Martijn de Vries, Sarah L Wilby, Antony L Palmer, Wojciech Polak, Inna O'Hea, Dominic Hodgson, John J van den Dobbelsteen
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Access obstruction to the prostate was evaluated using diagnostic magnetic resonance imaging (MRI) scans, after six upward rotations of the pelvis and the prostate in 5 degree steps, to indicate the effect of patient posture change from supine to lithotomy position. For patients with PAI, we evaluated if the steerable needle could access the obstructed volume of the prostate.</p><p><strong>Results: </strong>The data showed no clear relation between V<sub>p</sub> and PAI. In 23 of the 27 patients, in which PAI was observed, 14 showed obstruction of the prostate of ≥ 10 mm in the supine position (mean PAI ± standard deviation: 15.2 ±3.8 mm). Anatomical rotation reduced PAI by 4.8 mm after every 10 degrees of upward rotation, still resulting in obstructions of 8.1 ±2.4 mm in 10 of the 14 cases after 15 degree rotation. 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引用次数: 1
摘要
目的:一部分患者由于耻骨弓干扰(PAI)不能直接接受前列腺近距离放射治疗(BT)。由于直线、水平的穿刺针路径，在耻骨弓后方定位光源受限，可能会妨碍对目标体积的有效照射。本研究评估了前列腺体积(Vp)和患者姿势改变对PAI的影响，并证明可操纵针可拓宽前列腺肥大患者和观察PAI的纳入标准。材料和方法:本研究纳入27例Vp > 60 cc的患者。通过诊断性磁共振成像(MRI)扫描，在骨盆和前列腺以5度的步骤向上旋转6次后，评估前列腺通路阻塞，以指示患者从仰卧位到取石位的姿势改变的影响。对于PAI患者，我们评估了可引导针是否能进入阻塞的前列腺体积。结果:血凝素与PAI无明显关系。27例患者中有23例出现PAI，其中14例在仰卧位时前列腺梗阻≥10 mm (PAI平均值±标准差:15.2±3.8 mm)。解剖旋转每向上旋转10度，PAI降低4.8 mm，但旋转15度后，14例中仍有10例出现8.1±2.4 mm的阻塞。可操纵的针头可以进入前列腺的所有需要的坐标。结论:在前列腺肥大和PAI患者中，弯曲路径引导的能力使前列腺BT得以实现，并减少了需要放弃治疗的变化。
Overcoming pubic arch interference in prostate brachytherapy using steerable needles.
Purpose: A proportion of patients are not directly eligible for prostate brachytherapy (BT) due to pubic arch interference (PAI). Constraints in positioning sources behind the pubic arch due to linear, horizontal needle paths, may hamper effective irradiation of the target volume. This work evaluated the effect of prostate volume (Vp) and patient posture change on the amount of PAI, and demonstrated that steerable needles may broaden the inclusion criteria for patients with enlarged prostates and observed PAI.
Material and methods: Twenty-seven patients (Vp > 60 cc) were included in this study. Access obstruction to the prostate was evaluated using diagnostic magnetic resonance imaging (MRI) scans, after six upward rotations of the pelvis and the prostate in 5 degree steps, to indicate the effect of patient posture change from supine to lithotomy position. For patients with PAI, we evaluated if the steerable needle could access the obstructed volume of the prostate.
Results: The data showed no clear relation between Vp and PAI. In 23 of the 27 patients, in which PAI was observed, 14 showed obstruction of the prostate of ≥ 10 mm in the supine position (mean PAI ± standard deviation: 15.2 ±3.8 mm). Anatomical rotation reduced PAI by 4.8 mm after every 10 degrees of upward rotation, still resulting in obstructions of 8.1 ±2.4 mm in 10 of the 14 cases after 15 degree rotation. The steerable needle enabled access to all the required coordinates of the prostate.
Conclusions: The ability to steer along curved paths enables prostate BT in patients with enlarged prostates and PAI, and reduces the change of needing to abandon treatment.
期刊介绍：
The “Journal of Contemporary Brachytherapy” is an international and multidisciplinary journal that will publish papers of original research as well as reviews of articles. Main subjects of the journal include: clinical brachytherapy, combined modality treatment, advances in radiobiology, hyperthermia and tumour biology, as well as physical aspects relevant to brachytherapy, particularly in the field of imaging, dosimetry and radiation therapy planning. Original contributions will include experimental studies of combined modality treatment, tumor sensitization and normal tissue protection, molecular radiation biology, and clinical investigations of cancer treatment in brachytherapy. Another field of interest will be the educational part of the journal.
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