剂量表面积直方图对前列腺癌患者放射治疗后急性直肠炎的预测价值  

Predictive value of dose-surface histogram for acute radiation proctitis in prostate cancer patients following radiotherapy

作　　者：赵鑫[1] 杨梅柳 郝晓慧 魏天雄 张琪 常浩宇 武秀霞 Zhao Xin;Yang Mei-Liu;Hao Xiao-Hui;Wei Tian-Xiong;Zhang Qi;Chang Hao-Yu;Wu Xiu-Xia(Department of Radiotherapy,the First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei 075000,China;Department of Biology,Hengshui University,Hengshui,Hebei 053000,China)

机构地区：[1]河北北方学院附属第一医院放疗科,河北张家口075000 [2]衡水学院生命科学学院,河北衡水053000

出　　处：《解放军医学杂志》2025年第1期44-49,共6页Medical Journal of Chinese People's Liberation Army

基　　金：河北省医学科学研究课题计划项目(20241010)。

摘　　要：目的评价剂量表面积直方图(DSH)对前列腺癌(PCa)患者急性放射性直肠炎(RP)的预测价值。方法本研究为前瞻性随机对照临床研究。收集2018年1月-2023年1月河北北方学院附属第一医院放疗科收治的380例PCa患者,采用抽签法随机分为观察组(n=200)与对照组(n=180)。采用DSH评价观察组直肠剂量分布,剂量体积直方图(DVH)评价对照组直肠剂量分布。采用受试者操作特征(ROC)曲线评价两种计划评价工具对急性RP的预测效能。结果两组年龄、RPS评分、体重指数(BMI)等临床资料比较差异均无统计学意义(P>0.05)。两组急性RP级别比较差异无统计学意义(P>0.05)。两组S_(40)与V_(40)、S_(50)与V_(50)、S_(60)与V_(60)、S_(70)与V_(70)、S_(78)与V_(78)比较差异均有统计学意义(P<0.001)。S_(40)、S_(50)、V_(40)、V_(50)预测各级急性RP的曲线下面积(AUC)≤0.700,提示低等效能(P<0.001),S_(60)、V_(60)预测各级急性RP的AUC为0.700~0.900,提示中等效能(P<0.001),S_(70)、S_(78)、V_(70)、V_(78)预测各级急性RP的AUC>0.900,提示高等效能(P<0.001)。结论DSH对PCa患者直肠毒性的预测效能与DVH较为相似,在未来放射治疗计划设计中可弥补DVH的不足或单独用于计划评价。Objective To evaluate the predictive value of dose-surface histogram(DSH)for radiation proctitis(RP)in prostate cancer(PCa)patients undergoing radiotherapy.Methods This prospective randomized controlled clinical trial included 380 PCa patients who underwent image-guided radiotherapy in the First Affiliated Hospital of Hebei Northern University from January 2018 to January 2023.Patients were randomly divided into observation group(n=200)and control group(n=180).The rectal dose distribution of patients in the two groups was evaluated by using DSH and dose-volume histogram(DVH),respectively.The receiver operating characteristic(ROC)curve was utilized to evaluate the predictive value of DSH for acute RP,with DVH serving as a reference.Results The difference was not statistically significant in clinical information such as age,KPS score,and body mass index(BMI)between the observation and control groups(P>0.05),as well as in acute RP incidence(P>0.05).There were significant differences in S_(40)and V_(40),S_(50)and V_(50),S_(60)and V_(60),S_(70)and V_(70),and S_(78)and V_(78)between the two groups(P<0.05).S_(40),S_(50),V_(40),and V_(50)showed low efficacy(P<0.001)in predicting acute RP at each level,with AUC≤0.700.S_(60)and V_(60)showed moderate efficacy(P<0.001)in predicting acute RP at each level,with AUC 0.700-0.900.S_(70),S_(78),V_(70)and V_(78)showed high efficacy(P<0.001)in predicting acute RP at each level,with AUC>0.900.Conclusions The predictive value of DSH for rectal toxicity in patients with PCa is basically consistent with that of DVH.It is expected to become a novel and valuable tool for evaluating radiotherapy plans in the future.

关 键 词：剂量表面积直方图 前列腺癌 直肠毒性 预测 

分 类 号：R737.25[医药卫生—肿瘤] R445.2[医药卫生—临床医学]