Haworth Annette, Williams Scott
School of Physics, University of Sydney, Camperdown, NSW.
Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Vic.
J Contemp Brachytherapy. 2017 Aug;9(4):383-389. doi: 10.5114/jcb.2017.69809. Epub 2017 Aug 30.
Focal therapy for prostate cancer has been proposed as an alternative treatment to whole gland therapy, offering the opportunity for tumor dose escalation and/or reduced toxicity. Brachytherapy, either low-dose-rate or high-dose-rate, provides an ideal approach, offering both precision in dose delivery and opportunity for a highly conformal, non-uniform dose distribution. Whilst multiple consensus documents have published clinical guidelines for patient selection, there are insufficient data to provide clear guidelines on target volume delineation, treatment planning margins, treatment planning approaches, and many other technical issues that should be considered before implementing a focal brachytherapy program. Without consensus guidelines, there is the potential for a diversity of practices to develop, leading to challenges in interpreting outcome data from multiple centers. This article provides an overview of the technical considerations for the implementation of a clinical service, and discusses related topics that should be considered in the design of clinical trials to ensure precise and accurate methods are applied for focal brachytherapy treatments.
前列腺癌的聚焦治疗已被提议作为全腺体治疗的替代疗法，提供了肿瘤剂量递增和/或降低毒性的机会。近距离放射治疗，无论是低剂量率还是高剂量率，都提供了一种理想的方法，既能在剂量递送方面实现精确性，又能实现高度适形、非均匀剂量分布。虽然多个共识文件已经发布了患者选择的临床指南，但在实施聚焦近距离放射治疗计划之前，关于靶区勾画、治疗计划边界、治疗计划方法以及许多其他技术问题的数据不足，无法提供明确的指导方针。没有共识指南，就有可能出现多种不同的实践方法，这给解释来自多个中心的结果数据带来了挑战。本文概述了实施临床服务的技术考量，并讨论了在临床试验设计中应考虑的相关主题，以确保聚焦近距离放射治疗采用精确和准确的方法。
