title: Phase I/II prospective trial of cancer-specific imaging using ultrasound spectrum analysis tissue-type imaging to guide dose-painting prostate brachytherapy.
abstract: OBJECTIVE
  To assess the technical feasibility, toxicity, dosimetry, and preliminary efficacy of dose-painting brachytherapy guided by ultrasound spectrum analysis tissue-type imaging (TTI) in low-risk, localized prostate cancer.
  
  
  METHODS
  Fourteen men with prostate cancer who were candidates for brachytherapy as sole treatment were prospectively enrolled. Treatment planning goal was to escalate the tumor dose to 200% with a modest de-escalation of dose to remaining prostate compared with our standard. Primary end points included technical feasibility of TTI-guided brachytherapy and equivalent or better toxicity compared with standard brachytherapy. Secondary end points included dose escalation to tumor regions and de-escalated dose to nontumor regions on the preimplant plan, negative prostate biopsy at 2 years, and freedom from biochemical failure.
  
  
  RESULTS
  Thirteen of fourteen men successfully completed the TTI-guided brachytherapy procedure for a feasibility rate of 93%. A software malfunction resulted in switching one patient from TTI-guided to standard brachytherapy. An average of 2.7 foci per patient was demonstrated and treated with an escalated dose. Dosimetric goals on preplan were achieved. One patient expired from unrelated causes 65 days after brachytherapy. Toxicity was at least as low as standard brachytherapy. Two-year prostate biopsies were obtained from six men; five (83%) were definitively negative, one showed evidence of disease with treatment effect, and none were positive. No patients experienced biochemical recurrence after a median followup of 31.5 (24-52) months.
  
  
  CONCLUSIONS
  We have demonstrated that TTI-guided dose-painting prostate brachytherapy is technically feasible and results in clinical outcomes that are encouraging in terms of low toxicity and successful biochemical disease control.
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY. Electronic address: REnnis@chpnet.org.
authors.forename: Ronald D
authors.initials: RD
authors.lastname: Ennis
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: S Aidan
authors.initials: SA
authors.lastname: Quinn
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Frieda
authors.initials: F
authors.lastname: Trichter
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Shannon
authors.initials: S
authors.lastname: Ryemon
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Anudh
authors.initials: A
authors.lastname: Jain
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Kunal
authors.initials: K
authors.lastname: Saigal
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Sarayu
authors.initials: S
authors.lastname: Chandrashekhar
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Nicholas A
authors.initials: NA
authors.lastname: Romas
authors.affiliation: Department of Radiation Oncology, Mount Sinai Roosevelt Hospital, New York, NY.
authors.forename: Ernest J
authors.initials: EJ
authors.lastname: Feleppa
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D013057:Spectrum Analysis; D018084:Ultrasonography, Interventional / Q000379:methods*
chemical_list: D017430:Prostate-Specific Antigen
keywords: Brachytherapy; Dose painting; Focal therapy; Prostate cancer; Tissue-type imaging; Ultrasound spectrum analysis