Investigation of bladder dose and volume factors influencing late urinary toxicity after external beam radiotherapy for prostate cancer
Investigation of bladder dose and volume factors influencing late urinary toxicity after external beam radiotherapy for prostate cancer
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DOI：
10.1016/j.ijrobp.2006.10.042
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发表时间：
2007-03-15
影响因子：
7
通讯作者：
Kuban, Deborah
中科院分区：
文献类型：
--
作者：
Cheung, M. Rex;Tucker, Susan L.;Kuban, Deborah
背景资料：我们试图确定与前列腺癌放疗患者晚期泌尿毒性风险增加相关的膀胱剂量-体积因素。方法和材料：该回顾性分析包括128例前列腺癌患者的数据，这些患者按照方案接受2戈伊/次至46戈伊，随后增加至78戈伊治疗。该分析的终点是治疗2年内发生的1级或以上晚期泌尿生殖系统（GU）毒性。使用最大似然法将Lyman-Kutcher-Burman、平均剂量、阈值剂量和最热体积模型拟合至毒性数据。结果：基于剂量-体积直方图的模型拟合比基于剂量-壁直方图的模型更倾向于拟合毒性数据。最热的体积（热点）模型被认为是最好的拟合模型研究。最佳拟合是最热的2.9%膀胱（95% CI，1.1-6.8%）。该模型的受试者工作特征曲线下面积为0.74。热点模型将患者分为具有临床意义的亚组，接受≥ 78戈伊治疗的患者中有25%< 78 Gy to the hottest 2.9% of bladder had GU toxicity at eight years compared with similar to 50% when the dose was >（p = 0.002）。结论：这提供了第一个证据支持膀胱“热点”与前列腺癌外照射放射治疗后两年内的GU毒性有关。需要其他研究者的数据。在放射治疗计划中，应特别注意膀胱中高于78戈伊的热点。(c)2007爱思唯尔公司
Background: We sought to identify the bladder dose-volume factors associated with an increased risk of late urinary toxicity among prostate cancer patients treated with radiotherapy. Methods and Materials: This retrospective analysis included data from 128 prostate cancer patients treated on protocol with 2 Gy/fraction to 46 Gy followed by a boost to 78 Gy. The endpoint for this analysis was Grade 1 or greater late genitourinary (GU) toxicity occurring within two years of treatment. The Lyman-Kutcher-Burman, mean dose, threshold dose, and hottest volume models were fitted to the toxicity data using the maximum likelihood method. Results: Model fits based on dose-volume histograms tended to fit the toxicity data better than models based on dose-wall histograms. The hottest volume (hotspot) model was found to be the best-fitting model investigated. The best fit was for the hottest 2.9% of bladder (95% CI, 1.1-6.8%). This model has an area under the receiver operating characteristic curve of 0.74. The hotspot model separated the patients into clinically meaningful subgroups with similar to 25% of the patients who received < 78 Gy to the hottest 2.9% of bladder had GU toxicity at eight years compared with similar to 50% when the dose was >= 78 Gy (p = 0.002). Conclusion: This provides the first evidence supporting that bladder "hotspots" are related to GU toxicity within two years after external beam radiotherapy for prostate cancer. Confirming data are needed from other investigators. Particular attention should be given to hotspots higher than 78 Gy in bladder in radiation treatment planning. (c) 2007 Elsevier Inc.