title: Dose escalation to dominant intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate prostate brachytherapy. Prospective phase II trial.
abstract: To demonstrate the feasibility, safety and effectiveness of dose escalation to intraprostatic lesions with MRI-transrectal ultrasound fusion High-Dose-Rate (HDR) brachytherapy.
  
  
  
  15 patients with intermediate-high risk prostate cancer and visible dominant intra-prostatic nodule on mpMRI have been treated. The treatment consisted of combined MRI-TRUS fusion HDR-brachytherapy (1 fraction of 1500cGy) and hypofractionated external beam (3750cGy in 15 fractions). A dose of 1875Gy was delivered to at least 98% of the DIL volume.
  
  
  
  Median prostate volume was 23.8cc; median number of needles was 16 (13-18). Dose escalation to DIL was feasible in 14/15 patients (93%) without violating dosimetric constraints and 1 patient presented a minimal deviation of dosimetric restrictions. With a median follow-up of 18months (17-24), none of the patients developed acute urinary retention or grade ⩾3 toxicity. In addition to standard PSA follow-up, response has been assessed by mpMRI at 12months. All patients presented adequate morphological responses on anatomical and functional sequences.
  
  
  
  HDR brachytherapy using MRI-transrectal ultrasound fusion for image guidance is a suitable technique for partial prostate dose escalation. Tolerance and toxicity profiles are excellent and results are encouraging in terms of biochemical, morphological and functional response.
authors.affiliation: Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain. Electronic address: agomeziturriaga@gmail.com.
authors.forename: Alfonso
authors.initials: A
authors.lastname: Gomez-Iturriaga
authors.affiliation: Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
authors.forename: Francisco
authors.initials: F
authors.lastname: Casquero
authors.affiliation: Hospital Universitario Cruces, Radiology, Barakaldo, Spain.
authors.forename: Arantza
authors.initials: A
authors.lastname: Urresola
authors.affiliation: Hospital Universitario Cruces, Radiology, Barakaldo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Ezquerro
authors.affiliation: Hospital Universitario Cruces/Biocruces Health Research Institute, Barakaldo, Spain.
authors.forename: Jose I
authors.initials: JI
authors.lastname: Lopez
authors.affiliation: Hospital Universitario Cruces, Physics, Barakaldo, Spain.
authors.forename: Jose M
authors.initials: JM
authors.lastname: Espinosa
authors.affiliation: Hospital Universitario Cruces, Physics, Barakaldo, Spain.
authors.forename: Pablo
authors.initials: P
authors.lastname: Minguez
authors.affiliation: Hospital Universitario Cruces, Urology, Barakaldo, Spain.
authors.forename: Roberto
authors.initials: R
authors.lastname: Llarena
authors.affiliation: Hospital Universitario Cruces/Biocruces Health Research Institute, Clinical Epidemiology Unit, Barakaldo, Spain.
authors.forename: Ana
authors.initials: A
authors.lastname: Irasarri
authors.affiliation: Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Bilbao
authors.affiliation: Cancer Center for the Southern Interior, Radiation Oncology, British Columbia Cancer Agency, Kelowna, Canada.
authors.forename: Juanita
authors.initials: J
authors.lastname: Crook
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000379:methods*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D018084:Ultrasonography, Interventional
keywords: Dominant intraprostatic lesion; Dose escalation; High-Dose-Rate brachytherapy; Prostate cancer