Canter Daniel, Kutikov Alexander, Horwitz Eric M, Greenberg Richard E
Department of Urologic Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania 19111, USA.
Can J Urol. 2011 Aug;18(4):5844-8.
Surgical treatment for men with localized prostate cancer -open, laparoscopic, or robotically-assisted-- remains one of the therapeutic mainstays for this group of patients. Despite the stage migration witnessed in patients with prostate cancer since the introduction of prostate-specific antigen (PSA) screening, detection of extraprostatic disease at the time of surgery and biochemical recurrence following prostatectomy pose significant therapeutic challenges. 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. These transponders can be placed into the empty prostatic bed after prostatectomy to facilitate the delivery of radiation therapy in the post-surgical setting. In this article, we detail our technique for transrectal placement of electromagnetic transponders into the post-prostatectomy bed for the delivery of adjuvant or salvage intensity-modulated radiation therapy. We prefer this technique of post-surgical radiation therapy because it allows for improved localization of the target area allowing for the maximal delivery of the radiation dose while minimizing exposure of surrounding normal tissues. Although emerging, our initial oncologic and functional outcomes have been promising.
对于局限性前列腺癌男性患者，手术治疗——开放手术、腹腔镜手术或机器人辅助手术——仍然是这类患者的主要治疗手段之一。尽管自引入前列腺特异性抗原（PSA）筛查以来，前列腺癌患者出现了分期迁移，但手术时检测到前列腺外疾病以及前列腺切除术后的生化复发带来了重大的治疗挑战。根治性前列腺切除术（RP）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医疗技术公司）是一种目标定位设备，可连续监测三个可植入电磁应答器的位置。这些应答器可在前列腺切除术后放置到空的前列腺床中，以便在术后环境中进行放射治疗。在本文中，我们详细介绍了经直肠将电磁应答器放置到前列腺切除术后床中以进行辅助或挽救性调强放射治疗的技术。我们更喜欢这种术后放射治疗技术，因为它可以改善靶区定位，在使周围正常组织暴露最小化的同时，最大程度地给予放射剂量。尽管尚处于起步阶段，但我们初步的肿瘤学和功能结果很有前景。
