Becker-Schiebe Martina, Abaci Ali, Ahmad Tahera, Hoffmann Wolfgang
Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany; Radiation Oncology, Hannover Medical School, Hannover, Germany.
Department of Radiotherapy and Radio-Oncology, Klinikum Braunschweig, Hannover Medical School, Braunschweig, Germany.
Rep Pract Oncol Radiother. 2016 May-Jun;21(3):188-94. doi: 10.1016/j.rpor.2016.01.005. Epub 2016 Feb 20.
To determine the influence of IGRT in terms of toxicities compared to non-IGRT patients undergoing definitive RT.
Image-guided radiotherapy (IGRT) enables immediate correction of target movement by online imaging. For prostate cancer patients undergoing radiation therapy (RT), a geographical miss of the prostate may result in increased dose-volume effects in the rectum and bladder.
A total of 198 prostate cancer patients treated between 2003 and 2013 were recruited randomly for this evaluation. The rates of genitourinary (GU) and gastrointestinal (GI) toxicity for 96 non-IGRT patients (total dose: 72/73.8 Gy) were compared to those for 102 IGRT patients (total dose: 77.4 Gy) according to the Common Toxicity Criteria Version 3.0 (CTCAEv3.0). Follow-up information included treatment-related symptoms and PSA relapse.
After a median follow-up of 55.4 months, a statistically significant difference was noted for acute GI toxicities ≥1 in favour of IGRT. Significantly more patients treated by IGRT were free of acute GI symptoms (43% vs. 19%, p = 0.0012). In the non-IGRT group, more patients experienced acute GU side effects (89% vs. 80%, p = 0.07). Late toxicity scores were comparable for both cohorts.
Based on the data, we demonstrated that despite dose escalation, IGRT enabled us to reduce the GI side effects of radiation. IGRT can therefore be considered to be the standard of care for dose-escalated RT of localized prostate cancer.
确定与接受根治性放疗的非影像引导放疗（IGRT）患者相比，IGRT在毒性方面的影响。
影像引导放疗（IGRT）可通过在线成像即时校正靶区运动。对于接受放疗（RT）的前列腺癌患者，前列腺的几何位置偏差可能会导致直肠和膀胱的剂量体积效应增加。
随机招募了198例在2003年至2013年间接受治疗的前列腺癌患者进行本次评估。根据《常见毒性标准》第3.0版（CTCAEv3.0），比较了96例非IGRT患者（总剂量：72/73.8 Gy）与102例IGRT患者（总剂量：77.4 Gy）的泌尿生殖系统（GU）和胃肠道（GI）毒性发生率。随访信息包括与治疗相关的症状和前列腺特异性抗原（PSA）复发情况。
中位随访55.4个月后，在≥1级急性GI毒性方面，IGRT组具有统计学显著差异。接受IGRT治疗的患者中，无急性GI症状的患者明显更多（43%对19%，p = 0.0012）。在非IGRT组中，更多患者出现急性GU副作用（89%对80%，p = 0.07）。两组的晚期毒性评分相当。
基于这些数据，我们证明尽管剂量增加，但IGRT使我们能够减少放疗引起的GI副作用。因此，IGRT可被视为局限性前列腺癌剂量增加放疗的标准治疗方法。
