Gottschalk Alexander
Urol Oncol. 2014 Apr;32(3):374. doi: 10.1016/j.urolonc.2013.09.021.
To investigate the influence of diabetes mellitus (DM) on late genitourinary (GU) and gastrointestinal (GI) toxicity in patients treated with external beam radiotherapy (RT) for prostate cancer.
A total of 626 men were treated with curative-intent RT for prostate cancer from 1988 to 2008. Using the National Comprehensive Cancer Network risk category, the patients were considered to have low-risk (30%), intermediate-risk (42%), or high-risk (28%) prostate cancer. The median radiation dose was 74 Gy; 45% received androgen deprivation therapy for a median of 4 months. Late GU and GI Radiation Therapy Oncology Group toxicity was recorded prospectively at each visit after external beam RT. The median follow-up period was 55 months.
Of the 626 men, 102 (16%) had DM that was controlled by diet (8%), oral medications (52%), or insulin (39%). The patients with DM were more likely to receive intensity-modulated RT and androgen deprivation therapy and to have a shorter follow-up duration (P ≤.05 for all). Univariate analyses demonstrated that greater radiation dose, baseline urinary dysfunction, intensity-modulated RT, and DM were associated with grade 2 or greater GU toxicity, and transurethral resection of the prostate and DM were associated with grade 3 or greater GU toxicity. In addition, androgen deprivation therapy use, age ≥ 70 years, and anticoagulation were associated with grade 2 or greater GI toxicity, and age ≥ 70 years and anticoagulation were associated with grade 3 or greater GI toxicity. The multivariate analyses for late toxicity demonstrated a greater risk of grade 2 or greater (relative risk 1.36, P = .10) and grade 3 or greater GU toxicity (relative risk 2.74, P = .04) with DM.
A greater incidence of late GU toxicity was seen in patients with DM treated for prostate cancer. This relationship might be useful when considering the treatment of patients with DM, especially those receiving dose-escalated RT or with a history of transurethral resection of the prostate.
探讨糖尿病（DM）对接受前列腺癌体外放疗（RT）患者晚期泌尿生殖系统（GU）和胃肠道（GI）毒性的影响。
1988年至2008年，共有626名男性接受了前列腺癌根治性放疗。根据美国国立综合癌症网络风险分类，这些患者被认为患有低风险（30%）、中度风险（42%）或高风险（28%）前列腺癌。中位放射剂量为74 Gy；45%的患者接受了中位时长为4个月的雄激素剥夺治疗。在体外放疗后的每次随访中，前瞻性记录晚期GU和GI放射治疗肿瘤学组毒性。中位随访期为55个月。
在626名男性中，102名（16%）患有糖尿病，通过饮食控制（8%）、口服药物（52%）或胰岛素（39%）进行控制。糖尿病患者更有可能接受调强放疗和雄激素剥夺治疗，且随访时间较短（所有P值≤0.05）。单因素分析表明，更高的放射剂量、基线排尿功能障碍、调强放疗和糖尿病与2级或更高级别的GU毒性相关，经尿道前列腺切除术和糖尿病与3级或更高级别的GU毒性相关。此外，使用雄激素剥夺治疗、年龄≥70岁和抗凝与2级或更高级别的GI毒性相关，年龄≥70岁和抗凝与3级或更高级别的GI毒性相关。晚期毒性的多因素分析表明，糖尿病患者发生2级或更高级别（相对风险1.36，P = 0.10）和3级或更高级别GU毒性（相对风险2.74，P = 0.04）的风险更高。
接受前列腺癌治疗的糖尿病患者晚期GU毒性发生率更高。在考虑糖尿病患者的治疗时，尤其是那些接受剂量递增放疗或有经尿道前列腺切除术病史的患者，这种关系可能会有所帮助。
