RESUMO
PURPOSE: To retrospectively evaluate biochemical control and toxicity in patients who underwent 125I seed brachytherapy (BT) for intermediate-risk prostate cancer (PCa). MATERIALS AND METHODS: Between January 2004-December 2014, 395 patients with intermediate-risk PCa underwent 125I BT. Of these, 117 underwent preoperative planning (PP; 145â¯Gy) and 278 real-time intraoperative preplanning (IoP; 160â¯Gy). All patients were followed for ≥ 6 months (> 5 years in 48% of patients and > 7 years in 13%). Median follow-up was 59 months. RESULTS: Biochemical relapse-free survival (BRFS) rates at 5 and 8 years were, respectively, 91.7% and 82.1%. By treatment group, the corresponding BRFS rates were 93.5% and 90% for IoP and 89% and 76.8% for PP. The maximum dose to the urethra remained unchanged (217â¯Gy) despite the dose escalation (from 145 to 160â¯Gy), without any significant increase in treatment-related toxicity (pâ¯=â¯0.13). Overall toxicity outcomes in the series were excellent, with only 3 cases (0.76%) of grade 3 genitourinary toxicity. CONCLUSION: The real-time intraoperative planning technique at 160â¯Gy yields better biochemical controls than the preoperative planning technique at 145â¯Gy. Dose escalation did not increase urinary toxicity. The excellent results obtained with the IoP BT technique support its use as the first treatment option in this patient population.
RESUMO
Propósito: Describir la técnica utilizada en la radioterapia del eje craneoespinal en el Servicio de Oncología Radioterápica del Hospital LA FE, en cuyos campos se utilizan segmentos adicionales para optimizar la distribución de dosis resultante. Material y método: Para todos los pacientes se lleva a cabo una simulación virtual que permite localizar las estructuras críticas y determinar con precisión las colindancias entre los campos. En la planificación dosimétrica tridimensional (3D) se homogeneiza la distribución de dosis en el plano sagital, añadiendo eventualmente segmentos (1 ó 2) que apantallen las zonas sobredosificadas, durante una determinada proporción de las unidades de monitor. Resultados y discusión: La técnica descrita permite una adecuada optimización en este complejo tipo de tratamientos sin variar apenas el tiempo de planificación basada en la simulación virtual (AU)