前列腺癌大分割调强放疗副反应初步分析  

Toxicity of hypofractionated intensity-modulated radiotherapy in patients with prostate cancer

作　　者：房辉[1] 李晔雄[1] 刘跃平[1] 王维虎[1] 金晶[1] 王淑莲[1] 宋永文[1] 刘新帆[1] 亓姝楠[1] 刘清峰[1] 戴建荣[1] 余子豪[1] 

机构地区：[1]中国医学科学院北京协和医学院肿瘤医院放疗科,北京100021

出　　处：《中华放射肿瘤学杂志》2009年第3期209-213,共5页Chinese Journal of Radiation Oncology

基　　金：卫生部临床学科重点项目（07090010）;国家863课题（2006AA02Z345）;中国医学院肿瘤医院临床研究课题（LC2008838）

摘　　要：目的分析前列腺癌大分割照射患者的早期和晚期副反应，初步探讨副反应的影响因素。方法2006--2008年间37例前列腺癌患者接受大分割调强放疗（IMRT）。13例临床靶体积（CTV）包括前列腺±精囊或术后瘤床，24例包括前列腺、精囊（或术后瘤床）和盆腔淋巴引流区。分次照射剂量为2．3～2．8Gy（2．7Gy占26例）。95％PTV处方剂量前列腺精囊为62．5～75．0Gy，盆腔为50．0Gy。结果全组中位随访时间为14个月。早期胃肠反应发生率0级38％，1级24％，2级35％，3级3％；直肠V50〉27％与V55〉20％的≥1级早期直肠反应发生率不同（P〈0．05）。早期泌尿系统反应发生率0级30％，1级68％，2级0和3级3％；膀胱V60〈10％与V60〉10％的≥1级泌尿系统反应发生率也不同（χ^2=6．02，P=0．038）。晚期直肠反应发生率0级70％，1级24％，2级5％，无3、4级反应；直肠V65〈10％与V65〉10％的≥1级晚期胃肠反应发生率不同（χ^2=5．58，P=0．020）。晚期泌尿系统反应发生率0级38％，1级49％，2级11％，3级3％，无4级反应；膀胱平均剂量〉40Gy、V。〉32％与V50〉29％的≥2级晚期泌尿系统反应发生率均不同。结论前列腺癌大分割IMRT初步研究结果显示急性和晚期副反应均在可接受范围内。Objective TO analyze the acute and late toxicities in patients with prostate cancer treated with hypofractionated intensity-modulated radiotherapy （IMRT）. Methods Between June 2006 and June 2008, 37 patients with prostate cancer were treated with hypofractionated IMRT. The clinical target volume （CTV） was the prostate, seminal vesicles and pelvic lymph nodes in 24 patients, the prostate and seminal vesicles in 12, and only the tumor bed in 1. The dose per fraction was 2.3 -2.8 Gy, with 2.7 Gy in 26 patients. The minimal dose was 62.5 - 75.0 Gy to the prostate and seminal vesicles, and 50 Gy to the pelvic lymph nodes. Results The median follow-up was 14 months. None of the patients experienced grade 4 acute gastro-intestinal （GI） toxicity. Grade 1, 2 and 3 acute GI toxicity occurred in 24.3% , 35.1% and 2.7% of the patients, respectively. The rectal V50 〉 27% and V55 〉 20% were highly significantly associat- ed with grade ≥1 acute GI toxicity. Grade 1, 2 and 3 acute genitourinary （GU） toxicity occurred in 68% , 0% and 3% of the patients, respectively. The bladder V60 〉 10% was significantly associated with grade ≥1 acute GU toxicity. The incidence of late GI toxicity was low. No grade ≥3 late GI toxicity was observed. The incidence of late grade 1 and 2 GI toxicity was 24% and 5% , respectively. The rectal V65 〉 10% was highly significantly associated with grade ≥ 1 late GI toxicity. No late grade 4 GU toxicity was observed. The incidence of grade 1, 2 and 3 late GU toxicity was 49% , 11% and 3% , respectively. Grade ≥2 late GU toxicity was correlated with V40, V50 and mean dose of the bladder. Conclusions Acute and late toxicity of hypofractionated IMRT is acceptable in patients with prostate cancer.

关 键 词：前列腺肿瘤/放射疗法 放射疗法 大分割 放射疗法 调强 副反应 

分 类 号：R686[医药卫生—骨科学]