Transperineal gold marker implantation for image-guided external beam radiotherapy of prostate cancer : A single institution, prospective study.
OBJECTIVE
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.


CONCLUSIONS
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.
Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary. jorgokliton@gmail.com.
Kliton
K
Jorgo
Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
Péter
P
Ágoston
Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
Tibor
T
Major
Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
Zoltán
Z
Takácsi-Nagy
Centre of Radiotherapy, National Institute of Oncology, Ráth György u. 7-9, 1122, Budapest, Hungary.
Csaba
C
Polgár
D005240:Feasibility Studies; D057918:Fiducial Markers / Q000009:adverse effects; D006046:Gold; D006417:Hematuria / Q000209:etiology; D051516:Hemospermia / Q000209:etiology; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D008297:Male; D010147:Pain Measurement; D010502:Perineum; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D020266:Radiotherapy, Conformal / Q000379:methods*; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D011795:Surveys and Questionnaires; D014057:Tomography, X-Ray Computed
D006046:Gold
Complications; Fiducial markers; Image-guided radiotherapy; Local anesthesia; Safety