Van Gellekom Marion P R, Moerland Marinus A, Van Vulpen Marco, Wijrdeman Harm K, Battermann Jan J
Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands.
Int J Radiat Oncol Biol Phys. 2005 Nov 1;63(3):772-80. doi: 10.1016/j.ijrobp.2005.03.046. Epub 2005 Jun 20.
To investigate changes in quality of life (QoL) after permanent prostate brachytherapy and to correlate these changes with postimplant dosimetry based on magnetic resonance (MR) images.
For this study, 127 patients with low-stage prostate cancer and treated with brachytherapy received a QoL questionnaire at five time points: before treatment and at 4 weeks, 6 months, 1 year, and 2 years after treatment. The questionnaire included the RAND-36 generic health survey, the cancer-specific European Organization for Research and Treatment of Cancer (EORTC) core questionnaire, the tumor-specific EORTC prostate cancer module, and the American Urological Association symptom index. Postimplant dosimetry was based on registered T1 spin echo transversal, T2 turbo spin echo transversal, and T2 turbo spin echo sagittal MR images and CT images taken 4 weeks after implantation of the iodine-125 seeds. Calculated parameters were prostate volume, prostate volume receiving 100% (V100) and 150% (V150) dose, dose to 90% of the prostate volume (D90), maximum dose in 1-, 2-, and 5-cm3 rectum volume, distance between prostate and anterior rectum wall, and the maximum dose in 1%, 2%, and 5% urethra volume. Analysis of variance for repeated measures was used for comparison of the means of all variables in the different questionnaires. Linear regression analysis (stepwise) was used to investigate the correlations between QoL parameters and dosimetry parameters.
On average, only the QoL at 4 weeks after implant was significantly different from (worse than) the QoL at the other time points. Regression analysis showed a significant correlation between changes in bowel problems and the maximum dose in 2-cm3 rectum volume, between changes in urinary symptoms and prostate volume, and between changes in urinary problems and the D90 value of the prostate.
The QoL for patients with permanent prostate implants was worse in the first months after treatment but returned to baseline values 1 year after implant. Significant correlations were found between dose distribution and QoL.
研究永久性前列腺近距离放射治疗后生活质量（QoL）的变化，并将这些变化与基于磁共振（MR）图像的植入后剂量测定相关联。
在本研究中，127例接受近距离放射治疗的低分期前列腺癌患者在五个时间点接受了QoL问卷调查：治疗前以及治疗后4周、6个月、1年和2年。问卷包括兰德36项通用健康调查、癌症特异性欧洲癌症研究与治疗组织（EORTC）核心问卷、肿瘤特异性EORTC前列腺癌模块以及美国泌尿外科协会症状指数。植入后剂量测定基于碘-125种子植入后4周拍摄的注册T1自旋回波横向、T2快速自旋回波横向和T2快速自旋回波矢状MR图像以及CT图像。计算参数包括前列腺体积、接受100%（V100）和150%（V150）剂量的前列腺体积、前列腺体积90%的剂量（D90）、1立方厘米、2立方厘米和5立方厘米直肠体积中的最大剂量、前列腺与直肠前壁之间的距离以及1%、2%和5%尿道体积中的最大剂量。重复测量方差分析用于比较不同问卷中所有变量的均值。线性回归分析（逐步）用于研究QoL参数与剂量测定参数之间的相关性。
平均而言，仅植入后4周的QoL与其他时间点的QoL有显著差异（更差）。回归分析显示，肠道问题的变化与2立方厘米直肠体积中的最大剂量之间、泌尿症状的变化与前列腺体积之间以及泌尿问题的变化与前列腺的D90值之间存在显著相关性。
永久性前列腺植入患者的QoL在治疗后的头几个月较差，但在植入1年后恢复到基线值。发现剂量分布与QoL之间存在显著相关性。
