Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer: Preliminary results of a multicenter prospective study
Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer: Preliminary results of a multicenter prospective study
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DOI：
10.1016/j.ijrobp.2007.07.2354
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发表时间：
2008-03-15
影响因子：
7
通讯作者：
Valdagni, Riccardo
中科院分区：
文献类型：
--
作者：
Fiorino, Claudio;Fellm, Gianni;Valdagni, Riccardo
目的：为了评估在前瞻性研究组的前列腺癌（1.8 - 2戈伊分数）与三维适形放疗在70 - 80戈伊治疗的患者晚期直肠毒性的预测因素：方法和材料：共1,132例患者进入2002年和2004年之间的研究。主要基于主观客观管理、分析正常组织系统的晚期效应，通过自填式问卷评估三种类型的直肠毒性：大便频率/里急后重/疼痛、大便失禁和出血。分析了506例随访24个月的患者的数据。通过单变量和多变量（MVA）logistic analysis.Results：在1,132例患者中，21例、15例和30例分别出现大便频率/里急后重/疼痛、大便失禁和出血。排便频率/里急后重/疼痛与既往腹部/盆腔手术相关（MVA，p=0.05，比值比[OR]，3.3）。关于尿失禁，MVA显示接受量>= 40戈伊（V-40）（p=0.035，OR，1.037）和手术（p=0.02，OR，4.4）是最强的预测因子。V-40至V-70高度预测出血; V-70对MVA的影响最大（p=0.03），连同手术（p=0.06，OR，2.5），这也是3级出血的主要预测因素（p=0.02，OR = 4.2）。剂量-体积直方图的预测价值被证实为出血，与先前提出的限制一致（V-50 <55%，V-60 <40%，V-70 <25%，和V-75 < 5%）。可以建议失禁的剂量-体积直方图约束（V-40 < 65 - 70%）。既往腹部/盆腔手术与所有毒性类型相关;因此，对于有腹部/盆腔手术史的患者，可以建议修改出血限制（V-70 < 15%），尽管需要在更大人群中进行进一步验证，随访时间更长。(c)2008年爱思唯尔公司
Purpose: To assess the predictors of late rectal toxicity in a prospectively investigated group of patients treated at 70 - 80 Gy for prostate cancer (1.8 - 2 Gy fractions) with three-dimensional conformal radiotherapy.Methods and Materials: A total of 1,132 patients were entered into the study between 2002 and 2004. Three types of rectal toxicity, evaluated by a self-administered questionnaire, mainly based on the subjective objective management, analytic late effects of normal tissue system, were considered: stool frequency/tenesmus/pain, fecal incontinence, and bleeding. The data from 506 patients with a follow-up of 24 months were analyzed. The correlation between a number of clinical and dosimetric parameters and Grade 2 or greater toxicity was investigated by univariate and multivariate (MVA) logistic analyses.Results: Of the 1,132 patients, 21, 15, and 30 developed stool frequency/tenesmus/pain, fecal incontinence, and bleeding, respectively. Stool frequency/tenesmus/pain correlated with previous abdominal/pelvic surgery (MVA, p=0.05, odds ratio [OR], 3.3). With regard to incontinence, MVA showed the volume receiving >= 40 Gy (V-40) (p=0.035, OR, 1.037) and surgery (p=0.02, OR, 4.4) to be the strongest predictors. V-40 to V-70 were highly predictive of bleeding; V-70 showed the strongest impact on MVA (p=0.03), together with surgery (p=0.06, OR, 2.5), which was also the main predictor of Grade 3 bleeding (p=0.02, OR, 4.2).Conclusions: The predictive value of the dose-volume histogram was confirmed for bleeding, consistent with previously suggested constraints (V-50 < 55%, V-60 < 40%, V-70 < 25%, and V-75 < 5%). A dose - volume histogram constraint for incontinence can be suggested (V-40 < 65 - 70%). Previous abdominal/pelvic surgery correlated with all toxicity types; thus, a modified constraint for bleeding (V-70 < 15%) can be suggested for patients with a history of abdominal/pelvis surgery, although further validation on a larger population with longer follow-up is needed. (c) 2008 Elsevier Inc.