Department of Radiation Oncology, Northwestern Memorial Hospital, Chicago, IL, USA.
Urology. 2013 Jun;81(6):1196-201. doi: 10.1016/j.urology.2013.01.047. Epub 2013 Mar 26.
To investigate the influence of diabetes mellitus (DM) on late genitourinary (GU) and gastrointestinal (GI) toxicity in patients treated with external beam radiotherapy (RT) for prostate cancer.
A total of 626 men were treated with curative-intent RT for prostate cancer from 1988 to 2008. Using the National Comprehensive Cancer Network risk category, the patients were considered to have low-risk (30%), intermediate-risk (42%), or high-risk (28%) prostate cancer. The median radiation dose was 74 Gy; 45% received androgen deprivation therapy for a median of 4 months. Late GU and GI Radiation Therapy Oncology Group toxicity was recorded prospectively at each visit after external beam RT. The median follow-up period was 55 months.
Of the 626 men, 102 (16%) had DM that was controlled by diet (8%), oral medications (52%), or insulin (39%). The patients with DM were more likely to receive intensity-modulated RT and androgen deprivation therapy and to have a shorter follow-up duration (P ≤.05 for all). Univariate analyses demonstrated that greater radiation dose, baseline urinary dysfunction, intensity-modulated RT, and DM were associated with grade 2 or greater GU toxicity, and transurethral resection of the prostate and DM were associated with grade 3 or greater GU toxicity. In addition, androgen deprivation therapy use, age ≥70 years, and anticoagulation were associated with grade 2 or greater GI toxicity, and age ≥70 years and anticoagulation were associated with grade 3 or greater GI toxicity. The multivariate analyses for late toxicity demonstrated a greater risk of grade 2 or greater (relative risk 1.36, P = .10) and grade 3 or greater GU toxicity (relative risk 2.74, P = .04) with DM.
A greater incidence of late GU toxicity was seen in patients with DM treated for prostate cancer. This relationship might be useful when considering the treatment of patients with DM, especially those receiving dose-escalated RT or with a history of transurethral resection of the prostate.
研究糖尿病（DM）对接受前列腺癌外照射放疗（RT）治疗的患者晚期泌尿生殖系统（GU）和胃肠道（GI）毒性的影响。
共有 626 名男性患者于 1988 年至 2008 年接受根治性 RT 治疗前列腺癌。根据美国国家综合癌症网络风险分类，患者被认为患有低危（30%）、中危（42%）或高危（28%）前列腺癌。中位放疗剂量为 74Gy；45%的患者接受了中位时间为 4 个月的雄激素剥夺治疗。在每次外照射 RT 后随访时，前瞻性地记录晚期 GU 和 GI 放射治疗肿瘤学组毒性。中位随访时间为 55 个月。
在 626 名男性患者中，有 102 名（16%）患有 DM，其中 8%通过饮食控制，52%通过口服药物控制，39%通过胰岛素控制。患有 DM 的患者更有可能接受调强放疗和雄激素剥夺治疗，且随访时间更短（所有 P 值均≤.05）。单因素分析表明，更高的放疗剂量、基线尿功能障碍、调强放疗和 DM 与 2 级或更高级别的 GU 毒性相关，经尿道前列腺切除术和 DM 与 3 级或更高级别的 GU 毒性相关。此外，雄激素剥夺治疗的使用、年龄≥70 岁和抗凝与 2 级或更高级别的 GI 毒性相关，年龄≥70 岁和抗凝与 3 级或更高级别的 GI 毒性相关。晚期毒性的多因素分析表明，DM 患者发生 2 级或更高级别的 GU 毒性（相对风险 1.36，P=.10）和 3 级或更高级别的 GU 毒性（相对风险 2.74，P=0.04）的风险增加。
患有 DM 的前列腺癌患者发生晚期 GU 毒性的发生率更高。在考虑 DM 患者的治疗方案时，特别是在考虑接受剂量递增 RT 或有经尿道前列腺切除术史的患者时，这种关系可能很有用。
