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Purpose: Automatic planning for focal low-dose-rate prostate brachytherapy(LDR-PB) boost.  Methods: A simulated annealing approach was utilized for creating automaticfocal LDR-PB boost plans using both geometric (i.e. adherence of isodosecontours to structure contours) and dosimetric constraints. In 46 patients,four unilateral focal lesion scenarios were considered as the boost region, inthe anterior/posterior and superior/inferior quadrants. Plans consisted ofseeds with two air kerma strengths (0.740U and 0.351 or 0.354U) to achieverequired dose coverage on these smaller focal targets. Plan characteristics(including PTV V100 and V150, Rectum V50, Urethra V150, and number of needlesand seeds), were compared in terms of type of needle loading (dual vs. singleair kerma needles), boost quadrant and prostate volume. Plans were blindlyranked on 20 consecutive cases by two experienced radiation oncologists.  Results: Differences in plans generated using the two needle loadingtechniques were not clinically significant, particularly in terms of the PTVV100 and V150 and Urethra V150, with single air kerma loaded needlespotentially being more practical. A higher rectal dose was observed in theposterior boost quadrants (V50 >0.18), particularly in larger prostates (>40cc). In smaller prostates (<25 cc), obtaining adequate dose coverage whilesparing the urethra was more challenging. 88% of the plans were consideredclinically acceptable without (46%) or with (mostly minor) modifications.  Conclusions: The novel approach of using dual air kerma seeds combined withgeometric constraints within a simulated annealing-based automatic planningframework can lead to focal LDR-PB plans with high acceptability.

Automatic dual air kerma strength treatment planning for focal low-dose-rate prostate brachytherapy boost using dosimetric and geometric constraints