Ingrosso Gianluca, Carosi Alessandra, di Cristino Daniela, Ponti Elisabetta, Lancia Andrea, Murgia Alessandra, Bruni Claudia, Morelli Pasquale, Pietrasanta Franca, Santoni Riccardo
Department of Diagnostic Imaging, Molecular Imaging, Interventional Radiology and Radiotherapy, Tor Vergata General Hospital, Rome, Italy.
Rep Pract Oncol Radiother. 2017 Jan-Feb;22(1):64-70. doi: 10.1016/j.rpor.2016.10.006. Epub 2016 Nov 24.
To evaluate toxicity of high conformal image-guided radiotherapy of the prostate bed.
Radiotherapy of the prostate bed has a pivotal role in the post-operative and salvage settings, but few clinical data are available on the use of daily image guidance in combination with highly conformal techniques, and data on long-term results are lacking.
We analyzed 118 patients irradiated on the prostate bed using conformal plans processed with a micro-multileaf collimator, and daily checking treatment set-up with a cone-beam CT system. Correlation between toxicity and clinical-dosimetric parameters was assessed by the Cox regression model and log-rank test. Survival analyses were performed with the Kaplan-Meier method.
Median follow-up was 54.08 months. Late grade ≥2 gastro-intestinal (GI) and genito-urinary (GU) toxicity were 3.4% and 4.2%, respectively. Actuarial 4-year late grade ≥2 GI and GU toxicities were 4% and 6%, respectively. Four-year relapse-free survival was 87%. At log-rank test, acute grade ≥2 GI toxicity is associated with the use of antihypertensives ( = 0.03), and there is a trend toward significance between the use of anticoagulants and late grade ≥2 GI toxicity ( = 0.07). At Cox analysis, acute grade ≥2 GU toxicity is correlated with the percentage of bladder volume receiving more than 65 Gy ( = 0.02, HR 1.87 CI 1.25-2.8), and the maximal dose to the rectum is correlated to the development of late grade ≥2 GI toxicity ( = 0.03, HR 2.75 CI 1.10-6.9).
Conformal volumetric image-guided radiotherapy of the prostate bed leads to low toxicity rates.
评估前列腺床高适形图像引导放射治疗的毒性。
前列腺床放射治疗在术后及挽救性治疗中起关键作用,但关于每日图像引导联合高适形技术应用的临床数据较少,且缺乏长期结果数据。
我们分析了118例接受前列腺床放射治疗的患者,采用微多叶准直器处理的适形计划,并使用锥形束CT系统每日检查治疗摆位。通过Cox回归模型和对数秩检验评估毒性与临床剂量学参数之间的相关性。采用Kaplan-Meier法进行生存分析。
中位随访时间为54.08个月。晚期≥2级胃肠道(GI)和泌尿生殖系统(GU)毒性分别为3.4%和4.2%。4年精算晚期≥2级GI和GU毒性分别为4%和6%。4年无复发生存率为87%。在对数秩检验中,急性≥2级GI毒性与使用抗高血压药有关(P = 0.03),使用抗凝剂与晚期≥2级GI毒性之间有显著趋势(P = 0.07)。在Cox分析中,急性≥2级GU毒性与接受超过65 Gy的膀胱体积百分比相关(P = 0.02,HR 1.87 CI 1.25 - 2.8),直肠最大剂量与晚期≥2级GI毒性的发生相关(P = 0.03,HR 2.75 CI 1.10 - 6.9)。
前列腺床适形容积图像引导放射治疗导致低毒性率。