Protocol-based CT-guided brachytherapy for patients with prostate cancer and previous rectal extirpation-a curative approach.

IF 2.7 3区医学 Q3 ONCOLOGY Strahlentherapie und Onkologie Pub Date : 2024-08-02 DOI:10.1007/s00066-024-02266-y

Philipp Schubert, Vratislav Strnad, Thomas Weißmann, Claudia Schweizer, Michael Lotter, Stephan Kreppner, Andre Karius, Rainer Fietkau, Ricarda Merten

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Abstract

Objective: 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.

Patients and methods: 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.

Results: 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_bladder 64.3% (50.9-78.3%), D10_urethra 131.05% (123.2%-141.2%), and D30_urethra 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.

Conclusion: 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.

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基于规程的 CT 引导近距离放射治疗前列腺癌和既往直肠切除术患者--一种根治性方法。

目的：前列腺癌的治疗方法有很多。对于因直肠癌治疗而接受过直肠切除术的患者，由于解剖结构的改变和盆腔曾接受过放射治疗，治愈选择受到限制。在这项分析中，我们验证了 CT 引导下经会阴间质近距离放射治疗在这种特殊情况下的可行性：我们分析了 5 名转移性非转移前列腺癌患者的治疗过程和结果。所有患者均无法在超声引导下进行近距离治疗。在这5名患者中，3名仅使用Ir-192临时近距离放射治疗前列腺癌，2名使用体外放射治疗和临时近距离放射治疗作为辅助治疗。所有患者都在 CT 引导下进行了近距离治疗。我们分析了治疗的可行性、疗效、治疗相关毒性和生活质量（EORTC-30、IEFF、IPSS和ICIQ问卷）：中位随访时间为 35 个月。五名患者中有两名接受了增强照射（HDR 2 × 9 Gy，PDR 30 Gy）。五位患者中有三位接受了两次PDR近距离放射治疗，总剂量达60 Gy。剂量学参数的中位值如下：V100 94.7% (94.5-98.4%)、D2-膀胱 64.3% (50.9-78.3%)、D10-尿道 131.05% (123.2%-141.2%)、D30-尿道 122.45% (116.2%-129.5%)。在进行分析时，没有生化复发的记录。此外，早期和晚期副作用均未超过 CTCAE 2 级：结论：CT引导下的经会阴前列腺近距离放射治疗对既往接受过直肠手术和放射治疗的患者是安全的，是一种可能的治愈性治疗方案。在这种特殊情况下，可考虑对有新旧交替的前列腺癌患者进行近距离放射治疗，但最好在经验丰富的高容量中心进行。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Strahlentherapie und Onkologie 医学-核医学

CiteScore

5.70

自引率

12.90%

发文量

141

审稿时长

3-8 weeks

期刊介绍： Strahlentherapie und Onkologie, published monthly, is a scientific journal that covers all aspects of oncology with focus on radiooncology, radiation biology and radiation physics. The articles are not only of interest to radiooncologists but to all physicians interested in oncology, to radiation biologists and radiation physicists. The journal publishes original articles, review articles and case studies that are peer-reviewed. It includes scientific short communications as well as a literature review with annotated articles that inform the reader on new developments in the various disciplines concerned and hence allow for a sound overview on the latest results in radiooncology research. Founded in 1912, Strahlentherapie und Onkologie is the oldest oncological journal in the world. Today, contributions are published in English and German. All articles have English summaries and legends. The journal is the official publication of several scientific radiooncological societies and publishes the relevant communications of these societies.