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Prostatic fiducial markers implantation by transrectal ultrasound for adaptive image guided radiotherapy in localized cancer: 7-years experience

Vito Lacetera, Massimo Cardinali, Giovanna Mantello, Francesco Fenu, Giulia Sbrollini, Flavia Tombolini, Alessandro Conti, Stefania Maggi, Giovanni Muzzonigro, Andrea Benedetto Galosi
  • Vito Lacetera
    Clinica Urologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy | vlacetera@gmail.com
  • Massimo Cardinali
    SOD Radioterapia,Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Giovanna Mantello
    SOD Radioterapia,Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Francesco Fenu
    SOD Radioterapia,Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Giulia Sbrollini
    Clinica Urologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Flavia Tombolini
    Clinica Urologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Alessandro Conti
    Clinica Urologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Stefania Maggi
    SOD Fisica Sanitaria Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Giovanni Muzzonigro
    Clinica Urologica, Azienda Ospedaliero-Universitaria Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
  • Andrea Benedetto Galosi
    UOC di Urologia, Ospedale “Augusto Murri”, ASUR Marche, Fermo, Italy

Abstract

Objective: we present our 7-years’ experience with fiducial gold markers inserted before Image-Guided Radiotherapy (IGRT) focusing on our echo-guided technique reporting early and late complications. Material and methods: 78 prostate cancer (PCA) patients who underwent fiducial markers placement for adaptive IGRT (period 2007-2014) were selected. Mean patient age was 75 years (range 60-81), mean PSA 7.8 ng/ml (range 3.1-10), clinical stage < T3, mean Gleason Score 6.4 (range 6-7). We recorded early and late complications. Maximum distance between the Clinical Target Volume (CTV) and Planning Target Volume (PTV) was assessed for each direction and the mean PTV reduction was estimated. Results: we describe in details our echo-guided technique of intraprostatic gold fiducial markers insertion prior to adaptative IGRT. We report rare early toxicity (5-7% grade 1-2), a mean PTV reduction of 37% and a very low late toxicity (only 3.4% bladder G3 and 8% rectal G2 side effects). Conclusion: Our technique of fiducial gold markers implantation for adaptative IGRT is safe and well-tolerated and it resulted helpful to reduce CTV-PTV margin in all cases; the effects on clinical practice seem significant in terms of late toxicity but further investigations are needed with longer follow-up.

Keywords

Prostate cancer; Fiducial markers; Image guided radiotherapy; Transrectal ultrasound; CBCT: Cone Beam Computer Tomography; US: ultrasound; TRUS: Transrectal Ultrasound

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Submitted: 2015-01-23 15:42:43
Published: 2014-12-30 00:00:00
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Copyright (c) 2014 Vito Lacetera, Massimo Cardinali, Giovanna Mantello, Francesco Fenu, Giulia Sbrollini, Flavia Tombolini, Alessandro Conti, Stefania Maggi, Giovanni Muzzonigro, Andrea Benedetto Galosi

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