Background and Purpose:
In order to use a single implant with one treatment plan in fractionated high-dose-rate brachytherapy (HDR-B), applicator position shifts must be corrected prior to each fraction. The authors investigated the use of gold markers for X-ray-based setup and position control between the single fractions.
Patients and Methods:
Caudad-cephalad movement of the applicators prior to each HDR-B fraction was determined on radiographs using two to three gold markers, which had been inserted into the prostate as intraprostatic reference, and one to two radiopaque-labeled reference applicators. 35 prostate cancer patients, treated by HDR-B as a monotherapy between 10/2003 and 06/2006 with four fractions of 9.5 Gy each, were analyzed. Toxicity was scored according to the CTCAE Score, version 3.0. Median follow-up was 3 years.
Results:
The mean change of applicators positions compared to baseline varied substantially between HDR-B fractions, being 1.4 mm before fraction 1 (range, –4 to 2 mm), –13.1 mm before fraction 2 (range, –36 to 0 mm), –4.1 mm before fraction 3 (range, –21 to 9 mm), and –2.6 mm at fraction 4 (range, –16 to 9 mm). The original position of the applicators could be readjusted easily prior to each fraction in every patient. In 18 patients (51%), the applicators were at least once readjusted > 10 mm, however, acute or late grade ≥ 2 genitourinary toxicity was not increased (p = 1.0) in these patients.
Conclusion:
Caudad position shifts up to 36 mm were observed. Gold markers represent a valuable tool to ensure setup accuracy and precise dose delivery in fractionated HDR-B monotherapy of prostate cancer.
Hintergrund und Ziel:
Um ein einziges Implantat mit einem Bestrahlungsplan fur die fraktionierte High-Dose-Rate-Brachytherapie (HDR-B) nutzen zu konnen, mussen Positionsverschiebungen der Katheter vor jeder Fraktion erkannt und korrigiert werden. Die Autoren untersuchten den Nutzen von Goldmarkern fur rontgenbildbasierte Konfiguration und Positionskontrolle zwischen den Einzelfraktionen.
Patienten und Methodik:
Die kraniokaudalen Verschiebungen der Applikatoren wurden vor jeder HDR-B-Fraktion anhand von zwei bis drei Goldmarkern als intraprostatische Referenz und ein bis zwei rontgendicht markierten Referenzapplikatoren mittels Rontgenbild bestimmt. 35 Patienten mit Prostatakarzinom, welche zwischen 10/2003 and 06/2006 eine HDR-B als Monotherapie mit vier Fraktionen von jeweils 9,5 Gy erhielten, wurden untersucht. Die Behandlungstoxizitat wurde mit dem CTCAE-Score, Version 3.0, erfasst. Die mediane Nachbeobachtungszeit lag bei 3 Jahren.
Ergebnisse:
Die mittlere Positionsabweichung der Applikatoren von der Sollposition variierte erheblich zwischen den HDR-B-Fraktionen und betrug 1,4 mm vor der ersten Fraktion (Spannweite: –4 bis 2 mm), –13,1 mm vor der zweiten Fraktion (Spannweite: –36 bis 0 mm), –4,1 mm vor der dritten Fraktion (Spannweite: –21 bis 9 mm) und –2,6 mm vor der vierten Fraktion (Spannweite: –16 bis 9 mm). Die ursprungliche Position der Applikatoren konnte bei jedem Patienten problemlos vor jeder Fraktion wiederhergestellt werden. Bei 18 Patienten (51%) wurden die Applikatoren wenigstens einmal > 10 mm verschoben; dennoch war die genitourethrale Akut- oder Spattoxizitat Grad ≥ 2 bei diesen Patienten nicht erhoht (p = 1,0).
Schlussfolgerung:
Positionsverschiebungen von bis zu 36 mm nach kaudal wurden beobachtet. Goldmarker sind bei der fraktionierten HDR-B-Monotherapie des Prostatakarzinoms von Nutzen, um die akkurate Konfiguration und die prazise Verabreichung der Strahlendosis zu gewahrleisten.
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Ghadjar, P., Gwerder, N., Madlung, A. et al. Use of Gold Markers for Setup in Image-Guided Fractionated High-Dose-Rate Brachytherapy as a Monotherapy for Prostate Cancer. Strahlenther Onkol 185, 731–735 (2009). https://doi.org/10.1007/s00066-009-2007-7
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DOI: https://doi.org/10.1007/s00066-009-2007-7