Xiao Canhua, Moughan Jennifer, Movsas Benjamin, Konski Andre A, Hanks Gerald E, Cox James D, Roach Mack, Zeitzer Kenneth L, Lawton Colleen A, Peters Christopher A, Rosenthal Seth A, Hsu I-Chow Joe, Horwitz Eric M, Mishra Mark V, Michalski Jeff M, Parliament Matthew B, D'Souza David P, Pugh Stephanie L, Bruner Deborah W
Emory University, Atlanta, Georgia.
NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
Adv Radiat Oncol. 2018 Jun 7;3(3):405-411. doi: 10.1016/j.adro.2018.04.010. eCollection 2018 Jul-Sep.
A meta-analysis of sociodemographic variables and their association with late (>180 days from start of radiation therapy[RT]) bowel, bladder, and clustered bowel and bladder toxicities was conducted in patients with high-risk (clinical stages T2c-T4b or Gleason score 8-10 or prostate-specific antigen level >20) prostate cancer.
Three NRG trials (RTOG 9202, RTOG 9413, and RTOG 9406) that accrued from 1992 to 2000 were used. Late toxicities were measured with the Radiation Therapy Oncology Group Late Radiation Morbidity Scale. After controlling for study, age, Karnofsky Performance Status, and year of accrual, sociodemographic variables were added to the model for each outcome variable of interest in a stepwise fashion using the Fine-Gray regression models with an entry criterion of 0.05.
A total of 2432 patients were analyzed of whom most were Caucasian (76%), had a KPS score of 90 to 100 (92%), and received whole-pelvic RT+HT (67%). Of these patients, 13 % and 16% experienced late grade ≥2 bowel and bladder toxicities, respectively, and 2% and 3% experienced late grade ≥3 bowel and bladder toxicities, respectively. Late grade ≥2 clustered bowel and bladder toxicities were seen in approximately 1% of patients and late grade ≥3 clustered toxicities were seen in 2 patients (<1%). The multivariate analysis showed that patients who received prostate-only RT+HT had a lower risk of experiencing grade ≥2 bowel toxicities than those who received whole-pelvic RT+long-term (LT) HT (hazard ratio: 0.36; 95% confidence interval, 0.18-0.73; = .0046 and hazard ratio: 0.43; 95% confidence interval, 0.23-0.80; = .008, respectively). Patients who received whole-pelvic RT had similar chances of having grade ≥2 bowel or bladder toxicities no matter whether they received LT or short-term HT.
Patients with high-risk prostate cancer who receive whole-pelvic RT+LT HT are more likely to have a grade ≥2 bowel toxicity than those who receive prostate-only RT. LT bowel and bladder toxicities were infrequent. Future studies will need to confirm these findings utilizing current radiation technology and patient-reported outcomes.
对高危（临床分期为T2c - T4b或Gleason评分8 - 10或前列腺特异性抗原水平>20）前列腺癌患者的社会人口统计学变量及其与晚期（放疗开始后>180天）肠道、膀胱以及肠道和膀胱聚集性毒性反应的相关性进行荟萃分析。
使用了1992年至2000年期间开展的三项NRG试验（RTOG 9202、RTOG 9413和RTOG 9406）。采用放射治疗肿瘤学组晚期放射损伤量表来测量晚期毒性反应。在对研究、年龄、卡诺夫斯基体能状态和入组年份进行控制后，使用Fine - Gray回归模型，以0.05的纳入标准，将社会人口统计学变量逐步添加到每个感兴趣的结局变量模型中。
共分析了2432例患者，其中大多数为白种人（76%），卡诺夫斯基体能状态评分为90至100（92%），接受全盆腔放疗+激素治疗（67%）。在这些患者中，分别有13%和16%出现晚期2级及以上肠道和膀胱毒性反应，分别有2%和3%出现晚期3级及以上肠道和膀胱毒性反应。约1%的患者出现晚期2级及以上肠道和膀胱聚集性毒性反应，2例患者（<1%）出现晚期3级及以上聚集性毒性反应。多因素分析显示，接受仅前列腺放疗+激素治疗的患者发生2级及以上肠道毒性反应的风险低于接受全盆腔放疗+长期（LT）激素治疗的患者（风险比：0.36；95%置信区间，0.18 - 0.73；P = 0.0046和风险比：0.43；95%置信区间，0.23 - 0.80；P = 0.008）。接受全盆腔放疗的患者，无论接受LT还是短期激素治疗，发生2级及以上肠道或膀胱毒性反应的几率相似。
接受全盆腔放疗+LT激素治疗的高危前列腺癌患者发生2级及以上肠道毒性反应的可能性高于接受仅前列腺放疗的患者。晚期肠道和膀胱毒性反应并不常见。未来的研究需要利用当前的放射技术和患者报告的结局来证实这些发现。
