Defining a magnetic resonance scan sequence for permanent seed prostate brachytherapy postimplant assessment

AbstractPurposeWe describe a magnetic resonance (MR) scan sequence for prostate brachytherapy postimplant assessment.Methods and MaterialsOne brachytherapy team at the British Columbia Cancer Agency has incorporated MR–CT fusion into their permanent seed prostate brachytherapy quality assurance procedure. Several attempts were required to ensure that the diagnostic MR scanner at the adjoining general hospital performed the desired sequence, providing many examples of suboptimal scans and underlining the pitfalls for a center trying to incorporate the use of MR scanning into their brachytherapy program.ResultsThe recommended sequence (Fast Spin Echo T2-weighted, repetition time [TR]/echo time [TE] 4500/90, echo train length [ETL] 10, 20×20 field of view [FOV], 80 bandwidth [BW]) is associated with superior edge detection when compared with those images in which a typical diagnostic sequence was used. The use of a low bandwidth sequence does not compromise edge detection or seed identification when compared with a higher bandwidth.ConclusionsWe have defined a magnetic resonance imaging sequence, which appears to optimize both prostate delineation and identification of seeds, lending itself to straightforward fusion with CT images and allowing for less uncertainty in permanent seed prostate brachytherapy quality assurance

Smartphones and tablets: Reshaping radiation oncologists’ lives

BackgroundSmartphones and tablets are new handheld devices always connected to an information source and capable of providing instant updates, they allow doctors to access the most updated information and provide decision support at the point of care.AimThe practice of radiation oncology has always been a discipline that relies on advanced technology. Smartphones provide substantial processing power, incorporating innovative user interfaces and applications.Materials and methodsThe most popular smartphone and tablet app stores were searched for “radiation oncology” and “oncology” related apps. A web search was also performed searching for smartphones, tablets, oncology, radiology and radiation oncology.ResultsSmartphones and tablets allow rapid access to information in the form of podcasts, apps, protocols, reference texts, recent research and more.ConclusionWith the rapidly changing advances in radiation oncology, the trend toward accessing resources via smartphones and tablets will only increase, future will show if this technology will improve clinical care

A systematic review of randomised controlled trials of radiotherapy for localised prostate cancer

Background: Prostate cancer is the second most frequently diagnosed cancer and the sixth leading cause of cancer death in males. A systematic review of randomised controlled trials (RCTs) of radiotherapy and other non-pharmacological management options for localised prostate cancer was undertaken. Methods: A search of thirteen databases was carried out until March 2014.RCTs comparing radiotherapy (brachytherapy (BT) or external beam radiotherapy (EBRT)) to other management options i.e. radical prostatectomy (RP), active surveillance, watchful waiting, high intensity focused ultrasound (HIFU), or cryotherapy; each alone or in combination, e.g. with adjuvant hormone therapy (HT), were included. Methods followed guidance by the Centre for Reviews and Dissemination and the Cochrane Collaboration. Indirect comparisons were calculated using the Butcher method. Results: Thirty-six randomised controlled trials (RCTs, 134 references) were included. EBRT, BT and RP were found to be effective in the management of localised prostate cancer. While higher doses of EBRT seem to be related to favourable survival-related outcomes they might, depending on technique, involve more adverse events, e.g. gastrointestinal and genitourinary toxicity. Combining EBRT with hormone therapy shows a statistically significant advantage regarding overall survival when compared to EBRT alone (Relative risk 1.21, 95% confidence interval 1.12-1.30). Aside from mixed findings regarding urinary function, BT and radical prostatectomy were comparable in terms of quality of life and biochemical progression-free survival while favouring BT regarding patient satisfaction and sexual function. There might be advantages of EBRT (with/without HT) compared to cryoablation (with/without HT). No studies on HIFU were identified. Conclusions: Based on this systematic review, there is no strong evidence to support one therapy over another as EBRT, BT and RP can all be considered as effective mono therapies for localised disease with EBRT also effective for post-operative management. All treatments have unique adverse events profiles. Further large, robust RCTs which report treatment-specific and treatment combination-specific outcomes in defined prostate cancer risk groups following established reporting standards are needed. These will strengthen the evidence base for newer technologies, help reinforce current consensus guidelines and establish greater standardisation across practices