Department of Radiation Oncology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Int J Radiat Oncol Biol Phys. 2013 Aug 1;86(5):842-7. doi: 10.1016/j.ijrobp.2013.04.033.
To report on the incidence, nature, and management of rectal toxicities following individual or combination brachytherapy following treatment for prostate cancer over a 17-year period. We also report the patient and treatment factors predisposing to acute ≥ grade 2 proctitis.
A total of 2752 patients were treated for prostate cancer between October 1990 and April 2007 with either low-dose-rate brachytherapy alone or in combination with androgen depletion therapy (ADT) or external beam radiation therapy (EBRT) and were followed for a median of 5.86 years (minimum 1.0 years; maximum 19.19 years). We investigated the 10-year incidence, nature, and treatment of acute and chronic rectal toxicities following BT. Using univariate, and multivariate analyses, we determined the treatment and comorbidity factors predisposing to rectal toxicities. We also outline the most common and effective management for these toxicities.
Actuarial risk of ≥ grade 2 rectal bleeding was 6.4%, though notably only 0.9% of all patients required medical intervention to manage this toxicity. The majority of rectal bleeding episodes (72%) occurred within the first 3 years following placement of BT seeds. Of the 27 patients requiring management for their rectal bleeding, 18 underwent formalin treatment and nine underwent cauterization. Post-hoc univariate statistical analysis revealed that coronary artery disease (CAD), biologically effective dose, rectal volume receiving 100% of the prescription dose (RV100), and treatment modality predict the likelihood of grade ≥2 rectal bleeding. Only CAD, treatment type, and RV100 fit a Cox regression multivariate model.
Low-dose-rate prostate brachytherapy is very well tolerated and rectal bleeding toxicities are either self-resolving or effectively managed by medical intervention. Treatment planning incorporating adjuvant ADT while minimizing RV100 has yielded the best toxicity-free survival following BT.
报告在过去 17 年中，对前列腺癌进行单独或联合近距离放射治疗后，直肠毒性的发生率、性质和管理情况。我们还报告了导致急性≥2 级直肠炎的患者和治疗因素。
1990 年 10 月至 2007 年 4 月，共有 2752 例患者接受了低剂量率近距离放射治疗（单独或联合雄激素剥夺治疗（ADT）或外部束放射治疗（EBRT））治疗前列腺癌，并随访中位数为 5.86 年（最短 1.0 年；最长 19.19 年）。我们调查了 BT 后急性和慢性直肠毒性的 10 年发生率、性质和治疗方法。使用单变量和多变量分析，我们确定了导致直肠毒性的治疗和合并症因素。我们还概述了这些毒性的最常见和有效的管理方法。
≥2 级直肠出血的累积风险为 6.4%，但值得注意的是，只有 0.9%的患者需要医疗干预来治疗这种毒性。大多数直肠出血事件（72%）发生在 BT 种子放置后的前 3 年内。在 27 例需要治疗直肠出血的患者中，18 例行福尔马林治疗，9 例行烧灼治疗。事后单变量统计分析显示，冠状动脉疾病（CAD）、生物有效剂量、接受处方剂量 100%的直肠体积（RV100）和治疗方式预测≥2 级直肠出血的可能性。只有 CAD、治疗类型和 RV100 符合 Cox 回归多变量模型。
低剂量率前列腺近距离放射治疗具有很好的耐受性，直肠出血毒性要么自行缓解，要么通过医疗干预有效治疗。在最大限度地减少 RV100 的同时，结合辅助 ADT 的治疗计划，可在 BT 后获得最佳的无毒性生存。
