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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Gastro-intestinal and genito-urinary morbidity after 3D conformal radiotherapy of prostate cancer: observations of a randomized trial.
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Gastro-intestinal and genito-urinary morbidity after 3D conformal radiotherapy of prostate cancer: observations of a randomized trial.

机译：前列腺癌3D适形放疗后的胃肠道和泌尿生殖系统发病率：一项随机试验的观察结果。

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BACKGROUND AND PURPOSE: The late morbidity of a randomized study was analyzed after a follow up of 2 years. The difference in intestinal morbidity was analyzed as a function of the treatment arm and dose volume parameters. The correlation with acute toxicity and (pre-existing) bowel complaints was investigated. PATIENTS AND METHODS: 266 T1-4N0M0 prostate cancer patients were randomized for conventional (open fields) and 3D conformal radiotherapy using beams eye view blocked fields with the same dose (66Gy) and gross target volume-planning target volume margin (15mm). Apart from the RTOG toxicity scoring system a patient self-assessment questionnaire was used to obtain detailed information on morbidity. RESULTS: At 2 years there is only a trend for less rectal toxicity (grade>/=1) in favor of the conformal radiotherapy (grade 1, 47 versus 40% and grade 2, 10 versus 7% for conventional and conformal radiotherapy, respectively (P=0.1). A significant relation was found between late rectal toxicity (grade>/=1) and the volume of the anus and rectum exposed to>/=90% tumor dose (TD). A highly significant relationship is observed between acute rectum and anal toxicity and late rectal toxicity. The patient self-assessment questionnaire analysis revealed that patients are most bothered by compliance related symptoms like urgency, soiling and fecal loss. In a multivariate analysis, all other variables loose significance, when anal volume exposed to>/=90% TD and pre-treatment defaecation frequency are accounted for. Late anal toxicity is low and related only to acute anal toxicity. Late bladder toxicity is related solely to pre-treatment frequency and overall urological symptoms. The incidence of grade 2 toxicity increases with a factor 2.5-4 when (stool or urine) frequency is unfavorable at the start of treatment. CONCLUSIONS: Conformal radiotherapy at the dose level of 66Gy does not significantly decrease the incidence of rectal, anal and bladder toxicity compared to conventional radiotherapy. There is a significant relationship between acute and late toxicity and the anal volume exposed to 90% TD. Intestinal (and urological) symptoms at start have a major impact on late toxicity.
机译：背景与目的：随访2年后，分析了一项随机研究的晚期发病率。根据治疗组和剂量体积参数分析肠道发病率的差异。调查与急性毒性和（已有的）肠主诉的相关性。患者与方法：266例T1-4N0M0前列腺癌患者被随机分配至常规（开放视野）和3D保形放射疗法，使用相同剂量（66Gy）和总目标体积规划目标体积裕度（15mm）的束眼视场。除RTOG毒性评分系统外，还使用患者自我评估问卷来获取有关发病率的详细信息。结果：在2年时，仅直肠放疗的趋势更趋于减少（> / = 1级），而常规放疗和保形放疗分别为1级，47％对40％，2级，10％对7％。 （P = 0.1）。发现晚期直肠毒性（等级> / = 1）与肛门和直肠体积接触> / = 90％肿瘤剂量（TD）之间存在显着相关性，在两者之间发现高度相关性急性直肠和肛门毒性以及晚期直肠毒性。患者自我评估问卷分析显示，患者最容易受到依从性相关症状的困扰，例如尿急，弄脏和粪便流失;在多变量分析中，当暴露于肛门体积时，所有其他变量均无意义。占TD的> / = 90％，且治疗前排便频率高;晚期肛门毒性低，仅与急性肛门毒性有关;晚期膀胱毒性仅与治疗前频率和总体泌尿系统症状有关。当开始治疗时（粪便或尿液）的频率不利时，2级毒性以2.5-4的系数增加。结论：与常规放疗相比，剂量为66Gy的适形放疗并未显着降低直肠，肛门和膀胱毒性的发生率。急性毒性和晚期毒性与90％TD暴露于肛门的体积之间存在显着关系。开始时的肠道（和泌尿科）症状对后期毒性有重大影响。

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