Urethrogram-directed stereotactic body radiation therapy for clinically localized prostate cancer in patients with contraindications to magnetic resonance imaging
Urethrogram-directed stereotactic body radiation therapy for clinically localized prostate cancer in patients with contraindications to magnetic resonance imaging
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DOI：
10.3389/fonc.2015.00194
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发表时间：
2015-09-01
影响因子：
4.7
通讯作者：
Collins, Sean P.
中科院分区：
文献类型：
--
作者：
Paydar, Ima;Kim, Brian S.;Collins, Sean P.
目的：磁共振成像（MRI）引导的立体定向放射治疗（SBRT）已被确立为前列腺癌的安全有效的治疗方法。对于有 MRI 禁忌症的患者，CT 尿道造影是一种替代成像方法，可确定前列腺尖的位置以指导治疗。本研究旨在评估尿道造影定向 SBRT 治疗前列腺癌的安全性。方法：2009 年 2 月至 2014 年 1 月期间，31 名临床局限性前列腺癌男性在乔治城大学医院接受了尿道造影定向 SBRT 联合或不联合补充调强放射治疗 (IMRT) 的明确治疗。 SBRT 的主要治疗方式为分五次 35-36.25 Gy，或分三次 19.5 Gy 加强治疗，然后补充常规分次 IMRT（45-50.4 Gy）。使用不良事件通用术语标准 4.0 版 (CTCAE v.4.0) 记录毒性并进行评分。 结果：患者中位年龄为 70 岁，中位前列腺体积为 38 cc。中位随访时间为 3.7 年。患者均为老年人（中位年龄 = 70 岁），合并症很常见（卡尔森合并症指数 >= 2，占 36%）。 71% 的患者在治疗前使用过 α 受体激动剂，9.7% 的患者之前接受过良性前列腺增生治疗。 ≥3级GU毒性和≥2级GI毒性的3年精算发生率分别为3.2%和9.7%，并且没有4级或5级毒性。结论：磁共振成像是指导前列腺SBRT治疗的首选成像方式。然而，尿道造影引导的 SBRT 是治疗无法接受 MRI 的前列腺癌患者的安全替代方案。
Purpose: Magnetic resonance imaging (MRI)-directed stereotactic body radiation therapy (SBRT) has been established as a safe and effective treatment for prostate cancer. For patients with contraindications to MRI, CT-urethrogram is an alternative imaging approach to identify the location of the prostatic apex to guide treatment. This study sought to evaluate the safety of urethrogram-directed SBRT for prostate cancer.Methods: Between February 2009 and January 2014, 31 men with clinically localized prostate cancer were treated definitively with urethrogram -directed SBRT with or without supplemental intensity-modulated radiation therapy (IMRT) at Georgetown University Hospital. SBRT was delivered either as a primary treatment of 35-36.25 Gy in five fractions or as a boost of 19.5 Gy in three fractions followed by supplemental conventionally fractionated IMRT (45-50.4 Gy). Toxicities were recorded and scored using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAE v.4.0).Results: The median patient age was 70 years with a median prostate volume of 38 cc. The median follow-up was 3.7 years. The patients were elderly (Median age = 70), and comorbidities were common (Carlson comorbidity index >= 2 in 36%). Seventy-one percent of patients utilized alpha agonists prior to treatment, and 9.7% had prior procedures for benign prostatic hyperplasia. The 3-year actuarial incidence rates of >= Grade 3 GU toxicity and >= Grade 2 GI toxicity were 3.2 and 9.7%, respectively, and there were no Grade 4 or 5 toxicities.Conclusion: Magnetic resonance imaging is the preferred imaging modality to guide prostate SBRT treatment. However, urethrogram -directed SBRT is a safe alternative for the treatment of patients with prostate cancer who are unable to undergo MRI.