Buchser David, Gomez-Iturriaga Alfonso, Melcon J Ignacio Rodriguez, Casquero Francisco, Llarena Roberto, Cacicedo Jon, Bilbao Pedro
Hospital Universitario Cruces/Biocruces Health Research Institute, Radiation Oncology, Barakaldo.
Hospital Universitario Negrin, Las Palmas, Canary Islands.
J Contemp Brachytherapy. 2016 Dec;8(6):477-483. doi: 10.5114/jcb.2016.64441. Epub 2016 Dec 6.
To evaluate the feasibility of the use of real-time magnetic resonance imaging (MRI)-transrectal ultrasound (TRUS) fusion guided high-dose-rate brachytherapy (HDR-BT) +/- external beam radiation therapy (EBRT) in patients with histologically-proven local relapse after radical prostatectomy.
We retrospectively reviewed 13 patients treated with real-time MRI-TRUS fusion HDR-BT for a local relapse of prostate cancer after radical surgery. All patients underwent multiparametric magnetic resonance imaging (mpMRI) to confirm the presence of macroscopic lesions in prostate bed, and choline positron emission tomography/computed tomography (PET/CT) to rule out nodal or distant metastases. Local failure was confirmed by transrectal biopsy. Patients without previous EBRT received 1 fraction of 15 Gy with HDR-BT plus hypofractionated EBRT (37.5 Gy in 15 fractions). Two patients received 2 fractions of 12 Gy with HDR-BT without EBRT. Follow-up visits were at 1, 3, 6 months, and every 6 months thereafter.
After a median follow-up of 7 months, all patients showed an appropriate biochemical response. Median prostate-specific antigen (PSA) levels before treatment, 1 month, and 6 months after HDR-BT were 2.62 ng/ml (range: 1.55-9.61), 0.97 ng/ml (range: 0.12-3.14), 0.23 ng/ml (range: 0.1-0.74), respectively. Five patients (42%) experienced acute grade 1 GU toxicity and 1 patient (8%) suffered from grade 2 GU toxicity. Regarding gastrointestinal (GI) toxicity, 5 patients referred grade 1 acute toxicity and 1 grade 2 (proctitis). No late toxicity has been observed so far.
MRI-TRUS fusion guided salvage HDR-BT +/- EBRT is a feasible procedure for patients with local macroscopic relapse in tumor bed after radical prostatectomy. Exquisite selection of patients through mpMRI and choline PET/CT is crucial to avoid overtreatment. A larger number of patients and longer follow-up are required in order to draw more solid conclusions regarding the effectiveness of this strategy.
评估在根治性前列腺切除术后经组织学证实为局部复发的患者中，使用实时磁共振成像（MRI）-经直肠超声（TRUS）融合引导下的高剂量率近距离放射治疗（HDR-BT）±外照射放疗（EBRT）的可行性。
我们回顾性分析了13例接受实时MRI-TRUS融合HDR-BT治疗根治性前列腺切除术后前列腺癌局部复发的患者。所有患者均接受多参数磁共振成像（mpMRI）以确认前列腺床存在宏观病变，并接受胆碱正电子发射断层扫描/计算机断层扫描（PET/CT）以排除淋巴结或远处转移。经直肠活检证实局部复发。未接受过EBRT的患者接受1次15 Gy的HDR-BT加超分割EBRT（15次分割，共37.5 Gy）。2例患者接受2次12 Gy的HDR-BT，未接受EBRT。随访时间为术后1、3、6个月，此后每6个月随访一次。
中位随访7个月后，所有患者均显示出适当的生化反应。HDR-BT治疗前、治疗后1个月和6个月的中位前列腺特异性抗原（PSA）水平分别为2.62 ng/ml（范围：1.55 - 9.61）、0.97 ng/ml（范围：0.12 - 3.14）、0.23 ng/ml（范围：0.1 - 0.74）。5例患者（42%）出现1级急性泌尿生殖系统毒性，1例患者（8%）出现2级泌尿生殖系统毒性。关于胃肠道（GI）毒性，5例患者出现1级急性毒性，1例出现2级（直肠炎）。目前尚未观察到晚期毒性。
MRI-TRUS融合引导下的挽救性HDR-BT±EBRT对于根治性前列腺切除术后肿瘤床局部宏观复发的患者是一种可行的治疗方法。通过mpMRI和胆碱PET/CT精确选择患者对于避免过度治疗至关重要。为了就该策略的有效性得出更可靠的结论，需要更多的患者和更长时间的随访。
