Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer
Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer
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DOI：
10.1016/j.ijrobp.2007.11.044
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发表时间：
2008-03-15
影响因子：
7
通讯作者：
Amols, Howard I.
中科院分区：
文献类型：
--
作者：
Zelefsky, Michael J.;Levin, Emily J.;Amols, Howard I.
目的：方法：1988 ~ 2000年，对1571例T1 ~ T3期前列腺癌患者行三维适形放疗（3D-CRT）和调强放疗（IMRT），剂量范围66 ~ 81戈伊。中位随访时间为10年。治疗后毒性均根据美国国家癌症研究所的通用术语标准的不良事件分级。结果：在10年的精算可能性为≥ 2级GI毒性的发展是9%。与常规3D-CRT治疗的患者相比，使用IMRT显著降低了胃肠道（GI）毒性的风险（13%至5%; p < 0.001）。在出现急性症状的患者中，10年晚期毒性发生率为42%，而未出现急性症状的患者为9%（p < 0.0001）。晚期≥ 2级泌尿生殖系统（GU）毒性的10年发生率为15%。接受81戈伊（IMRT）治疗的患者在10年时GU症状的发生率为20%，而接受较低剂量治疗的患者为12%（p=0.01）。在治疗期间出现急性症状的患者中，10年后晚期毒性的发生率为35%，而对照组为12%（p < 0.001）。3级GI和GU毒性的发生率分别为1%和3%.Conclusions：严重的晚期毒性是不寻常的，尽管这些患者的高辐射剂量水平的交付。较高剂量与GI和GU 2级毒性增加相关，但IMRT显著降低了直肠炎的风险。在这些患者中，急性症状是晚期毒性的前兆。(c)2008年爱思唯尔公司
Purpose: To report the incidence and predictors of treatment-related toxicity at 10 years after three-dimensional conformal radiotherapy (3D-CRT) and intensity-modulated radiotherapy (IMRT) for localized prostate cancer.Methods and Materials: Between 1988 and 2000,1571 patients with stages T1 - T3 prostate cancer were treated with 3D-CRT/IMRT with doses ranging from 66 to 81 Gy. The median follow-up was 10 years. Posttreatment toxicities were all graded according to the National Cancer Institute's Common Terminology Criteria for Adverse Events.Results: The actuarial likelihood at 10 years for the development of Grade >= 2 GI toxicities was 9%. The use of IMRT significantly reduced the risk of gastrointestinal (GI) toxicities compared with patients treated with conventional 3D-CRT (13% to 5%; p < 0.001). Among patients who experienced acute symptoms the 10-year incidence of late toxicity was 42%, compared with 9% for those who did not experience acute symptoms (p < 0.0001). The 10-year incidence of late Grade >= 2 genitourinary (GU) toxicity was 15%. Patients treated with 81 Gy (IMRT) had a 20% incidence of GU symptoms at 10 years, compared with a 12% for patient treated to lower doses (p=0.01). Among patients who had developed acute symptoms during treatment, the incidence of late toxicity at 10 years was 35%, compared with 12% (p < 0.001). The incidence of Grade 3 GI and GU toxicities was 1% and 3%, respectively.Conclusions: Serious late toxicity was unusual despite the delivery of high radiation dose levels in these patients. Higher doses were associated with increased GI and GU Grade 2 toxicities, but the risk of proctitis was significantly reduced with IMRT. Acute symptoms were a precursor of late toxicities in these patients. (c) 2008 Elsevier Inc.