Division of Radiation Oncology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
Division of Diagnostic Radiology, Department of Radiology, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
BMC Med Imaging. 2024 Sep 9;24(1):235. doi: 10.1186/s12880-024-01420-3.
Radiotherapy (RT) is effective for cervical cancer but causes late side effects (SE) to nearby organs. These late SE occur more than 3 months after RT and are rated by clinical findings to determine their severity. While imaging studies describe late gastrointestinal (GI) SE, none demonstrate the correlation between the findings and the toxicity grading. In this study, we demonstrated the late GI toxicity prevalence, CT findings, and their correlation.
We retrospectively studied uterine cervical cancer patients treated with RT between 2015 and 2018. Patient characteristics and treatment(s) were obtained from the hospital's databases. Late RTOG/EORTC GI SE and CT images were obtained during the follow-up. Post-RT GI changes were reviewed from CT images using pre-defined criteria. Risk ratios (RR) were calculated for CT findings, and multivariable log binomial regression determined adjusted RRs.
This study included 153 patients, with a median age of 57 years (IQR 49-65). The prevalence of ≥ grade 2 RTOG/EORTC late GI SE was 33 (27.5%). CT findings showed 91 patients (59.48%) with enhanced bowel wall (BW) thickening, 3 (1.96%) with bowel obstruction, 7 (4.58%) with bowel perforation, 6 (3.92%) with fistula, 0 (0%) with bowel ischemia, and 0 (0%) with GI bleeding. Adjusted RRs showed that enhanced BW thickening (RR 9.77, 95% CI 2.64-36.07, p = 0.001), bowel obstruction (RR 5.05, 95% CI 2.30-11.09, p < 0.001), and bowel perforation (RR 3.82, 95% CI 1.96-7.44, p < 0.001) associated with higher late GI toxicity grades.
Our study shows CT findings correlate with grade 2-4 late GI toxicity. Future research should validate and refine these findings with different imaging and toxicity grading systems to assess their potential predictive value.
放射治疗（RT）对宫颈癌有效，但会导致附近器官的晚期副作用（SE）。这些晚期 SE 在 RT 后 3 个月以上发生，并通过临床发现进行评估以确定其严重程度。虽然影像学研究描述了晚期胃肠道（GI）SE，但没有一项研究显示这些发现与毒性分级之间的相关性。在这项研究中，我们展示了晚期 GI 毒性的发生率、CT 表现及其相关性。
我们回顾性研究了 2015 年至 2018 年间接受 RT 治疗的子宫颈癌患者。从医院的数据库中获取患者特征和治疗信息。在随访期间获得晚期 RTOG/EORTC GI SE 和 CT 图像。使用预定义标准从 CT 图像中回顾性评估 RT 后 GI 变化。计算 CT 表现的风险比（RR），并使用多变量对数二项式回归确定调整后的 RR。
本研究共纳入 153 例患者，中位年龄为 57 岁（IQR 49-65）。≥2 级 RTOG/EORTC 晚期 GI SE 的发生率为 33（27.5%）。CT 表现显示 91 例（59.48%）患者的肠壁增厚（BW）强化，3 例（1.96%）患者出现肠梗阻，7 例（4.58%）患者出现肠穿孔，6 例（3.92%）患者出现瘘管，0 例（0%）患者出现肠缺血，0 例（0%）患者出现 GI 出血。调整后的 RR 显示，肠壁增厚（RR 9.77，95%CI 2.64-36.07，p=0.001）、肠梗阻（RR 5.05，95%CI 2.30-11.09，p<0.001）和肠穿孔（RR 3.82，95%CI 1.96-7.44，p<0.001）与晚期 GI 毒性分级较高相关。
我们的研究表明 CT 表现与 2-4 级晚期 GI 毒性相关。未来的研究应使用不同的影像学和毒性分级系统来验证和完善这些发现，以评估其潜在的预测价值。
