Hasterok Maja, Szołtysik Monika, Nowicka Zuzanna, Goc Bartłomiej, Gräupner Donata, Majewski Wojciech, Rasławski Konrad, Rajwa Paweł, Jabłońska Iwona, Magrowski Łukasz, Przydacz Mikołaj, Krajewski Wojciech, Masri Oliwia, Miszczyk Marcin
IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland.
Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15, 92-215 Lodz, Poland.
Cancers (Basel). 2023 Nov 9;15(22):5334. doi: 10.3390/cancers15225334.
Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 ( < 0.001 and < 0.001) and rectum wall V46 ( = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 ( = 0.019 and = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall ( = 0.004) and bladder ( = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.
尽管前列腺癌治疗的效果日益显著，但其毒性仍是一个主要问题。我们研究的目的是评估前列腺切除术后前列腺床放疗（RT）患者不良事件（AE）的发生率以及剂量体积直方图（DVH）参数对治疗毒性发生的预后价值。AE根据CTCAE v.5.0进行评分。直肠和膀胱根据RTOG指南进行轮廓勾画。DVH参数使用从ECLIPSE治疗计划系统导出的数据进行评估。使用接受给定剂量的危及器官（OAR）百分比的连续剂量阈值和QUANTEC剂量限制分析泌尿生殖系统（GU）和胃肠道（GI）毒性。最终分析共纳入213例患者。18.7%的患者发生急性2级或更高等级（≥G2）GU AE，21.3%的患者发生晚期GU AE。11.7%的患者发生急性≥G2 GI毒性，11.2%的患者发生晚期≥G2 GI毒性。5例患者经历4级AE。最常见的不良反应是腹泻、直肠炎、膀胱炎和排尿困难。急性≥G2 GI毒性的最显著预测因素是直肠V47和V46（<0.001和<0.001）以及直肠壁V46（=0.001），而晚期≥G2 GI AE的最显著预测因素是直肠壁V47和V48（=0.019和=0.021）。膀胱或膀胱壁参数均与急性毒性风险无显著相关性。膀胱壁（=0.004）和膀胱（=0.005）的最小剂量是晚期≥G2 GU毒性的最显著预测因素。术后放疗与具有临床意义的AE风险相关，这与DVH参数有关，即使在符合普遍接受的剂量限制的患者中也是如此。考虑到术后辅助放疗缺乏生存获益，我们的结果支持通过早期挽救方法延迟治疗以避免或推迟毒性。
Zotero 插件