Loh Jasmin, Baker Katie, Sridharan Swetha, Greer Peter, Wratten Chris, Capp Anne, Gallagher Sarah, Martin Jarad
Department of Radiation Oncology, Calvary Mater Newcastle Hospital, Edith St, Waratah, NSW, 2298, Australia.
Faculty of Health and Medicine, University of Newcastle, Callaghan, NSW, Australia.
Radiat Oncol. 2015 Feb 13;10:38. doi: 10.1186/s13014-015-0347-2.
The use of gold fiducial markers (FM) for prostate image-guided radiotherapy (IGRT) is standard practice. Published literature suggests low rates of serious infection following this procedure of 0-1.3%, but this may be an underestimate. We aim to report on the infection incidence and severity associated with the use of transrectally implanted intraprostatic gold FM.
Three hundred and fifty-nine patients who underwent transrectal FM insertion between January 2012 and December 2013 were assessed retrospectively via a self-reported questionnaire. All had standard oral fluoroquinolone antibiotic prophylaxis. The patients were asked about infective symptoms and the treatment received including antibiotics and/or related hospital admissions. Potential infective events were confirmed through medical records.
285 patients (79.4%) completed the questionnaire. 77 (27.0%) patients experienced increased urinary frequency and dysuria, and 33 patients (11.6%) reported episodes of chills and fevers after the procedure. 22 patients (7.7%) reported receiving antibiotics for urinary infection and eight patients (2.8%) reported hospital admission for urosepsis related to the procedure.
The overall rate of symptomatic infection with FM implantation in this study is 7.7%, with one third requiring hospital admission. This exceeds the reported rates in other FM implantation series, but is in keeping with the larger prostate biopsy literature. Given the higher than expected complication rate, a risk-adaptive approach may be helpful. Where higher accuracy is important such as stereotactic prostate radiotherapy, the benefits of FM may still outweigh the risks. For others, a non-invasive approach for prostate IGRT such as cone-beam CT could be considered.
使用金基准标记物（FM）进行前列腺图像引导放疗（IGRT）是标准做法。已发表的文献表明，该操作后严重感染的发生率较低，为0 - 1.3%，但这可能是低估了。我们旨在报告经直肠植入前列腺内金FM相关的感染发生率和严重程度。
对2012年1月至2013年12月间接受经直肠FM植入的359例患者通过自我报告问卷进行回顾性评估。所有患者均接受标准口服氟喹诺酮类抗生素预防。询问患者感染症状以及接受的治疗，包括抗生素和/或相关住院情况。潜在感染事件通过病历确认。
285例患者（79.4%）完成了问卷。77例（27.0%）患者术后出现尿频和排尿困难，33例（11.6%）患者报告术后有寒战和发热发作。22例（7.7%）患者报告因尿路感染接受抗生素治疗，8例（2.8%）患者报告因与该操作相关的尿脓毒症住院。
本研究中FM植入后有症状感染的总体发生率为7.7%，其中三分之一需要住院。这超过了其他FM植入系列报道的发生率，但与更大规模的前列腺活检文献一致。鉴于并发症发生率高于预期，风险适应性方法可能会有所帮助。在诸如立体定向前列腺放疗等对准确性要求较高的情况下，FM的益处可能仍大于风险。对于其他情况，可以考虑采用诸如锥形束CT等前列腺IGRT的非侵入性方法。
