由于 HDR 近距离治疗前列腺癌时的针插入导致的金标记移位：一项前瞻性锥形束计算机断层扫描和千伏在线成像（kV-OBI）研究。
Gold marker displacement due to needle insertion during HDR-brachytherapy for treatment of prostate cancer: a prospective cone beam computed tomography and kilovoltage on-board imaging (kV-OBI) study.
机构信息
Department of Radiotherapy, University of Goettingen, Goettingen, Germany.
出版信息
Radiat Oncol. 2012 Feb 20;7:24. doi: 10.1186/1748-717X-7-24.
PURPOSE
To evaluate gold marker displacement due to needle insertion during HDR-brachytherapy for therapy of prostate cancer.
PATIENTS AND METHODS
18 patients entered into this prospective evaluation. Three gold markers were implanted into the prostate during the first HDR-brachytherapy procedure after the irradiation was administered. Three days after marker implantation all patients had a CT-scan for planning purpose of the percutaneous irradiation. Marker localization was defined on the digitally-reconstructed-radiographs (DRR) for daily (VMAT technique) or weekly (IMRT) set-up error correction. Percutaneous therapy started one week after first HDR-brachytherapy. After the second HDR-brachytherapy, two weeks after first HDR-brachtherapy, a cone-beam CT-scan was done to evaluate marker displacement due to needle insertion. In case of marker displacement, the actual positions of the gold markers were adjusted on the DRR.
RESULTS
The value of the gold marker displacement due to the second HDR-brachytherapy was analyzed in all patients and for each gold marker by comparison of the marker positions in the prostate after soft tissue registration of the prostate of the CT-scans prior the first and second HDR-brachytherapy. The maximum deviation was 5 mm, 7 mm and 12 mm for the anterior-posterior, lateral and superior-inferior direction. At least one marker in each patient showed a significant displacement and therefore new marker positions were adjusted on the DRRs for the ongoing percutaneous therapy.
CONCLUSIONS
Needle insertion in the prostate due to HDR-brachytherapy can lead to gold marker displacements. Therefore, it is necessary to verify the actual position of markers after the second HDR-brachytherapy. In case of significant deviations, a new DRR with the adjusted marker positions should be generated for precise positioning during the ongoing percutaneous irradiation.
目的
评估 HDR 近距离治疗前列腺癌时因针插入导致的金标记物移位。
方法
18 名患者参与了这项前瞻性评估。在 HDR 近距离治疗后第一次照射期间，将三个金标记物植入前列腺。植入标记物三天后，所有患者均进行 CT 扫描，以规划经皮照射。在数字重建射线照片（DRR）上定义标记物定位，以进行每日（VMAT 技术）或每周（IMRT）的设置误差校正。第一次 HDR 近距离治疗后一周开始进行经皮治疗。在第一次 HDR 近距离治疗后两周，第二次 HDR 近距离治疗后，进行锥形束 CT 扫描，以评估因针插入导致的标记物位移。如果发生标记物位移，则在 DRR 上调整金标记物的实际位置。
结果
通过比较第一次和第二次 HDR 近距离治疗前 CT 扫描中前列腺的软组织注册后的前列腺内标记物位置，分析了所有患者和每个金标记物因第二次 HDR 近距离治疗导致的金标记物位移值。前-后、侧和上-下方向的最大偏差分别为 5mm、7mm 和 12mm。至少在每个患者的一个标记物中显示出明显的位移，因此在进行中的经皮治疗中，对 DRR 上的新标记物位置进行了调整。
结论
由于 HDR 近距离治疗，前列腺内的针插入可导致金标记物移位。因此，有必要在第二次 HDR 近距离治疗后验证标记物的实际位置。如果发生明显偏差，应生成带有调整后标记物位置的新 DRR，以便在进行中的经皮照射期间进行精确定位。
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