DOSE-VOLUME RELATIONSHIPS FOR ACUTE BOWEL TOXICITY IN PATIENTS TREATED WITH PELVIC NODAL IRRADIATION FOR PROSTATE CANCER
DOSE-VOLUME RELATIONSHIPS FOR ACUTE BOWEL TOXICITY IN PATIENTS TREATED WITH PELVIC NODAL IRRADIATION FOR PROSTATE CANCER
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DOI：
10.1016/j.ijrobp.2008.10.086
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发表时间：
2009-09-01
影响因子：
7
通讯作者：
Calandrino, Riccardo
中科院分区：
文献类型：
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作者：
Fiorino, Claudio;Alongi, Filippo;Calandrino, Riccardo
目的：为了找到剂量-体积直方图（DVH）的肠腔（IC）和中度-重度急性肠毒性的男性前列腺癌治疗盆腔nodal radiation.Methods和材料：研究组包括191例局部前列腺癌患者进行全盆腔放疗根治性或辅助/挽救意图在2004年1月至2007年11月。其中175例患者有完整的计划/临床数据，其中91例采用传统四野技术（50.4戈伊，1.8戈伊/次）治疗，84例采用传统直线加速器（n = 26，50.4戈伊，1.8戈伊/次）或螺旋断层放射治疗（n = 58，50 -54戈伊，1.8-2戈伊/次）进行调强放疗。在计划靶体积（PTV）外的IC轮廓和DVH的前6周的治疗在所有患者中恢复。在单变量和多变量分析中研究了许多临床和DVH（V10-V55）变量与毒性之间的相关性。之间的相关性DVH为IC外的PTV和DVH为整个ICs.Results：22例患者出现毒性反应（3/22的IMRT/断层治疗组）。单变量分析显示V20-V50与毒性之间存在显著相关性（p = 0.0002-0.001），观察到V40-V50的预测值更高。既往膀胱切除术（p = 0.066）和腹部/盆腔手术（p = 0.12）也与毒性相关。包括V45、腹部/盆腔手术和直肠切除术的多变量分析显示，最具预测性的参数是V45（p = 0.002）和腹部/盆腔手术（p = 0.05，HR = 2.4）。结论：我们的避免IMRT方法大大降低了急性肠道毒性的发生率。IC的V40-V50和其次是先前的腹部/盆腔手术是急性肠毒性的主要预测因素。(C)2009 Elsevier Inc.
Purpose: To find correlation between dose-volume histograms (DVHs) of the intestinal cavity (IC) and moderate-severe acute bowel toxicity in men with prostate cancer treated with pelvic nodal irradiation.Methods and Materials: The study group consisted of 191 patients with localized prostate cancer who underwent whole-pelvis radiotherapy with radical or adjuvant/salvage intent during January 2004 to November 2007. Complete planning/clinical data were available in 175 of these men, 91 of whom were treated with a conventional four-field technique (50.4 Gy, 1.8 Gy/fraction) and 84 of whom were treated with IMRT using conventional Linac (n = 26,50.4 Gy, 1.8 Gy/fraction) or Helical TomoTherapy (n = 58,50-54 Gy, 1.8-2 Gy/fraction). The IC outside the planning target volume (PTV) was contoured and the DVH for the first 6 weeks of treatment was recovered in all patients. The correlation between a number of clinical and DVH (V10-V55) variables and toxicity was investigated in univariate and multivariate analyses. The correlation between DVHs for the IC outside the PTV and DVHs for the whole IC was also assessed.Results: Twenty-two patients experienced toxicity (3/22 in the IMRT/tomotherapy group). Univariate analyses showed a significant correlation between V20-V50 and toxicity (p = 0.0002-0.001), with a higher predictive value observed for V40-V50. Previous prostatectomy (p = 0.066) and abdominal/pelvic surgery (p = 0.12) also correlated with toxicity. Multivariate analysis that included V45, abdominal/pelvic surgery, and prostatectomy showed that the most predictive parameters were V45 (p = 0.002) and abdominal/pelvic surgery (p = 0.05, HR = 2.4)Conclusions: Our avoidance IMRT approach drastically reduces the incidence of acute bowel toxicity. V40-V50 of IC and, secondarily, previous abdominal/pelvic surgery were the main predictors of acute bowel toxicity. (C) 2009 Elsevier Inc.