前列腺适形近距离放疗:125I/103Pd术后剂量学分析。

G S Merrick, W M Butler, A T Dorsey, H L Walbert
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引用次数: 24

摘要

西雅图小组所取得的前列腺适形近距离放射治疗的良好长期效果的广泛复制,需要证据表明他们的植入物的技术质量在其他地方是可以实现的。使用改进的均匀加载算法进行预先规划,使用低活性种子,在低于规定剂量时,在规划体积内几乎没有区域产生,并且在两倍剂量时,种子之间没有相互连接的体积。手术过程稳定前列腺,利用横向和纵向超声以及造影增强透视定位前列腺靶点、针和种子及其与膀胱和直肠的关系。本文对1996年3月至6月间行经会阴超声适形前列腺近距离放射治疗的临床T1/T2前列腺腺癌患者进行了详细的术后剂量学分析。分析包括7例连续植入125I粒子的患者和5例连续植入103Pd粒子的患者。最小外周剂量(mPD)的中位覆盖率为前列腺体积的96%(范围80-99%)。在mPD的80%时,中位等剂量覆盖率为前列腺体积的100%(范围91-100%)。对于关键结构热点,尿道最大中位剂量为mPD的175%(范围115-227%),直肠前黏膜最大中位剂量为mPD的105%(范围83-133%)。术后剂量-体积直方图分析显示,我们对大于5 cm3的任何体积的最大剂量面为203%(范围175-247%)。这些结果表明,高质量的经会阴超声前列腺适形近距离放射治疗可以在社区医院环境中准确再现,生化无疾病证据(NED)结果和局部控制率将与西雅图组相当,没有意外的尿道或直肠并发症或副作用。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Prostatic conformal brachytherapy: 125I/103Pd postoperative dosimetric analysis.

Widespread replication of the favorable long-term results of prostatic conformal brachytherapy achieved by the Seattle group requires evidence that the technical quality of their implants is achievable elsewhere. Preplanning with a modified uniform loading algorithm using low activity seeds produces virtually no regions within the planning volume at less than the prescribed dose and no interconnected volumes between seeds at double the dose. The operative procedure stabilizes the prostate and locates the prostate targets, needles, and seeds and their relationship to the bladder and rectum using transverse and longitudinal ultrasound as well as contrast enhanced fluoroscopy. A detailed postoperative dosimetric analysis of patients with clinical T1/T2 adenocarcinoma of the prostate gland who underwent transperineal ultrasound conformal prostatic brachytherapy from March through June 1996 was performed. The analysis involved 7 consecutive patients implanted with 125I seeds and 5 consecutive patients implanted with 103Pd seeds. Median coverage to the full minimal peripheral dose (mPD) was 96% (range 80-99%) of the prostate volume. At 80% of the mPD, median isodose coverage was 100% (range 91-100%) of the prostate volume. Regarding hot spots to critical structures, the median maximal urethral dose was 175% of the mPD (range 115-227%) and the median maximal dose to the anterior rectal mucosa was 105% of the mPD (range 83-133%). Analysis of postoperative dose-volume histograms has shown that our maximal dose surface to any volume greater than 5 cm3 is 203% (range 175-247%). These results indicate that good quality transperineal ultrasound prostatic conformal brachytherapy can be accurately reproduced in a community hospital setting and that biochemical no evidence of disease (NED) results and local control rates will be comparable to those of the Seattle group with no unexpected urethral or rectal complications or side effects.

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