在接受放疗的前列腺癌患者中，膀胱和直肠的剂量-反应映射，有无基线毒性校正。
Dose-response mapping of bladder and rectum in prostate cancer patients undergoing radiotherapy with and without baseline toxicity correction.
作者信息
Puri Tanuj, Rancati Tiziana, Seibold Petra, Webb Adam, Osorio Eliana Vasquez, Green Andrew, Gioscio Eliana, Azria David, Farcy-Jacquet Marie-Pierre, Chang-Claude Jenny, Dunning Alison, Lambrecht Maarten, Avuzzi Barbara, de Ruysscher Dirk, Sperk Elena, Vega Ana, Veldeman Liv, Rosenstein Barry, Shortall Jane, Kerns Sarah, Talbot Christopher, Morris Andrew P, McWilliam Alan, Hoskin Peter, Choudhury Ananya, West Catharine, van Herk Marcel
机构信息
Division of Cancer Sciences, The Christie NHS Foundation Trust, The University of Manchester, UK.
Data Science Unit, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
出版信息
Phys Imaging Radiat Oncol. 2025 Jul 1;35:100805. doi: 10.1016/j.phro.2025.100805. eCollection 2025 Jul.
BACKGROUND AND PURPOSE
Radiotherapy dose-response maps (DRM) combine dose-surface maps (DSM) and toxicity outcomes to identify high-risk subregions in organ-at-risk. This study assesses the impact of baseline toxicity correction on the identification of high-risk subregions in dose-response modeling for prostate cancer patients undergoing radiotherapy.
MATERIALS AND METHODS
The analysis included 1808 datasets, with 589 exclusions before toxicity-specific data removal. Bladder/rectum were automatically segmented on planning computed tomography scans, DSMs unwrapped into 91x90 voxel grids, and converted to equivalent doses in 2 Gy fractions (EQD2; α/β = 1 Gy). Seventeen late toxicities were assessed with two methods: (i) baseline toxicity subtracted from the maximum of 12- and 24-months toxicity scores, dichotomized at grade 1, and (ii) maximum of 12- and 24-months toxicity scores dichotomized at grade 1. DSMs were split accordingly, and voxel-wise t-values computed using Welch's t-equation. Statistically significant voxels were identified via the 95th percentile of maximum of t-value (Tmax) distribution.
RESULTS
Event counts with baseline correction were 82/82/286/226 for urinary tract obstruction/retention/urgency/incontinence, respectively; without baseline correction, they were 93/104/465/361. For bladder DSMs, urinary incontinence, obstruction, retention, and urgency had 1143/186, 1768/1848, 516/0, and 33/0 significant voxels without/with baseline correction. For rectum DSMs, urinary incontinence and tract obstruction had 604/0 and 1980/889 significant voxels without/with baseline correction. However, no significant associations between rectal DSMs and rectum-related toxicities were found.
CONCLUSIONS
DRM without baseline correction appears more sensitive to high-risk subregions due to higher event counts. Non-linear toxicity grading and multivariable analysis may enhance DRM reliability.
背景与目的
放射治疗剂量反应图谱（DRM）结合剂量表面图谱（DSM）和毒性结果，以识别危及器官中的高风险子区域。本研究评估基线毒性校正对接受放射治疗的前列腺癌患者剂量反应建模中高风险子区域识别的影响。
材料与方法
分析包括1808个数据集，在去除特定毒性数据之前排除了589个。在计划计算机断层扫描上自动分割膀胱/直肠，将DSM展开为91×90体素网格，并转换为2 Gy分次的等效剂量（EQD2；α/β = 1 Gy）。用两种方法评估17种晚期毒性：（i）从12个月和24个月毒性评分的最大值中减去基线毒性，在1级进行二分法分类，以及（ii）在1级对12个月和24个月毒性评分的最大值进行二分法分类。相应地分割DSM，并使用韦尔奇t方程计算体素水平的t值。通过t值最大值（Tmax）分布的第95百分位数识别具有统计学意义的体素。
结果
经基线校正后，尿路梗阻/潴留/尿急/尿失禁的事件计数分别为82/82/286/226；未经基线校正时，分别为93/104/465/361。对于膀胱DSM，尿失禁、梗阻、潴留和尿急在未经/经基线校正时分别有1143/186、1768/1848、516/0和33/0个具有统计学意义的体素。对于直肠DSM，尿失禁和尿路梗阻在未经/经基线校正时分别有604/0和1980/889个具有统计学意义的体素。然而，未发现直肠DSM与直肠相关毒性之间存在显著关联。
结论
由于事件计数较高，未经基线校正的DRM似乎对高风险子区域更敏感。非线性毒性分级和多变量分析可能会提高DRM的可靠性。
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