Department of Radiotherapy, European Institute of Oncology, Milan, Italy; University of Milan, Milan, Italy.
Int J Radiat Oncol Biol Phys. 2010 Sep 1;78(1):26-34. doi: 10.1016/j.ijrobp.2009.07.1742. Epub 2010 Feb 3.
To analyze the correlation between acute and late injury in 973 prostate cancer patients treated with radiotherapy and to evaluate the effect of patient-, tumor-, and treatment-related variables on toxicity.
Of the 973 patients, 542 and 431 received definitive or postprostatectomy radiotherapy, respectively. Three-dimensional conformal radiotherapy included a six-field technique and two-dynamic arc therapy. Toxicity was classified according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. The correlation between acute and late toxicity (incidence and severity) was assessed.
Multivariate analysis showed that age </=65 years (p = .06) and use of the three-dimensional, six-field technique (p <.0001) correlated significantly with greater acute rectal toxicity. The three-dimensional, six-field technique (p = .0002), dose >70 Gy (p = .014), and radiotherapy duration (p = .05) correlated with greater acute urinary toxicity. Acute rectal toxicity (p <.0001) was the only factor that correlated with late rectal injury on multivariate analysis. Late urinary toxicity correlated with acute urinary events (p <.0001) and was inversely related to the use of salvage radiotherapy (p = .018). A highly significant correlation was found between the incidence of acute and late events for both rectal (p <.001) and urinary (p <.001) reactions. The severity of acute toxicity (Grade 2 or greater) was predictive for the severity of late toxicity for both rectal and urinary events (p <.001).
The results of our study have shown that the risk of acute reactions depends on both patient-related (age) and treatment-related (dose, technique) factors. Acute toxicity was an independent significant predictor of late toxicity. These findings might help to predict and prevent late radiotherapy-induced complications.
分析 973 例接受放疗的前列腺癌患者急性和晚期损伤之间的相关性，并评估患者、肿瘤和治疗相关变量对毒性的影响。
973 例患者中，542 例和 431 例分别接受根治性或前列腺切除术后放疗。三维适形放疗包括六野技术和双动态弧治疗。毒性按放射治疗肿瘤学组/欧洲癌症研究与治疗组织标准进行分类。评估了急性和晚期毒性（发生率和严重程度）之间的相关性。
多变量分析显示，年龄≤65 岁（p=0.06）和使用三维六野技术（p<0.0001）与急性直肠毒性显著相关。三维六野技术（p=0.0002）、剂量>70Gy（p=0.014）和放疗时间（p=0.05）与急性尿毒性显著相关。急性直肠毒性（p<0.0001）是多变量分析中唯一与晚期直肠损伤相关的因素。晚期尿毒性与急性尿事件相关（p<0.0001），与挽救性放疗的使用呈负相关（p=0.018）。直肠（p<0.001）和尿（p<0.001）反应的急性和晚期事件的发生率之间存在高度显著的相关性。急性毒性的严重程度（2 级或更高级别）是预测直肠和尿事件晚期毒性严重程度的独立显著指标（p<0.001）。
我们的研究结果表明，急性反应的风险取决于患者相关（年龄）和治疗相关（剂量、技术）因素。急性毒性是晚期毒性的独立显著预测因素。这些发现可能有助于预测和预防晚期放疗引起的并发症。
