Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: A prospective comparison of two seed implant methods - Preplanning and intraoperative planning
Iodine-125 brachytherapy for localized prostate cancer and urinary morbidity: A prospective comparison of two seed implant methods - Preplanning and intraoperative planning
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DOI：
10.1016/s0090-4295(03)00407-2
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发表时间：
2003-09-01
期刊：
影响因子：
2.1
通讯作者：
Chen, JZ
中科院分区：
文献类型：
--
作者：
Matzkin, H;Kaver, I;Chen, JZ
目标.比较两种目前使用的碘-125粒子植入技术治疗局限性前列腺癌的发病率。碘-125近距离放射治疗连续300例局限性前列腺癌患者。使用了两种粒子植入技术：预先计划（使用预装针）和术中计划（使用Mick施源器）。比较各组的泌尿系统发病率。前瞻性评估所有患者的国际前列腺症状评分。基于计算机断层扫描的植入物质量参数与下泌尿系统发病率相关。中位随访时间为30个月。在两个治疗组中，国际前列腺症状评分显著增加约9至12个月，此后恢复至基线水平。术中组的国际前列腺症状评分达到较高水平，并在较高水平上保持较长时间。尽管差异具有统计学显著性，但具有轻度临床意义。总体而言，两组的急性尿潴留发生率和手术需求均非常低（分别为2%和1%）。两组间无差异。术中方法的基于计算机断层扫描的植入物剂量测定参数显著更好。剂量学参数与症状严重程度呈正相关（P < 0.001）。这项前瞻性研究报告了两种不同种子植入技术后泌尿外科结局的首次大规模比较。两者均与非常低的尿潴留率或其他3级或更高的泌尿系统发病率相关。几乎所有的男性在最初的6到9个月都有更严重的泌尿系统症状，无论使用何种种子植入技术。采用术中方法治疗的患者表现出较长时间的毒性。由于术中粒子植入的腺体等剂量覆盖范围更好，剂量更大，我们倾向于这种方法。
Objectives. To compare morbidity between two currently used iodine-125 seed implantation techniques for the treatment of localized prostate cancer.Methods. Iodine-125 brachytherapy was used in 300 consecutive men with localized prostate cancer. Two seed implant techniques were used: preplanning, using preloaded needles, and intraoperative planning, using a Mick applicator. A comparison was made between the groups for urinary morbidity. The International Prostate Symptom Score was assessed prospectively among all patients. Computed tomography-based implant quality parameters were correlated with lower urinary system morbidity.Results. The median follow-up was 30 months. In both treatment groups, the International Prostate Symptom Score increased significantly for about 9 to 12 months and returned to baseline thereafter. The International Prostate Symptom Scores reached a higher level and remained at a higher level for a longer period in the intraoperative group. Although the differences were statistically significant, they were of mild clinical importance. Overall, the incidence of acute retention and the need for surgery was very low in both groups (2% and 1%, respectively). No differences were noted between the two groups. Significantly better computed tomography-based implant dosimetry parameters were noted with the intraoperative method. A positive correlation (P < 0.001) was found between the dosimetry parameters and symptom severity.Conclusions. This prospective study reports the first large-scale comparison of urologic outcomes after two different seed implant techniques. Both were associated with very low urinary retention rates or other grade 3 or greater urologic morbidity. Almost all men had worse urinary symptoms for the first 6 to 9 months, regardless of the seed implant technique used. Patients treated with the intraoperative method demonstrated toxicity for a longer duration. Because of the much better gland isodose coverage and greater doses delivered in the intraoperative seed implantation, we favor this method.