Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?
Are simple verbal instructions sufficient to ensure that bladder volume does not deteriorate prostate position reproducibility during spot scanning proton therapy?
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DOI：
10.1259/bjro.20210064
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发表时间：
2021
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本研究的目的是探讨在图像引导的点扫描质子治疗（SSPT）治疗局限性前列腺癌时，口头指示是否足以控制膀胱体积（BV）而不降低前列腺位置的可重复性。回顾性分析12例连续接受影像引导SSPT治疗的前列腺癌患者的268个疗程。除了严格的直肠容积控制程序外，在治疗前一小时使用简单的口头说明排尿。治疗前通过膀胱扫描测量BV，通过前列腺内基准标记物和两组x线透视图像测量前列腺运动。根据BV的可重复性，采用线性混合效应模型和系统和随机误差评估BV变化与前列腺运动的相关性。治疗期间的平均绝对BV变化从- 98.7 ml到86.3 ml（中位7.1 ml）。患者在左右方向的平均绝对前列腺运动为- 1.46 ~ 1.85 mm；颅尾方向为- 6.10 ~ 3.65 mm，前后方向为- 1.90 ~ 5.23 mm。SSPT期间BV变化与前列腺运动无明显关系。早期和晚期泌尿生殖系统和胃肠道毒性最小，随访时间至少为4.57年。简单的口头排尿提示足以控制BV，而不会影响图像引导下SSPT的前列腺运动和临床结果。在治疗精囊时，仍然需要仔细注意BV的变化。我们的数据表明BV变化与前列腺位置可重复性之间没有明显的关系，简单的口头排尿指导对于图像引导的SSPT来说是足够的。
The purpose of this study is to investigate whether verbal instructions are sufficient for bladder volume (BV) control not to deteriorate prostate position reproducibility in image-guided spot scanning proton therapy (SSPT) for localized prostate cancer. A total of 268 treatment sessions in 12 consecutive prostate cancer patients who were treated with image-guided SSPT with fiducial markers were retrospectively analyzed. In addition to strict rectal volume control procedures, simple verbal instructions to void urine one hour before the treatment were used here. The BV was measured by a Bladder Scan just before the treatment, and the prostate motion was measured by intraprostatic fiducial markers and two sets of X-ray fluoroscopy images. The correlation between the BV change and prostate motion was assessed by linear mixed-effects models and systematic and random errors according to the reproducibility of the BV. The mean absolute BV change during treatment was from −98.7 to 86.3 ml (median 7.1 ml). The mean absolute prostate motion of the patients in the left-right direction was −1.46 to 1.85 mm; in the cranial-caudal direction it was −6.10 to 3.65 mm, and in the anteroposterior direction −1.90 to 5.23 mm. There was no significant relationship between the BV change and prostate motion during SSPT. The early and late genitourinary and gastrointestinal toxicity was minimal with a minimum follow up of 4.57 years. Simple verbal instructions about urination was suggested to be sufficient to control the BV not to impact on the prostate motion and clinical outcomes in image-guided SSPT. Careful attention to BV change is still needed when the seminal vesicle is to be treated. Our data demonstrated that there was no apparent relationship between BV changes and prostate position reproducibility and simple verbal instruction about urination could be sufficient for image-guided SSPT.