立体定向体部放射治疗用于治疗合并炎症性肠病的局限性前列腺癌男性患者。
Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease.
机构信息
Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA.
Department of Radiation Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, 10075, USA.
出版信息
Radiat Oncol. 2021 Jul 9;16(1):126. doi: 10.1186/s13014-021-01850-1.
BACKGROUND
Historically, IBD has been thought to increase the underlying risk of radiation related toxicity in the treatment of prostate cancer. In the modern era, contemporary radiation planning and delivery may mitigate radiation-related toxicity in this theoretically high-risk cohort. This is the first manuscript to report clinical outcomes for men diagnosed with prostate cancer and underlying IBD curatively treated with stereotactic body radiation therapy (SBRT).
METHODS
A large institutional database of patients (n = 4245) treated with SBRT for adenocarcinoma of the prostate was interrogated to identify patients who were diagnosed with underlying IBD prior to treatment. All patients were treated with SBRT over five treatment fractions using a robotic radiosurgical platform and fiducial tracking. Baseline IBD characteristics including IBD subtype, pre-SBRT IBD medications, and EPIC bowel questionnaires were reviewed for the IBD cohort. Acute and late toxicity was evaluated using the CTCAE version 5.0.
RESULTS
A total of 31 patients were identified who had underlying IBD prior to SBRT for the curative treatment of prostate cancer. The majority (n = 18) were diagnosed with ulcerative colitis and were being treated with local steroid suppositories for IBD. No biochemical relapses were observed in the IBD cohort with early follow up. High-grade acute and late toxicities were rare (n = 1, grade 3 proctitis) with a median time to any GI toxicity of 22 months. Hemorrhoidal flare was the most common low-grade toxicity observed (n = 3).
CONCLUSION
To date, this is one of the largest groups of patients with IBD treated safely and effectively with radiation for prostate cancer and the only review of patients treated with SBRT. Caution is warranted when delivering therapeutic radiation to patients with IBD, however modern radiation techniques appear to have mitigated the risk of GI side effects.
背景
从历史上看，人们认为炎症性肠病（IBD）会增加前列腺癌治疗中放射性相关毒性的潜在风险。在现代，当代的放射治疗计划和实施可能会减轻这一理论上高危人群的放射性相关毒性。这是第一篇报告接受立体定向体部放射治疗（SBRT）根治性治疗前列腺癌且合并 IBD 的男性患者的临床结果的文献。
方法
通过对接受 SBRT 治疗前列腺腺癌的大型机构数据库（n=4245）进行查询，以确定在治疗前诊断为潜在 IBD 的患者。所有患者均使用机器人放射外科平台和基准跟踪进行 SBRT 五分割治疗。回顾了 IBD 队列的 IBD 特征，包括 IBD 亚型、SBRT 前 IBD 药物和 EPIC 肠问卷。使用 CTCAE 版本 5.0 评估急性和迟发性毒性。
结果
共确定了 31 例在接受 SBRT 根治性治疗前列腺癌之前患有潜在 IBD 的患者。其中大多数（n=18）被诊断为溃疡性结肠炎，正在使用局部类固醇栓剂治疗 IBD。在早期随访中，IBD 队列未观察到生化复发。高等级急性和迟发性毒性罕见（n=1，3 级直肠炎），任何胃肠道毒性的中位时间为 22 个月。最常见的低等级毒性是痔发作（n=3）。
结论
迄今为止，这是一组最大的 IBD 患者接受前列腺癌放射治疗的安全有效的病例之一，也是唯一一组接受 SBRT 治疗的患者的回顾性研究。在向 IBD 患者提供治疗性放射治疗时需要谨慎，但现代放射技术似乎已经降低了胃肠道副作用的风险。
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