Diabetes mellitus: A predictor for late radiation morbidity
Diabetes mellitus: A predictor for late radiation morbidity
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DOI：
10.1016/s0360-3016(98)00460-x
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发表时间：
1999-02-01
影响因子：
7
通讯作者：
Hanks, GE
中科院分区：
文献类型：
--
作者：
Herold, DM;Hanlon, AL;Hanks, GE
目的：鉴于老年人群中糖尿病的高频率以及前列腺癌，我们试图确定接受三维保形外束放疗（3DCRT）治疗的糖尿病患者是否患有晚期胃肠道（GI）的风险增加或泌尿生殖器和材料：1989年4月至1996年10月在1989年4月至1996年10月之间使用3DCRT治疗了9004名前列腺癌患者。中位患者年龄为69岁（范围48-89），前列腺剂量的中位中心为7211 CGY（6211-8074范围），中位随访时间为36个月（范围2-99）。每6个月对患者进行数字直肠检查，血清PSA和症状问卷的评估。使用放射治疗肿瘤学组（RTOG）定量辐射发病率，并修改后的晚期效应正常组织工作队（Lent）尺度。具有I型或I型病史的患者[I糖尿病被编码为糖尿病患者。糖尿病：一百二十一名患者患有糖尿病（总计13％）。糖尿病患者和非糖尿病患者之间的急性发病率没有差异。但是，糖尿病患者经历了更高的后期2级GI毒性（28％，17％，P = 0.011）和后期2级GU毒性（14％vs. 6％，P = 0.001）。糖尿病患者的后期3年级和4年胃肠道并发症有一种趋势，但没有针对后期3级和4级GU并发症。但是，这些类别的记录事件总数很少。糖尿病患者检查了晚期毒性的发作，比糖尿病患者早（中位数：10个月比24个月，p = 0.02）。考虑年龄，剂量，直肠阻塞，田间大小和糖尿病病史，在晚期2级GI毒性，剂量，剂量（P = 0.0001），糖尿病（P = 0.0110）和直肠阻塞（P = 0.0163）的逐步多元回归模型中出现了并发症的独立预测。对于后期2级GU的毒性，只有糖尿病的存在仍然具有独立意义（P = 0.0014）。结论：糖尿病在老年前列腺癌中很常见。糖尿病患者在前列腺癌外束放射疗法后，晚期2级GI和GU并发症的发展具有很大的风险。尽管糖尿病，辐射剂量和直肠阻塞预测了晚期胃肠道并发症，但只有糖尿病的存在会影响晚期GU发病率。医师可以考虑对糖尿病患者的治疗改良，尤其是那些希望进入剂量降低研究的患者。需要进一步研究糖尿病与晚期辐射并发症之间的关系。 （c）1999 Elsevier Science Inc.
Purpose: Given the high frequency of diabetes, as well as prostate cancer in the elderly population, we sought to determine whether diabetic patients treated with three-dimensional conformal external-beam radiotherapy (3DCRT) had an increased risk of late gastrointestinal (GI) or genitourinary (GU) complications.Methods and Materials: Nine-hundred forty-four prostate cancer patients were treated between April 1989 and October 1996 using 3DCRT. Median patient age was 69 years (range 48-89), median center of prostate dose was 7211 cGy (range 6211-8074) and median follow-up was 36 months (range 2-99). Patients were evaluated every 6 months with digital rectal examinations, serum PSAs and symptom questionnaires. Radiation morbidity was quantified using Radiation Therapy Oncology Group (RTOG) and modified Late Effects Normal Tissue Task Force (LENT) scales. Patients with a preexisting history of either Type I or Type I[I diabetes mellitus were coded as diabetics.Results: One hundred twenty-one patients had diabetes (13% of total). Rates of acute morbidity did not differ between diabetics and nondiabetics; however, diabetics experienced significantly more late grade 2 GI toxicity (28% vs. 17%,p = 0.011) and late grade 2 GU toxicity (14% vs. 6%,p = 0.001). There was a trend toward increased late grade 3 and 4 GI complications in diabetics, but not for late grade 3 and 4 GU complications; however, the total number of recorded events for these categories was small. Examining the onset of late toxicity, diabetics developed GU complications earlier than nondiabetics (median: 10 months vs. 24 months, p = 0.02). Considering age, dose, rectal blocking, field size, and history of diabetes in a stepwise multivariate regression model for late grade 2 GI toxicity, dose (p = 0.0001), diabetes (p = 0.0110), and rectal blocking (p = 0.0163) emerged independently predictive for complications. For late grade 2 GU toxicity, only the presence of diabetes remained independently significant (p = 0.0014).Conclusion: Diabetes mellitus is common in the elderly prostate cancer population. Diabetics are at a significant risk for the development of late grade 2 GI and GU complications after external-beam radiotherapy for prostate cancer. While diabetes, radiation dose, and rectal blocking predict for late GI complications, only the presence of diabetes influences late GU morbidity. Physicians may consider treatment modifications for diabetic patients, particularly those patients wishing to enter dose-escalation studies. Further study of the relationship between diabetes and late radiation complications is needed. (C) 1999 Elsevier Science Inc.