De Meerleer Gert, Vakaet Luc, Meersschout Sabine, Villeirs Geert, Verbaeys Antony, Oosterlinck Wim, De Neve Wilfried
Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium.
Int J Radiat Oncol Biol Phys. 2004 Nov 1;60(3):777-87. doi: 10.1016/j.ijrobp.2004.04.017.
Dose escalation improves local control in prostate cancer. At Ghent University Hospital, intensity-modulated radiotherapy (IMRT) is used to increase the dose to the prostate and/or seminal vesicles. We report on acute toxicity in 114 patients who received IMRT for prostate cancer.
Intensity-modulated radiotherapy was initiated after approval of our ethics committee. A class solution was used to plan all cases. Three beams (gantry 0 degrees , 116 degrees , and 244 degrees ) and anatomy-based segmentation were used to create an intensity-modulated dose distribution. Maximal rectal dose was set at 2 Gy per fraction. Detailed dose-volume histograms for all relevant structures were present. For all patients, we determined the pretreatment morbidity by a detailed preradiotherapy, in-house developed symptom scale. All patients were treated with 18 MV photons of an Elekta linear accelerator. Patients were seen on a weekly basis during treatment, and 1 month (M1) and 3 months (M3) thereafter. The registration of acute toxicity was standardized by a fixed questionnaire. The Radiation Therapy Oncology Group (RTOG) toxicity scale served as a basis, but additional symptoms, such as rectal blood loss, urgency, and incontinence, were scored as well.
All 114 IMRT plans were delivered successfully without any interruption or technical problem. Daily treatment time was always less than 8 min and less than 6 min in 90% of the cases. Grade 1 and Grade 2 gastrointestinal (GI) toxicities were observed in 44% and 29% of the patients, respectively, during the whole period. If only the RTOG scale was used, Grade 1 and Grade 2 GI toxicities were noted in 39% and 27% of the patients, respectively, leaving 34% free of acute RTOG-scaled toxicity. Grade 3 genitourinary (GU) toxicity was seen in 8 patients (7%), all but 1 during treatment. Grade 2 and Grade 1 GU toxicities were seen in 36% and 47% of the patients, respectively, leaving only 10% free of acute GU toxicity.
Anatomy-based IMRT to treat prostate cancer is incorporated into our daily routine without any problem. Acute toxicity is very low. Most of the recorded symptoms decrease over time, except for GI urgency and incontinence. The incorporation of additional symptoms makes the scoring more detailed.
剂量递增可改善前列腺癌的局部控制。在根特大学医院，调强放射治疗（IMRT）用于增加前列腺和/或精囊的剂量。我们报告了114例接受IMRT治疗前列腺癌患者的急性毒性反应。
在我们的伦理委员会批准后开始调强放射治疗。使用类解决方案来规划所有病例。采用三束射野（机架角度0度、116度和244度）和基于解剖结构的分割方法来创建调强剂量分布。直肠最大剂量设定为每分次2 Gy。给出了所有相关结构的详细剂量体积直方图。对于所有患者，我们通过详细的放疗前内部开发的症状量表来确定治疗前的发病率。所有患者均接受Elekta直线加速器的18 MV光子治疗。在治疗期间每周对患者进行检查，此后1个月（M1）和3个月（M3）进行检查。急性毒性反应的记录通过固定问卷进行标准化。以放射治疗肿瘤学组（RTOG）毒性量表为基础，但也对直肠失血、尿急和尿失禁等其他症状进行评分。
所有114个IMRT计划均成功实施，无任何中断或技术问题。每日治疗时间始终少于8分钟，90%的病例少于6分钟。在整个期间，分别有44%和29%的患者出现1级和2级胃肠道（GI）毒性反应。如果仅使用RTOG量表，分别有39%和27%的患者出现1级和2级GI毒性反应，34%的患者无急性RTOG分级毒性反应。8例患者（7%）出现3级泌尿生殖系统（GU）毒性反应，除1例在治疗期间外，其余均在治疗期间出现。分别有36%和47%的患者出现2级和1级GU毒性反应，只有10%的患者无急性GU毒性反应。
基于解剖结构的IMRT治疗前列腺癌已毫无问题地纳入我们的日常工作中。急性毒性反应非常低。除了胃肠道尿急和尿失禁外，大多数记录的症状会随着时间推移而减轻。纳入其他症状使评分更加详细。
