放射后尿路毒性减轻：腔内多束能量子体-伏安放射定位监测技术的应用
Reduction of Postradiation Therapy Urinary Toxicity Via Intrafractional Megavoltage-Kilovoltage Prostate Location Monitoring
DOI 原文链接
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影响因子:6.5
分区:医学1区 Top / 肿瘤学2区 核医学2区
发表日期:2025 Jan 01
作者:
Pengpeng Zhang, Laura Happersett, Sarah Burleson, Jung Hun Oh, Ahmed Elsayegh, Brian Leong, Maria Thor, Antonio Damato, Andrew Jackson, Laura Cervino, Joseph O Deasy, Michael Zelefsky
DOI:
10.1016/j.ijrobp.2024.07.2325
摘要
我们假设，利用自主开发的多束能量子体-伏安图像引导（MKIG）系统，确保在立体定向体部放疗（SBRT）中前列腺的正确定位，可以避免不必要的非靶组织剂量，从而减少毒性反应。我们建立了一个三维MKIG平台，能够实时准确追踪前列腺内植入的标记物，并将其临床转化为替代商业方案的腔内运动评估（IMR）系统，该系统仅在二维伏安视图中追踪标记物。从2017年至2019年，150例前列腺癌患者接受SBRT治疗并使用MKIG监测。标记物的运动轨迹提醒治疗师在位移超过1.5 mm时中断治疗并重新定位前列腺。另一组121名患者采用相同剂量和技术，但由IMR管理，作为对照。收集了腔内患者偏移和治疗时间的统计数据以评估流程效率。分析晚期尿路毒性（Grade ≥2）的发生率以评估临床并发症。随访中位时间为3.7年（0.2-8.2年）。MKIG组的治疗偏移次数（1.09对比0.28）和每次分次的平均治疗时间（579 ± 205秒对比357 ± 117秒）均高于IMR组。MKIG检测到的偏移中，75% ≤3 mm，而IMR为51%，表明MKIG能检测并校正更小的偏差。MKIG在晚期尿路毒性方面优于IMR，发生率为10.7%对19.8%（P = .047）。多变量分析显示，只有高于7的放疗前国际前列腺症状评分（P < .043）和使用MKIG是预测晚期尿路毒性的独立因素（P < .029）。自动化的MKIG引入对工作流程影响 minimal，并在SBRT期间定位前列腺方面优于IMR，显著降低了晚期尿路毒性。未来需要随机对照试验以验证其对患者结局的影响。
Abstract
We hypothesized that an in-house developed system using megavoltage and kilovoltage image guidance (MKIG) to ensure correct prostate positioning during stereotactic body radiation therapy (SBRT) could potentially avoid unwanted doses to nontarget tissues, leading to reduced toxicities.We built a 3-dimensional 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 2-dimensional kilovoltage views. From 2017 to 2019, 150 patients with prostate cancer were treated with SBRT and monitored using 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 (0.2-8.2 years).MKIG treatments had more treatment shifts (1.09 vs 0.28) and a longer average delivery time per fraction (579 ± 205 seconds vs 357 ± 117 seconds) than IMR treatments. Three-quarters (75%) of shifts resulting from MKIG were ≤3 mm, versus 51% in IMR, indicating that MKIG detected and corrected smaller deviations. The incidence of grade ≥2 urinary toxicity was lower in the MKIG than the IMR cohort: 10.7% versus 19.8% (P = .047). On multivariate analysis of late urinary toxicity, only high (>7) preradiation therapy international prostate symptom score (P < .043) and the use of MKIG were selected (P < .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 using randomized trials will be required to validate the impact on outcomes.