Objectives: To describe our technique and preliminary toxicity profile for ultrasound-guided outpatient placement of intraprostatic fiducial markers before intensity-modulated radiotherapy (IMRT) for prostate cancer. Methods: A total of 98 men with prostate cancer who underwent IMRT from August 2003 through September 2006 were included in the present study. All subjects underwent ultrasound-guided transrectal placement of 3 gold intraprostatic fiducial markers under local anesthesia using our standard technique. Daily on-line image guidance adjustments were made according to the location of the fiducial markers. The charts were reviewed to evaluate the acute toxicity profile of IMRT with fiducial markers during the treatment course using the Common Toxicity Criteria, version 3.0. The International Prostate Symptom Score, clinical stage, and Gleason score were tabulated. Results: Fiducial marker placement proceeded without complications. The median radiation dose administered was 75.6 Gy (range 50-79.2). Grade 1 or 2 enteritis was observed in 30 of 98 patients (31%), with no cases of rectal bleeding. Grade 1 or 2 perineal dermatitis occurred in 9 patients (9.2%). Genitourinary toxicity manifested in 75 patients (77%) as grade 1 or 2 cystitis. Four patients (4%) developed urinary retention, requiring catheterization. One patient (1%) had an episode of gross hematuria. No grade 3 toxicities were observed. No significant change in the International Prostate Symptom Score at 3 months in patients with available follow-up was found (P = .34). Conclusions: The placement of intraprostatic fiducial markers before prostate IMRT is a safe and efficacious method for prostate localization that produces an excellent toxicity profile.
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