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基于5-氟尿嘧啶的同步化疗和放疗对直肠癌所致急性小肠毒性的剂量-体积关系。

The dose-volume relationship of acute small bowel toxicity from concurrent 5-FU-based chemotherapy and radiation therapy for rectal cancer.

作者信息

Baglan Kathy L, Frazier Robert C, Yan Di, Huang Raywin R, Martinez Alvaro A, Robertson John M

机构信息

Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.

出版信息

Int J Radiat Oncol Biol Phys. 2002 Jan 1;52(1):176-83. doi: 10.1016/s0360-3016(01)01820-x.

Abstract

PURPOSE

A direct relationship between the volume of small bowel irradiated and the degree of acute small bowel toxicity experienced during concurrent 5-fluorouracil (5-FU)-based chemoradiotherapy for rectal carcinoma is well recognized but poorly quantified. This study uses three-dimensional treatment-planning tools to more precisely quantify this dose-volume relationship.

METHODS AND MATERIALS

Forty patients receiving concurrent 5-FU-based chemotherapy and pelvic irradiation for rectal carcinoma had treatment-planning CT scans with small bowel contrast. A median isocentric dose of 50.4 Gy was delivered using a posterior-anterior and opposed lateral field arrangement. Bowel exclusion techniques were routinely used, including prone treatment position on a vacuum bag cradle to allow anterior displacement of the abdominal contents and bladder distension. Individual loops of small bowel were contoured on each slice of the planning CT scan, and a small bowel dose-volume histogram was generated for the initial pelvis field receiving 45 Gy. The volume of small bowel receiving each dose between 5 and 40 Gy was recorded at 5-Gy intervals.

RESULTS

Ten patients (25%) experienced Common Toxicity Criteria Grade 3+ acute small bowel toxicity. A highly statistically significant association between the development of Grade 3+ acute small bowel toxicity and the volume of small bowel irradiated was found at each dose level. Specific dose-volume threshold levels were found, below which no Grade 3+ toxicity occurred and above which 50-60% of patients developed Grade 3+ toxicity. The volume of small bowel receiving at least 15 Gy (V15) was strongly associated with the degree of toxicity. Univariate analysis of patient and treatment-related factors revealed no other significant predictors of severe toxicity.

CONCLUSIONS

A strong dose-volume relationship exists for the development of Grade 3+ acute small bowel toxicity in patients receiving concurrent 5-FU-based chemoradiotherapy for rectal carcinoma.

摘要

目的

在以5-氟尿嘧啶(5-FU)为基础的直肠癌同步放化疗期间,照射的小肠体积与急性小肠毒性程度之间的直接关系已得到充分认识,但量化程度较低。本研究使用三维治疗计划工具更精确地量化这种剂量-体积关系。

方法和材料

40例接受以5-FU为基础的同步化疗和盆腔照射的直肠癌患者进行了带有小肠造影剂的治疗计划CT扫描。采用前后对侧野照射方式,等中心中位剂量为50.4 Gy。常规使用肠道排除技术,包括在真空袋支架上采用俯卧位治疗,以使腹部内容物向前移位并充盈膀胱。在计划CT扫描的每一层上勾勒出小肠的各个肠袢,并为接受45 Gy的初始盆腔野生成小肠剂量-体积直方图。以5 Gy间隔记录接受5至40 Gy之间各剂量的小肠体积。

结果

10例患者(25%)出现常见毒性标准3级及以上的急性小肠毒性。在每个剂量水平上,均发现3级及以上急性小肠毒性的发生与照射的小肠体积之间存在高度统计学显著关联。发现了特定的剂量-体积阈值水平,低于该水平无3级及以上毒性发生,高于该水平50%-60%的患者出现3级及以上毒性。接受至少15 Gy(V15)的小肠体积与毒性程度密切相关。对患者和治疗相关因素的单因素分析未发现其他严重毒性的显著预测因素。

结论

在接受以5-FU为基础的直肠癌同步放化疗的患者中,3级及以上急性小肠毒性的发生存在强烈的剂量-体积关系。

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