Facondo Giuseppe, Bottero Marta, Goanta Lucia, Farneti Alessia, Faiella Adriana, D'Urso Pasqualina, Sanguineti Giuseppe
Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Via Elio Chianesi 53, 00144, Rome, Italy.
Radiat Oncol. 2025 Mar 18;20(1):41. doi: 10.1186/s13014-025-02599-7.
To assess the rate and predictors of lower extremity lymphedema (LEL) after radiotherapy (RT) following radical prostatectomy (RP) ± pelvic lymph node dissection (PLND) for prostate cancer.
Patients (pts) treated with adjuvant or salvage RT after RP ± PLND and a minimum 2-year follow-up were included. LEL was defined as a volume difference ≥ 10% between limbs evaluated using circumferential measurements with a flexible non-stretch tape. The following predictors were investigated at logistic regression: age (continuous); body mass index (BMI, continuous); exercise level (low vs. medium/high); smoking (yes vs. no); cigarette pack/year (continuous); hypertension (yes ns no); vascular comorbidity (yes vs. no); diabetes (yes vs. no); PLND (yes vs. no); number of examined nodes (continuous); whole pelvis radiotherapy (WPRT) (yes vs. no); time between RP and RT (continuous); planning target volume (PTV) volume (continuous); PTV/BMI (continuous). Statistical significance was claimed for p < 0.05.
101 pts were examined. The median time from surgery to RT was 36.1 months (mths) (IQR: 15.0-68.3), the median time from RT to the date of study examination was 51.1 months (IQR: 36.8-65.3). 14 pts developed LEL (13.9%), 3 pts (2.9%) before RT, 11 pts (10.8%) after RT. The median time from RT to LEL was 4 mths (IQR: 0.5-17.3). At multivariable analysis (MVA) diabetes mellitus (DM) (OR = 32.8, p = 0.02), time between surgery and RT (OR = 0.966, p = 0.039) and exercise (OR = 0.03, p = 0.002) were independently correlated to LEL. The number of examined nodes was highly correlated to LEL at univariate analysis (OR = 1.066, p = 0.025) but was not confirmed at MVA (p = 0.719). Interestingly, the distribution of the examined nodes was statistically different between pts with low (median N = 12) vs. medium/high (N = 5) exercise (p = 0.034).
Clinically detectable LEL involves a minority of pts after RT. DM is a predisposing factor, while awaiting RT delivery has a protective effect favoring salvage over adjuvant RT.
评估前列腺癌根治性前列腺切除术（RP）±盆腔淋巴结清扫术（PLND）后放疗（RT）后下肢淋巴水肿（LEL）的发生率及预测因素。
纳入在RP±PLND后接受辅助或挽救性放疗且随访至少2年的患者。LEL定义为使用柔性非弹性卷尺进行周径测量评估的双下肢体积差异≥10%。在逻辑回归中研究以下预测因素：年龄（连续变量）；体重指数（BMI，连续变量）；运动水平（低与中/高）；吸烟（是与否）；每年吸烟包数（连续变量）；高血压（是与否）；血管合并症（是与否）；糖尿病（是与否）；PLND（是与否）；检查淋巴结数量（连续变量）；全盆腔放疗（WPRT）（是与否）；RP与RT之间的时间（连续变量）；计划靶体积（PTV）体积（连续变量）；PTV/BMI（连续变量）。p<0.05具有统计学意义。
检查了101例患者。从手术到放疗的中位时间为36.1个月（IQR：15.0 - 68.3），从放疗到研究检查日期的中位时间为51.1个月（IQR：36.8 - 65.3）。14例患者发生LEL（13.9%），放疗前3例（2.9%），放疗后11例（10.8%）。从放疗到发生LEL的中位时间为4个月（IQR：0.5 - 17.3）。在多变量分析（MVA）中，糖尿病（DM）（OR = 32.8，p = 0.02）、手术与放疗之间的时间（OR = 0.966，p = 0.039）和运动（OR = 0.03，p = 0.002）与LEL独立相关。检查淋巴结数量在单变量分析中与LEL高度相关（OR = 1.066，p = 0.025），但在MVA中未得到证实（p = 0.719）。有趣的是，低运动水平（中位N = 12）与中/高运动水平（N = 5）患者之间检查淋巴结的分布在统计学上存在差异（p = 0.034）。
临床上可检测到的LEL在放疗后涉及少数患者。DM是一个易感因素，而等待放疗实施对挽救性放疗比对辅助性放疗具有保护作用。
