Martínez-Arribas C M, González-San Segundo C, Cuesta-Álvaro P, Calvo-Manuel F A
Servicio de Oncología Radioterápica, Fundación Centro Oncológico de Galicia, A Coruña, España.
Servicio de Oncología Radioterápica, Hospital General Universitario Gregorio Marañón, Madrid, España.
Actas Urol Esp. 2017 Dec;41(10):615-623. doi: 10.1016/j.acuro.2017.03.010. Epub 2017 Jun 16.
To determine rectal and urinary toxicity after external beam radiation therapy (EBRT), assessing the results of patients who undergo radical or postoperative therapy for prostate cancer (pancreatic cancer) and their correlation with potential risk factors.
A total of 333 patients were treated with EBRT. Of these, 285 underwent radical therapy and 48 underwent postoperative therapy (39 cases of rescue and 9 of adjuvant therapy). We collected clinical, tumour and dosimetric variable to correlate with toxicity parameters. We developed decision trees based on the degree of statistical significance.
The rate of severe acute toxicity, both urinary and rectal, was 5.4% and 1.5%, respectively. The rate of chronic toxicity was 4.5% and 2.7%, respectively. Twenty-seven patients presented haematuria, and 9 presented haemorrhagic rectitis. Twenty-five patients (7.5%) presented permanent limiting sequela. The patients with lower urinary tract symptoms prior to the radiation therapy presented poorer tolerance, with greater acute bladder toxicity (P=0.041). In terms of acute rectal toxicity, 63% of the patients with mean rectal doses >45Gy and anticoagulant/antiplatelet therapy developed mild toxicity compared with 37% of the patients with mean rectal doses <45 Gy and without anticoagulant therapy. We were unable to establish predictors of chronic toxicity in the multivariate analysis. The long-term sequelae were greater in the patients who underwent urological operations prior to the radiation therapy and who were undergoing anticoagulant therapy.
The tolerance to EBRT was good, and severe toxicity was uncommon. Baseline urinary symptoms constitute the predictor that most influenced the acute urinary toxicity. Rectal toxicity is related to the mean rectal dose and with anticoagulant/antiplatelet therapy. There were no significant differences in severe toxicity between radical versus postoperative radiation therapy.
确定外照射放疗（EBRT）后的直肠和泌尿系统毒性，评估接受前列腺癌（胰腺癌）根治性或术后放疗患者的结果及其与潜在风险因素的相关性。
共有333例患者接受了EBRT治疗。其中，285例接受了根治性治疗，48例接受了术后治疗（39例挽救性治疗和9例辅助治疗）。我们收集了临床、肿瘤和剂量学变量，以与毒性参数相关联。我们根据统计学显著性程度建立了决策树。
严重急性泌尿系统和直肠毒性发生率分别为5.4%和1.5%。慢性毒性发生率分别为4.5%和2.7%。27例患者出现血尿，9例出现出血性直肠炎。25例患者（7.5%）出现永久性限制性后遗症。放疗前有下尿路症状的患者耐受性较差，急性膀胱毒性更大（P = 0.041）。在急性直肠毒性方面，平均直肠剂量>45Gy且接受抗凝/抗血小板治疗的患者中，63%出现轻度毒性，而平均直肠剂量<45Gy且未接受抗凝治疗的患者中这一比例为37%。在多变量分析中，我们未能确定慢性毒性的预测因素。放疗前接受泌尿外科手术且正在接受抗凝治疗的患者长期后遗症更多。
对EBRT的耐受性良好，严重毒性并不常见。基线泌尿系统症状是最影响急性泌尿系统毒性的预测因素。直肠毒性与平均直肠剂量以及抗凝/抗血小板治疗有关。根治性放疗与术后放疗在严重毒性方面无显著差异。
