Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
Int J Radiat Oncol Biol Phys. 2012 Jan 1;82(1):204-12. doi: 10.1016/j.ijrobp.2010.10.009. Epub 2010 Dec 16.
We compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicities in prostate cancer patients treated with three different high-dose radiation techniques.
A total of 1,903 patients with localized prostate cancer were treated with definitive RT at William Beaumont Hospital from 1992 to 2006: 22% with brachytherapy alone (BT), 55% with image-guided external beam (EB-IGRT), and 23% external beam with high-dose-rate brachytherapy boost (EBRT+HDR). Median dose with BT was 120 Gy for LDR and 38 Gy for HDR (9.5 Gy × 4). Median dose with EB-IGRT was 75.6 Gy (PTV) to prostate with or without seminal vesicles. For EBRT+HDR, the pelvis was treated to 46 Gy with an additional 19 Gy (9.5 Gy × 2) delivered via HDR. GI and GU toxicity was evaluated utilizing the NCI-CTC criteria (v.3.0). Median follow-up was 4.8 years.
The incidences of any acute ≥ Grade 2 GI or GU toxicities were 35%, 49%, and 55% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Any late GU toxicities ≥ Grade 2 were present in 22%, 21%, and 28% for BT, EB-IGRT, and EBRT+HDR (p = 0.01), respectively. Patients receiving EBRT+HDR had a higher incidence of urethral stricture and retention, whereas dysuria was most common in patients receiving BT. Any Grade ≥ 2 late GI toxicities were 2%, 20%, and 9% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Differences were most pronounced for rectal bleeding, with 3-year rates of 0.9%, 20%, and 6% (p < 0.001) for BT, EB-IGRT, and EBRT+HDR respectively.
Each of the three modern high-dose radiation techniques for localized prostate cancer offers a different toxicity profile. These data can help patients and physicians to make informed decisions regarding radiotherapy for prostate andenocarcinoma.
我们比较了三种不同高剂量放射技术治疗前列腺癌患者的急性和晚期泌尿生殖系统（GU）和胃肠道（GI）毒性。
1992 年至 2006 年，共有 1903 例局限性前列腺癌患者在威廉·博蒙特医院接受根治性放疗：22%单独接受近距离放射治疗（BT），55%接受图像引导外照射（EB-IGRT），23%接受外照射加高剂量率近距离放射治疗（EBRT+HDR）。BT 的中位剂量为 LDR 120 Gy 和 HDR 38 Gy（9.5 Gy×4）。EB-IGRT 的中位剂量为前列腺和精囊 75.6 Gy（PTV）。对于 EBRT+HDR，骨盆用 46 Gy 照射，另外用 19 Gy（9.5 Gy×2）通过 HDR 照射。GI 和 GU 毒性采用 NCI-CTC 标准（v.3.0）进行评估。中位随访时间为 4.8 年。
BT、EB-IGRT 和 EBRT+HDR 的任何急性≥2 级 GI 或 GU 毒性发生率分别为 35%、49%和 55%（p<0.001）。BT、EB-IGRT 和 EBRT+HDR 的任何晚期 GU 毒性≥2 级的发生率分别为 22%、21%和 28%（p=0.01）。接受 EBRT+HDR 的患者尿道狭窄和保留的发生率较高，而接受 BT 的患者最常见的是排尿困难。BT、EB-IGRT 和 EBRT+HDR 的任何≥2 级晚期 GI 毒性发生率分别为 2%、20%和 9%（p<0.001）。直肠出血的差异最为明显，BT、EB-IGRT 和 EBRT+HDR 的 3 年发生率分别为 0.9%、20%和 6%（p<0.001）。
局部前列腺癌的三种现代高剂量放射技术各有不同的毒性特征。这些数据可以帮助患者和医生就前列腺癌和腺癌的放疗做出明智的决策。
