Koerber Stefan A, Seither Ben, Slynko Alla, Haefner Matthias F, Krug David, Liermann Jakob, Adeberg Sebastian, Herfarth Klaus, Debus Juergen, Sterzing Florian
1 Department of Radiation Oncology, University Hospital Heidelberg, Heidelberg, Germany.
3 National Center of Radiation Oncology (NCRO), Heidelberg Institute of Radiation Oncology (HIRO), Heidelberg, Germany.
Tumori. 2019 Apr;105(2):174-180. doi: 10.1177/0300891618811273. Epub 2018 Nov 28.
We evaluated acute and chronic side effects of 3D conformal radiotherapy (3D-CRT) and intensity-modulated radiation therapy (IMRT) in female patients with anal carcinoma and accessed correlations between dosimetric parameters and the considered toxicities.
For 70 women with anal cancer treated at our department, acute and chronic side effects and quality of life (QoL) were evaluated with questionnaires using the Common Terminology Criteria for Adverse Events (CTCAE v. 4.0.) and Late Effects in Normal Tissue, Subjective, Objective Management and Analytic Scales (LentSoma) before, during, and after the treatment.
Forty-seven out of 70 (67%) patients completed the questionnaire and were enrolled in the study. Only poor urinary stream, loss of pubic hair during chemoradiation, and chronic vaginal dryness were observed more frequently in the 3D-CRT group compared to the IMRT group (univariable logistic regression p = .032, p = .04, p = .049, respectively). After the treatment, 43% in the 3D-CRT group and 29% in the IMRT group reported a severe loss of QoL. A higher proportion among the patients receiving a genital V20 ⩾35% showed grade 1-3 side effects such as chronic dyspareunia ( p = .035; Fisher exact test).
Our results suggest that the use of IMRT decreases acute and chronic adverse effects although reduced QoL also occurred in the IMRT group. These effects are likely to be underreported in retrospective studies using physician-reported outcome measures.
我们评估了三维适形放疗（3D-CRT）和调强放疗（IMRT）对女性肛管癌患者的急慢性副作用，并探讨了剂量学参数与所考虑毒性之间的相关性。
对在我院接受治疗的70例女性肛管癌患者，在治疗前、治疗期间和治疗后，使用不良事件通用术语标准（CTCAE v. 4.0）和正常组织晚期效应、主观、客观管理和分析量表（LentSoma）通过问卷调查评估急慢性副作用和生活质量（QoL）。
70例患者中有47例（67%）完成问卷调查并纳入研究。与IMRT组相比，3D-CRT组仅尿流不畅、放化疗期间阴毛脱落和慢性阴道干燥的发生率更高（单变量逻辑回归p值分别为0.032、0.04、0.049）。治疗后，3D-CRT组43%的患者和IMRT组29%的患者报告生活质量严重下降。接受生殖器V20≥35%的患者中，有更高比例出现1-3级副作用，如慢性性交困难（p = 0.035；Fisher精确检验）。
我们的结果表明，使用IMRT可减少急慢性不良反应，尽管IMRT组也出现了生活质量下降的情况。在使用医生报告结局指标的回顾性研究中，这些影响可能未得到充分报告。
