Valeriani Maurizio, Carnevale Alessia, Osti Mattia Falchetto, Minniti Giuseppe, De Sanctis Vitaliana, Agolli Linda, Bracci Stefano, Enrici Riccardo Maurizi
Tumori. 2013 Jul-Aug;99(4):474-9. doi: 10.1177/030089161309900406.
To evaluate acute toxicity of hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in the treatment of high-risk prostate cancer patients.
Between November 2009 and March 2012, 59 patients with high-risk prostate cancer were enrolled. The eclipse inverse planning system (Varian) was used to calculate an IMRT plan with simultaneous integrated boost, delivering 68.75 Gy (2.75 Gy per fraction) to the prostate, 55 Gy (2.2 Gy per fraction) to the seminal vesicles and positive nodes, and 45 Gy (1.8 Gy per fraction) to the pelvis, 4 fractions per week, 25 fractions. Prior to each treatment, patients underwent a kilo-voltage cone-beam CT performing an image-guided radiation therapy (IGRT). All patients were submitted to neoadjuvant, concomitant and adjuvant hormone therapy.
The median follow-up for all patients was 13 months (range, 3-28). At the last follow-up, no grade 3 or 4 side effect was observed. Toxicity occurred as follows during the treatment: grade 1 and 2 gastrointestinal toxicity 5.2% and 6.9%, respectively; grade 1 and 2 genitourinary toxicity 24.1% and 1.7%, respectively. Only 1.7% of the patients developed grade 3 genitourinary toxicity. No grade 3 gastrointestinal toxicity was observed.
The present study demonstrated that 4/w hypofractionated intensity-modulated radiotherapy with simultaneous integrated boost and image-guided radiotherapy in patients with high-risk prostate cancer is feasible and safe. Low acute toxicity rates were verified. Longer follow-up is needed to evaluate the outcomes in terms of late toxicity and survival.
评估大分割调强放疗联合同步整合加量及图像引导放疗在高危前列腺癌患者治疗中的急性毒性。
2009年11月至2012年3月，纳入59例高危前列腺癌患者。使用Eclipse逆向计划系统（瓦里安公司）计算同步整合加量的调强放疗计划，给予前列腺68.75 Gy（每次分割2.75 Gy），精囊和阳性淋巴结55 Gy（每次分割2.2 Gy），盆腔45 Gy（每次分割1.8 Gy），每周4次分割，共25次分割。每次治疗前，患者接受千伏锥形束CT引导下的图像引导放射治疗（IGRT）。所有患者均接受新辅助、同步和辅助激素治疗。
所有患者的中位随访时间为13个月（范围3 - 28个月）。在最后一次随访时，未观察到3级或4级副作用。治疗期间毒性反应发生情况如下：1级和2级胃肠道毒性分别为5.2%和6.9%；1级和2级泌尿生殖系统毒性分别为24.1%和1.7%。仅1.7%的患者出现3级泌尿生殖系统毒性。未观察到3级胃肠道毒性。
本研究表明，4次/周大分割调强放疗联合同步整合加量及图像引导放疗用于高危前列腺癌患者是可行且安全的。已证实急性毒性发生率较低。需要更长时间的随访以评估晚期毒性和生存方面的结果。
