Predictor of Severe Gastroduodenal Toxicity After Stereotactic Body Radiotherapy for Abdominopelvic Malignancies

被引:68
作者
Bae, Sun Hyun [1 ]
Kim, Mi-Sook [1 ]
Cho, Chul Koo [1 ]
Kang, Jin-Kyu [1 ]
Lee, Sang Yeob [1 ]
Lee, Kyung-Nam [1 ]
Lee, Dong Han [4 ]
Han, Chul Ju [2 ]
Yang, Ki Young [2 ]
Kim, Sang Bum [3 ]
机构
[1] Korea Inst Radiol & Med Sci, Dept Radiat Oncol, Seoul 139706, South Korea
[2] Korea Inst Radiol & Med Sci, Dept Internal Med, Seoul 139706, South Korea
[3] Korea Inst Radiol & Med Sci, Dept Gen Surg, Seoul 139706, South Korea
[4] Korea Inst Radiol & Med Sci, CyberKnife Ctr, Seoul 139706, South Korea
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2012年 / 84卷 / 04期
关键词
PHASE-I/II TRIAL; RADIATION-THERAPY; LIVER METASTASES; CARCINOMA; ONCOLOGY; CANCER;
D O I
10.1016/j.ijrobp.2012.06.005
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To identify the predictors for the development of severe gastroduodenal toxicity (GDT) in patients treated with stereotactic body radiotherapy (SBRT) using 3 fractionations for abdominopelvic malignancies. Methods and Materials: From 2001 to 2011, 202 patients with abdominopelvic malignancies were treated with curative-intent SBRT. Among these patients, we retrospectively reviewed the clinical records of 40 patients with the eligibility criteria as follows: 3 fractionations, follow-up period >= 1 year, absence of previous radiation therapy (RT) history or combination of external-beam RT and the presence of gastroduodenum (GD) that received a dose higher than 20% of prescribed dose. The median SBRT dose was 45 Gy (range, 33-60 Gy) with 3 fractions. We analyzed the clinical and dosimetric parameters, including multiple dose-volume histogram endpoints: V-20 (volume of GD that received 20 Gy), V-25, V-30, V-35, and D-max (the maximum point dose). The grade of GDT was defined by the National Cancer Institute Common Toxicity Criteria version 4.0, and GDT >= grade 3 was defined as severe GDT. Results: The median time to the development of severe GDT was 6 months (range, 3-12 months). Severe GDT was found in 6 patients (15%). D-max was the best dosimetric predictor for severe GDT. D-max of 35 Gy and 38 Gy were respectively associated with a 5% and 10% probability of the development of severe GDT. A history of ulcer before SBRT was the best clinical predictor on univariate analysis (P=.0001). Conclusions: We suggest that D-max is a valuable predictor of severe GDT after SBRT using 3 fractionations for abdominopelvic malignancies. A history of ulcer before SBRT should be carefully considered as a clinical predictor, especially in patients who receive a high dose to GD. (C) 2012 Elsevier Inc.
引用
收藏
页码:E469 / E474
页数:6
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