从 70Gy 到 80Gy 的调强放疗治疗前列腺癌：六年结果和晚期毒性的预测因素。
Intensity-modulated radiation therapy from 70Gy to 80Gy in prostate cancer: six- year outcomes and predictors of late toxicity.
机构信息
Departments of Radiation Oncology and Medical Physics, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne - CS 30519, 54519, Vandoeuvre-lès-Nancy Cedex, France.
Department of Biostatistics, Institut de Cancérologie de Lorraine, 6 Avenue de Bourgogne, 54519, Vandoeuvre-lès-Nancy, France.
出版信息
Radiat Oncol. 2017 Jun 16;12(1):99. doi: 10.1186/s13014-017-0839-3.
OBJECTIVE
To report grade ≥2 overall late rectal and urinary toxicities in patients (pts) with prostate cancer treated by intensity-modulated radiotherapy (IMRT) at 3 dose-levels. Identify predictors of radiation toxicity and report biochemical progression free survival (bPFS).
METHODS
A total of 277 pts were treated with 70Gy (10.8%), 74Gy (63.9%) and 80 Gy (25.3%) using IMRT without pelvic irradiation were analyzed. Short or long-course androgen deprivation therapy (ADT) was allowed in 46.1% of pts. The toxicity was described using the Common Terminology Criteria for Adverse Events (CTCAE) v4.0 scale. Cox regression models addressed demographics, disease and dosimetry characteristics as potential predictors of late grade ≥2 toxicity after adjusting for other modifying factors.
RESULTS
The median follow-up was 77 months (range 15; 150). There was no grade ≥4 toxicity. The 5-year cumulative rate of grade ≥2 late rectal and urinary toxicities was 6.3% (95% CI = 3.8%; 10.3%) and 25.3% (95% CI = 19.8%; 31.8%) respectively. In multivariate analysis, only the dose (80Gy vs 74 and 70Gy) was found to increase the risk of rectal toxicity (HR = 2.96 [1.07; 8.20]). For pts receiving 74 Gy, International Prostate Symptom Score (IPSS) at baseline ≥8 (HR = 2.40 [1.08; 5.35]) and dose ≥73Gy delivered in more than 2% of bladder (D2%) were found to be predictors of bladder toxicity (HR = 3.29 [1.36; 7.98]). The 5-year biochemical relapse free survival was 81.0% [74.5%; 86.0%] in the entire population, 97.5% [83.5%; 99.6%] in the low risk group, 84.9% [76.7%; 90.3%] in the intermediate risk group and 66.4% [51.8%; 77.4%] in the high-risk group. D'Amico low (HR = 0.09 [0.01; 0.69]) and intermediate risk groups (HR = 0.50 [0.28; 0.88]) as well as PSA nadir ≥0.2 ng/ml (HR = 1.79 [1.01; 3.21]) were predictive of biochemical relapse.
CONCLUSIONS
The rate of late rectal toxicity increased with higher doses, while Dmax ≥74Gy, D2% ≥ 73Gy for bladder wall and baseline IPSS ≥8 increased late urinary toxicity.
目的
报告前列腺癌患者接受强度调制放疗（IMRT）治疗时，≥2 级的总体晚期直肠和泌尿系统毒性的发生率。确定放射毒性的预测因素，并报告生化无进展生存期（bPFS）。
方法
共分析了 277 例接受 70Gy（10.8%）、74Gy（63.9%）和 80Gy（25.3%）剂量 IMRT 治疗且未接受盆腔照射的前列腺癌患者。46.1%的患者允许接受短期或长期雄激素剥夺治疗（ADT）。使用 CTCAE v4.0 量表描述毒性。Cox 回归模型将人口统计学、疾病和剂量学特征作为晚期≥2 级毒性的潜在预测因素进行分析，同时调整了其他修正因素。
结果
中位随访时间为 77 个月（范围 15；150）。没有发生≥4 级毒性。5 年累积的≥2 级晚期直肠和泌尿系统毒性发生率分别为 6.3%（95%CI=3.8%；10.3%）和 25.3%（95%CI=19.8%；31.8%）。多变量分析显示，只有剂量（80Gy 比 74Gy 和 70Gy）与直肠毒性的风险增加相关（HR=2.96[1.07；8.20]）。对于接受 74Gy 剂量的患者，基线时国际前列腺症状评分（IPSS）≥8（HR=2.40[1.08；5.35]）和膀胱 D2%（剂量≥73Gy 的体积）≥2%（HR=3.29[1.36；7.98]）是预测膀胱毒性的因素。整个队列的 5 年生化无复发生存率为 81.0%[74.5%；86.0%]，低危组为 97.5%[83.5%；99.6%]，中危组为 84.9%[76.7%；90.3%]，高危组为 66.4%[51.8%；77.4%]。D'Amico 低危组（HR=0.09[0.01；0.69]）和中危组（HR=0.50[0.28；0.88]）以及 PSA 最低值≥0.2ng/ml（HR=1.79[1.01；3.21]）是生化复发的预测因素。
结论
直肠毒性的发生率随剂量增加而增加，而膀胱壁 Dmax≥74Gy、D2%≥73Gy 和基线时 IPSS≥8 则增加了晚期泌尿系统毒性。
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