Patient Research Beta

Contact Us | Terms & Conditions | Privacy Policy | About

Elsevier is the world's leading publisher of Medical Information. We are proud to make available our Patient Research option as a Beta program for patients, or friends/family of patients, who have a medical need for information regarding a medical situation for them or someone they know. This Beta program provides the article you request for free, with a small handling fee, $4.95. After ordering the article and confirmation of payment, we will e-mail the document to you typically within 2 hours, but no longer than 24 hours. Prostate seed implantation using 3D-computer assisted intraoperative planning vs. a standard look-up nomogram: Improved target conformality with reduction in urethral and rectal wall dose International Journal of Radiation Oncology*Biology*Physics, Volume 60, Issue 5, 1 December 2004, Pages 1631-1638 Abstract: PurposeTo compare dosimetric outcomes between two real-time prostate seed implantation (PSI) techniques to evaluate the impact of three-dimensional (3D) intraoperative computer planning on target coverage, conformality, and preset urethral and rectal dose constraints.Methods and materialsOne hundred and fourteen patients with clinically localized prostate cancer underwent ultrasound-guided transperineal PSI of the prostate with 125I sources as monotherapy. From 1999 to 2001, 69 patients were implanted in real-time using a standard look-up nomogram (Group 1: NG-PSI). All patients were implanted with a modified peripheral loading technique in which 75–80% of the calculated total activity was delivered to the gland periphery, with the remaining 20–25% activity placed in the gland interior, to achieve a prescribed dose (PD) of 144 Gy to cover the gland with acceptable homogeneity. No preoperative or intraoperative planning was performed to set dose constraints to the urethra or anterior rectal wall. Dosimetric outcome from this group was compared with 45 patients subsequently implanted after 2001 using an intraoperative 3D computer planning system (Group 2: 3D-PSI). A similar modified peripheral loading technique was used as an option in the planning system. Preoperative dose constraints were placed on the urethra (V150 < 35%), prostate (V100 > 95% of PD; D90: 140–180 Gy), and rectal wall (V110 < 1.5 cc) with real-time dosimetric feedback performed after peripheral loading. Manual dose optimization was performed to determine interior needle position and remaining number and placement of 125I sources to adhere to urethral and rectal constraints and target coverage goals. Both groups underwent postimplant CT analysis to determine dosimetric outcome with regard toV100prostate, D90prostate, V150urethra, and V110rectum. Univariate and multivariate analysis was performed to determine variables impacting on dosimetric outcome.ResultsAnalysis of preimplant and postimplant variables demonstrated no difference in the median preimplant gland volume (33 cc vs. 35 cc; p = 0.31), median mCi/seed strengths (0.4 vs. 0.45 mCi; p = 0.23), median V100 (94% vs. 94%), or median D90 at postimplant Day 30 (165 Gy vs. 160 Gy; p = 0.26) between Groups 1 and 2. However, for Group 2 (3D-PSI) the median total mCi implanted (26 vs. 33 mCi; p < 0.0001) and the median number of seeds implanted (67 vs. 83; p < 0.0001) were reduced substantially. The percent of patients exceeding a D90 > 180 Gy was reduced from 29% in Group 1 to 16% in Group 2 (p = 0.08). A reduction was observed in the percent of patients receiving a D90 < 140 Gy (14% Group 1 vs. 9% Group 2, p = 0.56). The median V150urethra for Group 2 was reduced dramatically with 3D-PSI compared with NG-PSI (63% vs. 17%; p < 0.0001). A V150urethra > 30% was observed in 88% in Group 1 compared with 29% in Group 2, p < 0.0001. Similarly, the median V110rectum for Group 1 was significantly higher than that in Group 2 (1.93 vs. 0.26 cc; p < 0.0001). The percent of patients with V110rectum > 1.5 cc in Group 1 and Group 2 was 57% and 13%, respectively (p < 0.0001).ConclusionsThe adoption of 3D computer intraoperative dose planning and optimization for prostate seed implantation resulted in dramatic reductions in urethral and rectal wall doses, while consistently producing excellent target coverage with reduced dose variability above 180 Gy and below 140 Gy, compared with the use of a standard look-up nomogram. Additionally, the reduction in total mCi and number of seeds needed to achieve improved conformality was substantial and may have implications for cost savings. This Beta program is not intended for use by Medical Professionals. To obtain this document through the Patient Research option you must have a medical need, only use the document for personal use, and agree to all the terms and conditions below. Also, these articles can be obtained for free at your local public or university hospital library. We encourage you to use this as a means of obtaining articles of interest to you. Patient Research Terms and Conditions The terms and conditions set out below govern your use of the content made available through this web-site (the "Site"), including the article or articles that you have selected in connection with your personal medical research (the "Content") for delivery to the e-mail address you will be asked to provide in connection with this service (collectively, the "Service"). In order to provide this Service you understand and agree to provide the personal information you will be asked to provide after you accept these terms and conditions, although our use of such information will be limited to this purpose and otherwise governed by our privacy policy (see Privacy Policy). The Content, the Site and the Service are provided by Elsevier Inc. and its affiliates and licensors (collectively "Elsevier"). For further information about Elsevier or to contact us, see Contact Us. Permitted Uses You may access in a given twenty-four hour period a reasonable number of Content items, and you may download and print such Content after it has been delivered to your e-mail address. Such access and use is for your own personal use, although you may also share and discuss such Content with family members and medical professionals involved in your medical care or the care of a family member. You can make further copies for such family members and medical professionals. Prohibited Uses Personal use does not include the use by researchers, instructors or students for research purposes or educational use. You may not copy, display, distribute, modify, publish, reproduce, store, transmit, create derivative works from, or sell or license all or any part of the Content, or any other information obtained from or accessed through this Service in any medium to anyone. You may not modify in any way the text of the Content. You may not use any robots, spiders, crawlers or other automated downloading programs or devices to: (i) continuously and automatically search or index the Site or the Content, unless authorized by us; (ii) harvest personal information from this web site for purposes of sending unsolicited or unauthorized material; or (iii) cause disruption to the working of the Service or this Site. You may not use the Service or this Site to publish or distribute any advertising, promotional material, or solicitation to other users to use any goods or services. Copyright Notice All Content provided through this Service, and the Site layout, design, images, programs, text and other information displayed, are the property of Elsevier and is protected by copyright and other intellectual property laws. Warranty We will use reasonable efforts to respond to your requests for Content items and to maintain the indexes and other services involved in providing this Service and Site. Disclaimer of Warranties and Liability We make no other warranty whatsoever, including without limitation, that the operation of the Service or this Site will be uninterrupted or error-free; that defects will be corrected; that this Site, including the server that makes it available, is free of viruses or other harmful components; as to the results that may be obtained from use of the Content or other materials on the Site; or as to the accuracy, completeness, reliability, availability, suitability, quality, non-infringement or operation of any Content, product or service provided on or accessible from the Site. THIS SERVICE, SITE AND ALL CONTENT, PRODUCTS AND SERVICES INCLUDED IN OR ACCESSIBLE FROM THIS SITE ARE PROVIDED "AS IS" AND WITHOUT WARRANTIES OR REPRESENTATIONS OF ANY KIND (EXPRESS, IMPLIED AND STATUTORY, INCLUDING BUT NOT LIMITED TO THE WARRANTIES OF TITLE AND NONINFRINGEMENT AND THE IMPLIED WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE), ALL OF WHICH NAME DISCLAIMS TO THE FULLEST EXTENT PERMITTED BY LAW. YOUR USE OF THE SITE IS AT YOUR SOLE RISK. To the extent permissible under applicable laws, no responsibility is assumed for any injury and/or damage to persons, animals or property as a matter of products liability, negligence or otherwise, or from any use or operation of any ideas, instructions, methods, products or procedures contained in the Content or on this Site. If the Content items provided through the Service provide information about medical diagnoses and treatment, it is intended for professional use within the medical field. No suggested test or procedure should be carried out unless, in the judgment of a medical professional, its risk is justified. Because of rapid advances in the medical sciences, we recommend that the independent verification of diagnoses and drug dosages should be made. Discussions, views, and recommendations as to medical procedures, products, choice of drugs, and drug dosages are the responsibility of the authors. WE SHALL NOT BE LIABLE TO YOU OR ANYONE ELSE FOR ANY LOSS OR INJURY, CAUSED IN WHOLE OR PART BY ITS NEGLIGENCE OR CONTINGENCIES BEYOND ITS CONTROL IN PROCURING, COMPILING, INTERPRETING, REPORTING OR DELIVERING INFORMATION THROUGH THE SITE. IN NO EVENT WILL WE BE LIABLE TO YOU OR ANYONE ELSE FOR ANY DECISION MADE OR ACTION TAKEN BY YOU IN RELIANCE ON SUCH INFORMATION. WE SHALL NOT BE LIABLE TO YOU OR ANYONE ELSE FOR ANY DAMAGES (INCLUDING, WITHOUT LIMITATION, CONSEQUENTIAL, SPECIAL, INCIDENTAL, INDIRECT, OR SIMILAR DAMAGES) EVEN IF ADVISED OF THE POSSIBILITY OF SUCH DAMAGES. Governing Law and Venue These terms and conditions shall be governed by and construed in accordance with the laws of the State of New York, without regard to its conflicts of law principles. You hereby submit to and agree that the sole jurisdiction and venue for any actions that may arise under or in relation to the subject matter hereof shall be the courts located in the State of New York. Last revised: 10/2006 I have read and agree to the terms and conditions above