Departments of Radiology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Department of Urology, Kawasaki Medical School, Kurashiki, Okayama, Japan.
Int J Urol. 2022 Jul;29(7):725-732. doi: 10.1111/iju.14880. Epub 2022 Mar 30.
This study aimed to investigate preliminary outcomes of a prospective trial of magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer.
In our prospective study, data from patients who underwent this treatment between April 1, 2020 and March 31, 2021 were analyzed. In the procedure, the applicator needle was inserted through the perineum to target the lesion on the multiparametric magnetic resonance imaging, which was fused onto the transrectal ultrasound image. The prescription dose was set at a single fraction of 19 Gy. Data from patients who received whole-gland high-dose-rate brachytherapy were extracted and compared with data from patients who received ultrafocal high-dose-rate brachytherapy, to evaluate the frequency of acute adverse events.
Eight patients underwent ultrafocal high-dose-rate brachytherapy with a median observation period of 7.75 months (range 5.96-15.36 months). No acute genitourinary or gastrointestinal adverse events were observed in this cohort. The planned procedure was completed in all patients, and no unexpected adverse events were observed; however, prostate-specific antigen failure was detected in one patient. In the 25 patients who underwent whole-gland high-dose-rate brachytherapy, acute genitourinary and gastrointestinal adverse events were observed in 88% and 20% of the patients, respectively. Ultrafocal high-dose-rate brachytherapy was a significant factor in avoiding acute adverse genitourinary events in univariate and multivariate analyses (P < 0.001 and P = 0.032, respectively).
Magnetic resonance imaging-ultrasound fusion-guided ultrafocal high-dose-rate brachytherapy in localized prostate cancer is a safe and feasible treatment without acute genitourinary and gastrointestinal adverse events. Long-term observation and further investigation are warranted.
本研究旨在探讨前瞻性磁共振成像-超声融合引导超局灶高剂量率近距离治疗局限性前列腺癌的初步结果。
在我们的前瞻性研究中，分析了 2020 年 4 月 1 日至 2021 年 3 月 31 日期间接受该治疗的患者的数据。在该过程中，通过会阴将施源器针插入以靶向多参数磁共振成像上的病变，该病变与经直肠超声图像融合。处方剂量设定为单次 19Gy 剂量。提取了接受全腺体高剂量率近距离治疗的患者的数据，并与接受超局灶高剂量率近距离治疗的患者的数据进行比较，以评估急性不良事件的发生频率。
8 例患者接受超局灶高剂量率近距离治疗，中位观察期为 7.75 个月（5.96-15.36 个月）。该队列中未观察到急性泌尿生殖系统或胃肠道不良事件。所有患者均完成了计划的治疗过程，未观察到意外的不良事件；然而，有 1 例患者发生前列腺特异抗原失败。在 25 例接受全腺体高剂量率近距离治疗的患者中，88%和 20%的患者分别出现急性泌尿生殖系统和胃肠道不良事件。单因素和多因素分析均表明，超局灶高剂量率近距离治疗是避免急性不良泌尿生殖系统事件的显著因素（P<0.001 和 P=0.032）。
磁共振成像-超声融合引导超局灶高剂量率近距离治疗局限性前列腺癌是一种安全可行的治疗方法，无急性泌尿生殖系统和胃肠道不良事件。需要进行长期观察和进一步研究。
