Beschreibung:
<jats:p> 269 </jats:p><jats:p> Background: Salvage permanent brachytherapy (SPB) is one of treatment options in recurred men after external beam radiation therapy (EBRT). The accurate 3D correspondence between recurred cancer focus and location of seed implants using transrectal sonography (TRUS) is indispensable to design excellent dosimetry. The application of MRI-TRUS fusion targeted/systematic biopsy (Fusion-B) has enabled us to draw 3D recurred-cancer mapping. We have started SPB in men who recurred 3D-conformal EBRT using 3D-cancer mapping from Fusion-B. We introduce the novel dosimetric criteria for SPB-based on 3D cancer mapping. Methods: The patients with PSA failure (defined by Pheonix criteria) and without lymphnode/distant metastasis were enrolled in this study. In men who had suspicious recurrent focus/foci in MRI, we performed Fuision-B (ultrasound equipment: Image fusion: Koelis in France, and Biopsy: Medison in South Korea). We classified the three dosimetric patterns as follows: (1) Focal pattern: one core positive from target biopsy alone within hemilobe and GS less than 8. (2) Hemi-lobe pattern: positive cores within hemi-lobe from target/ systematic biopsies and GS less than 8. (3) Whole / focused gland pattern c/w hormonal therapy: Positive core(s) with GS greater than seven was identified regardless of positive biopsies location, or positive cores with GS less than eight from bilateral lobes. Prescribed dose to the target lesion, rV100 and uD90 were planned greater than 160Gy, 0% and less than 165Gy respectively. Results: Since August 2012, SPB has underwent in nine cases (PSA range prior to SPB: 2.22- 4.97ng/ml, age 61 to 77). In those cases, prescription dose at the 3D-conformal EBRT was 72 Gy and the duration between the 3D-conformal EBRT and SPB ranged from 41 to 107 months. The biopsy GS (-7/8-) obtained from Fuison-B distributed in 6/3 cases. Biopsy revealed single focus obtained from target biopsy in two cases. Focal and hemi-lobe pattern were chosen in two and one case, respectively. For the present, there is no re-PSA failure and G3-4 GI and GU comorbidities. Conclusions: To reduce the incidence of co-morbidity and maintain reasonable oncological outcome, it is informative to apply the 3D Cancer mapping for the SPB candidates. It is necessary to assess this criteria with the further follow-up. </jats:p>