Peach Matthew Sean, Showalter Timothy N, Ohri Nitin
Department of Radiation Oncology, University of Virginia School of Medicine, Charlottesville, VA 22908, USA.
Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, USA.
Prostate Cancer. 2015;2015:624736. doi: 10.1155/2015/624736. Epub 2015 Nov 30.
A small but meaningful percentage of men who are treated with external beam radiation therapy for prostate cancer will develop late gastrointestinal toxicity. While numerous strategies to prevent gastrointestinal injury have been studied, clinical trials concentrating on late toxicity have been difficult to carry out. Identification of subjects at high risk for late gastrointestinal injury could allow toxicity prevention trials to be performed using reasonable sample sizes. Acute radiation therapy toxicity has been shown to predict late toxicity in several organ systems. Late toxicities may occur as a consequential effect of acute injury. In this systematic review of published reports, we found that late gastrointestinal toxicity following prostate radiotherapy seems to be statistically and potentially causally related to acute gastrointestinal morbidity as a consequential effect. We submit that acute gastrointestinal toxicity may be used to identify at-risk patients who may benefit from additional attention for medical interventions and close follow-up to prevent late toxicity. Acute gastrointestinal toxicity could also be explored as a surrogate endpoint for late effects in prospective trials.
一小部分但有意义比例的接受前列腺癌外照射放疗的男性会出现晚期胃肠道毒性。虽然已经研究了许多预防胃肠道损伤的策略，但专注于晚期毒性的临床试验很难开展。识别晚期胃肠道损伤高危受试者可以使毒性预防试验在合理的样本量下进行。急性放射治疗毒性已被证明可预测多个器官系统的晚期毒性。晚期毒性可能是急性损伤的继发效应。在对已发表报告的这项系统评价中，我们发现前列腺放疗后的晚期胃肠道毒性似乎在统计学上与作为继发效应的急性胃肠道发病率存在潜在因果关系。我们认为，急性胃肠道毒性可用于识别可能从额外医疗干预关注和密切随访中受益以预防晚期毒性的高危患者。急性胃肠道毒性也可在前瞻性试验中作为晚期效应的替代终点进行探索。
