Radiother Oncol：膀胱充盈增加局部高危前列腺癌患者盆腔放疗后的急性毒性反应

本研究的目的旨在确定IMRT是否能减少选择性盆腔淋巴结放疗后前列腺癌患者的急性治疗相关毒性反应。来自加拿大多伦多大学的Suneil Jain等进行相关研究，其研究结果发表在Radiother Oncol 11月的期刊上。

本研究未前瞻性研究，共有230名患者被纳入研究，在研究中主要采用EPNI分割调强刺激前列腺。在研究进行过程中，根据文献报道的新的方法进行EPNI。共采用了三种方法，分别是(1) 4FB，(2) IMRT-Shih—即由Shin等在2005年提出的盆腔血管周围CTV区域为2cm的IMRT,(3)由RTOG提出的nodal volumes IMRT。最初的患者在在膀胱排空的情况下接受治疗，其余的患者则在膀胱充盈的情况下接受治疗

与IMRT-Shih组和IMRT-RTOG组相比，4FB组的2级急性胃肠道毒性反应发生率更高，三组的发生率分别为31.9%、20.8%和7.2%，三组差异具有显着统计学意义。此外，与两个IMRT组相比，4FB组的患者3级尿频发生率也更高，分别为8.5%、0%和0%。然而，多变量分析提示对毒性反应发生影响最大的因素是在膀胱充盈的情况下接受IMRT

研究结果提示，膀胱充盈情况似乎是预测IMRT治疗后急性毒性反应发生的主要预测因子。

与前列腺癌相关的拓展阅读：

• JNCI ：质子放射治疗可以将前列腺癌患者的副作用降到最低水平
• J Urol.：新的诊断创新可改进医生检测前列腺癌的方式
• NEJM：阿比特龙可使早期前列腺癌患者有显著获益
• 上海：20年间前列腺癌发病率翻了12倍多
• Science：科学家揪出前列腺癌罪魁祸首
更多信息请点击：有关前列腺癌更多资讯

DOI:10.1016/j.radonc.2012.09.020
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The effect of radiation technique and bladder filling on the acute toxicity of pelvic radiotherapy for localized high risk prostate cancer

Suneil Jain, D. Andrew Loblaw, Gerard C. Morton, Cyril Danjoux, Ewa Szumacher, William Chu, Hans T. Chung, Danny Vesprini, Arjun Sahgal, Liying Zhang, Andrea Deabreu, Patrick C.F. Cheung,

Purpose The goal of this project was to see if using IMRT to deliver elective pelvic nodal irradiation (EPNI) for prostate cancer reduced acute treatment toxicity. Methods Two hundred and thirty patients were enrolled into prospective trials delivering EPNI with a concomitant hypofractionated IMRT boost to the prostate. During accrual, the method of EPNI delivery changed as new literature emerged. Three methods were used (1) 4FB, (2) IMRT with 2 cm CTV margins around the pelvic vessels as suggested by Shih et al. (2005) [7] (IMRT-Shih), and (3) IMRT with nodal volumes suggested by the RTOG (IMRT-RTOG). Initially patients were treated with an empty bladder, with the remainder treated with bladder full. Results Patients in the 4FB group had higher rates of grade 2 acute GI toxicities compared to the IMRT-Shih and IMRT-RTOG groups (31.9% vs 20.8% vs 7.2%, p = 0.0009). Patients in the 4FB group had higher rates of grade 3 urinary frequency compared to the two IMRT groups (8.5% vs 0% vs 0%, p = 0.027). However, multivariate analysis suggested the factor that most influenced toxicity was bladder filling followed by IMRT. Conclusions Bladder filling appeared to be the dominant factor which predicted for acute toxicity, followed by the use of IMRT.