Chin Stephen, Aherne Noel J, Last Andrew, Assareh Hassan, Shakespeare Thomas P
Department of Radiation Oncology, Mid North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.
Rural Clinical School, University of New South Wales, Coffs Harbour, New South Wales, Australia.
J Med Imaging Radiat Oncol. 2017 Dec;61(6):804-811. doi: 10.1111/1754-9485.12632. Epub 2017 Jun 17.
We evaluated single institution toxicity outcomes after post-prostatectomy radiotherapy (PPRT) via image-guided intensity-modulated radiation therapy (IG-IMRT) with implanted fiducial markers following national eviQ guidelines, for which late toxicity outcomes have not been published.
Prospectively collected toxicity data were retrospectively reviewed for 293 men who underwent 64-66 Gy IG-IMRT to the prostate bed between 2007 and 2015.
Median follow-up after PPRT was 39 months. Baseline grade ≥2 genitourinary (GU), gastrointestinal (GI) and sexual toxicities were 20.5%, 2.7% and 43.7%, respectively, reflecting ongoing toxicity after radical prostatectomy. Incidence of new (compared to baseline) acute grade ≥2 GU and GI toxicity was 5.8% and 10.6%, respectively. New late grade ≥2 GU, GI and sexual toxicity occurred in 19.1%, 4.7% and 20.2%, respectively. However, many patients also experienced improvements in toxicities. For this reason, prevalence of grade ≥2 GU, GI and sexual toxicities 4 years after PPRT was similar to or lower than baseline (21.7%, 2.6% and 17.4%, respectively). There were no grade ≥4 toxicities.
Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT.
我们按照国家eviQ指南，对前列腺切除术后放疗（PPRT）采用植入基准标记的图像引导调强放疗（IG-IMRT）后的单机构毒性结果进行了评估，目前尚未公布其晚期毒性结果。
对2007年至2015年间接受64 - 66 Gy IG-IMRT治疗前列腺床的293名男性患者的前瞻性收集的毒性数据进行回顾性分析。
PPRT后的中位随访时间为39个月。基线时≥2级泌尿生殖系统（GU）、胃肠道（GI）和性功能毒性分别为20.5%、2.7%和43.7%，这反映了根治性前列腺切除术后仍存在毒性。新出现的（与基线相比）急性≥2级GU和GI毒性发生率分别为5.8%和10.6%。新出现的晚期≥2级GU、GI和性功能毒性分别发生在19.1%、4.7%和20.2%的患者中。然而，许多患者的毒性也有所改善。因此，PPRT后4年≥2级GU、GI和性功能毒性的患病率与基线相似或低于基线（分别为21.7%、2.6%和17.4%）。没有≥4级毒性反应。
采用澳大利亚轮廓勾画指南的前列腺切除术后IG-IMRT似乎具有可耐受的急性和晚期毒性。与基线相比，≥2级GU和GI毒性的4年患病率几乎没有变化，性功能毒性较基线有所改善。遵循这些指南应能让放射肿瘤学家放心。手术和PPRT的晚期毒性率高于确定性IG-IMRT，如果患者考虑手术且可能需要PPRT，应考虑到这一点。
