Combination of Dose Escalation with Technological Advances (Intensity-Modulated and Image-Guided Radiotherapy) Is Not Associated with Increased Morbidity for Patients with Prostate Cancer
Combination of Dose Escalation with Technological Advances (Intensity-Modulated and Image-Guided Radiotherapy) Is Not Associated with Increased Morbidity for Patients with Prostate Cancer
复制标题
DOI：
10.1007/s00066-011-2249-z
复制
发表时间：
2011-08-01
影响因子：
3.1
通讯作者：
Eble, Michael J.
中科院分区：
文献类型：
--
作者：
Pinkawa, Michael;Piroth, Marc D.;Eble, Michael J.
目的：评价前列腺癌患者调强调强(IMRT)和图像引导(IGRT)放射治疗的相关并发症，并与常规适形放射治疗(3DCRT)70.2-72GY进行比较。患者和方法：采用有效问卷(扩展前列腺癌综合指数)对所有患者在放疗前、放疗后最后一天以及放疗后2个月和16个月进行前瞻性调查。78对配对患者在调强放疗与三维适形放疗后的标准是：患者年龄、抗雄激素的使用、治疗量(整个盆腔)、预后危险组以及治疗前的尿液/肠道/性生活质量(QOL)。结果：剂量递增的调强放疗后的生活质量变化在所有领域都与三维适形放疗后的生活质量变化相似。只有放疗后1年以上的性功能评分与调强放疗相比略有下降(平均9分比6分；p=0.04)，勃起足够牢固的比例为14%比30%(p=0.03)。治疗2个月后，3DCRT与IMRT相比，疼痛排便频率更高(P=0.03)，但IMRT与3DCRT相比，直肠出血率有升高趋势(P=0.06)。结论：剂量增加与技术进步(IMRT和IGRT)的结合与前列腺癌患者的发病率增加无关。
Purpose: The aim was to evaluate treatment-related morbidity after intensity-modulated (IMRT) and image-guided (IGRT) radiotherapy with a total dose of 76 Gy in comparison to conventional conformal radiotherapy (3DCRT) up to 70.2-72 Gy for patients with prostate cancer.Patients and Methods: All patients were prospectively surveyed prior to, on the last day, as well as after a median time of 2 and 16 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Criteria for the 78 matched pairs after IMRT vs. 3DCRT were patient age, use of antiandrogens, treatment volume (whole pelvis), prognostic risk group, and urinary/bowel/sexual quality of life (QoL) before treatment.Results: QoL changes after dose-escalated IMRT were found to be similar to QoL changes after 3DCRT in all domains. Only sexual function scores more than 1 year after RT decreased slightly more after 3DCRT in comparison to IMRT (mean 9 vs. 6 points; p = 0.04), with erections firm enough for intercourse in 14% vs. 30% (p = 0.03). Painful bowel movements were reported more frequently after 3DCRT vs. IMRT 2 months after treatment (>= once a day in 10% vs. 1%; p = 0.03), but a tendency for higher rectal bleeding rates was found after IMRT vs. 3DCRT more than 1 year after RT (>= rarely in 20% vs. 9%; p = 0.06).Conclusion: Combination of dose escalation with technological advances (IMRT and IGRT) is not associated with increased morbidity for patients with prostate cancer.