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首页> 外文期刊>Radiotherapy and oncology: Journal of the European Society for Therapeutic Radiology and Oncology >Rectal sequelae after conformal radiotherapy of prostate cancer: dose-volume histograms as predictive factors.
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Rectal sequelae after conformal radiotherapy of prostate cancer: dose-volume histograms as predictive factors.

机译：前列腺癌保形放疗后的直肠后遗症：剂量-体积直方图作为预测因素。

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PURPOSE: To identify clinically relevant parameters predictive of late rectal bleeding derived from cumulative dose-volume histograms (DVHs) of the rectum after conformal radiotherapy of prostate cancer. MATERIALS AND METHODS: One hundred and nine patients treated with 3D conformal radiotherapy between 1/1994 and 1/1996 for localized prostate cancer (clinical stage T1-T3) were available for analysis. All patients received a total dose of 66 Gy/2 Gy per fraction (specified at the International Commission on Radiation Units and Measurements ICRU reference point). DVHs of the contoured rectum were analyzed by defining the absolute (aV) and relative (rV) rectum volume that received more than 30% (V30), 50% (V50), 70% (V70), 80% (V80), 90% (V90) and 100% (V100) of the prescribed dose. Additionally, a new aspect of DVH analysis was investigated by calculation of the area under the DVH-curve between several dose levels (area under the curve (AUC)-DVH). DVH-variables were correlated with radiation side effects evaluated in 3-6 months intervals and graded according to the EORTC/RTOG score. The median follow-up was 30 months (12-60 months). RESULTS: Univariate and multivariate stepwise Cox-Regression analysis including age, PTV, rectum size, rV100, rV90, rV80, rV70, rV50 rV30 and aV30 to aV100 were calculated. Late rectal bleeding (EORTC/RTOG grade 2) was significantly correlated with the percentage of rectum volume receiving > or = 90% of the prescribed dose (rV90) (P = 0.007) and inversely correlated in a significant way with the size of contoured rectum (P = 0.006) in multivariate analysis. In our series, a proportion of the rectum volume > or = 57% were included in the 90%-isodose (rV90 > or = 57%) in one half of the patients, with an actuarial incidence of 31% of late rectal bleeding at 3 years. In the other half of the patients, when rV90 < 57%, the 3-year actuarial incidence was 11% (P < 0.03). CONCLUSION: Our data demonstrate a dose-volume relationship at the reference dose of 60 Gy ( approximately 90% of the prescribed dose) with respect to late rectal toxicity. The rV90 seems to be the most useful and easily obtained parameter when comparing treatment plans to evaluate the risk of rectal morbidity.
机译：目的：从前列腺癌的保形放疗后，从直肠的累积剂量-体积直方图（DVHs）来确定可预测直肠晚期出血的临床相关参数。材料与方法：可以对在1/1994年至1/1996年之间接受3D保形放射疗法治疗的局部前列腺癌（临床分期为T1-T3）的109例患者进行分析。所有患者接受的总剂量为每部分66 Gy / 2 Gy（由国际辐射单位和测量委员会ICRU参考点指定）。通过定义接收的30％（V30），50％（V50），70％（V70），80％（V80），90％以上的绝对（aV）和相对（rV）直肠体积来分析轮廓直肠的DVH ％（V90）和100％（V100）的处方剂量。此外，通过计算几个剂量水平之间的DVH曲线下面积（曲线下面积（AUC）-DVH），研究了DVH分析的新方面。 DVH变量与以3-6个月为间隔评估的放射副作用相关，并根据EORTC / RTOG评分进行分级。中位随访时间为30个月（12-60个月）。结果：计算了单变量和多变量逐步Cox回归分析，包括年龄，PTV，直肠大小，rV100，rV90，rV80，rV70，rV50，rV30和aV30至aV100。晚期直肠出血（EORTC / RTOG 2级）与接受或超过处方剂量（rV90）的90％的直肠体积百分比显着相关（P = 0.007），并且与轮廓直肠的大小呈显着负相关（P = 0.006）在多变量分析中。在我们的系列研究中，一半的患者的90％等剂量（rV90>或= 57％）中包括了一部分直肠体积>或= 57％，精算发生率为31％时晚期直肠出血3年。在另一半患者中，当rV90 <57％时，三年精算发生率为11％（P <0.03）。结论：我们的数据表明参考剂量为60 Gy（约等于处方剂量的90％）相对于晚期直肠毒性的剂量-体积关系。当比较治疗计划以评估直肠疾病的风险时，rV90似乎是最有用和最容易获得的参数。

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