Purpose

Low-dose-rate brachytherapy is a highly effective treatment modality for prostate carcinoma, but postimplant dosimetry quality is essential and correlated with likelihood of treatment success. Registered ultrasound and fluoroscopy (iRUF) can facilitate real-time intraoperative monitoring and plan adaptation, with the aim of attaining superior dosimetric outcomes. The purpose of this research was to compare clinical postimplant dosimetric results of iRUF-guided brachytherapy against brachytherapy using standard ultrasound-guided intraoperative dosimetry methods.

Methods and Materials

We analyzed postimplant dosimetry in 292 patients treated with Pd-103 between January 2007 and December 2018. All patients had postimplant dosimetry measured on day 0 to 1 using fused magnetic resonance/computed tomography assessment. Fifty-two patients were treated in 2 prospective clinical trials using iRUF intraoperative dosimetry, including 6 patients in a pilot study and 46 treated in a phase 2 study. Postimplant dosimetry in iRUF-treated patients was compared with dosimetry from 240 patients treated using standard (real-time ultrasound) intraoperative seed tracking.

Results

For every parameter measuring dose coverage to the prostate, iRUF patients had significantly higher values, irrespective of adjustment for year of treatment. In adjusted analyses, parameters of dose to urethra and rectum were not significantly higher among iRUF-treated patients.

Conclusions

Use of iRUF intraoperative dosimetry was associated with improved postimplant dose coverage in prostate, without associated increases in doses to urethra or rectum.

中文翻译：

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使用动态术中剂量测定实现永久性前列腺近距离放射治疗的优越植入后剂量测定

目的

低剂量率近距离放射治疗是前列腺癌的一种高效治疗方式，但植入后剂量学质量至关重要，并且与治疗成功的可能性相关。注册超声和透视 (iRUF) 可以促进实时术中监测和计划调整，以实现卓越的剂量学结果。本研究的目的是比较 iRUF 引导的近距离放射治疗与使用标准超声引导的术中剂量测定方法的近距离放射治疗的临床植入后剂量测定结果。

方法和材料

我们分析了 2007 年 1 月至 2018 年 12 月期间接受 Pd-103 治疗的 292 名患者的植入后剂量测定。所有患者在第 0 至 1 天使用融合磁共振/计算机断层扫描评估进行了植入后剂量测定。52 名患者在 2 项使用 iRUF 术中剂量测定的前瞻性临床试验中接受治疗，其中 6 名患者在试点研究中，46 名患者在 2 期研究中接受治疗。将 iRUF 治疗患者的植入后剂量测定与使用标准（实时超声）术中种子跟踪治疗的 240 名患者的剂量测定进行比较。

结果

对于测量前列腺剂量覆盖率的每个参数，iRUF 患者的值显着更高，与治疗年份无关。在调整后的分析中，在 iRUF 治疗的患者中，尿道和直肠的剂量参数没有显着升高。

结论

iRUF 术中剂量测定的使用与前列腺植入后剂量覆盖率的提高有关，而尿道或直肠的剂量没有增加。