Thomas M. Pisansky, MD, Douglas G. Gold, MD, PhD, Keith M

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High-Dose-Rate Brachytherapy in the Curative Treatment of Patients With Localized Prostate Cancer Thomas M. Pisansky, MD, Douglas G. Gold, MD, PhD, Keith M. Furutani, PhD, O. Kenneth Macdonald, MD, Robert H. McLaren, MD, Lance A. Mynderse, MD, Torrence M. Wilson, MD, James R. Hebl, MD, Richard Choo, MD Mayo Clinic Proceedings Volume 83, Issue 12, Pages 1364-1372 (December 2008) DOI: 10.4065/83.12.1364 Copyright © 2008 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 1 Effect of dose rate on radiation-induced killing of cancer cells. Adapted from Principles and Practice of Brachytherapy,7 with permission from Blackwell Publishers Ltd. Mayo Clinic Proceedings 2008 83, 1364-1372DOI: (10.4065/83.12.1364) Copyright © 2008 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 2 Comparison of dosimetric quality parameters in high-dose-rate (HDR) brachytherapy and low-dose-rate (LDR) brachytherapy for patients with prostate cancer. Higher percent values are preferable for the volume of prostate receiving 100% of the prescribed dose (V100) and for the dose to 90% of the prostate (D90). Lower percent values are desirable for the prostate volume receiving 150% (V150) or 200% (V200) of the prescribed dose, and for the maximum dose received by the adjacent healthy organs: the urethra (Umax) and rectum (Rmax). Data from Brachytherapy.10 Mayo Clinic Proceedings 2008 83, 1364-1372DOI: (10.4065/83.12.1364) Copyright © 2008 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 3 Patient with prostate cancer who is in dorsal lithotomy position, with implantation equipment for high-dose-rate brachytherapy. The insets show (upper left) the face of the template through which brachytherapy needles are guided into the prostate and (upper right) an axial transrectal ultrasound (TRUS) schematic of the prostate with the template matrix superimposed. Mayo Clinic Proceedings 2008 83, 1364-1372DOI: (10.4065/83.12.1364) Copyright © 2008 Mayo Foundation for Medical Education and Research Terms and Conditions

FIGURE 4 Effect of high-dose-rate brachytherapy combined with external-beam radiotherapy on fraction of patients free from biochemical relapse. High dose (dotted line) was defined as 1650 cGy or greater. Low dose (solid line) was defined as less than 1650 cGy. Adapted from Strahlenther Onkol,3 with permission. Copyright Urban & Vogel. Mayo Clinic Proceedings 2008 83, 1364-1372DOI: (10.4065/83.12.1364) Copyright © 2008 Mayo Foundation for Medical Education and Research Terms and Conditions