比较直肠癌相对和绝对剂量-体积参数与前列腺癌患者急性和晚期放射性直肠炎的临床相关性。
Comparison of relative and absolute rectal dose-volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients.
机构信息
Department of Radiotherapy and Special Oncology, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
Institute for Biometry, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
出版信息
Strahlenther Onkol. 2019 Feb;195(2):103-112. doi: 10.1007/s00066-018-1365-4. Epub 2018 Sep 6.
PURPOSE
To compare relative and absolute dose-volume parameters (DV) of the rectum and their clinical correlation with acute and late radiation proctitis (RP) after radiotherapy (RT) for prostate cancer (PCa).
PATIENTS AND METHODS
366 patients received RT for PCa. In total, 49.2% received definitive RT, 20.2% received postoperative RT and 30.6% received salvage RT for biochemical recurrence. In 77.9% of patients, RT was delivered to the prostate or prostate bed, and additional whole pelvic RT was performed in 22.1%. 33.9% received 3D-RT, and 66.1% received IMRT. The median follow-up was 59.5 months (18.0-84.0 months). The relative (in %) and absolute (in ccm) rectal doses from 20-75 Gy including the receiver operating characteristics curves (rAUC) from 30-65 Gy (in % and ccm) and several other clinical parameters were analyzed in univariate and multivariate analyses. We performed the statistical analyses separately for the entire cohort (n = 366), patients with (n = 81) and without (n = 285) pelvic RT, comparing RP vs. RP ≥ grade I.
RESULTS
With the exception of the V50 (p = 0.02) in the univariate analyses for acute RP in the entire patient cohort, no absolute DV parameter (in ccm) was statistically significant associated with either acute or late RP. In the multivariate analyses, 3D-RT (p < 0.008) and rAUC (p = 0.006) were significant parameters for acute RP for the entire cohort, and the V50 (p = 0.01) was the significant parameter for patients with pelvic RT. The rAUC (p = 0.004) was significant for RT to the prostate/prostate bed. Regarding the statistical analysis for late RP, the rAUC (p = 0.001) was significant for the entire cohort, and rAUC (p = 0.001) was significant for RT of the prostate/prostate bed. No parameter was significant in patients with pelvic RT.
CONCLUSION
Absolute DV parameters in ccm are not required for RT in PCa patients.
目的
比较直肠的相对和绝对剂量-体积参数（DV）及其与前列腺癌（PCa）放疗后急性和晚期放射性直肠炎（RP）的临床相关性。
患者和方法
366 例 PCa 患者接受放疗。其中，49.2%为根治性放疗，20.2%为术后放疗，30.6%为生化复发的挽救性放疗。77.9%的患者接受前列腺或前列腺床放疗，22.1%的患者接受全盆腔放疗。33.9%的患者接受 3D-RT，66.1%的患者接受 IMRT。中位随访时间为 59.5 个月（18.0-84.0 个月）。在单变量和多变量分析中，分析了从 20 到 75Gy 的相对（以%表示）和绝对（以 ccm 表示）直肠剂量，以及包括 30 到 65Gy 的接收者操作特征曲线（rAUC）（以%和 ccm 表示）和其他几个临床参数。我们分别对整个队列（n=366）、接受（n=81）和不接受（n=285）盆腔放疗的患者以及比较 RP 与 RP≥1 级的患者进行了统计分析。
结果
除了整个患者队列中急性 RP 的单变量分析中的 V50（p=0.02）外，绝对剂量体积参数（以 ccm 表示）与急性或晚期 RP 均无统计学意义。在多变量分析中，3D-RT（p<0.008）和 rAUC（p=0.006）是整个队列急性 RP 的显著参数，而 V50（p=0.01）是接受盆腔放疗患者的显著参数。对于接受前列腺/前列腺床放疗的患者，V50（p=0.01）是显著参数。对于晚期 RP 的统计分析，rAUC（p=0.004）对整个队列有显著意义，rAUC（p=0.001）对前列腺/前列腺床的 RT 有显著意义。盆腔放疗患者中没有参数具有统计学意义。
结论
对于 PCa 患者的放疗，ccm 中的绝对剂量体积参数不是必需的。
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