Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial
Comparison of radiation side-effects of conformal and conventional radiotherapy in prostate cancer: a randomised trial
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DOI：
10.1016/s0140-6736(98)05180-0
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发表时间：
1999-01-23
期刊：
影响因子：
168.9
通讯作者：
Horwich, A
中科院分区：
文献类型：
--
作者：
Dearnaley, DP;Khoo, VS;Horwich, A
背景根治性放射治疗通常用于治疗局限性前列腺癌。晚期慢性副作用限制了可给予的剂量，并可能与正常组织受到照射的体积有关。适形放射治疗可以通过形成高剂量的前列腺体积，使直肠和膀胱得到较少的治疗。我们在一项关于适形放射治疗和常规放射治疗的随机对照试验中评估了这项新技术降低放射相关效应风险的能力。方法我们招募了前列腺癌患者，接受标准剂量的射线治疗，每天2次。这些男性被随机分配到适形放射治疗或常规放射治疗。主要终点是晚期放射并发症的发展(治疗后3个月)，用放射治疗和肿瘤学小组(RTOG)评分来衡量。在接受治疗的225名男性中，适形治疗组发生放射性直肠炎和出血的男性明显少于常规组(37比56%大于或等于RTOG1级，p=0.004；5vs15%大于或等于RTOG2级，p=0.01)。治疗后两组患者膀胱功能差异无统计学意义(53对59%大于或等于1级，p=0.34；20对23%大于或等于2级，p=0.61)。中位随访3.6年后，两组局部肿瘤控制率无显著差异(保形78%[95%可信区间66~86]，常规保形83%[69~90])。解释保形技术显著降低前列腺癌放疗后晚期放射性直肠炎的风险。广泛介绍这些放射治疗方法是合适的。我们的结果是剂量递增研究的基础，以改善局部肿瘤控制。
Background Radical radiotherapy is commonly used to treat localised prostate cancer. Late chronic side-effects limit the dose that can be given, and may be linked to the volume of normal tissues irradiated. Conformal radiotherapy allows a smaller amount of rectum and bladder to be treated, by shaping the high-dose volume to the prostate. We assessed the ability of this new technology to lessen the risk of radiation-related effects in a randomised controlled trial of conformal versus conventional radiotherapy.Methods We recruited men with prostate cancer for treatment with a standard dose of 64 Gy in daily 2 Gy fractions. The men were randomly assigned conformal or conventional radiotherapy treatment. The primary endpoint was the development of late radiation complications (>3 months after treatment) measured with the Radiation Therapy and Oncology Group (RTOG) score. Indicators of disease (cancer) control were also recorded.Findings In the 225 men treated, significantly fewer men developed radiation-induced proctitis and bleeding in the conformal group than in the conventional group (37 vs 56% greater than or equal to RTOG grade 1, p = 0.004; 5 vs 15% greater than or equal to RTOG grade 2, p = 0.01). There were no differences between groups in bladder function after treatment (53 vs 59% greater than or equal to grade 1, p = 0.34; 20 vs 23% greater than or equal to grade 2, p = 0.61). After median follow-up of 3.6 years there was no significant difference between groups in local tumour control (conformal 78% [95% CI 66-86], conventional 83% [69-90]).Interpretation Conformal techniques significantly lowered the risk of late radiation-induced proctitis after radiotherapy for prostate cancer. Widespread introduction of these radiotherapy treatment methods is appropriate. Our results are the basis for dose-escalation studies to improve local tumour control.