Department of Radiology, Nagoya City University Graduate School of Medical Sciences, Nagoya.
Department of Radiation Oncology, Nagoya Proton Therapy Center, Nagoya City West Medical Center, Nagoya.
Jpn J Clin Oncol. 2021 Feb 8;51(2):258-263. doi: 10.1093/jjco/hyaa172.
To compare the feasibility of transrectal and transperineal fiducial marker placement for prostate cancer before proton therapy.
From 2013 to 2015, the first 40 prostate cancer patients that were scheduled for proton therapy underwent transrectal fiducial marker placement, and the next 40 patients underwent transperineal fiducial marker placement (the first series). Technical and clinical success and pain scores were evaluated. In the second series (n = 280), the transrectal or transperineal approach was selected depending on the presence/absence of comorbidities, such as blood coagulation abnormalities. Seven patients refused to undergo the procedure. Thus, the total number of patients across both series was 353 (262 and 91 underwent the transrectal and transperineal approach, respectively). Technical and clinical success, complications, marker migration and the distance between the two markers were evaluated.
In the first series, the technical and clinical success rates were 100% in both groups. The transrectal group exhibited lower pain scores than the transperineal group. The overall technical success rates of the transrectal and transperineal groups were 100% (262/262) and 99% (90/91), respectively (P > 0.05). The overall clinical success rate was 100% in both groups, and there were no major complications in either group. The migration rates of the two groups did not differ significantly. The mean distance between the two markers was 25.6 ± 7.1 mm (mean ± standard deviation) in the transrectal group and 31.9 ± 5.2 mm in the transperineal group (P < 0.05).
Both the transrectal and transperineal fiducial marker placement methods are feasible and safe.
比较前列腺癌质子治疗前经直肠和经会阴放射性标记物植入的可行性。
2013 年至 2015 年，40 例拟行质子治疗的前列腺癌患者行经直肠放射性标记物植入术，40 例患者行经会阴放射性标记物植入术（第一系列）。评估技术和临床成功率及疼痛评分。第二系列（n=280）根据是否存在合并症，如凝血功能异常，选择经直肠或经会阴入路。7 例患者拒绝行该操作。因此，两系列的总患者数为 353 例（262 例和 91 例分别行经直肠和经会阴入路）。评估技术和临床成功率、并发症、标记物迁移和两个标记物之间的距离。
第一系列中，两组的技术和临床成功率均为 100%。经直肠组疼痛评分低于经会阴组。经直肠和经会阴组的总体技术成功率分别为 100%（262/262）和 99%（90/91）（P>0.05）。两组的总体临床成功率均为 100%，两组均无重大并发症。两组的标记物迁移率无显著差异。经直肠组两个标记物之间的平均距离为 25.6±7.1mm（均值±标准差），经会阴组为 31.9±5.2mm（P<0.05）。
经直肠和经会阴放射性标记物植入方法均可行且安全。
