Author/Editor		Kragelj, Borut; Guna, France; Burger, Janez
Title		Radical irradiation of the prostate. Combination of percutaneous irradiation and irradiation with LDR Ir-192 implants
Translated title		Radikalno obsevanje prostate v kombinaciji s perkutanim obsevanjem in implantacijo prostate z LDR Ir 192
Type		članek
Source		Radiol Oncol
Vol. and No.		Letnik 35, št. 2
Publication year		2001
Volume		str. 117-26
Language		eng
Abstract		Background. The irradiation of the carcinomas of the prostate with the doses above the tolerable ones of standard radiotherapy improves the local control of the disease. The aim of this study is to determine the acute toxicity and tolerability of the high-dose prostate irradiation combining external beam radiotherapy (EBRT) and interstitial low dose rate (LDR) brachyradiotherapy (BRT) Ir-192 of the prostate. Material and methods. We examined medical records of 8 patients with localized carcinoma of the prostate (T2-T3 No-x Mo) treated from August 1999 until February 2000. The initial PSA was 2.7-37.5 ng/ml (median 13.7) and Gleason score 4-9 (median 7). Radiotherapy consisted of 48.6-50.4 Gy of EBRT to the prostate and seminal vesicles (4 patients) or the whole pelvis (4 patients) and 20.0-28.0 Gy of interstital LDR Ir-192 BRT given as a single fraction, fluoroscopic guided transperineal Implantation of the prostate. The cumulative doses of percutaneous and interstitial irraditations to the prostate were 68.6 - 79.1 Gy. Results. Acute toxic effects of irradiation though observed in all patients were of only mild intensity. According to the RTOG criteria, 20/30 toxicities were assessed as grade 1, 9/30 as grade 2, and 1/30 as grade 3. In none of the patients, toxic effects required any specific modification of the treatment regimen. Conclusions. The very first experiences indicate moderate toxicity and optimal tolerance of the treatment by patients. An improvement of implantation techniques may be expected with regular CT controls of the implants and extra attentive care of the implants in the urethra region.
Summary		Izhodišča. Obsevanje prostatičnih karcinomov z dozami višjimi od še sprejemljivih doz ob klasični radioterapiji izboljša lokalno kontrolo bolezni. Namen študije je bil ugotoviti akutno toksičnost ter sprejemljivost visokodoznega obsevanja prostate s kombinacijo perkutanega obsevanja in intersticijske brahiradioterapije, kjer smo implantacijo prostate izvedli z Ir 192, ki je imel nizko hitrost doze (LDR). Materijal in metode. Pregledali smo dokumentacijo 8 bolnikov z lokaliziranimi karcinomi prostate (T2-3 N0-X M0). Izhodna vrednost PSA je bila 2,7 - 37,5 (mediana 13,7) ng/ml., točkovanje po Gleasonu pa 4-9 (mediana 7). Zdravljeni so bili avgusta 1999 do februarja 2000 s kombinacijo perkutanega obsevanja prostate in seminalnih vezikul (4 bolniki) oziroma medeničnega področja (4 bolniki) s 48.6 - 50,4 Gy ter intersicijskega obsevanja prostate LDR IR-192 z 20,0 do 28,0 Gy. Rezultati. Akutni stranski učinki obsevanja, ki so se pojavili pri vseh bolnikih, so bili neizraziti glede na RTOG kriterije je pri 20 do 30 bolnikov ocenjeno kot 1. stopnje, pri 9 do 30 2. stopnje in pri 1 do 30 bolnikov 3. stopnje. Pri nobenem bolniku ni bilo potrebno prilagajati zdravljenja zaradi stranskih učinkov. Zaključki. Začetne izkušnje kažejo na zmerno toksičnost ter optimalno sprejemljivost kombinacije perkutanega obsevanja in implantacije z LDR Ir 192. Tehniko implantacije bi lahko izboljšali z rednimi CT kontrolami implantata in z dodatno pozornostjo pri uvajanju igelj v področje ob uteri.
Descriptors		PROSTATIC NEOPLASMS RADIOTHERAPY DOSAGE BRACHYTHERAPY IRIDIUM RADIOISOTOPES