Technique of Injection of Hyaluronic Acid as a Prostatic Spacer and Fiducials Before Hypofractionated External Beam Radiotherapy for Prostate Cancer
Technique of Injection of Hyaluronic Acid as a Prostatic Spacer and Fiducials Before Hypofractionated External Beam Radiotherapy for Prostate Cancer
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DOI：
10.1016/j.urology.2016.09.045
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发表时间：
2017-01-01
期刊：
影响因子：
2.1
通讯作者：
Ruffion, Alain
中科院分区：
文献类型：
--
作者：
Boissier, Romain;Udrescu, Corina;Ruffion, Alain
目的 描述一种结合植入基准点和前列腺间隔物（透明质酸 [HA]）的技术，以减少前列腺癌图像引导外照射放疗 (EBRT) 联合大分割后的直肠毒性，并评估该手术的耐受性和学习曲线。 材料和方法 30 名低或中危前列腺癌患者被纳入 II 期试验：图像引导 EBRT 62 Gy 20 次 3.1 Gy 的调强放射治疗。由 1 名操作员在直肠和前列腺之间经直肠植入 3 个基准点并经会阴注射 10 cc HA（NASHA 凝胶垫片，Q-Med AB，乌普萨拉，瑞典）。在磁共振成像上测量 10 个点的 HA 厚度，以建立注射质量评分（最高评分 = 10）并确定手术的学习曲线。 结果 质量评分从患者 1-10、11-20 到 21-30 逐渐增加，中位评分分别为：7 [2-10]、5 [4-7] 和 8 [3-10]。前列腺基部、中部和顶端与直肠之间的HA平均厚度如下：15.1毫米[6.4-29]、9.8毫米[5-21.2]和9.9毫米[3.2-21.5]。 HA 注射引起的中位疼痛评分为 4 [1-8]，中长期没有残留疼痛。 结论 在局麻下建立直肠和前列腺之间的界面并植入基准点是可行的，学习曲线短，并且可能成为前列腺癌大分割 EBRT 之前的标准程序。 (C) 2016 爱思唯尔公司
OBJECTIVE To describe a technique combining the implantation of fiducials and a prostatic spacer (hyaluronic acid [HA]) to decrease the rectal toxicity after an image-guided external beam radiotherapy (EBRT) with hypofractionation for prostate cancer and to assess the tolerance and the learning curve of the procedure.MATERIALS AND METHODS Thirty patients with prostate cancer at low or intermediate risk were included in a phase II trial: image-guided EBRT of 62 Gy in 20 fractions of 3.1 Gy with intensity-modulated radiotherapy. A transrectal implantation of 3 fiducials and transperineal injection of 10 cc of HA (NASHA gel spacer, Q-Med AB, Uppsala, Sweden) between the rectum and the prostate was performed by 1 operator. The thickness of HA was measured at 10 points on magnetic resonance imaging to establish a quality score of the injection (maximum score = 10) and determine the learning curve of the procedure.RESULTS The quality score increased from patients 1-10, 11-20, to 21-30 with respective median scores: 7 [2-10], 5 [4-7], and 8 [3-10]. The average thicknesses of HA between the base, middle part, and apex of the prostate and the rectum were the following: 15.1 mm [6.4-29], 9.8 mm [5-21.2], and 9.9 mm [3.2-21.5]. The injection of the HA induced a median pain score of 4 [1-8] and no residual pain at mid-long term.CONCLUSION Creating an interface between the rectum and the prostate and the implantation of fiducials were feasible under local anesthesia with a short learning curve and could become a standard procedure before a hypofractionated EBRT for prostate cancer. (C) 2016 Elsevier Inc.