Fonteyne Valérie, Villeirs Geert, Speleers Bruno, De Neve Wilfried, De Wagter Carlos, Lumen Nicolas, De Meerleer Gert
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
Int J Radiat Oncol Biol Phys. 2008 Nov 1;72(3):799-807. doi: 10.1016/j.ijrobp.2008.01.040. Epub 2008 Apr 11.
To report on the acute toxicity of a third escalation level using intensity-modulated radiotherapy for prostate cancer (PCa) and the acute toxicity resulting from delivery of a simultaneous integrated boost (SIB) to an intraprostatic lesion (IPL) detected on magnetic resonance imaging (MRI), with or without spectroscopy.
Between January 2002 and March 2007, we treated 230 patients with intensity-modulated radiotherapy to a third escalation level as primary therapy for prostate cancer. If an IPL (defined by MRI or MRI plus spectroscopy) was present, a SIB was delivered to the IPL. To report on acute toxicity, patients were seen weekly during treatment and 1 and 3 months after treatment. Toxicity was scored using the Radiation Therapy Oncology Group toxicity scale, supplemented by an in-house-developed scoring system.
The median dose to the planning target volume was 78 Gy. An IPL was found in 118 patients. The median dose to the MRI-detected IPL and MRI plus spectroscopy-detected IPL was 81 Gy and 82 Gy, respectively. No Grade 3 or 4 acute gastrointestinal toxicity developed. Grade 2 acute gastrointestinal toxicity was present in 26 patients (11%). Grade 3 genitourinary toxicity was present in 15 patients (7%), and 95 patients developed Grade 2 acute genitourinary toxicity (41%). No statistically significant increase was found in Grade 2-3 acute gastrointestinal or genitourinary toxicity after a SIB to an IPL.
The results of our study have shown that treatment-induced acute toxicity remains low when intensity-modulated radiotherapy to 80 Gy as primary therapy for prostate cancer is used. In addition, a SIB to an IPL did not increase the severity or incidence of acute toxicity.
报告前列腺癌（PCa）调强放疗第三级剂量递增水平的急性毒性，以及对磁共振成像（MRI）检测到的前列腺内病变（IPL）（无论有无波谱分析）进行同步整合加量（SIB）所导致的急性毒性。
2002年1月至2007年3月期间，我们对230例患者采用调强放疗至第三级剂量递增水平作为前列腺癌的主要治疗方法。如果存在IPL（由MRI或MRI加波谱分析定义），则对IPL进行SIB。为报告急性毒性，在治疗期间每周对患者进行检查，并在治疗后1个月和3个月进行检查。使用放射治疗肿瘤学组毒性量表对毒性进行评分，并辅以内部开发的评分系统。
计划靶体积的中位剂量为78 Gy。118例患者发现有IPL。MRI检测到的IPL和MRI加波谱分析检测到的IPL的中位剂量分别为81 Gy和82 Gy。未发生3级或4级急性胃肠道毒性。26例患者（11%）出现2级急性胃肠道毒性。15例患者（7%）出现3级泌尿生殖系统毒性，95例患者出现2级急性泌尿生殖系统毒性（41%）。对IPL进行SIB后，2-3级急性胃肠道或泌尿生殖系统毒性未见统计学显著增加。
我们的研究结果表明，采用调强放疗至80 Gy作为前列腺癌主要治疗方法时，治疗引起的急性毒性仍然较低。此外，对IPL进行SIB并未增加急性毒性的严重程度或发生率。
