Prostate brachytherapyDosimetric impact of contouring and needle reconstruction uncertainties in US-, CT- and MRI-based high-dose-rate prostate brachytherapy treatment planning

Background and purposeThe purpose was to evaluate the dosimetric impact of target contouring and needle reconstruction uncertainties in an US-, CT- and MRI-based HDR prostate BT treatment planning.Material and methodsUS, CT, and MR images were acquired post-needle insertion in 22 HDR-BT procedures for 11 consecutive patients. Dose plans were simulated for an US-, CT- and MRI-based HDR-BT treatment planning procedure. Planning uncertainties in US- and CT-based plans were evaluated using MRI-based planning as reference. Target (CTVProstate) was re-contoured on MRI. Dose results were expressed in total equivalent dose given in 2 Gy fractionation dose for EBRT (46 Gy) plus 2 HDR-BT fractions.ResultsUncertainties in US- and CT-based planning caused the planned CTVProstate-D90% to decrease with a mean of 2.9 ± 5.0 Gy (p = 0.03) and 2.9 ± 2.9 Gy (p = 0.001), respectively. The intra-observer contouring variation on MRI resulted in a mean variation of 1.6 ± 1.5 Gy in CTVProstate-D90%. Reconstruction uncertainties on US resulted in a dose variation of ±3 Gy to the urethra, whereas data for CT were not available for this.ConclusionsUncertainties related to contouring and reconstruction in US- and CT-based HDR-BT treatment plans resulted in a systematic overestimation of the prescribed target dose. Inter-modality uncertainties (US and CT versus MR) were larger than MR intra-observer uncertainties.