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首页> 外文期刊>Urologic oncology >Prostate tumor alignment and continuous, real-time adaptive radiation therapy using electromagnetic fiducials: clinical and cost-utility analyses.
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Prostate tumor alignment and continuous, real-time adaptive radiation therapy using electromagnetic fiducials: clinical and cost-utility analyses.

机译：使用电磁基准进行前列腺肿瘤对准和连续，实时自适应放射治疗：临床和成本-效用分析。

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OBJECTIVE: To evaluate the accuracy, utility, and cost effectiveness of a new electromagnetic patient positioning and continuous, real-time monitoring system, which uses permanently implanted resonant transponders in the target (Calypso 4D Localization System and Beacon transponders, Seattle, WA) to continuously monitor tumor location and movement during external beam radiation therapy of the prostate. MATERIALS AND METHODS: This clinical trial studied 43 patients at 5 sites. All patients were implanted with 3 transponders each. In 41 patients, the system was used for initial alignment at each therapy session. Thirty-five patients had continuous monitoring during their radiation treatment. Over 1,000 alignment comparisons were made to a commercially available kV X-ray positioning system (BrainLAB ExacTrac, Munich, Germany). Using decision analysis and Markov processes, the outcomes of patients were simulated over a 5-year period and measured in terms of costs from a payer's perspective and quality-adjusted life years (QALYs). RESULTS: All patients had satisfactory transponder implantations for monitoring purposes. In over 75% of the treatment sessions, the correction to conventional positioning (laser and tattoos) directed by an electromagnetic patient positioning and monitoring system was greater than 5 mm. Ninety-seven percent (34/35) of the patients who underwent continuous monitoring had target motion that exceeded preset limits at some point during the course of their radiation therapy. Exceeding preset thresholds resulted in user intervention at least once during the therapy in 80% of the patients (28/35). Compared with localization using ultrasound, electronic portal imaging devices (EPID), or computed tomography (CT), localization with the electromagnetic patient positioning and monitoring system yielded superior gains in QALYs at comparable costs. CONCLUSIONS: Most patients positioned with conventional tattoos and lasers for prostate radiation therapy were found by use of the electromagnetic patient positioning and monitoring system to have alignment errors exceeding 5 mm. Almost all patients undergoing external beam radiation of the prostate have been shown to have target organ movement exceeding 3 mm during radiation therapy delivery. The ability of the electromagnetic technology to monitor tumor target location during the same time as radiation therapy is being delivered allows clinicians to provide real time adaptive radiation therapy for prostate cancer. This permits clinicians to intervene when the prostate moves outside the radiation isocenter, which should decrease adverse events and improve patient outcomes. Additionally, a cost-utility analysis has demonstrated that the electromagnetic patient positioning and monitoring system offers patient outcome benefits at a cost that falls well within the payer's customary willingness to pay (WTP) threshold of Dollars 50,000 per QALY.
机译：目的：评估新型电磁患者定位和连续实时监控系统的准确性，实用性和成本效益，该系统在目标中使用永久植入的共振应答器（Calypso 4D Localization System and Beacon应答器，西雅图，华盛顿）在前列腺的外部束放射治疗期间连续监测肿瘤的位置和运动。材料与方法：该临床试验研究了5个部位的43例患者。所有患者均植入了3个应答器。在41例患者中，该系统在每次治疗过程中用于初始对准。 35例患者在放射治疗期间进行了连续监测。与市售的kV X射线定位系统（BrainLAB ExacTrac，德国慕尼黑）进行了1,000多次比对比较。使用决策分析和马尔可夫过程，在5年的时间里模拟了患者的结局，并从付款人的角度和质量调整生命年（QALY）的角度对费用进行了衡量。结果：所有患者均具有令人满意的应答器植入物以进行监测。在超过75％的治疗疗程中，由电磁患者定位和监视系统指导的常规定位（激光和纹身）校正量大于5 mm。接受连续监测的患者中有百分之九十七（34/35）的目标运动在放射治疗过程中的某个时候超过了预设的限制。超过预设阈值会导致80％的患者在治疗期间至少进行一次用户干预（28/35）。与使用超声波，电子门禁成像设备（EPID）或计算机断层扫描（CT）进行定位相比，使用电磁患者定位和监视系统进行定位可以以可比的成本获得QALY的卓越收益。结论：大多数使用常规纹身和激光进行前列腺放射治疗的患者，是通过使用电磁患者定位和监测系统发现对准误差超过5毫米的。几乎所有接受前列腺外照射的患者均显示在放射治疗期间靶器官运动超过3毫米。电磁技术能够在放射治疗进行的同时监视肿瘤目标位置，从而使临床医生能够为前列腺癌提供实时的适应性放射治疗。当前列腺移出放射线等中心点时，这允许临床医生进行干预，这应该减少不良事件并改善患者预后。此外，成本效用分析表明，电磁患者定位和监视系统可为患者带来收益的好处，而费用却恰好在付款人的常规付款意愿（WTP）门槛（每QALY 50,000美元）的范围内。

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