Multisource Rotating Shield Brachytherapy Apparatus for Prostate Cancer.

PURPOSE:Our purpose is to present a novel multisource rotating shield brachytherapy (RSBT) apparatus for the simultaneous precise angular and linear positioning of partially shielded 153Gd brachytherapy sources in interstitial needles for the treatment of locally advanced prostate cancer. It is designed to lower the dose to nearby healthy tissues, the urethra in particular, relative to conventional high-dose-rate brachytherapy techniques. METHODS AND MATERIALS:Following needle implantation through the patient template, an angular drive mechanism is docked to the patient template. Each needle is coupled to a multisource afterloader catheter by a connector passing through a shaft. The shafts are rotated about their axes by translating a moving template between 2 stationary templates. The shafts' surfaces and moving template holes are helically threaded with the same pattern such that translation of the moving template causes simultaneous rotation of the shafts. The rotation of each shaft is mechanically transmitted to the catheter-source-shield combination, inside the needles, via several key-keyway pairs. The catheter angles are simultaneously incremented throughout treatment, and only a single 360° rotation of all catheters is needed for a full treatment. For each rotation angle, source depth in each needle is controlled by a multisource afterloader, which is proposed as an array of belt-driven linear actuators, each of which drives a wire that controls catheter depth in a needle. RESULTS:Treatment plans demonstrated that RSBT with the proposed apparatus reduced urethral D0.1cm3 (the minimum dose delivered to the hottest 0.1cm3 of the urethra) below that of conventional high-dose-rate brachytherapy by 31% for urethral dose gradient volume within 3 mm of the urethra surface. Treatment time to deliver 20 Gy with the proposed multisource RSBT apparatus by use of nineteen 62.4-GBq 153Gd sources was 122 minutes. CONCLUSIONS:The proposed RSBT delivery apparatus enables a mechanically feasible urethra-sparing treatment technique for prostate cancer in a clinically reasonable time frame.