Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio.
Pract Radiat Oncol. 2013 Oct-Dec;3(4):323-8. doi: 10.1016/j.prro.2012.08.004. Epub 2012 Sep 19.
To examine late gastrointestinal (GI) and genitourinary (GU) toxicity profiles of patients treated for prostate cancer either definitively or post-prostatectomy with both intensity modulated radiation therapy (IMRT) and image guided radiation therapy (IGRT).
A total of 333 patients treated definitively and 104 patients treated postoperatively with IMRT and varying IGRT techniques were retrospectively examined to evaluate GI and GU toxicity profiles >1 year from treatment. Available dosimetric data were used for correlative analysis.
The median follow-up time for the definitive patients was 41 months and the median follow-up time for the post-prostatectomy patients was 33 months. No late grade 4 or 5 GI or GU toxicities were observed. For definitive patients, the rates of grade ≥2 GI and GU toxicity at 3 years were 4.9% and 4.5%, respectively. In the postoperative cohort the rate of grade >2 GU toxicity was 11.6%, with no grade ≥2 GI toxicity. In the definitive cohort's Cox proportional hazards regression univariate analysis, use of anticoagulation was significantly associated with GI toxicity and age, bladder V50 and IGRT modality were associated with GU toxicity, and only age remained significant in the multivariate model. In univariate analysis for the postoperative cohort, no dosimetric value correlated with GU toxicity, nor did age or time from radical prostatectomy to radiation.
IMRT with IGRT achieved low rates of GI and GU toxicity in the definitive and postoperative setting.
检查接受调强放疗（IMRT）和图像引导放疗（IGRT）治疗的前列腺癌患者的晚期胃肠道（GI）和泌尿生殖系统（GU）毒性概况，这些患者或接受根治性治疗，或接受前列腺切除术后治疗。
对 333 例接受根治性治疗和 104 例接受术后 IMRT 治疗的患者进行回顾性检查，以评估治疗后 1 年以上的 GI 和 GU 毒性概况。对可用的剂量学数据进行了相关分析。
确定性治疗患者的中位随访时间为 41 个月，前列腺切除术后患者的中位随访时间为 33 个月。未观察到晚期 4 或 5 级 GI 或 GU 毒性。在确定性治疗患者中，3 年时≥2 级 GI 和 GU 毒性的发生率分别为 4.9%和 4.5%。在术后队列中，≥2 级 GU 毒性的发生率为 11.6%，无≥2 级 GI 毒性。在确定性队列的 Cox 比例风险回归单因素分析中，抗凝治疗与 GI 毒性显著相关，膀胱 V50 和 IGRT 方式与 GU 毒性相关，只有年龄在多因素模型中仍然显著。在术后队列的单因素分析中，没有剂量学值与 GU 毒性相关，年龄或根治性前列腺切除术后至放疗的时间也与 GU 毒性无关。
在根治性和术后治疗中，IMRT 联合 IGRT 可实现较低的 GI 和 GU 毒性发生率。
