高剂量率近距离放射治疗作为前列腺癌单一疗法治疗的患者中，剂量学参数与直肠和泌尿系统晚期毒性之间的相关性。
Correlation between dosimetric parameters and late rectal and urinary toxicities in patients treated with high-dose-rate brachytherapy used as monotherapy for prostate cancer.
作者信息
Konishi Koji, Yoshioka Yasuo, Isohashi Fumiaki, Sumida Iori, Kawaguchi Yoshifumi, Kotsuma Tadayuki, Adachi Kana, Morimoto Masahiro, Fukuda Shoichi, Inoue Takehiro
机构信息
Department of Radiation Oncology, Osaka University Graduate School of Medicine, Suita, Osaka, Japan.
出版信息
Int J Radiat Oncol Biol Phys. 2009 Nov 15;75(4):1003-7. doi: 10.1016/j.ijrobp.2008.12.051. Epub 2009 Apr 3.
PURPOSE
To evaluate the correlation between dosimetric parameters and late rectal and urinary toxicities in high-dose-rate brachytherapy (HDR-BT) used as monotherapy for prostate cancer.
METHODS AND MATERIALS
The data of 83 patients treated with HDR-BT alone for prostate cancer from 2001 through 2005 at Osaka University Hospital were analyzed. Median follow-up time was 36 months (range, 18-70). The total prescribed dose was 54 Gy in nine fractions over 5 days. Correlation between dosimetric parameters and late toxicities was examined.
RESULTS
The means of V30, V40, V50, V60, V70, D1cc, D2cc, D5cc, and D10cc of the rectum were significantly higher in 18 patients who presented with late rectal toxicity (Grades 1-3 rectal bleeding) than in the other 65 patients who did not. A significant difference was observed for D1cc-10cc but not for D5-90. The statistically most significant difference was observed for V40 and D5cc. Late rectal toxicity rate was significantly higher for patients with rectal V40 >or= 8 cc than those with the rectal V40 < 8 cc (42% vs. 8%; p < 0.001), as well as for patients with rectal D5cc >or= 27 Gy compared with those with rectal D5cc < 27 Gy (50% vs. 11%; p < 0.001). Dosimetric parameters of the urethra of 15 patients with late urinary toxicity were not significantly different from the 68 patients without toxicity.
CONCLUSION
Rectal V40 < 8 cc and D5cc < 27 Gy may be dose-volume constraints in HDR-BT used as monotherapy for prostate cancer.
目的
评估高剂量率近距离放射疗法（HDR-BT）作为前列腺癌单一疗法时剂量学参数与直肠及泌尿系统晚期毒性之间的相关性。
方法与材料
分析了2001年至2005年在大阪大学医院接受单纯HDR-BT治疗前列腺癌的83例患者的数据。中位随访时间为36个月（范围18 - 70个月）。总处方剂量为54 Gy，分9次在5天内给予。检查了剂量学参数与晚期毒性之间的相关性。
结果
18例出现晚期直肠毒性（1 - 3级直肠出血）的患者直肠的V30、V40、V50、V60、V70、D1cc、D2cc、D5cc和D10cc平均值显著高于其他65例未出现毒性的患者。D1cc - 10cc有显著差异，而D5 - 90无显著差异。V40和D5cc的统计学差异最为显著。直肠V40≥8 cc的患者晚期直肠毒性发生率显著高于直肠V40＜8 cc的患者（42%对8%；p＜0.001），直肠D5cc≥27 Gy的患者与直肠D5cc＜27 Gy的患者相比也是如此（50%对11%；p＜0.001）。15例出现晚期泌尿系统毒性的患者尿道的剂量学参数与68例无毒性的患者无显著差异。
结论
直肠V40＜8 cc和D5cc＜27 Gy可能是HDR-BT作为前列腺癌单一疗法时的剂量体积限制。
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