Prada Pedro J, Gonzalez Herminio, Menéndez Consuelo, Llaneza Ana, Fernández José, Santamarta Elena, Ricarte Pedro Pérez
Department of Radiation Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Department of Radiation Oncology, Hospital Universitario Central de Asturias, Oviedo, Spain.
Brachytherapy. 2009 Apr-Jun;8(2):210-217. doi: 10.1016/j.brachy.2008.11.010. Epub 2009 Feb 12.
Monitored rectal late morbidity using proctoscopy and a modified radiation therapy oncology group rectal bleeding scoring scale, in patients treated with permanent implant of I-125 and submitted to rectal protection with hyaluronic acid (HA) injecting in the perirectal fat to increase the distance between the prostate and the anterior rectal wall to decrease rectal toxicity. This is the first article looking at such injections in low-dose-rate brachytherapy patients and subsequent rectal toxicity.
Between January 2005 and July 2006, a total of 69 consecutive outpatients with low- and intermediate-risk prostate cancer were enrolled in a clinical trial. First group received brachytherapy alone with I-125 and the second group received brachytherapy I-125 and protection of the rectal wall with HA. We injected 6-8cc of HA in the perirectal fat, to increase the distance between the prostate and the anterior rectal wall. Proctoscopic examinations with scoring of mucosal damage were performed according to a descriptive scale, described by Wachter et al. The median follow-up at time of endoscopy was 18 months. Toxicity measures included modified radiation therapy oncology group late bleeding toxicity grading.
The hyaluronic and non-hyaluronic groups were similar for most patients, in tumor, treatment, and dosimetric characteristics. Patients treated with brachytherapy I-125 and rectal protection with HA had significantly smaller incidence of mucosal damage at the proctoscopic examinations (5% vs. 36%, p=0.002) and no macroscopic rectal bleeding (0% vs. 12%, p=0.047) than those treated with brachytherapy I-125 alone without HA. No toxicity was produced from the HA or its injection.
The increased distance between the rectal wall and the prostate, as a result from the injection of HA in the perirectal fat, has significantly decreased the rectal dose from low-dose-rate brachytherapy. Patients treated with brachytherapy I-125 and protection rectal with HA had significantly smaller incidence of mucosal damage at the proctoscopic examinations and no macroscopic rectal bleeding than those treated with brachytherapy I-125 alone without HA.
使用直肠镜检查和改良的放射肿瘤学组直肠出血评分量表监测直肠晚期发病率，这些患者接受了碘-125永久性植入治疗，并通过在直肠周围脂肪中注射透明质酸（HA）进行直肠保护，以增加前列腺与直肠前壁之间的距离，从而降低直肠毒性。这是首篇研究低剂量率近距离放射治疗患者进行此类注射及后续直肠毒性的文章。
2005年1月至2006年7月，共有69例连续的低危和中危前列腺癌门诊患者参加了一项临床试验。第一组仅接受碘-125近距离放射治疗，第二组接受碘-125近距离放射治疗并使用HA保护直肠壁。我们在直肠周围脂肪中注射6-8cc的HA，以增加前列腺与直肠前壁之间的距离。根据Wachter等人描述的描述性量表对黏膜损伤进行直肠镜检查评分。内镜检查时的中位随访时间为18个月。毒性测量包括改良的放射肿瘤学组晚期出血毒性分级。
在肿瘤、治疗和剂量学特征方面，大多数患者的透明质酸组和非透明质酸组相似。接受碘-125近距离放射治疗并使用HA进行直肠保护的患者，直肠镜检查时黏膜损伤的发生率显著更低（5%对36%，p=0.002），且无肉眼可见的直肠出血（0%对12%，p=0.047），而仅接受碘-125近距离放射治疗而未使用HA的患者则不然。HA及其注射未产生毒性。
通过在直肠周围脂肪中注射HA，直肠壁与前列腺之间的距离增加，显著降低了低剂量率近距离放射治疗的直肠剂量。接受碘-125近距离放射治疗并使用HA保护直肠的患者，直肠镜检查时黏膜损伤的发生率显著更低，且无肉眼可见的直肠出血，而仅接受碘-125近距离放射治疗而未使用HA的患者则不然。
