Schubert Philipp, Strnad Vratislav, Weißmann Thomas, Schweizer Claudia, Lotter Michael, Kreppner Stephan, Karius Andre, Fietkau Rainer, Merten Ricarda
Department of Radiation Oncology, University Hospital Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Universitätsstraße 27, 91054, Erlangen, Germany.
Comprehensive Cancer Center Erlangen-EMN, Erlangen, Germany.
Strahlenther Onkol. 2025 Jan;201(1):20-26. doi: 10.1007/s00066-024-02266-y. Epub 2024 Aug 2.
There are numerous curative treatment possibilities for prostate cancer. In patients who have undergone rectal extirpation for rectal cancer treatment, curative options are limited due to anatomic changes and previous irradiation of the pelvis. In this analysis, we validate the feasibility of CT-guided transperineal interstitial brachytherapy for this specific scenario.
We analyzed the treatment procedures and outcomes of 5 patients with metachronic nonmetastatic prostate cancer. Ultrasound-guided brachytherapy was not possible in any of the patients. Of these 5 patients, 3 were treated for prostate cancer using temporary brachytherapy with Ir-192 only, and 2 were treated with external-beam radiation therapy and temporary brachytherapy as a boost. CT-guided brachytherapy was performed in all patients. We analyzed the feasibility, efficacy, treatment-related toxicity, and quality of life (EORTC-30, IEFF, IPSS, and ICIQ questionnaires) of the treatments.
Median follow-up was 35 months. Two out of five patients received boost irradiation (HDR 2 × 9 Gy, PDR 30 Gy). Three out of five patients were treated with PDR brachytherapy in two sessions up to a total dose of 60 Gy. Dosimetric parameters were documented as median values as follows: V100 94.7% (94.5-98.4%), D2 64.3% (50.9-78.3%), D10 131.05% (123.2%-141.2%), and D30 122.45% (116.2%-129.5%). At the time of analysis, no biochemical recurrence had been documented. Furthermore, neither early nor late side effects exceeding CTCAE grade 2 were documented.
CT-guided transperineal brachytherapy of the prostate in patients with previous rectal surgery and radiation therapy is safe and represents a possible curative treatment option. Brachytherapy can be considered for patients with metachronic prostate cancer in this specific scenario, albeit preferably in experienced high-volume centers.
前列腺癌有多种治愈性治疗方法。对于因直肠癌治疗而接受直肠切除的患者，由于解剖结构改变和盆腔先前接受过放疗，治愈性选择有限。在本分析中，我们验证了CT引导下经会阴间质近距离放疗在这种特定情况下的可行性。
我们分析了5例复发性非转移性前列腺癌患者的治疗过程和结果。所有患者均无法进行超声引导下的近距离放疗。这5例患者中，3例仅使用Ir-192临时近距离放疗治疗前列腺癌，2例接受外照射放疗并辅以临时近距离放疗作为增强治疗。所有患者均接受了CT引导下的近距离放疗。我们分析了治疗的可行性、疗效、治疗相关毒性以及生活质量（使用欧洲癌症研究与治疗组织-30、IEFF、IPSS和ICIQ问卷）。
中位随访时间为35个月。5例患者中有2例接受了增强照射（高剂量率2×9 Gy，脉冲剂量率30 Gy）。5例患者中有3例分两次接受脉冲剂量率近距离放疗，总剂量达60 Gy。剂量学参数记录为中位值如下：V100为94.7%（94.5 - 98.4%），D2为64.3%（50.9 - 78.3%），D10为131.05%（123.2% - 141.2%），D30为122.45%（116.2% - 129.5%）。在分析时，未记录到生化复发。此外，未记录到超过美国国立癌症研究所常见不良反应事件评价标准2级的早期或晚期副作用。
对于先前接受过直肠手术和放疗的患者，CT引导下经会阴前列腺近距离放疗是安全的，是一种可能的治愈性治疗选择。在这种特定情况下，对于复发性前列腺癌患者可考虑进行近距离放疗，尽管最好在经验丰富的大容量中心进行。
