Rectum-spacer related acute toxicity - endoscopy results of 403 prostate cancer patients after implantation of gel or balloon spacers
Rectum-spacer related acute toxicity - endoscopy results of 403 prostate cancer patients after implantation of gel or balloon spacers
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DOI：
10.1186/s13014-019-1248-6
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发表时间：
2019-03-15
影响因子：
3.6
通讯作者：
Wolf, Frank
中科院分区：
文献类型：
--
作者：
Schoerghofer, Andreas;Drerup, Martin;Wolf, Frank
背景：在高剂量前列腺外束放射治疗中，直肠间隔物用于限制直肠前壁的剂量，并已被证明可以减少辐射引起的毒性。在这里，我们报告了大量接受凝胶型或球囊型间隔器的患者植入过程的并发症率和毒性。方法403例患者行直肠间隔，球囊264例，凝胶139例。分配是非随机的。276例患者采用正常分离方案，其余125例患者采用中度低分离方案。采用粘膜评分系统（维也纳直肠镜评分）和CTCAE V.4，通过内窥镜前瞻性评估间隔剂相关的急性和晚期直肠毒性。对于球囊亚组，在植入后计划mri的事后分析中，球囊垫片的位置和旋转还与直肠反应的发生率和等级相关。结果全组直肠毒性均很低，术后1天VRS平均评分为0.06，随访6个月0.31，随访12个月0.42。与植入过程直接相关的急性3级毒性（直肠穿孔和尿道损伤）发生率为1.49% (n=6)，仅见于接受间隔气囊的患者。植入后的MR成像分析未发现该间隔物的异常或旋转不当位置是间隔物相关G3毒性发生的预测因素。结论间隔器技术是减少直肠前壁给药剂量的有效手段。然而，在剂量节约方面的好处需要与低但可能的并发症风险（如直肠穿孔）进行权衡。
BackgroundRectal spacers are used to limit dose to the anterior rectal wall in high dose external beam radiation therapy of the prostate and have been shown to reduce radiation induced toxicity. Here we report the complication rate and toxicity of the implantation procedure in a large cohort of patients who have either received a gel- or balloon-type spacer.MethodsIn total, 403 patients received rectal spacing, 264 with balloon, 139 with gel. Allocation was non-randomized. Two hundred seventy-six patients were treated with normofractionated regimen, the remaining 125 patients in moderate hypofractionation. Spacer related acute and late rectal toxicity was prospectively assessed by endoscopy using a mucosa scoring system (Vienna Rectoscopy Score) as well as CTCAE V.4. For the balloon subgroup, position and rotation of balloon spacers were additionally correlated to incidence and grade of rectal reactions in a post-hoc analysis of post-implant planning MRIs.ResultsOverall rectal toxicity was very low with average VRS scores of 0.06 at the day after implantation, 0.10 at the end of RT, 0.31 at 6months and 0.42 at 12months follow up. Acute Grade 3 toxicity (rectum perforation and urethral damage) directly related to the implantation procedure occurred in 1.49% (n=6) and was seen exclusively in patients who had received the spacer balloon. Analysis of post implant MR imaging did not identify abnormal or mal-rotated positions of this spacer to be a predictive factors for the occurrence of spacer related G3 toxicities.ConclusionsSpacer technology is an effective means to minimize dose to the anterior rectal wall. However, the benefits in terms of dose sparing need to be weighed against the low, but possible risks of complications such as rectum perforation.