Rectal spacing, prostate coverage, and periprocedural outcomes after hydrogel spacer injection during low-dose-rate brachytherapy implantation
Rectal spacing, prostate coverage, and periprocedural outcomes after hydrogel spacer injection during low-dose-rate brachytherapy implantation
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DOI：
10.1016/j.brachy.2019.11.002
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发表时间：
2020-03-01
期刊：
影响因子：
1.9
通讯作者：
Moghanaki, Drew
中科院分区：
文献类型：
--
作者：
Kahn, Jenna;Dahman, Bassam;Moghanaki, Drew
目得：为了分析剂量的影响和围手术期的结果与生物可吸收的水凝胶直肠间隔期间注入低剂量率（LDR）前列腺近距离放射治疗implants.METHODS和MATERIALS：一个连续系列的80例患者植入搁浅的I-125 LDR近距离放射治疗种子进行了评价，其中40人进行了经会阴注射聚乙二醇（5毫升）之间的前列腺和直肠。在使用和不使用水凝胶垫片的患者之间比较了当天基于CT的剂量测定，以评价直肠和前列腺剂量测定的差异。根据不良事件通用术语标准（CTCAE）v4对医生报告的毒性进行编码。结果：基线患者和植入物特征相似。没有归因于水凝胶垫片的急性泌尿生殖系统或直肠毒性。比较有和没有水凝胶的患者，前列腺和直肠之间的平均间隔分别为13.9 +/- 5.2 mm vs. 6.5 +/- 5.0 mm（p < 0.0001）。相对于处方剂量，直肠1 cc、2 cc和5 cc的校正平均剂量分别降低了32%（p < 0.01）、26%（p < 0.01）和17%（p < 0.01）。前列腺覆盖率无统计学显著差异：平均V-100（92% vs. 91%）、V-150（45% vs. 48%）和D-90（106% vs. 106%）。在1个月随访时，1级直肠毒性为12.5% vs. 17.5%（p = 0.35）。没有患者发展等级>= 2直肠毒性与水凝胶，虽然一个没有without.CONCLUSION：水凝胶直肠间隔显着减少直肠暴露于LDR近距离放射治疗种子，前列腺覆盖或围手术期副作用没有明显的影响。这些结果仅反映了使用搁浅种子的LDR植入物。(C)2019年美国近距离放射治疗协会。爱思唯尔公司出版All rights reserved.
PURPOSE: To analyze the dosimetric impact and periprocedural outcomes with a bioabsorbable hydrogel rectal spacer injected during low-dose-rate (LDR) prostate brachytherapy implants.METHODS AND MATERIALS: A consecutive series of 80 patients implanted with stranded I-125 LDR brachytherapy seeds were evaluated, of which 40 underwent a transperineal injection of polyethylene glycol (5 cc) in between the prostate and rectum. Same day CT-based dosimetry was compared between patients with and without hydrogel spacer to evaluate for differences in rectal and prostate dosimetry. Physician-reported toxicities were coded with Common Terminology Criteria for Adverse Events (CTCAE) v4.RESULTS: Baseline patient and implant characteristics were similar. There were no acute genitourinary or rectal toxicities attributed to the hydrogel spacer. Comparing patients with and without hydrogel, the mean separation between the prostate and rectum was 13.9 +/- 5.2 mm vs. 6.5 +/- 5.0 mm (p < 0.0001), respectively. The adjusted mean dose to 1 cc, 2 cc, and 5 cc of the rectum relative to prescription dose was decreased by 32% (p < 0.01), 26% (p < 0.01), and 17% (p < 0.01), respectively. There were no statistically significant differences in prostate coverage: mean V-100 (92% vs. 91%), V-150 (45% vs. 48%), and D-90 (106% vs. 106%), respectively. At 1 month followup, grade 1 rectal toxicity was 12.5% vs. 17.5% (p = 0.35). No patients developed Grade >= 2 rectal toxicity with hydrogel, although one did without.CONCLUSION: Hydrogel rectal spacers significantly reduced rectal exposure to LDR brachytherapy seeds without an observable impact on prostate coverage or periprocedural side effects. These outcomes reflect only LDR implants that used stranded seeds. (C) 2019 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.