Efficacy of curvilinear catheter implantation for prostate cancer interventions

Abstract

High-dose-rate (HDR) brachytherapy (BT) is a widely utilized treatment for patients with intermediate- and high-risk prostate cancer. Despite its proven efficacy, it is often associated with side effects such as edema, urinary incontinence, and sexual dysfunction. A key limitation of HDR BT, however, lies in the risk of delivering excessive radiation to nearby organs-at-risk (OARs), including the urethra, bladder, and rectum. To minimize radiation exposure to OARs and improve patient outcomes, curvilinear catheter implantation has been investigated as an alternative to conventional rectilinear techniques. Unlike rectilinear catheter placement, curvilinear implantation enables the catheters to better conform to the natural contours of the prostate. This enhanced conformity allows for more precise dose delivery, reducing radiation exposure to surrounding OARs, while also potentially decreasing the number of needles required for the procedure. Despite its clear advantages, curvilinear catheter implantation has not been widely adopted in clinical practice due to challenges related to needle control, precise placement, and insertion accuracy. This work represents the culmination of a series of studies that: (i) evaluate the effectiveness of curvilinear catheter application, (ii) explore methods to control the initial needle insertion angle, (iii) develop robotic systems for precise needle insertion, and (iv) support the training of new physicians in curvilinear catheter implantation techniques.