Soulen R L, Romero J A, Chuba P J, Evelhoch J L, Simpson R E, Forman J D
Department of Radiology, Wayne State University, Detroit, Michigan 48201, USA.
Radiat Oncol Investig. 1997;5(2):81-91. doi: 10.1002/(SICI)1520-6823(1997)5:2<81::AID-ROI6>3.0.CO;2-F.
The purpose of this study was to investigate the cause of hip complaints following conformal neutron therapy delivered by opposed lateral and oblique anterior ports to treat prostate cancer. Twenty-seven patients with hip complaints following neutron or mixed neutron and photon therapy for prostate cancer had 34 magnetic resonance imaging (MRI) studies 3-39 (mean 15.3) months following treatment; for comparison, 13 similarly treated patients without hip complaints were imaged 1-32 (mean 13.8) months post-treatment; 25/40 imaged patients received concurrent nonsteroidal hormone therapy. Coronal and axial images of the hips/pelvis were obtained utilizing T1 weighted spin echo and fat suppressed inversion recovery (STIR) sequences. Signal amplitude (SA) of involved muscles was measured on the STIR images and normalized to that of the psoas outside the treatment field. Hip complaints ranged from mild soreness or motion limitation to severe pain and limitation of ambulation; presence and severity of symptoms (sx) were significantly related to neutron dose (P = 0.020 and 0.0001) but not to hormone therapy (each P > 0.17). Normalized SA of the obturator muscles differed significantly with neutron dose (P = 0.013), the presence, and the severity, of sx (P = 0.0002 and 0.0007); estimated extent of abnormal muscle also differed significantly with neutron dose (P = 0.039), presence, and severity, of sx (P = 0.00004 and 0.0007); [hormone treatment had a profound effect on SA (P = 0.0001) and extent (P = 0.005) which was independent of sx (P = 0.10 and 0.14, respectively) and neutron dose (P = 0.33 and 0.32, respectively)]. Subcutaneous changes localized lateral to the greater trochanter were seen in all, and edema of the subjacent gluteus muscles in many, symptomatic hips; only 4/13 asymptomatic hips showed subcutaneous changes, 6 had mild gluteus edema. Avascular necrosis of the femoral head was seen in 5 symptomatic hips, with marked acetabular necrosis in 3 of these; small joint effusions were seen in 8 symptomatic hips; asymptomatic hips had no significant bone or joint abnormalities. Neutron therapy for prostate cancer designed to spare the rectum results in significant dose-dependent, musculoskeletal complications which are well demonstrated by MRI. SA abnormalities of irradiated muscle correlate significantly with neutron dose and both presence and severity of hip sx. Protocol modifications have been implemented to reduce these complications. MRI provides an objective means to assess both complications and the success of new protocols in ameliorating them. Concurrent hormone therapy has a profound effect on muscle changes on MRI which is independent of neutron dose and sx.
本研究旨在调查采用对侧侧向和斜前野进行适形中子治疗前列腺癌后出现髋部不适的原因。27例前列腺癌患者在接受中子或中子与光子混合治疗后出现髋部不适，在治疗后3至39（平均15.3）个月进行了34次磁共振成像（MRI）检查；作为对照，13例接受类似治疗但无髋部不适的患者在治疗后1至32（平均13.8）个月进行了成像检查；40例成像患者中有25例接受了同期非甾体激素治疗。利用T1加权自旋回波和脂肪抑制反转恢复（STIR）序列获取髋部/骨盆的冠状位和轴位图像。在STIR图像上测量受累肌肉的信号幅度（SA），并将其与治疗野外腰大肌的信号幅度进行归一化。髋部不适的范围从轻度酸痛或活动受限到严重疼痛和行走受限；症状的存在和严重程度（sx）与中子剂量显著相关（P = 0.020和0.0001），但与激素治疗无关（各P > 0.17）。闭孔肌的归一化SA随中子剂量（P = 0.013）、sx的存在和严重程度（P = 0.0002和0.0007）有显著差异；估计的异常肌肉范围也随中子剂量（P = 0.039）、sx的存在和严重程度（P = 0.00004和0.0007）有显著差异；[激素治疗对SA（P = 0.0001）和范围（P = 0.005）有深远影响，这与sx（分别为P = 0.10和0.14）和中子剂量（分别为P = 0.33和0.32）无关]。在所有有症状的髋部均可见到大转子外侧的皮下改变，许多有症状的髋部还可见到相邻臀肌的水肿；13例无症状髋部中只有4例出现皮下改变，6例有轻度臀肌水肿。5例有症状的髋部可见股骨头缺血性坏死，其中3例有明显的髋臼坏死；8例有症状的髋部可见小关节积液；无症状髋部无明显的骨骼或关节异常。旨在保护直肠的前列腺癌中子治疗会导致显著的剂量依赖性肌肉骨骼并发症，MRI能很好地显示这些并发症。受照射肌肉的SA异常与中子剂量以及髋部sx的存在和严重程度显著相关。已实施方案修改以减少这些并发症。MRI提供了一种客观手段来评估并发症以及新方案在改善并发症方面的成效。同期激素治疗对MRI上的肌肉改变有深远影响，这与中子剂量和sx无关。
