Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis.
Transitioning from conventional radiotherapy to intensity-modulated radiotherapy for localized prostate cancer: changing focus from rectal bleeding to detailed quality of life analysis.
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DOI：
10.1093/jrr/rru061
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发表时间：
2014-11
影响因子：
2
通讯作者：
Ogawa K
中科院分区：
文献类型：
--
作者：
Yamazaki H;Nakamura S;Nishimura T;Yoshida K;Yoshioka Y;Koizumi M;Ogawa K
随着现代放射技术的出现，我们已经能够为局限性前列腺癌提供更高的放射治疗剂量，而不会产生严重的不良反应。我们从文献中回顾和分析了体外放射治疗（EBRT）毒性谱的变化。晚期直肠出血是主要的不良反应，据报道，对于高达70 Gy的2D常规放疗，≥2级不良事件的发生率为bb0 - 20%。发现3D适形放射治疗（3D- crt）可将发生率降低至10%。此外，调强放射治疗（IMRT）将其进一步降低到几个百分点。然而，与此同时，使用高精度外部放疗的剂量递增会增强泌尿系统毒性。我们应该更加关注详细的生活质量（QOL）分析，不仅是直肠出血，还有其他特定症状（如尿失禁和阳痿），原因有二：(i)因为年龄在80岁至80岁之间的患者越来越多，（ii）因为高剂量放疗和/或激素治疗提高了生存率；年龄不仅是前列腺特异性抗原（PSA）控制的重要预后因素，而且是不良反应的重要预后因素。这些因素将治疗目的的主要焦点从生存和避免PSA失败转移到维持良好的生活质量，特别是对老年患者。总之，前列腺癌患者放疗后毒性分析的重点正从直肠出血转向总体精细生活质量评价。
With the advent of modern radiation techniques, we have been able to deliver a higher prescribed radiotherapy dose for localized prostate cancer without severe adverse reactions. We reviewed and analyzed the change of toxicity profiles of external beam radiation therapy (EBRT) from the literature. Late rectal bleeding is the main adverse effect, and an incidence of >20% of Grade ≥2 adverse events was reported for 2D conventional radiotherapy of up to 70 Gy. 3D conformal radiation therapy (3D-CRT) was found to reduce the incidence to ∼10%. Furthermore, intensity-modulated radiation therapy (IMRT) reduced it further to a few percentage points. However, simultaneously, urological toxicities were enhanced by dose escalation using highly precise external radiotherapy. We should pay more attention to detailed quality of life (QOL) analysis, not only with respect to rectal bleeding but also other specific symptoms (such as urinary incontinence and impotence), for two reasons: (i) because of the increasing number of patients aged >80 years, and (ii) because of improved survival with elevated doses of radiotherapy and/or hormonal therapy; age is an important prognostic factor not only for prostate-specific antigen (PSA) control but also for adverse reactions. Those factors shift the main focus of treatment purpose from survival and avoidance of PSA failure to maintaining good QOL, particularly in older patients. In conclusion, the focus of toxicity analysis after radiotherapy for prostate cancer patients is changing from rectal bleeding to total elaborate quality of life assessment.
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影响因子：
3.4
作者：
Barnett, G. C.;De Meerleer, G.;Dearnaley, D. P.
通讯作者：
Dearnaley, D. P.
DOI：
10.1016/j.ijrobp.2004.07.695
发表时间：
2004-11-15
影响因子：
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作者：
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通讯作者：
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DOI：
10.1016/j.ijrobp.2011.03.056
发表时间：
2012-03-01
影响因子：
7
作者：
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通讯作者：
Lebesque, Joos V.
影响因子：
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作者：
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通讯作者：
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影响因子：
2.1
作者：
Fisch, BM;Pickett, B;Roach, M
通讯作者：
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