Permanent prostate brachytherapy: Dosimetric results and analysis of a learning curve with a dynamic dose-feedback technique
Permanent prostate brachytherapy: Dosimetric results and analysis of a learning curve with a dynamic dose-feedback technique
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DOI：
10.1016/j.ijrobp.2006.01.035
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发表时间：
2006-07-01
影响因子：
7
通讯作者：
Beaney, Ronald
中科院分区：
文献类型：
--
作者：
Acher, Peter;Popert, Rick;Beaney, Ronald
目的：采用术中反向计划动态剂量反馈的永久性前列腺近距离放射治疗(PPB)计划是在没有替代技术的第一手经验的情况下启动的。这项研究的目的是评估与这种方法相关的剂量学学习曲线。方法和材料：从2003年12月到2004年6月，共有77名患者接受了PPB植入，作为局限性前列腺癌的单一治疗，处方剂量为145Gy1251粒疏松。结果：术中剂量学中位数为：D90(最小剂量至90%的前列腺)=170GY(范围135~203GY)，V100(接受100%处方剂量的前列腺体积)=96%(范围86~100)，V150=66%(范围34~86)。术后D90=168Gy132~197GyV100=95%(86~99)，V150=74%(51~84)。植入活度的中位数为每立方厘米前列腺0.79mci(范围0.541-1.13)。病例数与所研究的任何术后剂量学参数均无显著相关性。在序列结束时，每个病例的门到门或时间从中位数138分钟减少到97.5分钟，最初28例的相关系数为-0.76。结论：在适当训练的环境中，从一开始就可以获得满意的剂量学参数，而不会产生学习曲线效应。就OR时间而言，临床上动态剂量反馈PPB相对于其他技术的学习曲线是显而易见的。(C)2006年爱思唯尔公司。
Purpose: A permanent prostate brachytherapy (PPB) program utilizing intrauperative inverse-planned dynamic dose-feedback was initiated without prior firsthand experience of alternative techniques. The purpose of this study is to assess the dosimetric learning curve associated with this approach.Methods and Materials: A total of 77 patients underwent PPB implants as monotherapy for localized prostate cancer to a prescription dose of 145 Gy with loose 1251 seeds between December 2003 and June 2004. Intraoperative and postoperative dosimetric values, total implanted radioactivity, and operating room (OR) times were compared by sequential case number for all cases.Results: The median intraoperative dosimetric values were: D90 (the minimum dose to 90% of the prostate) = 170 Gy (range, 135-203 Gy), V100 (the volume of the prostate that receives 100% of the prescription dose) = 96% (range, 86-100), V150 = 66% (range, 34-86). Median postoperative dosimetric values were as follows: D90 = 168 Gy (range, 132-197 Gy), V100 = 95% (range, 86-99), V150 = 74% (range, 51-84). Median implanted activity was 0.79 mCi per cubic centimeter of prostate (range, 0.541-1.13). There was no significant correlation by case number on any postoperative dosimetric parameter studied. Door-to-door OR time was reduced from median 138 to 97.5 min per case at the end of the series with a correlation coefficient of -0.76 for the initial 28 cases.Conclusion: Satisfactory dosimetric parameters can be achieved from the outset without a learning curve effect in an appropriately trained environment. The learning curve for dynamic dose-feedback PPB in a clinic naive to other techniques is apparent in terms of OR time. (c) 2006 Elsevier Inc.