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Factors Predicting Late Rectal Disorders after Radiation Therapy for Prostate Cancer

Chinese Medical Journal 2017年第20期130卷 2441-2446页

作者： Toshiya Maebayashi Naoya Ishibashi Takuya Aizawa Masakuni Sakaguchi Hideki Sato Katsuhiko Sato Tsuyoshi Matsui Kenya Yamaguchi Satoru Takahashi Department of Radiology Nihon University School of Medicine Tokyo 173-8610 Japan Department of Gastroenterology and Hepatology Nihon University School of Medicine Tokyo 173-8610 Japan Department of Urology Nihon University School of Medicine Tokyo 173-8610 Japan

Background： Although various studies have been conducted on the effects of radiation therapy for prostate cancer, rectal toxicity after radiation therapy for prostate cancer, which is an important late adverse event associated with radiation therapy, has not been sufficiently examined. This study aimed to assess the associations of late rectal disorder （LRD） with dosimetric, anatomic, and clinical factors in patients with prostate cancer who underwent three-dimensional conformal radiation therapy （3D-CRT）. Methods： We retrospectively analyzed 104 patients undergoing 3D-CRT between January 2009 and October 2011. Thirty patients were administered anticoagulation/antiplatelet （AC/AP） agents. The standard dose was 74 Gy. Uni- and multi-va,iate analyses we,e performed to identify factors predictive of LRD after 3D-CRT. Results： The median follow-up period was 66 （range： 14 87） months. LRD occurred in 10.6% （11/104） of patients. The median time fi＇om RT to LRD was 15 months （range： 7MI months）. Sixty-four percent of those with LRD （7/11 patients） had been given AC/AP agents. Fitly-five （6/11 ） patients had severe internal iliac artery calcification. By univariate analysis, significant predictors of LRD were internal iliac artery calcification, administration of AC/AP agents, and age. Being very elderly was the significant predictor identified by multivariate analysis （P = 0.0276）. For patients receiving AC/AP agents and those with severe internal iliac artery calcification, the LRD incidences were 23.3% （7/30 patients） and 23.1% （6/26 patients）, respectively, and being 75 years of age or older was a significant predictor in these subsets. Conclusions： Our results suggest advanced age, administration of AC/AP agents, and severe internal iliac artery calcification to be risk factors tbr LRD in patients undergoing standard RT. Therefore, it is necessary to administer radiation with particular caution in the very elderly, especially those receiving AC/AP agents and/or with severe internal iliac artery calcification.

关键词： Anticoagulation/Antiplatelet Agents Late Rectal Disorder Prostate Cancer Radiation Therapy severe internal lliac artery calcification

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