Borghetti Paolo, Spiazzi Luigi, Cozzaglio Claudia, Pedretti Sara, Caraffini Bruno, Triggiani Luca, Greco Diana, Bardoscia Lilia, Barbera Fernando, Buglione Michela, Magrini Stefano Maria
Radiation Oncology Department, Spedali Civili Hospital and Brescia University, Piazzale Spedali Civili 1, IT-25123, Brescia, Italy.
Medical Physics Department, Spedali Civili Hospital, Brescia, Italy.
Radiol Med. 2018 Jan;123(1):63-70. doi: 10.1007/s11547-017-0807-x. Epub 2017 Sep 18.
To evaluate biochemical relapse-free survival (bRFS), overall survival (OS), late rectal and bladder toxicities in a retrospective single institution series, also applying an in-house software for biological dose calculation.
258 patients submitted to radiotherapy after prostatectomy were considered. Differences between groups were calculated using the log-rank test and the relevant clinical and therapeutic variables were considered for multivariate analysis. PRODVH is an in-house system able to calculate mean dose-volume histograms (DVHs) of a series of patients, to convert them in biologically effective DVHs (BEDVHs) and allowing to compare them with ANOVA and t Student test.
Adjuvant radiotherapy (ART) and salvage radiotherapy (SRT) were performed in 131 (50.8%) and 127 patients (49.2%). At multivariate analysis advanced T stage, androgen deprivation total (ADT) and SRT resulted as independent variables related to a worst bRFS (p = 0.019, 0.001 and 0.02), while GS > 7 and SRT affected negatively OS (p 0.047 and 0.039). High grade toxicity events occurred mainly in patients treated with 3-dimensional conformal radiotherapy (3DCRT) (proctitis p = 0.006; cystitis: p = 0.041). A significantly more favorable mean rectum BEDVH for patients with G0 or G1 rectal toxicity was shown (p < 0.001). Mean BEDVH for both bladder (p < 0.01) and rectum (p < 0.05) were also significantly better for volumetric modulated arc therapy-image guided radiotherapy (VMAT-IGRT) plans than for 3DCRT plans.
ART is better than SRT in terms of bRFS and OS, particularly for more aggressive cases, advanced T stage and higher Gleason Score. Postoperative prostate cancer radiotherapy should be applied as soon as possible after surgery. The use of modern techniques such as VMAT-IGRT significantly reduces toxicity.
在一个回顾性单机构系列研究中评估无生化复发生存期（bRFS）、总生存期（OS）、晚期直肠和膀胱毒性，同时应用内部软件进行生物剂量计算。
纳入258例前列腺切除术后接受放疗的患者。使用对数秩检验计算组间差异，并考虑相关临床和治疗变量进行多因素分析。PRODVH是一个内部系统，能够计算一系列患者的平均剂量体积直方图（DVH），将其转换为生物等效剂量体积直方图（BEDVH），并允许通过方差分析和t检验进行比较。
131例（50.8%）患者接受辅助放疗（ART），127例（49.2%）患者接受挽救性放疗（SRT）。多因素分析显示，T分期进展、雄激素剥夺总量（ADT）和SRT是与较差的bRFS相关的独立变量（p = 0.019、0.001和0.02），而Gleason评分>7和SRT对OS有负面影响（p = 0.047和0.039）。高级别毒性事件主要发生在接受三维适形放疗（3DCRT）的患者中（直肠炎p = 0.006；膀胱炎：p = 0.041）。G0或G1级直肠毒性患者显示出明显更有利的平均直肠BEDVH（p < 0.001）。容积调强弧形放疗-图像引导放疗（VMAT-IGRT）计划的膀胱（p < 0.01）和直肠（p < 0.05）平均BEDVH也明显优于3DCRT计划。
在bRFS和OS方面，ART优于SRT，特别是对于侵袭性更强的病例、T分期进展和更高的Gleason评分。术后前列腺癌放疗应在手术后尽快进行。使用VMAT-IGRT等现代技术可显著降低毒性。
