Jeroen Van Moorselaar

THREE-DIMENSIONAL CONTROLLED INTERSTITIAL HYPERTHERMIA COMBINED WITH RADIOTHERAPY FOR LOCALLY ADVANCED PROSTATE CARCINOMA—A FEASIBILITY STUDY

PURPOSE To perform a feasibility study of three-dimensional spatially controlled interstitial hyperthermia for locally advanced prostate cancer. METHODS AND MATERIALS Twelve patients with prostate cancer (T3NxM0) were treated with conventional external beam radiotherapy and one interstitial hyperthermia treatment. Hyperthermia was delivered with the 27-MHz multielectrode current source (MECS) interstitial hyperthermia technique on an outpatient basis. Guided by transrectal ultrasonography, 12 catheters (range 7-16) were placed in the prostate through a template. Two electrodes per probe were inserted. Thermometry (average 100 sensors) was performed from within the probes for online temperature control. Additional thermometry was done in the prostate, rectum, urethra, and bladder. Reconstruction was done by sonography. Prostate perfusion was estimated from the thermal decay at the end of treatment. The full three-dimensional temperature distribution was calculated. RESULTS No toxicities greater than Grade 2 were recorded. A learning curve for implantation, position verification, reconstruction, and temperature simulation was experienced. Perfusion was 47 mL/100 g/min (range 30-65). The average measured temperature was T(90) (90% of the prostate reached a temperature of at least:) 39.9 degrees C and T(50) 44.1 degrees C. The average calculated temperatures were lower: T(90), 39.4 degrees C and T(50), 41.8 degrees C, because the entire prostate was taken into account. The tumor temperatures were T(90), 40.7 degrees C and T(50), 43.0 degrees C. The bladder and rectal temperatures were below the safety limits. CONCLUSION Multielectrode-current-source interstitial hyperthermia is technically feasible and well tolerated. It was not possible to achieve the goal temperature of 42-43 degrees C because of high perfusion and implantation limitations.

How quality influences the clinical outcome of external beam radiotherapy for localized prostate cancer

For the delivery of good‐quality external beam radiotherapy (EBRT) in localized prostate cancer, under‐dosage to the peripheral zone (tumour) is one likely cause of poor results. The quality is improved by daily verification of the position of the prostate, and the use of magnetic resonance imaging (MRI) in delineation. Currently these are demands on quality that should be incorporated in each radiotherapy department. The use of MRI in staging is also expected to improve patient selection for EBRT. Furthermore, an adequate radiation dose should be delivered. In this overview we describe what the urologist should expect from radiation oncologists to obtain the optimum results for the patients.