在前列腺癌调强放射治疗中，非图像引导放射治疗与基于靶标的图像引导放射治疗（有无缩小边缘）的临床和剂量比较

IF 2.2 Q3 ONCOLOGY Advances in Radiation Oncology Pub Date : 2024-08-24 DOI:10.1016/j.adro.2024.101612

Itsuko Serizawa PhD , Takuyo Kozuka PhD , Takashi Soyano MD , Kazuma Sasamura MD , Tatsuya Kamima Bsc , Hiroaki Kunogi PhD , Nozomi Kurihara MPh , Noboru Numao PhD , Shinya Yamamoto PhD , Junji Yonese PhD , Yasuo Yoshioka PhD

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引用次数: 0

摘要

目的本研究旨在比较前列腺癌调强放射治疗（IMRT）中使用靶标图像引导放射治疗（IGRT）和非IGRT治疗患者的疗效和毒性。方法和材料共有518名中高危前列腺癌患者在接受至少3个月的新辅助雄激素剥夺治疗后接受了IMRT治疗，分39次治疗，每次治疗78 Gy。在这些患者中，371 人属于非 IGRT 组，147 人属于 IGRT 组，包括采用与非 IGRT 组相同边缘的 IGRT-A 组和采用缩小边缘的 IGRT-B 组。结果非IGRT组、IGRT-A组和IGRT-B组的5年无生化复发生存率分别为88%、95%和98%（非IGRT vs IGRT-A，P = .396；IGRT-A vs IGRT-B，P = .426）。中危和高危患者分别为94%、93%和96%（非IGRT vs IGRT-A，P = .916；IGRT-A vs IGRT-B，P = .646），以及87%、96%和100%（非IGRT vs IGRT-A，P = .500；IGRT-A vs IGRT-B，P = .483）。在非IGRT组和IGRT-A组中，急性≥2级胃肠道毒性和晚期≥2级泌尿生殖系统毒性的发生率分别为17%和7%（P = .019），以及28%和16%（P = .028）。在IGRT-A组和IGRT-B组中，急性≥2级泌尿生殖系统毒性的发生率分别为45%和21%（P = .003）。IGRT-B组膀胱壁和直肠壁的所有V60Gy = 至少接受60Gy的体积和V70Gy = 至少接受70Gy的体积值均小于IGRT-A组。此外，通过减少 IGRT 治疗规划中的边缘，毒性也会进一步降低。这些过程不会降低无生化复发生存率。

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Clinical and Dosimetric Comparison Between Non-image Guided Radiation Therapy and Fiducial-Based Image Guided Radiation Therapy With or Without Reduced Margin in Intensity Modulated Radiation Therapy for Prostate Cancer

Purpose

This study aimed to compare the outcomes and toxicities between patients treated with image guided radiation therapy (IGRT) using fiducial markers and non-IGRT in intensity modulated radiation therapy (IMRT) for prostate cancer.

Methods and Materials

In total, 518 patients with intermediate- and high-risk prostate cancer received IMRT with 78 Gy in 39 fractions after neoadjuvant androgen deprivation therapy for at least 3 months. Of these patients, 371 were in the non-IGRT group and 147 in the IGRT group, including the IGRT-A group using the same margins as the non-IGRT group and the IGRT-B group using reduced margins. The median follow-up periods for the non-IGRT, IGRT-A, and IGRT-B groups were 99 months, 88 months, and 63 months, respectively.

Results

The 5-year biochemical recurrence-free survival rates in the non-IGRT, IGRT-A, and IGRT-B groups were 88%, 95%, and 98% (non-IGRT vs IGRT-A, P = .396; IGRT-A vs IGRT-B, P = .426), respectively. Those for intermediate- and high-risk patients were 94%, 93%, and 96% (non-IGRT vs IGRT-A, P = .916; IGRT-A vs IGRT-B, P = .646), respectively, and 87%, 96%, and 100% (non-IGRT vs IGRT-A, P = .500; IGRT-A vs IGRT-B, P = .483), respectively. For the non-IGRT and IGRT-A groups, the rates of acute grade ≥ 2 gastrointestinal toxicities and late grade ≥ 2 genitourinary toxicities were 17% and 7% (P = .019), respectively, and 28% and 16% (P = .028), respectively. In the IGRT-A and IGRT-B groups, the rates of acute grade ≥ 2 genitourinary toxicities were 45% and 21% (P = .003), respectively. All V60_Gy = the volume at least received 60Gy and V70_Gy = the volume at least received 70Gy values of the bladder and rectal walls in the IGRT-B group were smaller than those in the IGRT-A group.

Conclusions

IGRT with fiducial markers results in lower acute and late toxicities compared with non-IGRT in IMRT for intermediate- and high-risk prostate cancer. Moreover, the toxicities are further decreased by reducing the margins in the treatment planning under IGRT. These processes do not decrease the biochemical recurrence-free survival rates.

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来源期刊

Advances in Radiation Oncology Medicine-Radiology, Nuclear Medicine and Imaging

CiteScore

4.60

自引率

4.30%

发文量

208

审稿时长

98 days

期刊介绍： The purpose of Advances is to provide information for clinicians who use radiation therapy by publishing: Clinical trial reports and reanalyses. Basic science original reports. Manuscripts examining health services research, comparative and cost effectiveness research, and systematic reviews. Case reports documenting unusual problems and solutions. High quality multi and single institutional series, as well as other novel retrospective hypothesis generating series. Timely critical reviews on important topics in radiation oncology, such as side effects. Articles reporting the natural history of disease and patterns of failure, particularly as they relate to treatment volume delineation. Articles on safety and quality in radiation therapy. Essays on clinical experience. Articles on practice transformation in radiation oncology, in particular: Aspects of health policy that may impact the future practice of radiation oncology. How information technology, such as data analytics and systems innovations, will change radiation oncology practice. Articles on imaging as they relate to radiation therapy treatment.