Intensity modulated radiotherapy for localized prostate cancer: rigid compliance to dose-volume constraints as a warranty of acceptable toxicity?
Intensity modulated radiotherapy for localized prostate cancer: rigid compliance to dose-volume constraints as a warranty of acceptable toxicity?
复制标题
对局部前列腺癌的强度调节放射疗法：对剂量 - 体积约束的严格依从性作为可接受的毒性保证？
DOI：
10.1186/1748-717x-2-6
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发表时间：
2007-01-15
影响因子：
3.6
通讯作者：
Nadalin, Wladmir
中科院分区：
文献类型：
--
作者：
Chen, Michael J;Weltman, Eduardo;Hanriot, Rodrigo M;Luz, Fabio P;Cecilio, Paulo J;da Cruz, Jose C;Moreira, Frederico R;Santos, Adriana S;Martins, Lidiane C;Nadalin, Wladmir
目的：观察调强放疗（IMRT）单独或根治性前列腺癌术后的毒副反应。在2001年8月至2003年12月期间，132例前列腺癌患者接受了调强放射治疗，其中125例在至少一年的随访时间后可进行急性和晚期毒性分析。临床和治疗数据，包括正常组织剂量体积直方图（DVH）的限制，进行了审查。根据放射治疗肿瘤组（RTOG）毒性量表评价胃肠道（GI）和泌尿生殖系统（GU）体征和症状。中位处方剂量为76戈伊。中位随访时间为26.1个月。在125例患者中，73例（58.4%）出现急性1级或2级GI，97例（77.2%）出现急性1级或2级GU毒性。仅2例患者（1.6%）发生3级GI急性毒性，仅3例患者（2.4%）发生3级GU急性毒性。关于1级和2级晚期毒性，分别有26例患者（20.8%）和21例患者（16.8%）出现GI和GU毒性。6例患者（4.8%）发生2级GI晚期毒性，4例患者（3.2%）发生2级GU晚期毒性。无患者出现任何3级或以上晚期毒性。仅11.2%的治疗计划不符合DVH限制。在单变量分析中，未发现2级GI晚期毒性的显著风险因素，但输送至PTV的平均剂量与较高的2级GU晚期毒性相关（p = 0.042）。调强放射治疗是一种耐受性良好的常规治疗局限性前列腺癌的技术，具有短期和中期可接受的毒性特征。根据这里提供的数据，严格遵守DHV约束可能会防止正常组织并发症的发生率更高。
To report the toxicity after intensity modulated radiotherapy (IMRT) for patients with localized prostate cancer, as a sole treatment or after radical prostatectomy. Between August 2001 and December 2003, 132 patients with prostate cancer were treated with IMRT and 125 were evaluable to acute and late toxicity analysis, after a minimum follow-up time of one year. Clinical and treatment data, including normal tissue dose-volume histogram (DVH) constraints, were reviewed. Gastro-intestinal (GI) and genito-urinary (GU) signs and symptoms were evaluated according to the Radiation Therapy Oncology Group (RTOG) toxicity scales. Median prescribed dose was 76 Gy. Median follow-up time was of 26.1 months. From the 125 patients, 73 (58.4%) presented acute Grade 1 or Grade 2 GI and 97 (77.2%) presented acute Grade 1 or Grade 2 GU toxicity. Grade 3 GI acute toxicity occurred in only 2 patients (1.6%) and Grade 3 GU acute toxicity in only 3 patients (2.4%). Regarding Grade 1 and 2 late toxicity, 26 patients (20.8%) and 21 patients (16.8%) presented GI and GU toxicity, respectively. Grade 2 GI late toxicity occurred in 6 patients (4.8%) and Grade 2 GU late toxicity in 4 patients (3.2%). None patient presented any Grade 3 or higher late toxicity. Non-conformity to DVH constraints occurred in only 11.2% of treatment plans. On univariate analysis, no significant risk factor was identified for Grade 2 GI late toxicity, but mean dose delivered to the PTV was associated to higher Grade 2 GU late toxicity (p = 0.042). IMRT is a well tolerable technique for routine treatment of localized prostate cancer, with short and medium-term acceptable toxicity profiles. According to the data presented here, rigid compliance to DHV constraints might prevent higher incidences of normal tissue complication.