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直线加速器引导与磁共振引导的立体定向体部放疗用于局限性前列腺癌:急性耐受性的比较评估

Linac-based versus MR-guided SBRT for localized prostate cancer: a comparative evaluation of acute tolerability.

作者信息

Nicosia Luca, Mazzola Rosario, Rigo Michele, Giaj-Levra Niccolò, Pastorello Edoardo, Ricchetti Francesco, Vitale Claudio, Figlia Vanessa, Cuccia Francesco, Ruggieri Ruggero, Alongi Filippo

机构信息

Advanced Radiation Oncology Department, IRCCS Sacro Cuore Don Calabria Hospital, Cancer Care Center, Via Don Sempreboni 5, 37034, Negrar Di Valpolicella, Verona, Italy.

University of Brescia, Brescia, Italy.

出版信息

Radiol Med. 2023 May;128(5):612-618. doi: 10.1007/s11547-023-01624-7. Epub 2023 Apr 13.

Abstract

AIM

This study aims to compare acute toxicity of prostate cancer (PCa) stereotactic body radiotherapy (SBRT) delivered by MR-guided radiotherapy (MRgRT) with 1.5-T MR-linac or by volumetric modulated arc (VMAT) with conventional linac.

METHODS

Patients with low-to-favorable intermediate risk class PCa were treated with exclusive SBRT (35 Gy in five fractions). Patients treated with MRgRT were enrolled in an Ethical Committee (EC) approved trial (Prot. n° 23,748), while patients treated with conventional linac were enrolled in an EC approved phase II trial (n° SBRT PROG112CESC). The primary end-point was the acute toxicity. Patients were included in the analysis if they had at least 6 months of follow-up for the primary end-point evaluation. Toxicity assessment was performed according to CTCAE v5.0 scale. International Prostatic Symptoms Score (IPSS) was also performed.

RESULTS

A total of 135 patients were included in the analysis. Seventy-two (53.3%) were treated with MR-linac and 63 (46.7%) with conventional linac. The median initial PSA before RT was 6.1 ng/ml (range 0.49-19). Globally, acute G1, G2, and G3 toxicity occurred in 39 (28.8%), 20 (14.5%), and 5 (3.7%) patients. At the univariate analysis, acute G1 toxicity did not differ between MR-linac and conventional linac (26.4% versus 31.8%), as well as G2 toxicity (12.5% versus 17.5%; p = 0.52). Acute G2 gastrointestinal (GI) toxicity occurred in 7% and 12.5% of cases in MR-linac and conventional linac group, respectively (p = 0.06), while acute G2 genitourinary toxicity occurred in 11% and 12.8% in MR-linac and conventional linac, respectively (p = 0.82). The median IPSS before and after SBRT was 3 (1-16) and 5 (1-18). Acute G3 toxicity occurred in two cases in the MR-linac and three cases in the conventional linac group (p = n.s.).

CONCLUSION

Prostate SBRT with 1.5-T MR-linac is feasible and safe. Compared to conventional linac, MRgRT might to potentially reduce the overall G1 acute toxicity at 6 months, and seems to show a trend toward a lower incidence of grade 2 GI toxicity. A longer follow-up is necessary to assess the late efficacy and toxicity.

摘要

目的

本研究旨在比较采用1.5-T磁共振直线加速器的磁共振引导放疗(MRgRT)与采用传统直线加速器的容积调强弧形放疗(VMAT)进行前列腺癌(PCa)立体定向体部放疗(SBRT)的急性毒性。

方法

低至中度有利风险类别的PCa患者接受单纯SBRT(5次分割,共35 Gy)治疗。接受MRgRT治疗的患者参加了伦理委员会(EC)批准的试验(方案编号23,748),而接受传统直线加速器治疗的患者参加了EC批准的II期试验(编号SBRT PROG112CESC)。主要终点是急性毒性。如果患者对主要终点评估至少有6个月的随访,则纳入分析。毒性评估根据CTCAE v5.0量表进行。还进行了国际前列腺症状评分(IPSS)。

结果

共有135例患者纳入分析。72例(53.3%)接受磁共振直线加速器治疗,63例(46.7%)接受传统直线加速器治疗。放疗前前列腺特异性抗原(PSA)的中位数为6.1 ng/ml(范围0.49-19)。总体而言,39例(28.8%)、20例(14.5%)和5例(3.7%)患者发生了急性1级、2级和3级毒性。单因素分析显示,磁共振直线加速器与传统直线加速器在急性1级毒性方面无差异(26.4%对31.8%),2级毒性也无差异(12.5%对17.5%;p = 0.52)。急性2级胃肠道(GI)毒性在磁共振直线加速器组和传统直线加速器组中的发生率分别为7%和12.5%(p = 0.06),而急性2级泌尿生殖系统毒性在磁共振直线加速器组和传统直线加速器组中的发生率分别为11%和12.8%(p = 0.82)。SBRT前后IPSS的中位数分别为3(1-16)和5(1-18)。急性3级毒性在磁共振直线加速器组有2例,在传统直线加速器组有3例(p = 无统计学意义)。

结论

采用1.5-T磁共振直线加速器进行前列腺SBRT是可行且安全的。与传统直线加速器相比,MRgRT可能在6个月时潜在降低总体1级急性毒性,并且似乎显示出2级GI毒性发生率较低的趋势。需要更长时间的随访来评估晚期疗效和毒性。

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