Iocolano Michelle, Blacksburg Seth, Carpenter Todd, Repka Michael, Carbone Susan, Demircioglu Gizem, Miccio Maryann, Katz Aaron, Haas Jonathan
Department of Radiation Oncology, NYU Winthrop Hospital, Mineola, NY, United States.
Stony Brook University School of Medicine, Stony Brook, NY, United States.
Front Oncol. 2020 Feb 27;10:203. doi: 10.3389/fonc.2020.00203. eCollection 2020.
Fiducial marker placement is required in patients undergoing robotic-based Stereotactic Body Radiotherapy (SBRT) or image-guided radiation therapy (IGRT) for prostate cancer. Many patients take antiplatelet or anticoagulant medication due to other medical comorbidities. They are often required to temporarily discontinue these medications prior to invasive medical procedures as they are prone to bleed. Some patients are unable to discontinue therapy due to an elevated risk of thromboembolic events. The purpose of this study is to report this institution's experience placing fiducial markers in prostate cancer patients who are on chronic antiplatelet or anticoagulant medication. From August 2015-March 2019 57 patients on chronic antiplatelet or anticoagulation therapy who were not cleared to stop these medications underwent transrectal ultrasound guided (TRUS) fiducial marker placement for SBRT/IGRT. All patients were monitored by a registered nurse during the procedure for prolonged bleeding that required staff to hold pressure to the area with a 4 × 4 gauze until it resolved. All patients were also called the following day to assess for ongoing bleeding events. Treatment planning CT scan confirmed the ideal geometry of the marker placement. All 57 patients on antiplatelet or anticoagulant medication who underwent fiducial marker placement were discharged home the same day of the procedure. Four patients experienced persistent bleeding that required a nurse to hold prolonged pressure to the area. No patient experienced significant bleeding the following day or any untoward cardiovascular event. This series suggests the use of antiplatelet or anticoagulant medication is not an absolute contraindication to fiducial marker placement in patients undergoing SBRT or IGRT for prostate cancer. These patients should be closely monitored after the procedure for bleeding complications. Practitioners may consider the patient's medical comorbidities, risk factors for thromboembolism, and overall functional status as there is no standardized protocol for discontinuing anticoagulant or antiplatelet therapy for fiducial marker placement.
对于接受基于机器人的立体定向体部放射治疗（SBRT）或图像引导放射治疗（IGRT）的前列腺癌患者，需要放置基准标记物。许多患者由于其他合并症而服用抗血小板或抗凝药物。由于他们容易出血，在进行侵入性医疗程序之前，通常需要暂时停用这些药物。一些患者由于血栓栓塞事件风险升高而无法停药。本研究的目的是报告本机构在接受慢性抗血小板或抗凝药物治疗的前列腺癌患者中放置基准标记物的经验。从2015年8月至2019年3月，57例接受慢性抗血小板或抗凝治疗且未被批准停用这些药物的患者接受了经直肠超声引导（TRUS）的基准标记物放置，用于SBRT/IGRT。在手术过程中，所有患者均由注册护士监测是否有持续出血，这需要工作人员用4×4纱布对该区域施压直至出血停止。所有患者在第二天也会被电话随访以评估是否有持续出血事件。治疗计划CT扫描证实了标记物放置的理想几何形状。所有57例接受抗血小板或抗凝药物治疗并进行基准标记物放置的患者在手术当天均出院回家。4例患者出现持续出血，需要护士对该区域长时间施压。第二天没有患者出现大量出血或任何不良心血管事件。本系列研究表明，对于接受前列腺癌SBRT或IGRT的患者，使用抗血小板或抗凝药物并非放置基准标记物的绝对禁忌证。术后应密切监测这些患者是否有出血并发症。由于对于基准标记物放置停用抗凝或抗血小板治疗没有标准化方案，从业者可能需要考虑患者的合并症、血栓栓塞风险因素和整体功能状态。
