Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands.
Department of Radiation Oncology, Erasmus MC Cancer Institute, Rotterdam, The Netherlands; Department of Medical Physics & Informatics, HollandPTC, Delft, The Netherlands.
Radiother Oncol. 2020 Jul;148:38-43. doi: 10.1016/j.radonc.2020.03.035. Epub 2020 Apr 6.
To investigate relationships between patient-reported acute gastro-intestinal symptoms in a locally advanced cervical cancer (LACC) prospective cohort and clinical and dosimetric parameters, while also taking spatial dose into account.
A total of 103 patients was included, receiving radiotherapy based on a plan-library-based plan-of-the-day protocol, combined either with concurrent chemotherapy or with neo-adjuvant chemotherapy and concomitant hyperthermia. Toxicity endpoints were extracted from questionnaires sent out weekly during treatment and regularly in the acute phase after treatment. Endpoints were defined for symptoms concerning obstipation, diarrhea, fecal leakage, bowel cramps and rectal bleeding. Dose surface maps were constructed for the rectum. Clinical parameters and dosimetric parameters of the bowel bag and rectum were collected for all patients.
The use of concomitant chemotherapy and an increase in Planning Target Volume (PTV) resulted in a significant increase in reported diarrhea. The dose-volume parameters V-V of the rectum were found to be significant, unlike dose-volume parameters of the bowel bag. Additionally, a significantly higher dose to the inferior part of the rectum was found for patients reporting diarrhea. No significance was reached for fecal leakage and bowel cramps.
The significance of results for patients reporting diarrhea symptoms found for PTV volume indicates a potential benefit for a plan-of-the-day protocol. Additionally, the results suggest that a reduction of inferior rectum dose could decrease patient-reported diarrhea symptoms, while the administration of concomitant chemotherapy appears to lead to radiosensitizing effects that increase these symptoms.
本研究旨在调查局部晚期宫颈癌（LACC）前瞻性队列中患者报告的急性胃肠道症状与临床和剂量学参数之间的关系，同时考虑空间剂量。
共纳入 103 例患者，根据基于计划库的每日计划方案接受放疗，联合同步化疗或新辅助化疗和同期热疗。毒性终点从治疗期间每周和治疗后急性阶段定期发送的问卷中提取。终点定义为便秘、腹泻、粪便渗漏、肠痉挛和直肠出血相关症状。为直肠构建剂量表面图。收集所有患者的肠袋和直肠的临床参数和剂量学参数。
同期化疗的使用和计划靶区（PTV）的增加导致报告的腹泻显著增加。与肠袋的剂量学参数不同，直肠的剂量-体积参数 V-V 被发现具有显著意义。此外，报告腹泻的患者直肠下部分的剂量明显更高。粪便渗漏和肠痉挛没有达到显著水平。
对于报告腹泻症状的患者，PTV 体积的结果具有重要意义，表明每日计划方案可能有益。此外，结果表明降低直肠下部剂量可能会减少患者报告的腹泻症状，而同期化疗似乎会导致放射增敏作用，增加这些症状。
