The Impact of Clinical Factors on the Development of Late Radiation Toxicity: Results from the Medical Research Council RT01 Trial (ISRCTN47772397)
The Impact of Clinical Factors on the Development of Late Radiation Toxicity: Results from the Medical Research Council RT01 Trial (ISRCTN47772397)
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DOI：
10.1016/j.clon.2011.03.001
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发表时间：
2011-11-01
影响因子：
3.4
通讯作者：
Dearnaley, D. P.
中科院分区：
文献类型：
--
作者：
Barnett, G. C.;De Meerleer, G.;Dearnaley, D. P.
目的：各种剂量学参数已被证明会影响晚期辐射毒性的发生率。其他治疗和患者相关因素的影响尚不明确。本研究的目的是阐明这些因素的影响，在发展中的晚期症状后，根治性放疗的前列腺。材料和方法：患者和治疗相关的因素，被认为是影响发展的晚期毒性进行了分析，在788例患者接受根治性放疗的前列腺在医学研究理事会RT 01试验。晚期毒性数据使用放射治疗肿瘤学小组，正常组织的晚期效应/主观、客观、管理、分析、皇家马斯登医院和加州大学，洛杉矶，前列腺癌指数记录。急性毒性采用放射治疗肿瘤组分级系统进行测量。结果：在多变量分析中，急性肠毒性与直肠炎增加有统计学显著相关性（风险比=1.63，95%置信区间1.18，2.24; P=0.003）和排便频率增加（危险比=1.77，95%可信区间1.27，2.46; P =0.001）高血压与尿流不良风险降低密切相关（危险比=0.25，95%可信区间0.09，0.71; P=0.009）。直肠出血的风险随着年龄的增加而增加（风险比=1.04/岁，95%置信区间1.01，1.08; P=0.009）。正如预期的那样，较高的处方剂量增加了几个晚期毒性终点的风险。尽管急性膀胱毒性与5年时膀胱症状的存在相关，但当计算膀胱功能较基线的变化时，除尿频和血尿外，所有症状的影响均消失。有任何治疗前膀胱症状的患者更有可能报告尿频（风险比=2.09，95%置信区间1.48，2.95; P
Aims: A variety of dosimetric parameters have been shown to influence the incidence of late radiation toxicity. The effect of other treatment- and patient-related factors is less well established. The aim of this study was to elucidate the influence of such factors in the development of late symptoms after radical radiotherapy to the prostate.Materials and methods: Patient- and treatment-related factors that are thought to influence the development of late toxicity were analysed in 788 patients who had received radical radiotherapy to the prostate in the Medical Research Council RT01 trial. Late toxicity data were recorded using the Radiation Therapy Oncology Group, Late Effects of Normal Tissues/Subjective, Objective, Management, Analytic, Royal Marsden Hospital and the University of California, Los Angeles, Prostate Cancer Index. Acute toxicity was measured using the Radiation Therapy Oncology Group grading system.Results: On multivariate analysis, acute bowel toxicity was statistically significantly associated with increased proctitis (hazard ratio=1.63, 95% confidence interval 1.18, 2.24; P=0.003) and increased stool frequency (hazard ratio=1.77, 95% confidence interval 1.27, 2.46; P =0.001).Hypertension was strongly associated with a decreased risk of poor urinary stream (hazard ratio=0.25, 95% confidence interval 0.09, 0.71; P=0.009). There was an increased risk of rectal bleeding with increased age (hazard ratio=1.04 per year of age, 95% confidence interval 1.01, 1.08; P=0.009). As expected, a higher prescribed dose increased the risk of several late toxicity end points. Although acute bladder toxicity was associated with the presence of bladder symptoms at 5 years, the effect disappeared for all symptoms except increased urinary frequency and haematuria when a change in bladder function from baseline was calculated. Patients with any pretreatment bladder symptoms were more likely to report increased urinary frequency (hazard ratio=2.09, 95% confidence interval 1.48, 2.95; P