Le rôle de la curiethérapie prostatique guidée par imagerie 3D sur le ratio thérapeutique: l'expérience du CHU de Québec
2007; Elsevier BV; Volume: 11; Issue: 8 Linguagem: Inglês
10.1016/j.canrad.2007.09.144
ISSN1769-6658
AutoresWilliam Foster, Luc Beaulieu, François Harel, André‐Guy Martin, Éric Vigneault,
Tópico(s)Advanced Radiotherapy Techniques
ResumoTo evaluate the impact of adaptative image-guided brachytherapy on therapeutic outcome and toxicity in prostate cancer.The 1,110 first patients treated at the CHUQ-l'Hôtel-Dieu de Québec were divided in five groups depending on the technique used for the implantation, the latest being intra operative treatment planning. Biochemical disease free survival (5-bDFS), toxicities and dosimetric parameters were compared between the groups.5-bDFS (ASTRO+Houston) were of 88.5% and 90.5% for the whole cohort. The use of intra operative treatment planning resulted in better dosimetric parameters. Clinically, this resulted in a decreased use of urethral catheterism, from 18.8% in group 1 to 5.2% in group 5, and in a reduction in severe acute urinary side effects (21.3 vs 33.3% P=0.01) when compared with preplanning. There was also less late gastrointestinal side effects (groups 5 vs 1: 26.6 vs 43.2% P<0.05). Finally, when compared with preplanning, intra operative treatment planning was associated with a smaller reduction between planned D90 and the dose calculated at the CT scan 1 month after the implant (38 vs 66 Gy).The evolution of prostate brachytherapy technique toward intra operative treatment planning allowed dosimetric gains which resulted in significant clinical benefits by increasing the therapeutic ratio mainly through a decreased urinary toxicity. A longer follow-up will answer the question whether there is an impact on 5-bDFS.
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