Title Utvrđivanje metoda odabira ciljnih volumena u svakodnevnom radu pri radikalnom liječenju raka prostate Title (english) Determination of methods for selecting target volumes in daily work during radical treatment of prostate cancer Author Vinka Belas Solarić Mentor Tomislav Omrčen (mentor)Mentor Lidija Beketić-Orešković (sumentor)Committee member Mario Podrug (predsjednik povjerenstva)Committee member Darijo Hrepić (član povjerenstva) Committee member Tomislav Omrčen (član povjerenstva)Granter University of Split Defense date and country 2024-07-04, Croatia Scientific / art field, BIOMEDICINE AND HEALTHCARE Abstract Uvod: Komplikacije liječenja raka prostate (RP), kao najčešće zloćudne novotvorine muškaraca u razvijenom dijelu svijeta, predstavljaju značajan javnozdravstveni problem. Nakon radikalne radioterapije, kasni neželjeni učinci ovise o nizu čimbenika, a među osobito bitnima je veličina ozračenog kliničkog ciljnog volumena (CTV). Unatoč toj činjenici, ne postoji jednoobrazni, standardizirani i opće prihvaćeni postupak za određivanje CTV-a.
Cilj: Istraživanjem se pokušalo utvrditi metodu određivanja CTV-a pri radikalnoj radioterapiji RP u svakodnevnoj kliničkoj praksi.
Ispitanici i metode: U istraživanje, koje je obuhvatilo period od 2020. do 2022., bilo je uključeno 210 bolesnika s lokaliziranim adenokarcinomom prostate koji su radikalno zračeni u Klinici za tumore, u KBC Sestre milosrdnice, u Zagrebu. Opaženi odabir CTV-a uspoređivan je sa CTV-ima koji su za svakog pojedinog bolesnika određivani primjenom metoda predloženih u stručnoj literaturi: pripadnost rizičnoj skupini, Roachov matematički model, nomogram Memorijalnog centra za rak Sloan Kettering (MSKCC) i Smjernice hrvatskih stručnih društava.
Rezultati: Medijan dobi uključenih bolesnika iznosio je 75 godina, s rasponom od 54 do 87 godina. Bolest niskog rizika imalo je 3,8% bolesnika, srednjeg rizika 69,5% bolesnika i visokog rizika 26,7% bolesnika. Opaženi CTV je kod 21% bolesnika uključivao samo prostatu, kod 50% bolesnika prostatu i sjemenske mjehuriće te kod 29% prostatu, sjemenske mjehuriće i zdjelične limfne čvorove. Opažena raspodjela CTV-a statistički se značajno razlikovala od CTV-a određenih temeljem rizičnih skupina (p=0,0396), temeljem Roachovog matematičkog modela (p=0,0023), temeljem MSKCC nomograma (p=0,0005) i temeljem Smjernica hrvatskih stručnih društava (p=0,0012). Statistički značajne razlike nema između CTV-a određenih na bazi Smjernica hrvatskih stručnih društava i na bazi MSKCC nomograma. Statistički granično značajna razlika postoji između CTV-a definiranih prema rizičnim skupinama i prema Roachovim jednadžbama. Između svih drugih preporučenih CTV-a postoji statistički značajna razlika. Opaženi i preporučeni CTV-i međusobno pozitivno koreliraju i pokazuju slične trendove.
Rasprava: Istraživanjem je utvrđeno da su opaženi CTV-i odabirani nejednolikim pristupom. Izgled violinskog grafa upućuje da se odlučivanje većinski temeljilo na rizičnim skupinama. Visoka korelacija pokazuje da su se kao nadopuna rizičnim skupinama koristili MSKCC nomogrami i Smjernice hrvatskih stručnih društava.
Zaključak: Istraživanjem je zapaženo da određivanje CTV-a u kliničkoj praksi nije jednoobrazno što bi bio uvjet za postavljanje na nacionalnu razinu nego je prilagođeno normama svakog bolničkog centra posebno.
Abstract (english) Introduction: Complications of prostate cancer (PC) treatment, the most common malignant neoplasm in men in the developed world, present a significant public health issue. Following radical radiotherapy, late adverse effects depend on various factors, with the size of the irradiated clinical target volume (CTV) being particularly crucial. Despite this, there is currently no unified, standardized, and universally accepted procedure for determining the CTV.
Aim: The study aimed to determine methods for defining the CTV in radical radiotherapy for PC in routine clinical practice.
Patients and Methods: The study, conducted from 2020 to 2022, included 210 patients with localized adenocarcinoma of the prostate who underwent radical radiation therapy at the University Hospital for Tumors, University Hospital centar of Sisters of Mercy in Zagreb, Croatia. The observed selection of CTV was compared with CTVs determined for each patient using methods proposed in the literature: membership in risk groups, Roach's mathematical model, Memorial Sloan Kettering Cancer Center (MSKCC) nomogram, and Croatian Society for Oncology.
Results: The median age of the patients was 75 years, ranging from 54 to 87 years. Low-risk disease was observed in 3.8% of patients, intermediate-risk in 69.5%, and high-risk in 26.7%. The observed CTV included only the prostate in 21% of patients, the prostate and seminal vesicles in 50%, and the prostate, seminal vesicles, and pelvic lymph nodes in 29%. The observed distribution of CTV significantly differed from CTVs determined based on risk groups (p=0.0396), Roach's model (p=0.0023), MSKCC nomogram (p=0.0005), and Croatian Society for Oncology (p=0.0012). There were no statistically significant differences between CTVs determined based on Croatian Society guidelines and MSKCC nomogram. A statistically borderline significant difference existed between CTVs defined according to risk groups and Roach's equations. There was a statistically significant difference between all other recommended CTVs. Observed and recommended CTVs positively correlated with each other and exhibited similar trends.
Discussion: The study found that observed CTVs were selected with a non-uniform approach. The appearance of the violin plot suggests that decision-making was predominantly based on risk groups. High correlation indicates that MSKCC nomograms and Croatian Society guidelines were used as complementary tools alongside risk groups.
Conclusion: The study observed that CTV determination in clinical practice is not standardized, which would be a prerequisite for national-level implementation, but rather tailored to the norms of each hospital center individually.
Keywords
rak prostate
klinički ciljni volumeni
rizične skupine
nomogrami
Roachove jednadžbe
Keywords (english)
prostate cancer
clinical target volume
risk groups
nomograms
Roach's equations
Language croatian URN:NBN urn:nbn:hr:176:894222 Study programme Title: Graduate University Study Programme of Radiologic Technology Type of resource Text File origin Born digital Access conditions Access restricted to students and staff of home institution Terms of use Created on 2024-07-05 11:16:41
