Canter Daniel, Greenberg Richard E, Horwitz Eric M, Kutikov Alexander, Li Jinsheng, Long Christopher, Buyyounouski Mark, Boorjian Stephen A
Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA.
Can J Urol. 2010 Oct;17(5):5365-9.
Radiation therapy (RT) after radical prostatectomy (RP) has been associated with a survival benefit in both the adjuvant and salvage setting. Nevertheless, optimal targeting of the prostate bed following surgery remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA, USA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. We describe our technique of ultrasound-guided placement of these transponders into the prostate bed for adjuvant and salvage RT.
Seventeen patients presenting to Fox Chase Cancer Center for postoperative RT underwent transrectal ultrasound-guided placement of Calypso beacons. The three transponders were placed approximately 1 cm apart in a triangular fashion around the vesico-urethral anastomosis and in the retrovesicular tissue.
All patients were successfully implanted without periprocedural complications. Appropriate beacon position was confirmed by CT scan performed at the time of RT simulation. Intensity-modulated radiation therapy was delivered at a dose of 68 Gy (range 64-68). Treatment was well-tolerated with no Grade 3 or 4 toxicities. Grade > 2 enteritis was not observed, and there were no cases of rectal bleeding. Genitourinary toxicity was noted in 10 patients and consisted of Grade 1 and 2 frequency and dysuria. No patient developed gross hematuria or urinary retention. All patients (9/9) with at least 6 months of follow up after treatment had an undetectable PSA.
The placement of Calypso transponders for adjuvant/salvage RT is a safe and efficacious method for treatment targeting with an acceptable acute toxicity profile.
根治性前列腺切除术后进行放射治疗（RT）在辅助治疗和挽救性治疗中均与生存获益相关。然而，术后前列腺床的最佳靶向定位仍然具有挑战性。Calypso 4D定位系统（美国华盛顿州西雅图市的Calypso Medical Technologies公司）是一种靶区定位设备，可连续监测三个可植入电磁应答器的位置。我们描述了在辅助性和挽救性放疗中，经超声引导将这些应答器放置到前列腺床的技术。
17例到福克斯蔡斯癌症中心接受术后放疗的患者接受了经直肠超声引导下的Calypso信标放置。三个应答器以三角形方式围绕膀胱尿道吻合口并在膀胱后组织中彼此相距约1 cm放置。
所有患者均成功植入，无围手术期并发症。在放疗模拟时通过CT扫描确认了信标位置合适。调强放射治疗的剂量为68 Gy（范围64 - 68）。治疗耐受性良好，无3级或4级毒性反应。未观察到>2级的肠炎，也无直肠出血病例。10例患者出现泌尿生殖系统毒性，表现为1级和2级尿频和排尿困难。无患者发生肉眼血尿或尿潴留。所有接受治疗后至少随访6个月的患者（9/9）PSA检测不到。
放置Calypso应答器用于辅助/挽救性放疗是一种安全有效的治疗靶向方法，急性毒性反应可接受。
