Department of Radiation Oncology, Marilia Medical School, Marília, São Paulo, Brazil.
Radiat Oncol. 2013 Apr 21;8:94. doi: 10.1186/1748-717X-8-94.
To compare the acute toxicities in radical treatment of prostate cancer between conventional schedule (C-ARM) with 78 Gy/39 fractions and hypofractionation conformal treatment (H-ARM) with 69 Gy/23 fractions.
This prospective double arm study consisted of 217 patients with prostate cancer, 112 in H-ARM and 105 in C-ARM arm. C-ARM received conventional six- field conformal radiotherapy with 78 Gy in 39 fractions while H-ARM received hypofractionation with 69 Gy in 23 fractions. Weekly assessment of acute reactions was done during treatment and with one, and 3 months using RTOG scale. Univariated analysis was performed to evaluate differences between the incidences of acute reaction in the treatment arms. Variables with p value less than 0.1 were included in the multivariated logistic regression.
There was no difference between H-ARM versus C-ARM for severity and incidence in genitourinary (GU) and gastrointestinal (GI) acute toxicity. During the treatment comparing H-ARM with C-ARM no differences was observed for GI toxicity (grade 0-3; H-ARM=45.5%, 34%, 18.7% and 1.8% versus C-ARM=47.6%, 35.2%, 17.2% and 0). For acute GU toxicity no difference was detected between H-ARM (grade 0-3; 22.3%, 54.5%, 18.7% and 4.5%) and C-ARM (grade 0-3; 25.8%, 53.3%, 17.1% and 3.8%).At the 3- months follow-up, persistent Grade> =2 acute GU and GI toxicity were 2.5% and 1.8% in H-ARM versus 5.7% and 3% in C-ARM (p>0.05). In univariated and multivariated analyses, there was not any dosimetric predictor for GI and GU toxicity.
Our data demonstrate that hypofractionated radiotherapy achieving high biological effective dose using conformal radiotherapy is feasible for prostate cancer, being well tolerated with minimal severe acute toxicity.
比较常规分割（C-ARM）78 Gy/39 次与适形调强放疗低分割（H-ARM）69 Gy/23 次治疗前列腺癌的急性毒性。
这项前瞻性双臂研究纳入了 217 例前列腺癌患者，其中 112 例接受 H-ARM 治疗，105 例接受 C-ARM 治疗。C-ARM 组接受常规六野适形调强放疗，78 Gy/39 次；H-ARM 组接受低分割调强放疗，69 Gy/23 次。在治疗期间及治疗后 1 个月和 3 个月使用 RTOG 量表每周评估急性反应。采用单变量分析评估治疗臂急性反应发生率的差异。将 p 值<0.1 的变量纳入多变量逻辑回归。
在泌尿生殖系（GU）和胃肠道（GI）急性毒性的严重程度和发生率方面，H-ARM 与 C-ARM 之间无差异。在治疗期间，H-ARM 与 C-ARM 相比，GI 毒性（0-3 级；H-ARM=45.5%、34%、18.7%和 1.8%，C-ARM=47.6%、35.2%、17.2%和 0）无差异。急性 GU 毒性方面，H-ARM（0-3 级；22.3%、54.5%、18.7%和 4.5%）与 C-ARM（0-3 级；25.8%、53.3%、17.1%和 3.8%）无差异。在 3 个月随访时，H-ARM 持续 2 级以上 GU 和 GI 毒性的发生率分别为 2.5%和 1.8%，C-ARM 分别为 5.7%和 3%（p>0.05）。单变量和多变量分析均显示，GI 和 GU 毒性无剂量预测因子。
我们的数据表明，使用适形调强放疗实现高生物有效剂量的适形调强放疗治疗前列腺癌是可行的，具有较好的耐受性，急性毒性轻微。
