2014 ULTRASOUND-GUIDED IMPLANTATION OF ELECTROMAGNETIC TRANSPONDERS INTO THE PROSTATE BED FOR LOCALIZATION AND TRACKING DURING INTENSITY MODULATED RADIATION THERAPY FOLLOWING RADICAL PROSTATECTOMY

Abstract

You have accessJournal of UrologyImaging/Radiology: Uroradiology I1 Apr 20102014 ULTRASOUND-GUIDED IMPLANTATION OF ELECTROMAGNETIC TRANSPONDERS INTO THE PROSTATE BED FOR LOCALIZATION AND TRACKING DURING INTENSITY MODULATED RADIATION THERAPY FOLLOWING RADICAL PROSTATECTOMY Daniel Canter, Mark Buyyounouski, Alexander Kutikov, Jinsheng Li, Richard E. Greenberg, Eric M. Horwitz, and Stephen A. Boorjian Daniel CanterDaniel Canter More articles by this author , Mark BuyyounouskiMark Buyyounouski More articles by this author , Alexander KutikovAlexander Kutikov More articles by this author , Jinsheng LiJinsheng Li More articles by this author , Richard E. GreenbergRichard E. Greenberg More articles by this author , Eric M. HorwitzEric M. Horwitz More articles by this author , and Stephen A. BoorjianStephen A. Boorjian More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.2047AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Radiation therapy (RT) after radical prostatectomy (RRP) has been associated with a survival benefit in both the adjuvant and salvage settings. Nevertheless, rectal and urethral toxicities of treatment have been demonstrated, while optimal targeting of the prostate bed following RRP remains challenging. The Calypso 4D Localization System (Calypso Medical Technologies, Seattle, WA) is a target positioning device that continuously monitors the location of three implantable electromagnetic transponders. This system has been previously utilized for prostate localization in patients undergoing primary RT. Here, we describe our technique of ultrasound-guided placement of Calypso transponders in the prostate bed following RRP for adjuvant/salvage RT. METHODS Seventeen patients presenting to Fox Chase Cancer Center for RT following RRP (2 adjuvant, 15 salvage) underwent transrectal ultrasound-guided placement of Calypso transponders prior to RT. After topical anesthesia was applied to the perianal area, a transrectal ultrasound of the prostate bed was performed. Using the sagittal orientation on the ultrasound probe, the region of the urethrovesical anastomosis was visualized, and 5 cc of lidocaine was injected on either side of the anastomosis for anesthetic as well as to distend the region between the rectal wall and bladder. The three Calypso transponders were placed approximately 1 cm apart in a triangular orientation around the anastomosis under ultrasound guidance. RESULTS All patients were successfully implanted with three transponders without peri-procedural complications. Appropriate seed position was confirmed by CT scan performed for RT simulation. All patients received intensity modulated RT, with a median radiation dose of 68 Gy (range 64-68). Treatment was well-tolerated, with no Grade 3 or 4 toxicities. Grade > 2 enteritis was not observed; there were no cases of rectal bleeding. Genitourinary toxicity was noted in 10 patients, and consisted of Grade 1 and 2 frequency and dysuria. No patient developed gross hematuria or urinary retention. 16/17 patients achieved a reduction in PSA at the first post-RT follow-up. CONCLUSIONS The placement of Calypso transponders for adjuvant/salvage RT is a safe and efficacious method for treatment localization that is associated with an excellent acute toxicity profile. Longer follow-up will be required to evaluate the oncological benefit to this technique. Philadelphia, PA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e781 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Daniel Canter More articles by this author Mark Buyyounouski More articles by this author Alexander Kutikov More articles by this author Jinsheng Li More articles by this author Richard E. Greenberg More articles by this author Eric M. Horwitz More articles by this author Stephen A. Boorjian More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...