Departments of Radiation Oncology and Molecular Radiation Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Departments of Oncology, Biostatistics and Bioinformatics Division, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Pract Radiat Oncol. 2021 Jul-Aug;11(4):264-271. doi: 10.1016/j.prro.2021.03.001. Epub 2021 Mar 13.
Low-dose-rate brachytherapy is a highly effective treatment modality for prostate carcinoma, but postimplant dosimetry quality is essential and correlated with likelihood of treatment success. Registered ultrasound and fluoroscopy (iRUF) can facilitate real-time intraoperative monitoring and plan adaptation, with the aim of attaining superior dosimetric outcomes. The purpose of this research was to compare clinical postimplant dosimetric results of iRUF-guided brachytherapy against brachytherapy using standard ultrasound-guided intraoperative dosimetry methods.
We analyzed postimplant dosimetry in 292 patients treated with Pd-103 between January 2007 and December 2018. All patients had postimplant dosimetry measured on day 0 to 1 using fused magnetic resonance/computed tomography assessment. Fifty-two patients were treated in 2 prospective clinical trials using iRUF intraoperative dosimetry, including 6 patients in a pilot study and 46 treated in a phase 2 study. Postimplant dosimetry in iRUF-treated patients was compared with dosimetry from 240 patients treated using standard (real-time ultrasound) intraoperative seed tracking.
For every parameter measuring dose coverage to the prostate, iRUF patients had significantly higher values, irrespective of adjustment for year of treatment. In adjusted analyses, parameters of dose to urethra and rectum were not significantly higher among iRUF-treated patients.
Use of iRUF intraoperative dosimetry was associated with improved postimplant dose coverage in prostate, without associated increases in doses to urethra or rectum.
低剂量率近距离放射疗法是治疗前列腺癌的一种非常有效的方法，但植入后剂量学质量至关重要，并且与治疗成功的可能性相关。注册超声和荧光透视（iRUF）可以促进实时术中监测和计划适应，以实现更好的剂量学结果。本研究的目的是比较 iRUF 引导近距离放射疗法与使用标准超声引导术中剂量学方法的临床植入后剂量学结果。
我们分析了 2007 年 1 月至 2018 年 12 月期间接受 Pd-103 治疗的 292 例患者的植入后剂量学。所有患者均在第 0 至 1 天使用融合磁共振/计算机断层扫描评估进行了植入后剂量学测量。52 例患者接受了 iRUF 术中剂量学的 2 项前瞻性临床试验治疗，包括 6 例试点研究和 46 例 2 期研究。将 iRUF 治疗患者的植入后剂量学与使用标准（实时超声）术中种子跟踪治疗的 240 例患者的剂量学进行比较。
对于测量前列腺剂量覆盖的每个参数，iRUF 患者的值均显著更高，无论是否对治疗年份进行了调整。在调整分析中，iRUF 治疗患者的尿道和直肠剂量参数没有显著升高。
使用 iRUF 术中剂量学与前列腺植入后剂量覆盖的改善相关，而尿道和直肠的剂量无明显增加。
