对行前列腺低剂量率近距离放射治疗的患者进行泌尿生殖系统和胃肠道毒性的定期评估。

BACKGROUND

To compare the periodical incidence rates of genitourinary (GU) and gastrointestinal (GI) toxicity in patients who underwent prostate low-dose-rate brachytherapy between the monotherapy group (seed implantation alone) and the boost group (in combination with external beam radiation therapy (EBRT)).

METHODS

A total of 218 patients with a median follow-up of 42.5 months were enrolled. The patients were divided into 2 groups by treatment modality, namely, the monotherapy group (155 patients) and the boost group (63 patients). The periodical incidence rates of GU and GI toxicity were separately evaluated and compared between the monotherapy group and the boost group using the National Cancer Institute - Common Terminology Criteria for Adverse Events, version 3.0. To elucidate an independent factor among clinical and postdosimetric parameters to predict grade 2 or higher GU and GI toxicity in the acute and late phases, univariate and multivariate logistic regression analyses were carried out.

RESULTS

Of all patients, 78.0% showed acute GU toxicity, and 7.8% showed acute GI toxicity, while 63.8% showed late GU toxicity, and 21.1% showed late GI toxicity. The incidence rates of late GU and GI toxicity were significantly higher in the boost group. Multivariate analysis showed that the International Prostate Symptom Score (IPSS) before seed implantation was a significant parameter to predict acute GU toxicity, while there were no significant predictive parameters for acute GI toxicity. On the other hand, combination with EBRT was a significant predictive parameter for late GU toxicity, and rectal volume (mL) receiving 100% of the prescribed dose (R100) was a significant predictive parameter for late GI toxicity.

CONCLUSIONS

The boost group showed higher incidence rates of both GU and GI toxicity. Higher IPSS before seed implantation, combination with EBRT and a higher R100 were significant predictors for acute GU, late GU and late GI toxicity.

背景

比较行前列腺低剂量率近距离放射治疗的患者中单纯治疗组（单纯种子植入）和加量组（联合外照射放射治疗（EBRT））的泌尿生殖系统（GU）和胃肠道（GI）毒性的定期发生率。

方法

共纳入 218 例患者，中位随访时间为 42.5 个月。根据治疗方式将患者分为两组，即单纯治疗组（155 例）和加量组（63 例）。分别使用国家癌症研究所-常见不良事件术语标准，版本 3.0 评估和比较单纯治疗组和加量组的 GU 和 GI 毒性的定期发生率。为了阐明临床和后剂量学参数中预测急性和晚期 2 级或更高 GU 和 GI 毒性的独立因素，进行了单变量和多变量逻辑回归分析。

结果

所有患者中，78.0%出现急性 GU 毒性，7.8%出现急性 GI 毒性，63.8%出现晚期 GU 毒性，21.1%出现晚期 GI 毒性。加量组的晚期 GU 和 GI 毒性发生率明显更高。多变量分析显示，种子植入前国际前列腺症状评分（IPSS）是预测急性 GU 毒性的显著参数，而急性 GI 毒性无显著预测参数。另一方面，联合 EBRT 是晚期 GU 毒性的显著预测参数，直肠体积（mL）接受 100%规定剂量（R100）是晚期 GI 毒性的显著预测参数。