Incidence and predictors of lower extremity lymphedema after postoperative radiotherapy for prostate cancer.

IF 3.3 2区医学 Q2 ONCOLOGY

Radiation Oncology Pub Date : 2025-03-18 DOI:10.1186/s13014-025-02599-7

Giuseppe Facondo, Marta Bottero, Lucia Goanta, Alessia Farneti, Adriana Faiella, Pasqualina D'Urso, Giuseppe Sanguineti

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引用次数: 0

Abstract

Background: To assess the rate and predictors of lower extremity lymphedema (LEL) after radiotherapy (RT) following radical prostatectomy (RP) ± pelvic lymph node dissection (PLND) for prostate cancer.

Methods: Patients (pts) treated with adjuvant or salvage RT after RP ± PLND and a minimum 2-year follow-up were included. LEL was defined as a volume difference ≥ 10% between limbs evaluated using circumferential measurements with a flexible non-stretch tape. The following predictors were investigated at logistic regression: age (continuous); body mass index (BMI, continuous); exercise level (low vs. medium/high); smoking (yes vs. no); cigarette pack/year (continuous); hypertension (yes ns no); vascular comorbidity (yes vs. no); diabetes (yes vs. no); PLND (yes vs. no); number of examined nodes (continuous); whole pelvis radiotherapy (WPRT) (yes vs. no); time between RP and RT (continuous); planning target volume (PTV) volume (continuous); PTV/BMI (continuous). Statistical significance was claimed for p < 0.05.

Results: 101 pts were examined. The median time from surgery to RT was 36.1 months (mths) (IQR: 15.0-68.3), the median time from RT to the date of study examination was 51.1 months (IQR: 36.8-65.3). 14 pts developed LEL (13.9%), 3 pts (2.9%) before RT, 11 pts (10.8%) after RT. The median time from RT to LEL was 4 mths (IQR: 0.5-17.3). At multivariable analysis (MVA) diabetes mellitus (DM) (OR = 32.8, p = 0.02), time between surgery and RT (OR = 0.966, p = 0.039) and exercise (OR = 0.03, p = 0.002) were independently correlated to LEL. The number of examined nodes was highly correlated to LEL at univariate analysis (OR = 1.066, p = 0.025) but was not confirmed at MVA (p = 0.719). Interestingly, the distribution of the examined nodes was statistically different between pts with low (median N = 12) vs. medium/high (N = 5) exercise (p = 0.034).

Conclusions: Clinically detectable LEL involves a minority of pts after RT. DM is a predisposing factor, while awaiting RT delivery has a protective effect favoring salvage over adjuvant RT.

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前列腺癌术后放疗后下肢淋巴水肿的发生率及预测因素。

背景：评估前列腺癌根治性前列腺切除术（RP）±盆腔淋巴结清扫（PLND）后放疗（RT）后下肢淋巴水肿（LEL）的发生率及预测因素。方法：纳入RP±PLND术后接受辅助或补救性RT治疗的患者，随访至少2年。LEL定义为四肢之间的体积差≥10%，采用柔性非拉伸胶带进行周向测量。logistic回归分析了以下预测因素：年龄（连续）；身体质量指数（BMI，连续）；运动水平（低vs.中/高）；吸烟（是否吸烟）；卷烟包/年（连续）；高血压（是或否）；血管合并症（有vs没有）；糖尿病（是或不是）；PLND（是vs.否）；检查节点数（连续）；全骨盆放疗（WPRT）（是与否）；RP和RT之间的时间（连续）；规划目标体积（PTV）体积（连续）；PTV / BMI(连续)。结果：101名患者接受了检查。从手术到放疗的中位时间为36.1个月（IQR: 15.0 ~ 68.3），从放疗到研究检查的中位时间为51.1个月（IQR: 36.8 ~ 65.3）。14例发生LEL(13.9%)，放疗前3例（2.9%），放疗后11例（10.8%）。从放疗到LEL的中位时间为4个月（IQR: 0.5-17.3）。在多变量分析（MVA）中，糖尿病（DM）（OR = 32.8, p = 0.02）、手术与RT之间的时间（OR = 0.966, p = 0.039）和运动（OR = 0.03, p = 0.002）与LEL独立相关。在单变量分析中，检查节点的数量与LEL高度相关（OR = 1.066, p = 0.025），但在MVA中未得到证实（p = 0.719）。有趣的是，低（中位N = 12）与中/高（N = 5）运动的患者（p = 0.034）之间检查淋巴结的分布有统计学差异。结论：临床可检测到的LEL涉及一小部分放疗后的患者，糖尿病是一个易感因素，而等待放疗给予的保护作用有利于挽救而不是辅助放疗。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Radiation Oncology ONCOLOGY-RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING

CiteScore

6.50

自引率

2.80%

发文量

181

审稿时长

3-6 weeks

期刊介绍： Radiation Oncology encompasses all aspects of research that impacts on the treatment of cancer using radiation. It publishes findings in molecular and cellular radiation biology, radiation physics, radiation technology, and clinical oncology.