Cyberknife 立体定向放射外科治疗经腹会阴联合切除术(CYRANO)后的前列腺癌:计算机断层扫描和电磁导航引导经会阴 fiducial 标记植入技术。

Cyberknife Radiosurgery for Prostate Cancer after Abdominoperineal Resection (CYRANO): The Combined Computer Tomography and Electromagnetic Navigation Guided Transperineal Fiducial Markers Implantation Technique.

机构信息

Division of Radiation Oncology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.

Division of Interventional Radiology, IEO European Institute of Oncology IRCCS, 20141 Milan, Italy.

出版信息

Curr Oncol. 2023 Aug 28;30(9):7926-7935. doi: 10.3390/curroncol30090576.

Abstract

In this technical development report, we present the strategic placement of fiducial markers within the prostate under the guidance of computed tomography (CT) and electromagnetic navigation (EMN) for the delivery of ultra-hypofractionated cyberknife (CK) therapy in a patient with localized prostate cancer (PCa) who had previously undergone chemo-radiotherapy for rectal cancer and subsequent abdominoperineal resection due to local recurrence. The patient was positioned in a prone position with a pillow under the pelvis to facilitate access, and an electromagnetic fiducial marker was placed on the patient's skin to establish a stable position. CT scans were performed to plan the procedure, mark virtual points, and simulate the needle trajectory using the navigation system. Local anesthesia was administered, and a 21G needle was used to place the fiducial markers according to the navigation system information. A confirmatory CT scan was obtained to ensure proper positioning. The implantation procedure was safe, without any acute side effects such as pain, hematuria, dysuria, or hematospermia. Our report highlights the ability to use EMN systems to virtually navigate within a pre-acquired imaging dataset in the interventional room, allowing for non-conventional approaches and potentially revolutionizing fiducial marker positioning, offering new perspectives for PCa treatment in selected cases.

摘要

在本技术发展报告中,我们介绍了在 CT 和电磁导航(EMN)引导下在前列腺内放置基准标记物的策略,以便为局部前列腺癌(PCa)患者提供超分割 Cyberknife(CK)治疗,该患者先前因直肠癌接受了化疗和放疗,随后因局部复发接受了腹会阴切除术。患者取俯卧位,骨盆下垫枕头以方便操作,并在患者皮肤上放置电磁基准标记物以建立稳定的位置。进行 CT 扫描以规划手术、标记虚拟点并使用导航系统模拟针轨迹。给予局部麻醉,并根据导航系统信息使用 21G 针放置基准标记物。进行确认性 CT 扫描以确保正确定位。植入程序是安全的,没有任何急性副作用,如疼痛、血尿、排尿困难或血精。我们的报告强调了在介入室中使用 EMN 系统在预先获取的成像数据集中进行虚拟导航的能力,允许采用非常规方法,有可能彻底改变基准标记物定位方式,为选定病例的 PCa 治疗提供新视角。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/611a/10529393/b37e16408501/curroncol-30-00576-g001.jpg

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