PSOR8 Presentation Time: 12:05 PM
Brachytherapy（2022）
Memorial Sloan Kettering Cancer Center
Abstract
Purpose To develop ABCD, an HDR brachytherapy prostate optimizer with mixed bound and unbound functionalities and evaluate its performance. Materials and Methods ABCD utilized linear optimization with iterative constraint refinement. ABCD aims to maximize (unbounded) dose to voxels within the prostate while achieving bounded constraints on organs-at-risk (urethra and rectum Dmax). 20 HDR prostate plans were retrospectively optimized using ABCD and with a commercial optimizer (VEGO, Varian Medical Systems) with constraints of rectum Dmax < 17.1Gy and urethra Dmax < 22.8Gy. These constraints were chosen to mimic potential dose constraints for monotherapy prostate HDR patients. For VEGO, a prostate D90 objective iteratively increased by the user until rectum and urethra limits were reached was used. Prostate V19Gy, D90, D98 and Dmin were reported. Statistical comparison was performed using a paired T-test (p < 0.05 for significance). Results ABCD vs VEGO prostate metrics were (median with range): V19Gy = 98.3 (85.8 - 100) % vs 95.9 (87.5 - 99.6, p = 0.008 < 0.05) %; D90 = 20.8 (18.3 - 22.3) Gy vs 21.0 (18.2 - 23.2, p = 0.1 > 0.05) Gy; D98 = 19.1 (16.6 - 21.1) Gy vs 17.7 (14.1 - 20.0, p = 8 × 10−5 < 0.05) Gy; Dmin = 16.5 (15.2 - 18.7) Gy vs 12.5 (10.5 - 16.4, p = 4 × 10−10 < 0.05) Gy. ABCD respected rectum and urethral constraints; commercial optimizer plans had to be rescaled to meet the constraints. Conclusion Dose escalation to the prostate was possible with ABCD without iterative optimization by the user. While ABCD did not specifically aim to escalate D90 dose, it achieved similar results compared to specific D90 escalation strategies with a commercial optimizer while at the same time permitting statistically significant dose escalation of all other metrics investigated. Further work is ongoing to investigate the utility in DIL boosts, as well as integrating needle suggestions within the optimization step to provide superior dose coverage.
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