从低剂量率前列腺近距离放射治疗计划向高剂量率计划的转变：比较初始剂量测定并通过有针对性的干预提高工作流程效率。
Transitioning From a Low-Dose-Rate to a High-Dose-Rate Prostate Brachytherapy Program: Comparing Initial Dosimetry and Improving Workflow Efficiency Through Targeted Interventions.
作者信息
Solanki Abhishek A, Mysz Michael L, Patel Rakesh, Surucu Murat, Kang Hyejoo, Plypoo Ahpa, Bajaj Amishi, Korpics Mark, Martin Brendan, Hentz Courtney, Gupta Gopal, Farooq Ahmer, Baldea Kristin G, Pawlowski Julius, Roeske John, Flanigan Robert, Small William, Harkenrider Matthew M
机构信息
Department of Radiation Oncology, Loyola University Chicago, Stritch School of Medicine, Maywood, Illinois.
Department of Radiation Oncology, University of Chicago, Chicago, Illinois.
出版信息
Adv Radiat Oncol. 2018 Oct 23;4(1):103-111. doi: 10.1016/j.adro.2018.10.004. eCollection 2019 Jan-Mar.
PURPOSE
We transitioned from a low-dose-rate (LDR) to a high-dose-rate (HDR) prostate brachytherapy program. The objective of this study was to describe our experience developing a prostate HDR program, compare the LDR and HDR dosimetry, and identify the impact of several targeted interventions in the HDR workflow to improve efficiency.
METHODS AND MATERIALS
We performed a retrospective cohort study of patients treated with LDR or HDR prostate brachytherapy. We used iodine-125 seeds (145 Gy as monotherapy, and 110 Gy as a boost) and preoperative planning for LDR. For HDR, we used iridium-192 (13.5 Gy × 2 as monotherapy and 15 Gy × 1 as a boost) and computed tomography-based planning. Over the first 18 months, we implemented several targeted interventions into our HDR workflow to improve efficiency. To evaluate the progress of the HDR program, we used linear mixed-effects models to compare LDR and HDR dosimetry and identify changes in the implant procedure and treatment planning durations over time.
RESULTS
The study cohort consisted of 122 patients (51 who received LDR and 71 HDR). The mean D90 was similar between patients who received LDR and HDR ( = .28). HDR mean V100 and V95 were higher ( < .0001), but mean V200 and V150 were lower ( < .0001). HDR rectum V100 and D1cc were lower ( < .0001). The HDR mean for the implant procedure duration was shorter (54 vs 60 minutes; = .02). The HDR mean for the treatment planning duration dramatically improved with the implementation of targeted workflow interventions (3.7 hours for the first quartile to 2.0 hours for the final quartile; < .0001).
CONCLUSIONS
We successfully developed a prostate HDR brachytherapy program at our institution with comparable dosimetry to our historic LDR patients. We identified several targeted interventions that improved the efficiency of treatment planning. Our experience and workflow interventions may help other institutions develop similar HDR programs.
目的
我们从低剂量率（LDR）前列腺近距离放射治疗方案过渡到高剂量率（HDR）方案。本研究的目的是描述我们开展前列腺HDR方案的经验，比较LDR和HDR剂量测定法，并确定HDR工作流程中几种有针对性干预措施对提高效率的影响。
方法和材料
我们对接受LDR或HDR前列腺近距离放射治疗的患者进行了一项回顾性队列研究。LDR使用碘-125种子（单药治疗为145 Gy，追加剂量为110 Gy）并进行术前规划。对于HDR，我们使用铱-192（单药治疗为13.5 Gy×2，追加剂量为15 Gy×1）并基于计算机断层扫描进行规划。在最初的18个月里，我们在HDR工作流程中实施了几种有针对性的干预措施以提高效率。为评估HDR方案的进展，我们使用线性混合效应模型比较LDR和HDR剂量测定法，并确定植入手术和治疗计划持续时间随时间的变化。
结果
研究队列包括122例患者（51例接受LDR，71例接受HDR）。接受LDR和HDR的患者之间平均D90相似（ = 0.28）。HDR的平均V100和V95更高（ < 0.0001），但平均V200和V150更低（ < 0.0001）。HDR直肠V100和D1cc更低（ < 0.0001）。植入手术持续时间的HDR平均值更短（54分钟对60分钟； = 0.02）。随着有针对性的工作流程干预措施的实施，治疗计划持续时间的HDR平均值显著改善（第一四分位数为3.7小时，最后四分位数为2.0小时； < 0.0001）。
结论
我们在本机构成功开展了前列腺HDR近距离放射治疗方案，其剂量测定法与我们既往的LDR患者相当。我们确定了几种提高治疗计划效率的有针对性干预措施。我们的经验和工作流程干预措施可能有助于其他机构开展类似的HDR方案。
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