Turkiye Klinikleri Urology - Special Topics

Prostat Kanseri Özel Sayısı
.: REVIEW
Lokalize Prostat Kanserinin Küratif Tedavisinde Brakiterapinin Yeri
The Role of Brachytherapy in the Definitive Management of Localized Prostate Cancer
Murat ÇALOĞLUa, Vuslat YÜRÜT ÇALOĞLUa
aRadyasyon Onkolojisi AD, Trakya Üniversitesi Tıp Fakültesi, Edirne
Turkiye Klinikleri J Urology-Special Topics. 2014;7(4):94-100
Article Language: TR
ÖZET
Prostat kanseri erkeklerde cilt maligniteleri hariç tutulduğunda en sık görülen malignitedir. Düşük riskli lokal hastalıkta cerrahi ve radyoterapi temel tedavi seçenekleridir. Brakiterapi ya düşük doz hızlı kalıcı radyoaktif kaynakların veya yüksek doz hızlı bir kaynağının geçici olarak yerleştirilmesi ile uygulanır. Düşük riskli prostat kanserinde monoterapi olarak düşük doz hızlı brakiterapi oldukça etkin bir tedavi seçeneğidir. Brakiterapi ile oldukça yüksek dozlar sağlam dokuları ışınlamadan direk olarak prostata verilir. Kullanılacak kaynaklar açısından I125 ile Pd103'ün etkinliklerinde bir fark bulunmamıştır. Prostata verilecek izodoz PTV'nin %95'inden fazlasını kapsamalıdır. D90'nın verilen dozun %90'ından daha fazla olması (145 Gy'lik uygulama için 130 Gy) önerilir. Düşük doz hızlı prostat brakiterapisi, irritatif ve obstrüktif bulgulardan oluşan akut üriner toksisitesi ile birliktedir ve en önemli risk faktörü büyük prostat volümüdür. Bu tedaviyle düşük riskli hastalıkta 7-10 yıllık bNED oranları %95'in üzerindedir. Yüksek doz hızlı brakiterapide ise ''adımlayan kaynak'' olan yüksek aktiviteli Ir192 kaynağının sırayla transperineal yerleştirilmiş her iğnenin içerisinde adım adım ilerlemesi ile oldukça konformal bir radyoterapi yapılmış olur. Prostat gland geç reaksiyon veren dokulardan olduğu için (α/β oranı 1.5-3) tedavide daha büyük fraksiyon dozu verilmesiyle daha fazla hücre ölümü gerçekleşir. Yüksek doz hızlı brakiterapi genel olarak orta ve yüksek riskli hastalarda eksternal radyoterapiye kombine edilerek (50 Gy/25fr+2×10 Gy) kullanılabilir. Eksternal radyoterapi ile kıyaslandığında hem yüksek hem de düşük doz hızlı prostat brakiterapisi, hayli etkin intraprostatik doz artışı sağlayarak prostata çok daha yüksek ve konformal doz vermektedir. Toksisite profilleri daha iyidir. Son zamanlarda düşük doz hızlı ve yüksek doz hızlı brakiterapi endikasyonları birbiri içine geçmeye başlamıştır.

Anahtar Kelimeler: Brakiterapi; prostat kanseri; radyoterapi
ABSTRACT
Prostate carcinoma is the most common malignancy in men excluding skin malignancies. Surgery and radiotherapy are the main treatment options for the low-risk localized disease. Brachytherapy is applied by placing either permanent radioactive sources with low dose rate or temporary radioactive sources with high dose rate. The low-dose-rate brachytherapy as monotherapy is a highly effective treatment option for low-risk prostate cancer. A fairly high dose is given directly into the prostate with brachytherapy sparing the healthy tissues of irradiation. In terms of resources to be used, the effectiveness of I125 and Pd103 is not different. The isodose will be given to the prostate should cover more than 95% of PTV. D90 is recommended to be more than 90% of the administered dose (130 Gy for 145 Gy). Low-dose-rate prostate brachytherapy has been associated with acute urinary toxicity consisting of irritative and obstructive symptoms and the most important risk factor is a large prostate volume. bNED rates for 7-10 years are above 95% in low-risk disease with this treatment. A highly conformal radiation treatment can then be delivered to the target using a ''stepping source'' of high activity 192Ir, which is automatically advanced in step-wise fashion, along each of the needles in turn. Since the prostate gland is one of the late reactive tissues (α/β ratio 1.5-3), treatment by administering a larger fraction of the dose, causes more cell death. In general, high dose rate brachytherapy is combined with external beam radiotherapy for medium and in high-risk patients (50 Gy/25F +2 × 10 Gy). Both high and low dose-rate prostate brachytherapy, providing highly effective intraprostatic dose escalation, give much higher and more conformal dose to the prostate when compared with external beam radiation therapy. Their toxicity profiles are also better than those of external beam radiotherapy. Recently, low-dose and high-dose-rate brachytherapy indications have begun to be overlapped with each other.

Keywords: Brachytherapy; prostatic neoplasms; radiotherapy

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30.03.2014

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