title: Clinical results from first use of prostate stent as fiducial for radiotherapy of prostate cancer.
abstract: OBJECTIVE
  A clinical feasibility study using a removable prostate stent as fiducial for image-guided radiotherapy (IGRT) of localized prostate cancer (PC).
  
  
  METHODS
  The study included patients with local or locally advanced PC. The clinical target volume (CTV) was outlined on magnetic resonance (MR) images co-registered to planning computer tomography (CT) images. Daily online IGRT was delivered using the stent as fiducial. Risk of migration was estimated using multiple MR. Acute urinary toxicity was scored using the international prostate symptom score (IPSS). Late gastro-intestinal (GI) and genito-urinary (GU) toxicity was scored using the Radio Therapy Oncology Group (RTOG) score, biochemical failure (BF) was defined as an elevation of prostate specific antigen (PSA) above nadir plus 2 ng/ml after radiotherapy.
  
  
  RESULTS
  One hundred men were enrolled in the study. Ninety completed radiotherapy with the stent as fiducial. No migration of the stent was seen, but three cases of dislocation of the stent to the bladder were observed. Acute urinary toxicity based on IPSS was comparable to toxicity in patients who had gold markers (GM) as fiducials. Removal of the stent was associated with a high frequency of urinary retention. Late GI and GU toxicity and BF were comparable to those of other studies, but longer observation time is needed.
  
  
  CONCLUSIONS
  This study reports the first clinical results of using a prostate stent as fiducial. No migration of the stent observed. Dislocation of the stent to the urinary bladder was observed in three cases, requiring removal of the stent and insertion of a new fiducial. Acute toxicity during radiotherapy evaluated from IPSS was comparable to toxicity in patients with GM. Removal of the stent was associated with a high frequency of post procedural urinary retention. Late toxicity and BF were comparable to those of other studies, though longer observation time is needed.
authors.affiliation: Department of Medical Physics, Department of Oncology, Aalborg Hospital, Aarhus University Hospital, Aalborg, Denmark. jhc@rn.dk
authors.forename: Jesper
authors.initials: J
authors.lastname: Carl
authors.forename: Jane
authors.initials: J
authors.lastname: Nielsen
authors.forename: Mats
authors.initials: M
authors.lastname: Holmberg
authors.forename: Erik Hoejkjaer
authors.initials: EH
authors.lastname: Larsen
authors.forename: Knud
authors.initials: K
authors.lastname: Fabrin
authors.forename: Rune V
authors.initials: RV
authors.lastname: Fisker
mesh_terms: D000368:Aged; D005240:Feasibility Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D015607:Stents; D014057:Tomography, X-Ray Computed