Martin Thomas, Baltas Dimos, Kurek Ralf, Röddiger Sandra, Kontova Marina, Anagnostopoulos Georgios, Dannenberg Thomas, Buhleier Thomas, Skazikis Georgies, Tunn Ulf, Zamboglou Nikolaos
Department of Radiation Oncology, Klinikum Offenbach, Offenbach/Main, Germany.
Strahlenther Onkol. 2004 Apr;180(4):225-32. doi: 10.1007/s00066-004-1215-4.
Pilot study to evaluate feasibility, acute toxicity and conformal quality of three-dimensional (3-D) conformal high-dose- rate (HDR) brachytherapy as monotherapy for localized prostate cancer using intraoperative real-time planning.
Between 05/2002 and 05/2003, 52 patients with prostate cancer, prostate-specific antigen (PSA) < or = 10 ng/ml, Gleason score < or = 7 and clinical stage < or = T2a were treated. Median PSA was 6.4 ng/ml and median Gleason score 5. 24/52 patients had stage T1c and 28/52 stage T2a. For transrectal ultrasound-(TRUS-)guided transperineal implantation of flexible plastic needles into the prostate, the real-time HDR planning system SWIFT((R)) was used. After implantation, CT-based 3-D postplanning was performed. All patients received one implant for four fractions of HDR brachytherapy in 48 h using a reference dose (D(ref)) of 9.5 Gy to a total dose of 38.0 Gy. Dose-volume histograms (DVHs) were analyzed to evaluate the conformal quality of each implant using D(90), D(10) urethra, and D(10) rectum. Acute toxicity was evaluated using the CTC (Common Toxicity Criteria) scales.
Median D(90) was 106% of D(ref) (range: 93-115%), median D(10) urethra 159% of D(ref) (range: 127-192%), and median D(10) rectum 55% of D(ref) (range: 35-68%). Median follow-up is currently 8 months. In 2/52 patients acute grade 3 genitourinary toxicity was observed. No gastrointestinal toxicity > grade 1 occurred.
3-D conformal HDR brachytherapy as monotherapy using intraoperative real-time planning is a feasible and highly conformal treatment for localized prostate cancer associated with minimal acute toxicity. Longer follow-up is needed to evaluate late toxicity and biochemical control.
进行一项初步研究，以评估术中实时计划的三维（3-D）适形高剂量率（HDR）近距离放射治疗作为局限性前列腺癌单一疗法的可行性、急性毒性和适形质量。
在2002年5月至2003年5月期间，对52例前列腺癌患者进行了治疗，这些患者的前列腺特异性抗原（PSA）≤10 ng/ml，Gleason评分≤7，临床分期≤T2a。PSA中位数为6.4 ng/ml，Gleason评分中位数为5。52例患者中，24例为T1c期，28例为T2a期。对于经直肠超声（TRUS）引导下经会阴将柔性塑料针植入前列腺的操作，使用了实时HDR计划系统SWIFT（R）。植入后，进行基于CT的三维后装计划。所有患者均接受一次植入，在48小时内分4次进行HDR近距离放射治疗，参考剂量（D（ref））为9.5 Gy，总剂量为38.0 Gy。分析剂量体积直方图（DVH），使用D（90）、尿道D（10）和直肠D（10）评估每次植入的适形质量。使用常见毒性标准（CTC）量表评估急性毒性。
D（90）中位数为D（ref）的106%（范围：93 - 115%），尿道D（10）中位数为D（ref）的159%（范围：127 - 192%），直肠D（10）中位数为D（ref）的55%（范围：35 - 68%）。目前中位随访时间为8个月。在52例患者中有2例观察到急性3级泌尿生殖系统毒性。未发生大于1级的胃肠道毒性。
术中实时计划的三维适形HDR近距离放射治疗作为单一疗法，对于局限性前列腺癌是一种可行且高度适形的治疗方法，急性毒性极小。需要更长时间的随访来评估晚期毒性和生化控制情况。
