Doležel M-, Odrážka K-, Vaňásek J, Štuk J, Hlávka A, Vítková M, Ulrych V, Kohlová T, Vlachová Z, Hafuda A, Hartmann I
Klin Onkol. 2020 Winter;33(1):49-54. doi: 10.14735/amko202049.
The combination of intensity modulated radiation therapy (IMRT) and image guided radiotherapy (IGRT) plays a significant role in sparing normal tissue during prostate cancer treatment. We report the clinical outcomes of 260 patients treated with high-dose IGRT as well as the toxicity of high-dose IGRT in these patients.
From September 2008 to February 2012, 260 men with clinically localized prostate cancer underwent radical radiotherapy. Two hundred patients were treated with IMRT (78 Gy in 39 fractions) to the prostate and base of seminal vesicles using an adaptive protocol combining cone-beam computed tomography (CBCT) and kilovoltage image matching with individualized safety margin calculation. Sixty patients underwent treatment with the same prescribed dose using RapidArc with a reduced safety margin of 6 mm and daily online matching using CBCT. Late toxicity was scored prospectively according to the RTOG/FC-LENT scale.
Eighteen patients (6.9%) experienced acute grade 2 gastrointestinal toxicity. There was no acute grade 3 or 4 gastrointestinal toxicity. Thirty-nine patients (15%) experienced acute grade 2 genitourinary toxicity and 6 patients (2.3%) had grade 3 gerourinary toxicity. Genitourinary toxicity grade 4 was observed in 5 (1.9%) patients, due to installation of a urinary catheter. At a median follow up of 84.2 months, the estimated 7-year cumulative incidences of grade 2 gastrointestinal and genitourinary toxicity were 4.4 and 7.1% respectively. The estimated 7-year prostate specific antigen relapse free survival was 97.1% for low-risk disease, 83.6% for intermediate-risk disease and 75% for high-risk patients.
The use of IMRT in combination with IGRT results in a low rate of late toxicity. The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study. The Editorial Board declares that the manuscript met the ICMJE recommendation for biomedical papers. Submitted: 8. 9. 2019 Accepted: 25. 10. 2019.
调强放射治疗（IMRT）与图像引导放射治疗（IGRT）相结合在前列腺癌治疗中对保护正常组织起着重要作用。我们报告了260例接受高剂量IGRT治疗患者的临床结果以及这些患者中高剂量IGRT的毒性。
2008年9月至2012年2月，260例临床局限性前列腺癌男性患者接受了根治性放疗。200例患者采用自适应方案，将锥形束计算机断层扫描（CBCT）与千伏图像匹配相结合，并进行个体化安全边缘计算，对前列腺和精囊基部进行调强放射治疗（78 Gy，分39次）。60例患者使用容积旋转调强放疗（RapidArc）以6 mm的减小安全边缘和每日使用CBCT进行在线匹配，接受相同规定剂量的治疗。根据美国放射肿瘤学会/佛罗里达大学晚期放射损伤正常组织效应迟发分级标准（RTOG/FC-LENT）对晚期毒性进行前瞻性评分。
18例患者（6.9%）出现2级急性胃肠道毒性。无3级或4级急性胃肠道毒性。39例患者（15%）出现2级急性泌尿生殖系统毒性，6例患者（2.3%）出现3级泌尿生殖系统毒性。5例（1.9%）患者因留置导尿管出现4级泌尿生殖系统毒性。中位随访84.2个月时，2级胃肠道和泌尿生殖系统毒性的7年累积发生率估计分别为4.4%和7.1%。低危疾病、中危疾病和高危患者的7年前列腺特异性抗原无复发生存率估计分别为97.1%、83.6%和75%。
调强放射治疗联合图像引导放射治疗导致晚期毒性发生率较低。作者声明他们在研究中使用的药物、产品或服务方面没有潜在的利益冲突。编辑委员会声明该手稿符合国际医学期刊编辑委员会（ICMJE）对生物医学论文的建议。提交日期：2019年9月8日 接受日期：2019年" 10月25日
