Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation

Christopher W. Smith; Ryan Alfano; Douglas Hoover; Kathleen Surry; David D'Souza; Jonathan Thiessen; Irina Rachinsky; John Butler; Jose A. Gomez; Mena Gaed; Madeleine Moussa; Joseph Chin; Stephen Pautler; Glenn S. Bauman; Aaron D. Ward

Physics and Imaging in Radiation Oncology (Jul 2021)

Prostate specific membrane antigen positron emission tomography for lesion-directed high-dose-rate brachytherapy dose escalation

Christopher W. Smith,
Ryan Alfano,
Douglas Hoover,
Kathleen Surry,
David D'Souza,
Jonathan Thiessen,
Irina Rachinsky,
John Butler,
Jose A. Gomez,
Mena Gaed,
Madeleine Moussa,
Joseph Chin,
Stephen Pautler,
Glenn S. Bauman,
Aaron D. Ward

Affiliations

Christopher W. Smith: Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
Ryan Alfano: Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
Douglas Hoover: Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
Kathleen Surry: Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
David D'Souza: Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
Jonathan Thiessen: Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada
Irina Rachinsky: Western University Department of Medical Imaging, 1151 Richmond St., London, ON N6A 3K7, Canada
John Butler: Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada
Jose A. Gomez: Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
Mena Gaed: Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
Madeleine Moussa: Western University Department of Pathology and Laboratory Medicine, 1151 Richmond St., London, ON N6A 3K7, Canada
Joseph Chin: Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
Stephen Pautler: Western University Department of Surgery, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada
Glenn S. Bauman: Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada
Aaron D. Ward: Baines Imaging Research Laboratory, 790 Commissioners Rd E, London, ON N6A 5W9, Canada; Lawson Health Research Institute, 750 Base Line Rd E, London, ON N6C 2R5, Canada; Western University Department of Medical Biophysics, 1151 Richmond St., London, ON N6A 3K7, Canada; Western University Department of Oncology, 1151 Richmond St., London, ON N6A 3K7, Canada; London Regional Cancer Program, 790 Commissioners Rd E, London, ON N6A 4L6, Canada; Corresponding author at: Department of Medical Biophysics, 1151 Richmond Street N, London, ON N6A 5C1, Canada.

Journal volume & issue: Vol. 19
pp. 102 – 107

Abstract

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Background and purpose: Prostate specific membrane antigen positron emission tomography imaging (PSMA-PET) has demonstrated potential for intra-prostatic lesion localization. We leveraged our existing database of co-registered PSMA-PET imaging with cross sectional digitized pathology to model dose coverage of histologically-defined prostate cancer when tailoring brachytherapy dose escalation based on PSMA-PET imaging. Materials and methods: Using a previously-developed automated approach, we created segmentation volumes delineating underlying dominant intraprostatic lesions for ten men with co-registered pathology-imaging datasets. To simulate realistic high-dose-rate brachytherapy (HDR-BT) treatments, we registered the PSMA-PET-defined segmentation volumes and underlying cancer to 3D trans-rectal ultrasound images of HDR-BT cases where 15 Gray (Gy) was delivered. We applied dose/volume optimization to focally target the dominant intraprostatic lesion identified on PSMA-PET. We then compared histopathology dose for all high-grade cancer within whole-gland treatment plans versus PSMA-PET-targeted plans. Histopathology dose was analyzed for all clinically significant cancer with a Gleason score of 7or greater. Results: The standard whole-gland plans achieved a median [interquartile range] D98 of 15.2 [13.8–16.4] Gy to the histologically-defined cancer, while the targeted plans achieved a significantly higher D98 of 16.5 [15.0–19.0] Gy (p = 0.007). Conclusion: This study is the first to use digital histology to confirm the effectiveness of PSMA-PET HDR-BT dose escalation using automatically generated contours. Based on the findings of this study, PSMA-PET lesion dose escalation can lead to increased dose to the ground truth histologically defined cancer.

Published in Physics and Imaging in Radiation Oncology

ISSN: 2405-6316 (Online)
Publisher: Elsevier
Country of publisher: Ireland
LCC subjects: Medicine: Medicine (General): Medical physics. Medical radiology. Nuclear medicine; Medicine: Internal medicine: Neoplasms. Tumors. Oncology. Including cancer and carcinogens
Website: https://www.journals.elsevier.com/physics-and-imaging-in-radiation-oncology/

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