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图像引导放疗降低了高危前列腺癌囊外疾病剂量不足的风险，并改善了生化控制。

Image-guided radiotherapy reduces the risk of under-dosing high-risk prostate cancer extra-capsular disease and improves biochemical control.

机构信息

Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.

Department of Radiation Oncology, Rigshospitalet, Copenhagen, Denmark.

出版信息

Radiat Oncol. 2018 Apr 12;13(1):64. doi: 10.1186/s13014-018-0978-1.

DOI:10.1186/s13014-018-0978-1
PMID:29650035
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5898030/
Abstract

BACKGROUND

To determine if reduced dose delivery uncertainty is associated with daily image-guidance (IG) and Prostate Specific Antigen Relapse Free Survival (PRFS) in intensity-modulated radiotherapy (IMRT) of high-risk prostate cancer (PCa).

METHODS

Planning data for consecutive PCa patients treated with IMRT (n = 67) and IG-IMRT (n = 35) was retrieved. Using computer simulations of setup errors, we estimated the patient-specific uncertainty in accumulated treatment dose distributions for the prostate and for posterolateral aspects of the gland that are at highest risk for extra-capsular disease. Multivariate Cox regression for PRFS considering Gleason score, T-stage, pre-treatment PSA, number of elevated clinical risk factors (T2c+, GS7+ and PSA10+), nomogram-predicted risk of extra-capsular disease (ECD), and dose metrics was performed.

RESULTS

For IMRT vs. IG-IMRT, plan dosimetry values were similar, but simulations revealed uncertainty in delivered dose external to the prostate was significantly different, due to positioning uncertainties. A patient-specific interaction term of the risk of ECD and risk of low dose to the ECD (p = 0.005), and the number of elevated clinical risk factors (p = 0.008), correlate with reduced PRFS.

CONCLUSIONS

Improvements in PSA outcomes for high-risk PCa using IG-IMRT vs. IMRT without IG may be due to improved dosimetry for ECD.

摘要

背景

为了确定在高强度调强放疗（IMRT）治疗高危前列腺癌（PCa）中，减少剂量传递不确定性是否与每日图像引导（IG）和前列腺特异性抗原无复发生存率（PRFS）相关。

方法

回顾性分析了连续接受 IMRT（n=67）和 IG-IMRT（n=35）治疗的 PCa 患者的计划数据。通过对设置误差的计算机模拟，我们估计了前列腺和腺体后外侧部位（发生囊外疾病风险最高）的累积治疗剂量分布的患者特异性不确定性。使用多变量 Cox 回归分析考虑到 Gleason 评分、T 分期、治疗前 PSA、升高的临床危险因素数量（T2c+、GS7+和 PSA10+）、列线图预测的囊外疾病风险（ECD）和剂量指标的 PRFS。

结果

与 IMRT 相比，IG-IMRT 的计划剂量值相似，但模拟显示由于定位不确定性，前列腺外的剂量传递不确定性明显不同。ECD 风险和 ECD 低剂量风险的患者特异性交互项（p=0.005）以及升高的临床危险因素数量（p=0.008）与 PRFS 降低相关。

结论

与没有 IG 的 IMRT 相比，IG-IMRT 可改善高危 PCa 的 PSA 结果，这可能是由于 ECD 的剂量学改善。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/3fb89c3ab25e/13014_2018_978_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/503d6f989d93/13014_2018_978_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/e5e757b1abd3/13014_2018_978_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/3fb89c3ab25e/13014_2018_978_Fig3_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/503d6f989d93/13014_2018_978_Fig1_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/e5e757b1abd3/13014_2018_978_Fig2_HTML.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/979c/5898030/3fb89c3ab25e/13014_2018_978_Fig3_HTML.jpg

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