Moreau Juliette, Biau Julian, Achard Jean-Louis, Toledano Ivan, Benhaim Charles, Kwiatkowski Fabrice, Loos Geneviève, Lapeyre Michel
Radiotherapy, Centre Jean Perrin.
Cureus. 2017 Oct 12;9(10):e1769. doi: 10.7759/cureus.1769.
Purpose Prostate motion occurs during radiotherapy for localized prostate cancer. We evaluated the input of intraprostatic fiducials for image-guided radiation therapy and compared it with bony anatomy and skin marks. Methods Eleven patients were implanted with three fiducial markers in the prostate. Daily sets of orthogonal kV-kV images were compared with digitally reconstructed radiography. Data were recorded for skin marks, bony anatomy, and fiducial markers. The variations were analyzed along three principal axes (left-right: LR, superoinferior: SI, and anteroposterior: AP). Results A total of 2,417 measures were recorded over 38 fractions of radiotherapy (76 Gy). Fiducial marker movements from bony anatomy were ≤ 5 mm for 84.2% (confidence interval: CI 95%±1.5), 91.3% (CI 95%±1.1), and 99.5% (CI 95%±0.4) of the measures along the AP, SI, and LR axes, respectively. Ninety-five percent of the shifts between a fiducial marker and the bony anatomy were < 8 mm in the AP and SI axes, and < 3 mm in the LR axis. Fiducial marker movements from skin marks were ≤ 5 mm for 64.8% (CI 95%±1.9), 79.2% (CI 95%±1.6), and 87.2% (CI 95%±1.3) of the measures along the AP, SI, and LR axes, respectively. Bony anatomy movements from skin marks were ≤ 5 mm for 84% (CI 95%±1.4), 92% (CI 95%±1.1), and 87% (CI 95%±1.3) of the measurements along the AP, SI, and LR axes, respectively. Conclusion Using fiducial markers provides better accuracy of repositioning of the prostate than using bony anatomy and skin marks for image-guided radiotherapy of prostate cancer.
目的 局限性前列腺癌放射治疗期间会发生前列腺运动。我们评估了前列腺内基准标记物在图像引导放射治疗中的作用，并将其与骨骼解剖结构和皮肤标记进行比较。方法 11例患者在前列腺内植入了3个基准标记物。将每日的正交千伏-千伏图像与数字重建射线照相进行比较。记录皮肤标记、骨骼解剖结构和基准标记物的数据。分析沿三个主轴（左右：LR、上下：SI、前后：AP）的变化。结果 在38次放射治疗（76 Gy）中总共记录了2417次测量。沿AP、SI和LR轴测量时，基准标记物相对于骨骼解剖结构的移动分别有84.2%（95%置信区间：CI±1.5）、91.3%（CI 95%±1.1）和99.5%（CI 95%±0.4）≤5 mm。在AP和SI轴上，基准标记物与骨骼解剖结构之间95%的位移<8 mm，在LR轴上<3 mm。沿AP、SI和LR轴测量时，基准标记物相对于皮肤标记的移动分别有64.8%（CI 95%±1.9）、79.2%（CI 95%±1.6）和87.2%（CI 95%±1.3）≤5 mm。沿AP、SI和LR轴测量时，骨骼解剖结构相对于皮肤标记的移动分别有84%（CI 95%±1.4）、92%（CI 95%±1.1）和87%（CI 95%±1.3）≤5 mm。结论 在前列腺癌的图像引导放射治疗中，使用基准标记物比使用骨骼解剖结构和皮肤标记能提供更好的前列腺重新定位准确性。
