White Evan C, Murphy James D, Chang Daniel T, Koong Albert C
Department of Radiation Oncology, Stanford Cancer Institute, Stanford University School of Medicine, Stanford, CA.
Am J Clin Oncol. 2015 Dec;38(6):564-9. doi: 10.1097/COC.0000000000000010.
To determine the short-term and long-term toxicity of abdominal and pelvic radiation therapy in a cohort of patients with inflammatory bowel disease (IBD). We hypothesize that with newer techniques, such as intensity-modulated radiation therapy (IMRT) and 3-dimensional conformal radiotherapy (3D-CRT), patients with IBD can safely undergo abdominal and pelvic radiation, with low risk for major acute or late toxicity.
Nineteen consecutive patients with IBD (14 with ulcerative colitis, 5 with Crohn disease) who were treated with abdominal or pelvic external beam radiation therapy at Stanford University from 1997 to 2011 were identified. Fourteen patients were treated with IMRT and 5 were treated with 3D-CRT. Treated sites included prostate (n=8), gastric/esophageal (n=5), rectal/anal (n=3), and liver (n=3) tumors. Charts were reviewed and toxicity was graded according to the Common Terminology Criteria for Acute Events version 4.0. Median follow-up was 32.5 months. Fisher exact test was used to determine if any clinical and/or treatment factors were associated with toxicity outcomes.
Acute grade ≥3 toxicity occurred in 2 patients (11%). Late grade ≥3 toxicity occurred in 1 patient (6%). Acute grade ≥2 toxicity occurred in 28% of patients treated with IMRT versus 100% of patients treated with 3D-CRT (P=0.01). Acute grade ≥2 gastrointestinal toxicity was lower in patients treated with IMRT versus 3D-CRT (14% vs. 100%, respectively, P=0.002). Late grade ≥2 toxicity occurred in 21% of patients. Higher total dose (Gy) and biologically effective dose (Gy) were associated with increased rates of late grade ≥2 toxicity (P=0.02 and 0.03, respectively).
These data suggest that select patients with IBD can safely undergo abdominal and pelvic radiation therapy. The use of IMRT was associated with decreased acute toxicity. Acute and late severe toxicity rates were low in this patient population with the use of modern radiation techniques.
确定炎性肠病（IBD）患者队列中腹部和盆腔放射治疗的短期和长期毒性。我们假设，采用强度调制放射治疗（IMRT）和三维适形放射治疗（3D-CRT）等新技术，IBD患者能够安全地接受腹部和盆腔放射治疗，发生严重急性或晚期毒性的风险较低。
确定了1997年至2011年在斯坦福大学接受腹部或盆腔外照射放射治疗的19例连续IBD患者（14例溃疡性结肠炎，5例克罗恩病）。14例患者接受IMRT治疗，5例患者接受3D-CRT治疗。治疗部位包括前列腺（n = 8）、胃/食管（n = 5）、直肠/肛门（n = 3）和肝脏（n = 3）肿瘤。查阅病历并根据《急性事件通用术语标准》第4.0版对毒性进行分级。中位随访时间为32.5个月。采用Fisher精确检验确定是否有任何临床和/或治疗因素与毒性结果相关。
2例患者（11%）发生急性≥3级毒性。1例患者（6%）发生晚期≥3级毒性。接受IMRT治疗的患者中有28%发生急性≥2级毒性，而接受3D-CRT治疗的患者中这一比例为100%（P = 0.01）。接受IMRT治疗的患者急性≥2级胃肠道毒性低于接受3D-CRT治疗的患者（分别为14%和100%，P = 0.002）。21%的患者发生晚期≥2级毒性。较高的总剂量（Gy）和生物等效剂量（Gy）与晚期≥2级毒性发生率增加相关（分别为P = 0.02和0.03）。
这些数据表明，部分IBD患者能够安全地接受腹部和盆腔放射治疗。IMRT的使用与急性毒性降低相关。在该患者群体中，采用现代放射技术时急性和晚期严重毒性发生率较低。
