Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy
Impact of advanced radiotherapy techniques and dose intensification on toxicity of salvage radiotherapy after radical prostatectomy
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DOI：
10.1038/s41598-019-57056-9
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发表时间：
2020-01-10
影响因子：
4.6
通讯作者：
Shibamoto，Yuta
中科院分区：
文献类型：
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作者：
Tomita，Natsuo;Uchiyama，Kaoru;Shibamoto，Yuta
在根治性乳腺癌切除术后的挽救性放疗（SRT）中，剂量递增放疗与调强放疗（IMRT）和影像引导放疗（IGRT）的安全性和有效性尚不清楚。我们研究了这些先进的放射治疗技术和剂量强化对SRT毒性的影响。这项多机构回顾性研究纳入了421例接受SRT的患者，中位剂量为66戈伊，分次为2-戈伊。IMRT和IGRT分别用于225例（53%）和321例（76%）患者。在中位随访50个月时，晚期2级或更高胃肠道（GI）和泌尿生殖系统（GU）毒性的累积发生率分别为4.8%和24%。多变量分析显示，不使用IMRT或IGRT，或两者兼而有之，（风险比[HR] 3.1，95%可信区间[CI] 1.8- 5.4，p < 0.001）和使用全盆腔放疗（HR 7.6，CI 1.0-56，p= 0.048）与晚期GI毒性相关，而较高剂量≥68戈伊是唯一与GU毒性相关的因素（HR 3.1，CI 1.3- 7.4，p = 0.012）。这项研究表明，胃肠道毒性的发生率可以减少调强放疗和IGRT在SRT，而剂量强化可能会增加GU毒性，即使这些先进的技术。
The safety and efficacy of dose-escalated radiotherapy with intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) remain unclear in salvage radiotherapy (SRT) after radical prostatectomy. We examined the impact of these advanced radiotherapy techniques and dose intensification on the toxicity of SRT. This multi-institutional retrospective study included 421 patients who underwent SRT at the median dose of 66 Gy in 2-Gy fractions. IMRT and IGRT were used for 225 (53%) and 321 (76%) patients, respectively. At the median follow-up of 50 months, the cumulative incidence of late grade 2 or higher gastrointestinal (GI) and genitourinary (GU) toxicities was 4.8% and 24%, respectively. Multivariate analysis revealed that the non-use of either IMRT or IGRT, or both (hazard ratio [HR] 3.1, 95% confidence interval [CI] 1.8–5.4,p< 0.001) and use of whole-pelvic radiotherapy (HR 7.6, CI 1.0–56,p= 0.048) were associated with late GI toxicity, whereas a higher dose ≥68 Gy was the only factor associated with GU toxicities (HR 3.1, CI 1.3–7.4,p= 0.012). This study suggested that the incidence of GI toxicities can be reduced by IMRT and IGRT in SRT, whereas dose intensification may increase GU toxicity even with these advanced techniques.