High-dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients
High-dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients
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DOI：
10.1016/s0360-3016(02)02857-2
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发表时间：
2002-08-01
影响因子：
7
通讯作者：
Leibel, SA
中科院分区：
文献类型：
--
作者：
Zelefsky, MJ;Fuks, Z;Leibel, SA
目的：报道772例临床局限性前列腺癌患者接受高剂量调强放疗（IMRT）的急性、晚期毒性和初步生化结果。方法与材料：1996年4月至2001年1月，对772例临床局限性前列腺癌患者进行IMRT治疗。使用反规划方法计划处理，并通过动态多叶准直提供所需的光束强度分布图。698例（90%）接受81.0 Gy治疗，74例（10%）接受86.4 Gy治疗。急性和晚期毒性按照放射治疗肿瘤学组发病率分级量表进行评分。PSA复发的定义是根据美国放射肿瘤治疗学会共识声明。中位随访时间为24个月（6-60个月）。结果：35例患者（4.5%）出现急性2级直肠毒性，没有患者出现急性3级或更高级别直肠症状。217名患者（28%）出现急性2级泌尿系统症状，1名患者出现尿潴留（3级）。11例（1.5%）发生晚期2级直肠出血。4名患者（0.1%）出现3级直肠毒性，需要一次或多次输血或激光烧灼术。未观察到4级直肠并发症。3年精算发生晚期2级直肠毒性的可能性为4%。72例（9%）出现晚期2级尿毒性，5例（0.5%）出现3级尿毒性（尿道狭窄）。3年精算概率大于或等于晚期2级尿毒性为15%。有利、中等和不利风险组患者的3年PSA无复发生存率分别为92%、86%和81%。结论：这些数据证明了大剂量IMRT在大量患者中的可行性。与传统三维适形放疗技术相比，急性和晚期直肠毒性似乎显著降低。短期PSA控制率似乎至少与类似剂量水平的三维适形放疗所达到的效果相当。基于这一有利的风险效益比，IMRT已成为我院局部前列腺癌适形治疗的标准模式。(C) 2002爱思唯尔科学有限公司
Purpose: To report the acute and late toxicity and preliminary biochemical outcomes in 772 patients with clinically localized prostate cancer treated with high-dose intensity-modulated radiotherapy (IMRT).Methods and Materials: Between April 1996 and January 2001, 772 patients with clinically localized prostate cancer were treated with IMRT. Treatment was planned using an inverse-planning approach, and the desired beam intensity profiles were delivered by dynamic multileaf collimation. A total of 698 patients (90%) were treated to 81.0 Gy, and 74 patients (10%) were treated to 86.4 Gy. Acute and late toxicities were scored by the Radiation Therapy Oncology Group morbidity grading scales. PSA relapse was defined according to The American Society of Therapeutic Radiation Oncology Consensus Statement. The median follow-up time was 24 months (range: 6-60 months).Results: Thirty-five patients (4.5%) developed acute Grade 2 rectal toxicity, and no patient experienced acute Grade 3 or higher rectal symptoms. Two hundred seventeen patients (28%) developed acute Grade 2 urinary symptoms, and one experienced urinary retention (Grade 3). Eleven patients (1.5%) developed late Grade 2 rectal bleeding. Four patients (0.1%) experienced Grade 3 rectal toxicity requiring either one or more transfusions or a laser cauterization procedure. No Grade 4 rectal complications have been observed. The 3-year actuarial likelihood of : late Grade 2 rectal toxicity was 4%. Seventy-two patients (9%) experienced late Grade 2 urinary toxicity, and five (0.5%) developed Grade 3 urinary toxicity (urethral stricture). The 3-year actuarial likelihood of greater than or equal to late Grade 2 urinary toxicity was 15%. The 3-year actuarial PSA relapse-free survival rates for favorable, intermediate, and unfavorable risk group patients were 92%, 86%, and 81%, respectively.Conclusions: These data demonstrate the feasibility of high-dose IMRT in a large number of patients. Acute and late rectal toxicities seem to be significantly reduced compared with what has been observed with conventional three-dimensional conformal radiotherapy techniques. Short-term PSA control rates seem to be at least comparable to those achieved with three-dimensional conformal radiotherapy at similar dose levels. Based on this favorable risk:benefit ratio, IMRT has become the standard mode of conformal treatment delivery for localized prostate cancer at our institution. (C) 2002 Elsevier Science Inc.