tailieunhanh - Endourooncology New Horizons in Endourology - part 10

MRSI hướng dẫn liều leo thang trong 44 bệnh nhân bị ung thư tuyến tiền liệt lâm sàng địa phương (dữ liệu chưa được công bố). Tỷ lệ choline và citrate cho tuyến tiền liệt đã được phân tích, và các khu vực có nguy cơ cao cho các tế bào ác tính đã được xác định. Các tọa độ của voxels bất thường được xác định trên MRS | Tumor Control Outcome 161 MRSI-guided dose escalation in 44 patients with clinically localized prostate cancer unpublished data .The ratios of choline and citrate for the prostate were analyzed and regions of high risk for malignant cells were identified. The coordinates of abnormal voxels identified on MRS were transferred and overlaid on the intraoperative ultrasound images. A computer-based intraoperative conformal treatment-planning system was used to determine the optimal seed distribution to deliver a prescription dose of 144Gy to the target volume prostate 200 to 300 of the prescription dose to the abnormal regions identified on MRS and to maintain the urethral and rectal doses within tolerance ranges. The MRSI-identified abnormal voxels received a mean dose of 343 Gy 238 of the 144Gy prescription dose . The minimum dose delivered to the MRS-abnormal voxels was 182 Gy 126 of the prescribed target dose . Despite the dose escalation achieved for the MRS-positive voxels the urethral and rectal doses were maintained within tolerance ranges. The median average rectal and urethral doses were 49 and 130 of the prescription dose. The percentages of patients with acute grade 2 gastrointestinal toxicity 6 and 12 months after implantation were both 2 . The percentages of patients with acute grade 2 genitourinary toxicity 6 and 12 months after implantation were 30 and 14 respectively. The percentage of patients with late grade 2 gastrointestinal toxicity 12 months after implantation was 7 .The percentage of patients with late grade 2 genitourinary toxicity 12 months after implantation was 18 . One patient 2 developed late grade 3 genitourinary toxicity urethral stricture and no patients developed late grade 3 or higher gastrointestinal toxicity. Further studies will be necessary to fully explore the specificity and sensitivity of MRS and its pathologic correlation with radical prostatectomy specimens. These data nevertheless indicate that new biologic-based imaging .

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