Fiduciels intraprostatiques dans le cadre de la radiothérapie stéréotaxique du cancer de la prostate |
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| Institution: | 1. Département universitaire de radiothérapie, centre de lutte contre le cancer Oscar-Lambret, 3, rue Fréderic-Combemale, 59020 Lille cedex, France;2. Site de recherche intégrée sur le cancer (Siric) OncoLille, 3, rue Fréderic-Combemale, 59020 Lille cedex, France;3. Université de Lille, 2, avenue Oscar-Lambret, 59000 Lille, France;1. Department of Imaging and Interventional Radiology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong S.A.R., People?s Republic of China;2. Anatomical and Cellular Pathology, Prince of Wales Hospital, The Chinese University of Hong Kong, Shatin, Hong Kong S.A.R., People?s Republic of China;3. The Laboratory Animal Services Centre, The Chinese University of Hong Kong, Shatin, Hong Kong S.A.R., People?s Republic of China.;1. Service d’urologie, université Lille-Nord-de-France, CHU de Lille, 59000 Lille, France;2. Centre hospitalier Lyon-sud, hospices civiles de Lyon, 69310 Lyon, France;3. Hôpital Edouard-Herriot, hospices civiles de Lyon, 69003 Lyon, France;4. Hôpital d’instruction des Armées Val-de-Grâce, 75005 Paris, France;5. Polyclinique Saint-François – Saint-Antoine, 03100 Montluçon, France;6. Clinique Océane, 56000 Vannes, France;7. 6 Kyoto Prefectural University of Medicine, 602-0841 Kyoto, Japon;1. Service de médecine vasculaire et thérapeutique, hôpital Nord, CHU de Saint-Étienne, avenue A.-Raimond, 42055 Saint-Étienne, France;2. Service de radiologie centrale, hôpital Nord, CHU de Saint-Étienne, avenue A.-Raimond, 42055 Saint-Étienne, France;3. Inserm, SAINBIOSE, U1059, dysfonction vasculaire et hémostase, université Jean-Monnet, 42055 Saint-Étienne, France;1. CONICET-CIGEOBIO Instituto de Geología, Gabinete de Estratigrafía, Universidad Nacional de San Juan, Argentina;2. CONICET Mendoza Instituto Argentino de Investigación de las Zonas Aridas, Universidad Nacional de San Juan, Argentina;3. Universidad Nacional de San Juan, Argentina;1. Centre Briochin d’urologie, clinique du Littoral, 22000 Saint-Brieuc, France;2. Service d’urologie, université de Rennes 1, CHU de Rennes, 35000 Rennes, France;1. Service d’imagerie diagnostique et interventionnelle de l’adulte, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France;2. Service de médecine nucléaire, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France;3. Service d’oncologie médicale, hôpital Saint-André, CHU de Bordeaux, 1, place Jean-Burguet, 33076 Bordeaux, France;4. Service d’urologie, hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, 33076 Bordeaux, France |
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| Abstract: | PurposeImage-guided radiotherapy for prostate cancer is widely used in radiotherapy departments. Intraprostatic gold fiducial markers are used to visualize prostate position and motion before and during treatment. The aim of this report is to describe our experience of implanting intraprostatic fiducial markers under local anesthesia before hypofractionated stereotactic radiotherapy for prostate cancer and to assess its tolerance and reproducibility.Patients and methodsOver a 6 and a half year period, 226 patients with prostate cancer received a stereotactic radiotherapy using the CyberKnife® system (Accuray) in our institution. Eighteen patients were treated for recurrence after prostatectomy; these patients were excluded from the study. Among the 208 remaining patients, 94 patients (45.2%) received stereotactic radiotherapy as a boost after external beam radiotherapy (three fractions of 6 Gy); 36 patients (17.3%) were had a re-irradiation (six fractions of 6 Gy) and 78 patients (37.5%) had a exclusive stereotactic radiotherapy (68 patients received five fractions of 7.25 Gy and 11 patients five fractions of 6.25 Gy). Four markers were implanted in all patients using transrectal ultrasound; the procedure was performed under local anesthesia, using transperineal access. The four fiducial markers were implanted in two strands with two fiducial each one, 1 cm apart. In order to follow the recommendations of the image-guided radiotherapy system, the two strands of the two markers were located on the same plane in the middle of the prostate, at least 2 cm apart from the midline. After insertion, correct positioning of fiducials markers was verified by X-ray. Dosimetry scanning was performed after the implantation procedure; prostate position tracking was possible before and during treatment through the kilovoltage incorporated system of the robotic accelerator. Clinical data, X-ray verification and dosimetry scanner have been retrospectively reviewed for all patients.ResultsThe tolerance to procedure was excellent; only four patients (1.8%) described pain related to implant. No urinary side effects were reported. Median time from fiducial implantation to dosimetry scanner was 16 days (4–113 days). Four fiducials were found within the prostate at dosimetry scanner in 181 patients and three in 27 remaining patients. All intraprostatic fiducials were used to track the prostate gland before and during treatment.ConclusionsIntraprostatic fiducial markers implantation is a safe and reproducible procedure that allows us to have reliable prostate information before and during stereotactic radiotherapy. |
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| Keywords: | Intraprostatic fiducial Prostate cancer Hypofractionated radiotherapy |
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