我们假设，使用 MV 和 kV 图像引导 (MKIG) 的内部开发系统可确保 SBRT 期间正确的前列腺定位，有可能避免对非目标组织造成不必要的剂量，从而降低毒性。我们构建了一个可准确跟踪的 3D MKIG 平台实时前列腺植入基准点并进行临床翻译，该系统取代了商业方法，即分次内运动检查 (IMR)，该方法仅跟踪 2D kV 视图中的基准点。 2017年至2019年，150名前列腺癌患者接受了SBRT治疗并通过MKIG进行监测。当位移超过 1.5 毫米阈值时，基准点的运动轨迹会提醒治疗师中断并重新定位前列腺。由 121 名患者组成的对照组接受相同的剂量方案和治疗技术，但采用 IMR 管理。收集分次内患者轮班和分娩时间的统计数据，以评估工作流程的效率。分析≥2级泌尿道毒性的发生率以评估临床并发症。中位随访时间为 3.7 年（0.2 至 8.2 年）。与 IMR 治疗相比，MKIG 治疗具有更多的治疗轮次（1.09 比 0.28）和更长的每次分次平均给药时间（579±205 秒 vs. 357±117 秒）。 MKIG 产生的偏移有四分之三 (75%) ≤3mm，而 IMR 中这一比例为 51%，这表明 MKIG 检测到并纠正了较小的偏差。 MKIG 组中 2 级以上尿路毒性的发生率低于 IMR 组：10.7% vs. 19.8% (p=0.047)。在晚期尿毒性的多变量分析中，仅选择高 (>7) 的 RT 前 IPSS (p<0.043) 和使用 MKIG (p<0.029)。自动化和定量 MKIG 对工作流程的影响最小，并且在以下方面优于 IMR在 SBRT 期间定位前列腺，这与临床上显着降低晚期尿毒性相关。需要通过随机试验进行进一步的临床测试来验证对结果的影响。版权所有 © 2024。由 Elsevier Inc. 出版。

We hypothesized that an in-house developed system using MV and kV image guidance (MKIG) to ensure correct prostate positioning during SBRT could potentially avoid unwanted doses to non-target tissues, leading to reduced toxicities.We built a 3D MKIG platform that accurately tracks prostate implanted fiducials in real-time and clinically translated the system to replace a commercial approach, intrafraction motion review (IMR), which only tracks fiducials in the 2D kV views. From 2017 to 2019, 150 prostate cancer patients were treated with SBRT and monitored by MKIG. The motion trace of the fiducials alerts therapists to interrupt and reposition the prostate when displacement exceeds a 1.5 mm threshold. A comparison cohort of 121 patients was treated with the same dose regimen and treatment technique but managed by IMR. Statistics of intrafractional patient shifts and delivery time were collected to evaluate the workflow efficacy. The incidence of grade ≥2 urinary toxicities was analyzed to assess clinical complications. The median follow-up time was 3.7 years (0.2 to 8.2 years).MKIG treatments had more treatment shifts (1.09 vs. 0.28) and a longer average delivery time per fraction (579±205s vs. 357±117s) than IMR treatments. Three-quarters (75%) of shifts resulting from MKIG were ≤3mm, vs. 51% in IMR, indicating that MKIG detected and corrected smaller deviations. The incidence of grade ≥2 urinary toxicity was lower in the MKIG than IMR cohort: 10.7% vs. 19.8% (p=0.047). On multivariate analysis of late urinary toxicity, only high (>7) pre-RT IPSS (p<0.043) and the use of MKIG were selected (p< 0.029).Automated and quantitative MKIG introduced minimal workflow impact and was superior to IMR in localizing the prostate during SBRT, which correlated with a clinically significant reduction in late urinary toxicity. Further clinical testing via randomized trial will be required to validate the impact on outcomes.Copyright © 2024. Published by Elsevier Inc.