目的:发生泌尿生殖系统(GU)毒性是前列腺癌(PCa)外照射(EBRT)后观察到的常见不良事件。最近的研究结果表明,输送给特定的泌尿器官风险(OAR),如输尿管的剂量,膀胱三角区,尿道参与了GU毒性的发展。
方法:由三名放射肿瘤学家组成的多学科工作组,一个城市放射学家,并在2022年创建了一名泌尿科医生。首先,鉴定并讨论了可能参与GU毒性的OAR。进行了文献综述,解决与尿OAR相关的几个问题:解剖学和放射学定义,辐射诱导的损伤,剂量体积参数。其次,结果被提交并与一组放射肿瘤学家讨论,“泌尿外科放射治疗法语小组”(GFRU)成员。此后,GFRU专家被要求回答一份专门的问卷,包括35个有争议的问题有关的排尿OAR的划定。
结果:确定以下结构对PCaEBRT至关重要:输尿管,膀胱,膀胱颈,膀胱三角区,尿道(前列腺内,膜质,自负),横纹括约肌,和前列腺摘除后或经尿道电切术(TURP)腔后。就35个项目中的32个达成了共识。
结论:该共识强调了上尿路和下尿路的现代泌尿系统结构被考虑用于PCa的EBRT治疗计划。目前的建议还提出了尿液OAR的标准化定义,用于日常实践和未来的临床试验。
OBJECTIVE: The occurrence of genitourinary (GU) toxicity is a common adverse event observed after external beam radiation therapy (EBRT) for prostate cancer (PCa). Recent findings suggest that the dose delivered to specific urinary organs at risk (OARs) such as the ureters, bladder trigone, and urethra is involved in the development of GU toxicity.
METHODS: A multidisciplinary task force including 3 radiation oncologists, a uroradiologist, and a urologist was created in 2022. First, OARs potentially involved in GU toxicity were identified and discussed. A literature review was performed, addressing several questions relative to urinary OARs: anatomic and radiological definition, radiation-induced injury, and dose-volume parameters. Second, results were presented and discussed with a panel of radiation oncologists and members of the \"Francophone Group of Urological Radiation Therapy.\" Thereafter, the \"Francophone Group of Urological Radiation Therapy\" experts were asked to answer a dedicated questionnaire, including 35 questions on the controversial issues related to the delineation of urinary OARs.
RESULTS: The following structures were identified as critical for PCa EBRT: ureters, bladder, bladder neck, bladder trigone, urethra (intraprostatic, membranous, and spongious), striated sphincter, and postenucleation or posttransurethral resection of the prostate cavity. A consensus was obtained for 32 out of 35 items.
CONCLUSIONS: This consensus highlights contemporary urinary structures in both the upper and lower urinary tract to be considered for EBRT treatment planning of PCa. The current recommendations also propose a standardized definition of urinary OARs for both daily practice and future clinical trials.