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Transperineal gold marker implantation for image-guided external beam radiotherapy of prostate cancer

A single institution, prospective study

Transperineale Implantation von Goldmarkern für die bildgestützte perkutane Strahlentherapie beim Prostatakarzinom

Eine unizentrische prospektive Studie

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Abstract

Purpose

To present the feasibility and complications of transperineal fiducial marker implantation in prostate cancer patients undergoing image-guided radiotherapy (IGRT)

Methods and materials

Between November 2011 and April 2016, three radiopaque, gold-plated markers were transperineally implanted into the prostate of 300 patients under transrectal ultrasound guidance and with local anaesthesia. A week after the procedure patients filled in a questionnaire regarding pain, dysuria, urinary frequency, nocturia, rectal bleeding, hematuria, hematospermia or fever symptoms caused by the implantation. Pain was scored on a 1–10 scale, where score 1 meant very weak and score 10 meant unbearable pain. The implanted gold markers were used for daily verification and online correction of patients’ setup during IGRT.

Results

Based on the questionnaires no patient experienced fever, infection, dysuria or rectal bleeding after implantation. Among the 300 patients, 12 (4%) had hematospermia, 43 (14%) hematuria, which lasted for an average of 3.4 and 1.8 days, respectively. The average pain score was 4.6 (range 0–9). Of 300 patients 87 (29%) felt any pain after the intervention, which took an average of 1.5 days. None of the patients needed analgesics after implantation. Overall, 105 patients (35%) reported less, 80 patients (27%) more, and 94 patients (31%) equal amount of pain during marker implantation compared to biopsy. The 21 patients who had a biopsy performed under general anesthesia did not answer this question.

Conclusion

Transperineal gold marker implantation under local anesthesia was well tolerated. Complications were limited; rate and frequency of perioperative pain was comparable to the pain caused by biopsy. The method can be performed safely in clinical practice.

Zusammenfassung

Zielsetzung

Darstellung von Machbarkeit und Komplikationen der transperinealen Implantation von Goldmarkern bei mit perkutaner Strahlentherapie (IGRT) behandelten Prostatakarzinompatienten.

Material und Methoden

Zwischen November 2011 und April 2016 bekamen 300 Patienten drei röntgendichte Goldmarker unter transrektaler Ultraschallkontrolle und Lokalanästhesie transperineal in die Prostata implantiert. Die Patienten beantworteten 1 Woche nach Implantation einen Fragebogen über Schmerzempfinden, Dysurie, Harnausscheidungsfrequenz, Nykturie, rektale Blutung, Hämaturie, Hämatospermie oder Fiebersymptome, verursacht durch die Implantation. Im Schmerzscore von 1–10 beschreibt 1 sehr schwache und 10 unerträglich starke Schmerzen. Die implantierten Goldmarker wurden zur täglichen Kontrolle und Online-Korrektur bei der IGRT genutzt.

Ergebnisse

In den Fragebögen berichtete kein Patienten über Fieber, Infektion, Dysurie oder rektale Blutung nach Implantation. Von 300 Patienten hatten 12 (4 %) Hämatospermien und 43 (14 %) Hämaturien, die jeweils 3,4 und 1,8 Tagen andauerten. Der durchschnittliche Schmerzscore war 4,6 (Spanne 0–9). Von 300 Patienten klagten 87 (29 %) nach dem Eingriff über leichte Schmerzen innerhalb von 1,5 Tagen; kein Patienten benötigte nach Implantation Analgetika. Insgesamt 105 Patienten (35 %) berichteten über weniger, 80 Patienten (27 %) über mehr und 94 Patienten (31 %) über gleich starke Schmerzen während der Implantation im Vergleich zur Biopsie. Diese Frage hatten 21 Patienten, bei denen eine Biopsie unter Allgemeinanästhesie durchgeführt wurde, nicht beantwortet.

Schlussfolgerung

Die transperineale Implantation von Goldmarkern unter Lokalanästhesie wurde gut vertragen. Komplikationen waren begrenzt; Rate und Frequenz von perioperativ auftretenden Schmerzen waren vergleichbar mit denen einer Biopsie. Die Methode ist in der klinischen Praxis sicher durchführbar.

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Authors and Affiliations

  1. Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7–9, 1122, Budapest, Hungary

    Kliton Jorgo M.D., Péter Ágoston, Tibor Major, Zoltán Takácsi-Nagy & Csaba Polgár

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  1. Kliton Jorgo M.D.
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  2. Péter Ágoston
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  3. Tibor Major
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  4. Zoltán Takácsi-Nagy
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Correspondence to Kliton Jorgo M.D..

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Conflict of interest

K. Jorgo, P. Ágoston, T. Major, Z. Takácsi-Nagy and C. Polgár declare that they have no competing interests.

Ethical standards

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. Informed consent was obtained from all individual participants included in the study.

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Jorgo, K., Ágoston, P., Major, T. et al. Transperineal gold marker implantation for image-guided external beam radiotherapy of prostate cancer. Strahlenther Onkol 193, 452–458 (2017). https://doi.org/10.1007/s00066-017-1104-2

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  • DOI: https://doi.org/10.1007/s00066-017-1104-2

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