Lee W R, McQuellon R P, Harris-Henderson K, Case L D, McCullough D L
Department of Radiation Oncology, Comprehensive Cancer Center of the Wake Forest University School of Medicine, Winston-Salem, NC 27157-1030, USA.
Int J Radiat Oncol Biol Phys. 2000 Jan 1;46(1):77-81. doi: 10.1016/s0360-3016(99)00355-7.
To prospectively assess the health-related quality of life (HRQOL) and changes in HRQOL during the first year after permanent source interstitial brachytherapy (PIB).
Thirty-one men treated with PIB between September 1997 and March 1998 completed a quality of life (functional assessment of cancer therapy-prostate: FACT-P) and a urinary symptom questionnaire (international prostate symptom score: IPSS) prior to treatment (T0), 1 month (T1), 3 months (T3), 6 months (T6), and 12 months (T12) following PIB. All participants were treated with 125I alone. Repeated measures analyses of variance (ANOVA) were conducted on all quality of life and urinary outcome measures for all 31 patients at all time points.
The median age of the study population was 66 (range 51-80). All men had clinical T1c-T2b prostate cancer. The Gleason score was < or =6 in 27/31 (87%). Median pretreatment PSA was 7.8 ng/ml (range 1.1-20.6). The mean score (and standard deviation) at T0, T1, T3, T6, and T12 for the FACT-P questionnaire are as follows: 140.5 (13.5), 132.7 (15.3), 137.2 (17.4), 140.1 (16.0), and 142.4 (15.3). For the global test across time, statistically significant differences were observed for the cumulative scores of FACT-P (p<0.0012). The decrease in HRQOL was most marked 1 month following PIB. Examination of the subscales within the FACT-P instrument demonstrated statistically significant changes over time for the following: physical well-being (PWB), functional well-being (FWB), and prostate cancer (PCS). By 3 months, all HRQOL measures had returned to near baseline. The mean score (and standard deviation) at T0, T1, T3, T6, and T12 for the IPSS questionnaire are as follows: 8.3 (5.5), 18.4 (8.0), 15.7 (7.4), 13.7 (7.4), and 10.2 (5.7). For the global test across time, statistically significant differences were observed for the IPSS scores (p<0.0001). The maximum increase in IPSS occurred 1 month following PIB.
The results of this preliminary analysis suggest that clinically meaningful decreases in HRQOL, as measured by the FACT-P instrument, are evident within weeks after PIB. By 3 months, however, FACT-P scores return to near baseline levels. A validated instrument designed to measure urinary symptoms (IPSS) demonstrates that moderate to severe urinary symptoms persist for at least 3-6 months following PIB. One year following PIB, the scores on the FACT-P and IPSS questionnaires had returned to baseline.
前瞻性评估永久性源间质近距离放射治疗（PIB）后第一年的健康相关生活质量（HRQOL）及HRQOL的变化。
1997年9月至1998年3月间接受PIB治疗的31名男性在治疗前（T0）、PIB后1个月（T1）、3个月（T3）、6个月（T6）和12个月（T12）完成了生活质量问卷（癌症治疗功能评估-前列腺：FACT-P）和泌尿系统症状问卷（国际前列腺症状评分：IPSS）。所有参与者均仅接受¹²⁵I治疗。对所有31名患者在所有时间点的所有生活质量和泌尿系统结局指标进行重复测量方差分析（ANOVA）。
研究人群的中位年龄为66岁（范围51 - 80岁）。所有男性均患有临床T1c - T2b期前列腺癌。31例中有27例（87%）Gleason评分≤6分。治疗前PSA中位数为7.8 ng/ml（范围1.1 - 20.6）。FACT-P问卷在T0、T1、T3、T6和T12时的平均得分（及标准差）如下：140.5（13.5）、132.7（15.3）、137.2（17.4）、140.1（16.0）和142.4（15.3）。对于整个时间跨度的总体检验，FACT-P累积得分存在统计学显著差异（p < 0.0012）。HRQOL下降在PIB后1个月最为明显。对FACT-P量表各子量表的检查显示，以下方面随时间有统计学显著变化：身体健康（PWB）、功能健康（FWB）和前列腺癌（PCS）。到3个月时，所有HRQOL指标均恢复至接近基线水平。IPSS问卷在T0、T1、T3、T6和T12时的平均得分（及标准差）如下：8.3（5.5）、18.4（8.0）、15.7（7.4）、13.7（7.4）和10.2（5.7）。对于整个时间跨度的总体检验，IPSS得分存在统计学显著差异（p < 0.0001）。IPSS最大增幅出现在PIB后1个月。
这项初步分析结果表明，以FACT-P量表衡量，PIB后数周内HRQOL出现具有临床意义的下降。然而，到3个月时，FACT-P得分恢复至接近基线水平。一种经过验证的用于测量泌尿系统症状的量表（IPSS）显示，PIB后中度至重度泌尿系统症状至少持续3 - 6个月。PIB后一年，FACT-P和IPSS问卷得分已恢复至基线水平。
