容积调强弧形放疗联合每日图像引导对高危前列腺癌具有更好的毒性特征。
Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer.
机构信息
Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan, USA.
Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Egypt.
出版信息
Asian Pac J Cancer Prev. 2021 Jan 1;22(1):61-68. doi: 10.31557/APJCP.2021.22.1.61.
PURPOSE
To compare radiotherapy-induced toxicity for localized prostate-cancer (PCa) treated with versus without daily image-guidance.
PATIENTS AND METHODS
We identified consecutive intermediate and high-risk localized PCa patients treated with definitive radiotherapy using intensity-modulated radiotherapy (IMRT) with variable duration of androgen-deprivation therapy (ADT) within 2015-2016 (Arm-A) and 2005-2007 (Arm-B). Arm-A cases received daily online imaging guidance (IGRT) using cone-beam computed tomography (CBCT) unlike Arm-B candidates with no daily IGRT. After reporting demographic, clinico-pathological features and treatment details, we compared acute (within 3 months post-therapy) and late RT-induced toxicities between study groups graded by RTOG/CTCAE criteria. Uni/multivariate analyses (UVA/MVA) were performed to identify independent predictors for RT-related side-effects.
RESULTS
We were able to identify 257 cases who met our inclusion criteria. Overall, median age was 73 years (48-85), 67% had intermediate-risk and 47% received ADT. Arm-A included 72 patients who received IMRT delivered using volumetric-modulated arc therapy (VMAT), whereas, Arm-B was formed of 185 cases who utilized step-and-shoot static IMRT. Clinico-pathological features and treatment details were non-different across study arms except that Arm-A had more Grade Group 3, higher median total dose (79.2 vs. 74 Gy) and more pelvic lymph-nodes RT (p <0.05). Although acute toxicity was similar across groups, Arm-B encountered higher late toxicity score, more intense late genitourinary side-effects (P=0.008), with non-different late lower-gastrointestinal toxicities. On MVA, lack of daily CBCT, African-American race and higher comorbidities were independently predictive for late toxicities. Conclusion: IMRT with daily CBCT permitted safe delivery of dose-escalated IMRT with improved toxicity profile for higher-risk prostate cancer.
目的
比较局部前列腺癌（PCa）接受有和无每日图像引导放疗的放疗诱导毒性。
方法
我们在 2015-2016 年（A 组）和 2005-2007 年（B 组）期间，使用调强放疗（IMRT）和可变时长雄激素剥夺治疗（ADT）连续识别接受根治性放疗的中高危局限性 PCa 患者。与 B 组患者没有每日 IGRT 不同，A 组患者接受每日在线成像引导（IGRT），使用锥形束计算机断层扫描（CBCT）。在报告人口统计学、临床病理特征和治疗细节后，我们比较了两组患者接受 RTOG/CTCAE 标准分级的急性（治疗后 3 个月内）和晚期 RT 诱导毒性。进行单变量/多变量分析（UVA/MVA），以确定与 RT 相关副作用的独立预测因素。
结果
我们能够确定符合纳入标准的 257 例患者。总体而言，中位年龄为 73 岁（48-85 岁），67%为中危患者，47%接受 ADT。A 组 72 例患者接受容积调强弧形治疗（VMAT），B 组 185 例患者接受分步静态 IMRT。除 A 组患者的 3 级不良事件比例更高、中位总剂量更高（79.2 与 74 Gy）、骨盆淋巴结放疗更多（p <0.05）外，两组的临床病理特征和治疗细节无差异。尽管两组的急性毒性相似，但 B 组晚期毒性评分更高，晚期泌尿生殖系统不良反应更严重（P=0.008），晚期下消化道毒性无差异。多变量分析显示，缺乏每日 CBCT、非裔美国人种族和更高的合并症是晚期毒性的独立预测因素。
结论
每日 CBCT 的 IMRT 可安全地进行剂量递增 IMRT，改善高危前列腺癌的毒性谱。
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