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Papers by Thomas BRUN

Heart Rhythm, May 1, 2022

Strahlentherapie und Onkologie, 2021

This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor b... more This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3–4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1–2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5‑year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4–85.1), 61.6% (95% CI = 49.0–72.0), and 71.4% (95% CI = 58.6–80.8), respectively. Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication.

International Journal of Radiation Oncology*Biology*Physics, 2018

Focal treatments aim at treating the IT and sparing the rest of the prostate gland. The combinati... more Focal treatments aim at treating the IT and sparing the rest of the prostate gland. The combination of approved technologies in imaging and treatment has allowed for the effective delivery of interstitial radiation to small MRI targets. At 1 year, the treated area was clear of cancer and the toxicities were negligible. Purpose: Focal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterized index tumors (ITs). We assessed the feasibility of low-dose-rate ultrafocal brachytherapy. Methods and Materials: The present study was an institutional review boardeapproved European Clinical Trials Databaseeregistered phase II protocol. Patients referred (October 2013 to August 2016) for active surveillance (prostate-specific antigen <10 ng/mL, cT1c-cT2a, Gleason score on referring biopsy specimens 6 (3þ3), 3 positive biopsy cores, 50% of cancer) were preselected. Inclusion was confirmed when complementary image-guided biopsy findings informed a single Prostate Imaging Reporting and Data System (PI-RADS) !3, Gleason score 7a (3þ4) lesion. A ultrasound-visible ancillary marker was positioned within the IT using a magnetic resonance imaging (MRI)/3-dimensional transrectal ultrasound (TRUS) elastic fusionguided system (Koelis). Ultrafocal transperineal delivery of 125 I seeds used classic 2dimensional TRUS (Bard-FlexFocus) and dose optimization (Variseed Treatment Planning System). Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering !95% of the prescribed dose (160 Gy) to the IT (primary objective). Adverse events (Common Terminology Criteria for Adverse Events) and quality of life (5-item International Index of Erectile Function, International Prostate Symptom

Journal of Contemporary Brachytherapy, 2018

Purpose: The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-... more Purpose: The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-rate brachytherapy mesh implantation in pelvic locations in an animal model, before applying it clinically. Material and methods: The animal model was the Romanov adult ewe. Non-radioactive dummy I-125 seeds were implanted by laparotomy in the pelvic area. Forty-five dummy seeds were placed on a 10 cm² polyglactin mesh to obtain a dose of 160 Gy at 5 mm from the center of each seed. Three CT scans were performed at day 15, day 70, and day 180 after surgery to check the positioning of the mesh for eventual seed migration according to bony landmarks and to perform a 3D theoretical dosimetric study. The experimental study design was based on Simon's minimax plan with a preliminary analysis of 10 ewes to validate the protocol and a second series of 7 ewes. Results: After the first step, 9 of 10 ewes were investigated. For 8 of 9 animals, the 160 Gy isodose line volume was within 10%, showing feasibility of the procedure and allowing 7 more to be added. At the end of the study, 16 of 17 animals were examined. No seeds loss was observed. The volume difference of the 160 Gy isodose line was within 10% in 13 of 16 ewes between the three CT scans. Twelve out of 16 had a coordinate deviation less than or equal to 10 mm on the three axes between the first and the third scans. Conclusions: These results show the technical feasibility of the pelvic mesh implantation in ewes. A phase I study for patients with locally advanced or recurrent pelvic tumors amenable to surgery, in combination with surgical resection should be possible.

Brachytherapy

To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with... more To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with multiparametric MRI for low- and intermediate-risk prostate cancer. UFB provisional dose plans for small target volumes (<7 cc) were calculated on a prostate training phantom to optimize the seeds number and strength. Clinical UFB consisted in a contour-based nonrigid registration (MRI/Ultrasound) to implant a fiducial marker at the location of the tumor focus. Dosimetry was performed with iodine-125 seeds and a prescribed dose of 160 Gy. On CT scans acquired at 1 month, dose coverage of 152 Gy to the ultra-focal gross tumor volume was evaluated. Registrations between magnetic resonance and CT scans were assessed on the first 8 patients with three software solutions: VariSeed, 3D Slicer, and Mirada, and quantitative evaluations of the registrations were performed. Impact of these registrations on the initial dose matrix was performed. Mean differences between simulated dose plans and...

Journal of Clinical Oncology, 2017

e555 Background: Focal brachytherapy is proposed in our institute as an alternative treatment to ... more e555 Background: Focal brachytherapy is proposed in our institute as an alternative treatment to active surveillance for low-grade prostate cancer (PCa). This study aims at characterizing the tumor focus and its margin with multiparametric Magnetic Resonance Imaging (mpMRI). Methods: Patients pre-qualified for this study were positive for PCa (Gleason 3+3) on a previous standard biopsy series. New series of mp-MRI-guided and ultrasound-targeted biopsies were performed and in total, 17 patients with confirmed tumor and diameter < 20mm were included in this phase II clinical trial (NCT01902680). mpMRI were acquired on a 1.5T Magnetom Aera Siemens scan. Anatomic imaging consists in Fast Spin Echo T2-weighted MRI (T2-MRI) and functional Diffusion Weighted MRI (DWI-MRI) and Dynamic Contrast Enhanced MRI (DCE-MRI) were also performed. After mpMRI registration, tumor volumes of interest (VOI) were drawn on anatomic T2-MRI. VOI and VOI+2mm were reported on functional DWI-MRI and DCE-MRI....

Journal of Clinical Oncology, 2017

124 Background: Biology suggests that the most significant focus drives the natural history of pr... more 124 Background: Biology suggests that the most significant focus drives the natural history of prostate cancer. We assessed the feasibility of ultrafocal brachytherapy (BT) of the index tumor. Methods: In a 2-step Simon’s design (&=0.1, ß=0.1), 17 patients were needed to assess that 100% of clinical target volume (CTV) - gross tumor volume on T2-MRI plus 2mm margin - received ≥95% of the prescribed dose (primary objective: D100≥152Gy). Pre-inclusion:EAU guidelines for Surveillance [PSA <10ng/mL, cT1c-cT2a, Gleason sum on referring biopsies ≤6(3+3), ≤3 positive biopsies, ≤50% of cancer] and for BT [IPSS <10, no TURP, prostate <60mL, >10yr life expectancy]. Inclusion:when mpMRI detected a PIRADS≥3 focal lesion, confirmed as Gleason sum ≤7a (3+4) cancer on elastic fusion registration (EFR) biopsies (Koelis). Procedure:EFR was used to insert trans-rectally a US-visible marker (Bard SourceLink) within CTV before biplanar TRUS for BT. Dose distribution was optimized by inverse...

Physica Medica, 2015

To compare detectors for dosimetric verification before VMAT treatments and evaluate their sensit... more To compare detectors for dosimetric verification before VMAT treatments and evaluate their sensitivity to errors. Measurements using three detectors (ArcCheck, 2d array 729 and EPID) were used to validate the dosimetric accuracy of the VMAT delivery. Firstly, performance of the three devices was studied. Secondly, to assess the reliability of the detectors, 59 VMAT treatment plans from a variety of clinical sites were considered. Thirdly, systematic variations in collimator, couch and gantry angle plus MLC positioning were applied to four clinical treatments (two prostate, two head and neck cases) in order to establish the detection sensitivity of the three devices. Measurements were compared with TPS computed doses via gamma analysis (3%/3 mm and 2%/2 mm) with an agreement of at least 95% and 90% respectively in all pixels. Effect of the errors on the dose distributions was analyzed. Repeatability and reproducibility were excellent for the three devices. The average pass rate for the 59 cases was superior to 98% for all devices with 3%/3 mm criteria. It was found that for the plans delivered with errors, the sensitivity was quite similar for all devices. Devices were able to detect a 2 mm opened or closed MLC error with 3%/3 mm tolerance level. An error of 3° in collimator, gantry or couch rotation was detected by the three devices using 2%/2 mm criteria. All three devices have the potential to detect errors with more or less the same threshold. Nevertheless, there is no guarantee that pretreatment QA will catch delivery errors.

Springer Optimization and Its Applications, 2008

ABSTRACT For the past 20 years, ontologies have become more and more popular in various research ... more ABSTRACT For the past 20 years, ontologies have become more and more popular in various research fields such as Web technologies, databases, information retrieval methods, and so forth. The first goal of this chapter is to answer general questions about ontologies, such as: What exactly is an ontology? What is the purpose of ontology? Which types of systems use an ontology? The second goal of the chapter is to help readers understand how UML can be used to model ontologies in agricultural systems. UML and the Web Ontology Language (OWL) are compared, and an example inspired by the French project named Farm Information Management is presented.

International Journal of Radiation Oncology Biology Physics, 2013

Between 2000 and 2008, 574 consecutive patients underwent I-125 permanent prostate brachytherapy ... more Between 2000 and 2008, 574 consecutive patients underwent I-125 permanent prostate brachytherapy for low-risk and intermediaterisk prostate cancer. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. The median follow-up time was 69.3 months. Satisfactory 5-year biochemical recurrence-free survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (PZ.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.

Heart Rhythm, May 1, 2022

Strahlentherapie und Onkologie, 2021

This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor b... more This study aims to assess the outcomes of adjuvant interstitial brachytherapy (BT) to the tumor bed for oral cavity squamous cell carcinoma (SCC), and to compare the oncological outcomes and toxicity profile of low-dose-rate (LDR) and pulsed-dose-rate (PDR) BT. This retrospective single-center study included all patients who underwent postoperative LDR- or PDR-BT to the tumor bed as the sole adjuvant treatment for an oral tongue or floor of the mouth SCC between January 2000 and December 2020. A total of 79 patients were eligible for this study. The cohort was divided into an LDR group (n = 38) and a PDR group (n = 41). The median time interval between surgery and brachytherapy was 55 days. Median delivered total dose was 55 Gy and median hospital stay was 5 days. Five patients (8.3%) experienced grade 3–4 early toxicity, 2 in the LDR group and 3 in the PDR group. Late toxicities were present in 28 patients (44.4%) and were dominated by grade 1–2 residual pain and dysesthesia, without a statistical difference between the groups. After a median follow-up of 65.1 months, 5‑year local control (LC), disease-free survival (DFS), and overall survival (OS) for the whole cohort were 76.3% (95% CI = 63.4–85.1), 61.6% (95% CI = 49.0–72.0), and 71.4% (95% CI = 58.6–80.8), respectively. Adjuvant BT after excision of oral cavity SCC provides satisfactory oncological outcomes along with good tolerance. In our study, PDR-BT showed similar oncological and functional results to LDR-BT in this indication.

International Journal of Radiation Oncology*Biology*Physics, 2018

Focal treatments aim at treating the IT and sparing the rest of the prostate gland. The combinati... more Focal treatments aim at treating the IT and sparing the rest of the prostate gland. The combination of approved technologies in imaging and treatment has allowed for the effective delivery of interstitial radiation to small MRI targets. At 1 year, the treated area was clear of cancer and the toxicities were negligible. Purpose: Focal therapy of prostate cancer requires precise positioning of therapeutic agents within well-characterized index tumors (ITs). We assessed the feasibility of low-dose-rate ultrafocal brachytherapy. Methods and Materials: The present study was an institutional review boardeapproved European Clinical Trials Databaseeregistered phase II protocol. Patients referred (October 2013 to August 2016) for active surveillance (prostate-specific antigen <10 ng/mL, cT1c-cT2a, Gleason score on referring biopsy specimens 6 (3þ3), 3 positive biopsy cores, 50% of cancer) were preselected. Inclusion was confirmed when complementary image-guided biopsy findings informed a single Prostate Imaging Reporting and Data System (PI-RADS) !3, Gleason score 7a (3þ4) lesion. A ultrasound-visible ancillary marker was positioned within the IT using a magnetic resonance imaging (MRI)/3-dimensional transrectal ultrasound (TRUS) elastic fusionguided system (Koelis). Ultrafocal transperineal delivery of 125 I seeds used classic 2dimensional TRUS (Bard-FlexFocus) and dose optimization (Variseed Treatment Planning System). Following Simon's optimal design, 17 patients were required to assess the feasibility of delivering !95% of the prescribed dose (160 Gy) to the IT (primary objective). Adverse events (Common Terminology Criteria for Adverse Events) and quality of life (5-item International Index of Erectile Function, International Prostate Symptom

Journal of Contemporary Brachytherapy, 2018

Purpose: The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-... more Purpose: The aim of this study is to investigate the feasibility of perioperative I-125 low-dose-rate brachytherapy mesh implantation in pelvic locations in an animal model, before applying it clinically. Material and methods: The animal model was the Romanov adult ewe. Non-radioactive dummy I-125 seeds were implanted by laparotomy in the pelvic area. Forty-five dummy seeds were placed on a 10 cm² polyglactin mesh to obtain a dose of 160 Gy at 5 mm from the center of each seed. Three CT scans were performed at day 15, day 70, and day 180 after surgery to check the positioning of the mesh for eventual seed migration according to bony landmarks and to perform a 3D theoretical dosimetric study. The experimental study design was based on Simon's minimax plan with a preliminary analysis of 10 ewes to validate the protocol and a second series of 7 ewes. Results: After the first step, 9 of 10 ewes were investigated. For 8 of 9 animals, the 160 Gy isodose line volume was within 10%, showing feasibility of the procedure and allowing 7 more to be added. At the end of the study, 16 of 17 animals were examined. No seeds loss was observed. The volume difference of the 160 Gy isodose line was within 10% in 13 of 16 ewes between the three CT scans. Twelve out of 16 had a coordinate deviation less than or equal to 10 mm on the three axes between the first and the third scans. Conclusions: These results show the technical feasibility of the pelvic mesh implantation in ewes. A phase I study for patients with locally advanced or recurrent pelvic tumors amenable to surgery, in combination with surgical resection should be possible.

Brachytherapy

To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with... more To present the feasibility study of optimal dose coverage in ultra-focal brachytherapy (UFB) with multiparametric MRI for low- and intermediate-risk prostate cancer. UFB provisional dose plans for small target volumes (<7 cc) were calculated on a prostate training phantom to optimize the seeds number and strength. Clinical UFB consisted in a contour-based nonrigid registration (MRI/Ultrasound) to implant a fiducial marker at the location of the tumor focus. Dosimetry was performed with iodine-125 seeds and a prescribed dose of 160 Gy. On CT scans acquired at 1 month, dose coverage of 152 Gy to the ultra-focal gross tumor volume was evaluated. Registrations between magnetic resonance and CT scans were assessed on the first 8 patients with three software solutions: VariSeed, 3D Slicer, and Mirada, and quantitative evaluations of the registrations were performed. Impact of these registrations on the initial dose matrix was performed. Mean differences between simulated dose plans and...

Journal of Clinical Oncology, 2017

e555 Background: Focal brachytherapy is proposed in our institute as an alternative treatment to ... more e555 Background: Focal brachytherapy is proposed in our institute as an alternative treatment to active surveillance for low-grade prostate cancer (PCa). This study aims at characterizing the tumor focus and its margin with multiparametric Magnetic Resonance Imaging (mpMRI). Methods: Patients pre-qualified for this study were positive for PCa (Gleason 3+3) on a previous standard biopsy series. New series of mp-MRI-guided and ultrasound-targeted biopsies were performed and in total, 17 patients with confirmed tumor and diameter < 20mm were included in this phase II clinical trial (NCT01902680). mpMRI were acquired on a 1.5T Magnetom Aera Siemens scan. Anatomic imaging consists in Fast Spin Echo T2-weighted MRI (T2-MRI) and functional Diffusion Weighted MRI (DWI-MRI) and Dynamic Contrast Enhanced MRI (DCE-MRI) were also performed. After mpMRI registration, tumor volumes of interest (VOI) were drawn on anatomic T2-MRI. VOI and VOI+2mm were reported on functional DWI-MRI and DCE-MRI....

Journal of Clinical Oncology, 2017

124 Background: Biology suggests that the most significant focus drives the natural history of pr... more 124 Background: Biology suggests that the most significant focus drives the natural history of prostate cancer. We assessed the feasibility of ultrafocal brachytherapy (BT) of the index tumor. Methods: In a 2-step Simon’s design (&=0.1, ß=0.1), 17 patients were needed to assess that 100% of clinical target volume (CTV) - gross tumor volume on T2-MRI plus 2mm margin - received ≥95% of the prescribed dose (primary objective: D100≥152Gy). Pre-inclusion:EAU guidelines for Surveillance [PSA <10ng/mL, cT1c-cT2a, Gleason sum on referring biopsies ≤6(3+3), ≤3 positive biopsies, ≤50% of cancer] and for BT [IPSS <10, no TURP, prostate <60mL, >10yr life expectancy]. Inclusion:when mpMRI detected a PIRADS≥3 focal lesion, confirmed as Gleason sum ≤7a (3+4) cancer on elastic fusion registration (EFR) biopsies (Koelis). Procedure:EFR was used to insert trans-rectally a US-visible marker (Bard SourceLink) within CTV before biplanar TRUS for BT. Dose distribution was optimized by inverse...

Physica Medica, 2015

To compare detectors for dosimetric verification before VMAT treatments and evaluate their sensit... more To compare detectors for dosimetric verification before VMAT treatments and evaluate their sensitivity to errors. Measurements using three detectors (ArcCheck, 2d array 729 and EPID) were used to validate the dosimetric accuracy of the VMAT delivery. Firstly, performance of the three devices was studied. Secondly, to assess the reliability of the detectors, 59 VMAT treatment plans from a variety of clinical sites were considered. Thirdly, systematic variations in collimator, couch and gantry angle plus MLC positioning were applied to four clinical treatments (two prostate, two head and neck cases) in order to establish the detection sensitivity of the three devices. Measurements were compared with TPS computed doses via gamma analysis (3%/3 mm and 2%/2 mm) with an agreement of at least 95% and 90% respectively in all pixels. Effect of the errors on the dose distributions was analyzed. Repeatability and reproducibility were excellent for the three devices. The average pass rate for the 59 cases was superior to 98% for all devices with 3%/3 mm criteria. It was found that for the plans delivered with errors, the sensitivity was quite similar for all devices. Devices were able to detect a 2 mm opened or closed MLC error with 3%/3 mm tolerance level. An error of 3° in collimator, gantry or couch rotation was detected by the three devices using 2%/2 mm criteria. All three devices have the potential to detect errors with more or less the same threshold. Nevertheless, there is no guarantee that pretreatment QA will catch delivery errors.

Springer Optimization and Its Applications, 2008

ABSTRACT For the past 20 years, ontologies have become more and more popular in various research ... more ABSTRACT For the past 20 years, ontologies have become more and more popular in various research fields such as Web technologies, databases, information retrieval methods, and so forth. The first goal of this chapter is to answer general questions about ontologies, such as: What exactly is an ontology? What is the purpose of ontology? Which types of systems use an ontology? The second goal of the chapter is to help readers understand how UML can be used to model ontologies in agricultural systems. UML and the Web Ontology Language (OWL) are compared, and an example inspired by the French project named Farm Information Management is presented.

International Journal of Radiation Oncology Biology Physics, 2013

Between 2000 and 2008, 574 consecutive patients underwent I-125 permanent prostate brachytherapy ... more Between 2000 and 2008, 574 consecutive patients underwent I-125 permanent prostate brachytherapy for low-risk and intermediaterisk prostate cancer. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. The median follow-up time was 69.3 months. Satisfactory 5-year biochemical recurrence-free survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse Purpose: To review the clinical outcome of I-125 permanent prostate brachytherapy (PPB) for low-risk and intermediate-risk prostate cancer and to compare 2 techniques of loose-seed implantation. Methods and Materials: 574 consecutive patients underwent I-125 PPB for low-risk and intermediate-risk prostate cancer between 2000 and 2008. Two successive techniques were used: conventional implantation from 2000 to 2004 and automated implantation (Nucletron, FIRST system) from 2004 to 2008. Dosimetric and biochemical recurrence-free (bNED) survival results were reported and compared for the 2 techniques. Univariate and multivariate analysis researched independent predictors for bNED survival. Results: 419 (73%) and 155 (27%) patients with low-risk and intermediate-risk disease, respectively, were treated (median follow-up time, 69.3 months). The 60-month bNED survival rates were 95.2% and 85.7%, respectively, for patients with low-risk and intermediate-risk disease (PZ.04). In univariate analysis, patients treated with automated implantation had worse bNED survival rates than did those treated with conventional implantation (P<.0001). By day 30, patients treated with automated implantation showed lower values of dose delivered to 90% of prostate volume (D90) and volume of prostate receiving 100% of prescribed dose (V100). In multivariate analysis, implantation technique, Gleason score, and V100 on day 30 were independent predictors of recurrence-free status. Grade 3 urethritis and urinary incontinence were observed in 2.6% and 1.6% of the cohort, respectively, with no significant differences between the 2 techniques. No grade 3 proctitis was observed. Conclusion: Satisfactory 60-month bNED survival rates (93.1%) and acceptable toxicity (grade 3 urethritis <3%) were achieved by loose-seed implantation. Automated implantation was associated with worse dosimetric and bNED survival outcomes.