Ogino Ryo, Ishii Kentaro, Nakajima Toshifumi, Hosokawa Yukinari, Kubo Kazuki, Takemura Reiko, Morimoto Hideyuki, Matsuda Shogo, Kawamorita Ryu, Tada Takuhito
Department of Radiology, National Hospital Organization Osaka Minami Medical Center, Osaka, Japan.
Department of Radiation Oncology, Tane General Hospital, Osaka, Japan.
Cancer Diagn Progn. 2022 Nov 3;2(6):648-653. doi: 10.21873/cdp.10155. eCollection 2022 Nov-Dec.
BACKGROUND/AIM: To evaluate whether whole-pelvis (WP) volumetric modulated arc therapy (VMAT) is associated with increased late toxicity compared with prostate-only (PO) VMAT in patients with localized prostate cancer.
Participants comprised 384 consecutive patients treated with definitive VMAT to 78 Gy in 39 fractions from July 2011 to August 2016. Of these, 183 patients received PO-VMAT and 201 patients received initial WP-VMAT to 46.8 Gy in 26 fractions using a simultaneous integrated boost technique. Gastrointestinal (GI) and genitourinary (GU) toxicities were prospectively scored using Common Terminology Criteria for Adverse Events version 4.0.
Median follow-up was 49 months (range=16-88 months) in the PO-VMAT group and 52 months (range=10-85 months) in the WP-VMAT group. Frequencies of Grade 3 late GI and GU toxicities were ≤3% across both groups. No patients experienced Grade 4+ toxicity. Cumulative incidences of Grade 2+ late GI and GU toxicities were similar between PO- and WP-VMAT groups (p=0.508 and p=0.838, respectively). Five-year cumulative incidences of Grade 2+ late GI and GU toxicities were 12.2% and 6.6% for the PO-VMAT group and 12.3% and 8.9% for the WP-VMAT group, respectively.
WP-VMAT did not increase late GI and GU toxicities. This suggests that concerns about increasing toxicity profile are insufficient reason for omitting WPRT for patients with high-risk prostate cancer.
背景/目的：评估与局限性前列腺癌患者仅行前列腺（PO）容积调强弧形放疗（VMAT）相比，全盆腔（WP）VMAT是否会增加晚期毒性。
研究对象为2011年7月至2016年8月期间连续接受根治性VMAT治疗、分39次给予78 Gy剂量的384例患者。其中，183例患者接受PO-VMAT，201例患者采用同步整合加量技术、分26次给予初始WP-VMAT 46.8 Gy剂量。采用不良事件通用术语标准第4.0版对胃肠道（GI）和泌尿生殖系统（GU）毒性进行前瞻性评分。
PO-VMAT组的中位随访时间为49个月（范围=16 - 88个月），WP-VMAT组为52个月（范围=10 - 85个月）。两组3级晚期GI和GU毒性的发生率均≤3%。无患者发生4级及以上毒性。PO-VMAT组和WP-VMAT组2级及以上晚期GI和GU毒性的累积发生率相似（分别为p = 0.508和p = 0.838）。PO-VMAT组2级及以上晚期GI和GU毒性的5年累积发生率分别为12.2%和6.6%，WP-VMAT组分别为12.3%和8.9%。
WP-VMAT未增加晚期GI和GU毒性。这表明，对于高危前列腺癌患者而言，担心毒性增加并不是省略全盆腔放疗（WPRT）的充分理由。
