Fujii Kyohei, Nakano Masahiro, Kawakami Shogo, Tanaka Yuichi, Kainuma Takuro, Tsumura Hideyasu, Tabata Ken-Ichi, Satoh Takefumi, Iwamura Masatsugu, Ishiyama Hiromichi
Division of Radiation Oncology, Kitasato University Hospital, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan.
Department of Radiation Oncology, Kitasato University School of Medicine, 1-15-1 Kitasato, Minamiku, Sagamiharashi 252-0329, Japan.
Curr Oncol. 2023 May 16;30(5):5062-5071. doi: 10.3390/curroncol30050383.
The indications for stereotactic body radiotherapy (SBRT) for prostate cancer have increased. However, the relationships between adverse events and risk factors remain unclear. This study aimed to clarify associations between adverse events and dose index for prostate SBRT. Participants comprised 145 patients irradiated with 32-36 Gy in 4 fractions. Radiotherapy-related risk factors such as dose-volume histogram parameters and patient-related risk factors such as T stage and Gleason score were evaluated in a competing risk analysis. Median follow-up duration was 42.9 months. A total of 9.7% had acute Grade ≥ 2 GU toxicities and 4.8% had acute Grade ≥ 2 GI toxicities. A total of 11.1% had late Grade ≥ 2 GU toxicities and 7.6% had late Grade ≥ 2 GI toxicities. Two (1.4%) patients suffered from late Grade 3 GU toxicities. Similarly, two (1.4%) patients suffered from late Grade 3 GI toxicities. Acute GU and GI events correlated with prostate volume and dose to the hottest 10 cc volume (D10cc)/volumes receiving a minimum of 30 Gy (V30 Gy) of rectum, respectively. Late GI toxicity, frequency, and rectal hemorrhage correlated with rectal D0.1 cc/D1 cc, maximum dose to the bladder, and rectal D0.1 cc, respectively. Toxicities after prostate SBRT using 32-36 Gy/4 fractions were acceptable. Our analysis showed that acute toxicities correlated with volume receiving a medium dose level, and late toxicities correlated with highest point dose of organs at risk.
前列腺癌立体定向体部放疗（SBRT）的适应证有所增加。然而，不良事件与风险因素之间的关系仍不明确。本研究旨在阐明前列腺SBRT不良事件与剂量指数之间的关联。研究对象包括145例接受4次分割、32 - 36 Gy照射的患者。在竞争风险分析中评估了放疗相关风险因素，如剂量体积直方图参数，以及患者相关风险因素，如T分期和 Gleason评分。中位随访时间为42.9个月。共有9.7%的患者发生急性≥2级泌尿生殖系统毒性反应，4.8%的患者发生急性≥2级胃肠道毒性反应。共有11.1%的患者发生晚期≥2级泌尿生殖系统毒性反应，7.6%的患者发生晚期≥2级胃肠道毒性反应。两名（1.4%）患者出现晚期3级泌尿生殖系统毒性反应。同样，两名（1.4%）患者出现晚期3级胃肠道毒性反应。急性泌尿生殖系统和胃肠道事件分别与前列腺体积以及直肠接受至少30 Gy的最热点10 cc体积（D10cc）/体积（V30 Gy）的剂量相关。晚期胃肠道毒性、发生率和直肠出血分别与直肠D0.1 cc/D1 cc、膀胱最大剂量以及直肠D0.1 cc相关。采用32 - 36 Gy/4次分割的前列腺SBRT后的毒性反应是可接受的。我们的分析表明，急性毒性反应与接受中等剂量水平的体积相关，而晚期毒性反应与危及器官的最高点剂量相关。
