implant parameters and dose-volume histogram (DVH) related parameters of the prostate, OARs, and ECE were compared between both plans.
  
  
  RESULTS
  Mean radial distance of ECE was 3.6 mm (SD: 1.1). No significant differences were found between prostate V100, V150, V200, and OARs DVH-related parameters between the plans. Mean values of ECE V100, V150, and V200 were 85.9% (SD: 15.1), 18.2% (SD: 17.3), and 5.85% (SD: 7) when the doses were prescribed to the PTVUS, whereas ECE V100, V150, and V200 were 99.3% (SD: 1.2), 45.8% (SD: 22.4), and 19.6% (SD: 12.6) when doses were prescribed to PTVMR (p = 0.028, p = 0.002 and p = 0.004, respectively).
  
  
  CONCLUSIONS
  TRUS/MRI fusion provides important information for prostate brachytherapy, allowing for better coverage and higher doses to extracapsular disease in patients with clinical stage T3a.
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gomez-Iturriaga
authors.affiliation: Department of Radiation Oncology, British Columbia Cancer Agency, Cancer Center for the Southern Interior, Kelowna, BC, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Casquero
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Claudia
authors.initials: C
authors.lastname: Carvajal
authors.affiliation: Department of Radiology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Arantxa
authors.initials: A
authors.lastname: Urresola
authors.affiliation: Department of Radiology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Begoña
authors.initials: B
authors.lastname: Canteli
authors.affiliation: Department of Radiology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ezquerro
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Hortelano
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Jon
authors.initials: J
authors.lastname: Cacicedo
authors.affiliation: Department of Radiation Physics, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Jose Maria
authors.initials: JM
authors.lastname: Espinosa
authors.affiliation: Department of Radiation Physics, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Fernando
authors.initials: F
authors.lastname: Perez
authors.affiliation: Department of Radiation Physics, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Minguez
authors.affiliation: Department of Radiation Oncology, Cruces University Hospital, Barakaldo, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Bilbao
keywords: MRI/TRUS fusion; extracapsular extension; high-dose-rate brachytherapy; prostate cancer
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