纳入基于常规磁共振成像的计划用于前列腺癌高剂量率近距离放射治疗：临床可行性和剂量学结果评估。
Incorporating Routine Magnetic Resonance Imaging-based Planning for the Delivery of High-dose-rate Brachytherapy for Prostate Cancer: An Evaluation of Clinical Feasibility and Dosimetric Outcomes.
作者信息
Saigal Kunal, All Sean, Potrebko Peter, Feranec Nicholas, Keller Andrew, Lizaso Mel, Warner Chris, Nguyen Nina, Jain Anudh, Biagioli Matthew
机构信息
Radiation Oncology, Florida Hospital, Orlando, USA.
Radiation Oncology, University of Central Florida College of Medicine, Orlando, USA.
出版信息
Cureus. 2019 Feb 16;11(2):e4085. doi: 10.7759/cureus.4085.
Introduction To evaluate the implementation and dosimetric outcomes of magnetic resonance imaging (MRI) planning for improved target and normal tissue definition for the treatment of prostate cancer with high-dose-rate brachytherapy (HDRBT). Methods From August 2015 to October 2017, 137 unique patients with newly diagnosed localized prostate cancer underwent a total of 174 outpatient brachytherapy procedures using MRI-based treatment planning. Patients receiving brachytherapy as monotherapy underwent two separate procedures while those receiving brachytherapy as a boost after external beam radiation therapy underwent a single procedure. The target volume was defined as the prostate +/- seminal vesicles as clinically appropriate without any additional margin. Pre-treatment dose-volume histogram (DVH) goals to the target were: D90≥95%, V90≥95%, V100≥90%, V150≤30%, V200≤15%. DVH goals to organs-at-risk (OARs): urethra D.01cc ≤115%, bladder D1cc ≤75%, rectum D1cc ≤75%, neurovascular bundle D0.1cc ≤100%, penile bulb D1cc ≤100%. Procedure times were recorded at each step of the procedure, from catheter insertion to removal. Results The median target volume was 45.9 cc, the median volume receiving the prescription dose was 53.0 cc, and the median selectivity index was 0.9. The median values for target dosimetry were as follows: D90=99.9%, V90=95.7%, V100=90.1%, V150=28.1%, V200=10.5%. The median values for OAR dosimetry were: urethra D.01cc=114.3%, bladder D1cc=68.3%, rectum D1cc=51.8%, left neurovascular bundle D0.1cc=86.8%, right neurovascular bundle D0.1cc=88.5%, penile bulb D1cc=31.7%. The median time from catheter insertion to end of HDRBT delivery was four hours 14 minutes (range 2:56-9:08); total treatment package time was five hours 32 minutes (range 3:31-9:45). Conclusion Routine MRI-based treatment planning is feasible for the delivery of HDRBT for prostate cancer. We met stringent dosimetric criteria despite more objective target and normal tissue definition with MRI imaging. Treatment package time remains reasonable. We have adopted MRI as our standard imaging modality for HDRBT for prostate cancer.
引言 评估磁共振成像（MRI）计划在高剂量率近距离放射治疗（HDRBT）中用于改善前列腺癌治疗的靶区和正常组织定义的实施情况及剂量学结果。方法 2015年8月至2017年10月，137例新诊断的局限性前列腺癌患者共接受了174次基于MRI治疗计划的门诊近距离放射治疗。接受单纯近距离放射治疗的患者进行了两次单独的治疗，而接受外照射放疗后追加近距离放射治疗的患者进行了一次治疗。靶区体积定义为前列腺±精囊，根据临床情况确定，不设额外边界。靶区的治疗前剂量体积直方图（DVH）目标为：D90≥95%，V90≥95%，V100≥90%，V150≤30%，V200≤15%。危及器官（OARs）的DVH目标为：尿道D0.01cc≤115%，膀胱D1cc≤75%，直肠D1cc≤75%，神经血管束D0.1cc≤100%，阴茎球部D1cc≤100%。记录从导管插入到拔除的每个步骤的操作时间。结果 中位靶区体积为45.9 cc，接受处方剂量的中位体积为53.0 cc，中位选择性指数为0.9。靶区剂量学的中位值如下：D90 = 99.9%，V90 = 95.7%，V100 = 90.1%，V150 = 28.1%，V200 = 10.5%。OARs剂量学的中位值为：尿道D0.01cc = 114.3%，膀胱D1cc = 68.3%，直肠D1cc = 51.8%，左侧神经血管束D0.1cc = 86.8%，右侧神经血管束D0.1cc = 88.5%，阴茎球部D1cc = 31.7%。从导管插入到HDRBT治疗结束的中位时间为4小时14分钟（范围2:56 - 9:08）；总治疗套餐时间为5小时32分钟（范围3:31 - 9:45）。结论 基于MRI的常规治疗计划对于前列腺癌的HDRBT治疗是可行的。尽管MRI成像能更客观地定义靶区和正常组织，但我们仍达到了严格的剂量学标准。治疗套餐时间仍然合理。我们已将MRI作为前列腺癌HDRBT的标准成像方式。
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