Keyes Mira, Schellenberg Devin, Moravan Veronika, McKenzie Michael, Agranovich Alexander, Pickles Tom, Wu Jonn, Liu Mitchell, Bucci Joseph, Morris W James
Department of Radiation Oncology, Vancouver Cancer Centre, Vancouver, BC, Canada.
Int J Radiat Oncol Biol Phys. 2006 Mar 1;64(3):825-34. doi: 10.1016/j.ijrobp.2005.04.056.
To evaluate the incidence and factors predictive of acute urinary retention (AUR) in 805 consecutive patients treated with prostate brachytherapy monotherapy and to examine the possible effect of a learning curve.
Between July 1998 and November 2002, 805 patients were treated with prostate brachytherapy. Low-risk patients (Gleason Score (GS) < or = 6; prostate specific antigen (PSA) < or = 10, and < or = T2b [UICC 1997]) received implant alone. Patients with prostate volume of 50 cc or more, GS = 7, or PSA = 10 to 15 received 6 months of androgen suppression (AS) with brachytherapy. Patient, treatment, and dosimetric factors examined include baseline prostate symptom score (IPSS), diabetes, vascular disease, PSA, Gleason score, clinical stage, AS, ultrasound planning target volume (PUTV), postimplant prostate volume (obtained with "Day 30" postimplant CT), CT:PUTV ratio (surrogate for postimplant edema), number of seeds, number of needles, number of seeds per needle, dosimetric parameters (V100, V150, and D90), date of implant (learning curve), and implanting oncologists. Univariate and multivariate analyses were carried out.
Acute urinary retention in the first 200 patients was 17% vs. 6.3% in the most recently treated 200 patients (p = 0.002). Overall AUR was 12.7%, and prolonged urinary obstruction incidence (> 20 days) was 5%. On multivariate analysis, factors predictive of any AUR include baseline IPSS (p = < 0.004), CT:PUTV ratio (p = < 0.001), PUTV (p = < 0.001), and implant order (learning curve) (p = 0.001). Factors predictive for "prolonged" catheterization (> 20 days) on multivariate analysis include IPSS (p < 0.01), number of needles (p < 0.001), diabetes mellitus (p = 0.048), and CT:PUTV ratio (p < 0.001)
Over the years, our AUR rate has fallen significantly (from 17% to 6.3%). On multivariate analysis, highly significant factors include IPSS, PUTV, CT:PUTV ratio (i.e., degree of prostate edema), and order of implant (learning curve). Over the course of the program, we have deliberately reduced the number of needles and OR time per patient, which have potentially minimized intraoperative trauma and may have contributed to less toxicity. A learning curve in prostate brachytherapy programs affect not only the outcome but also the toxicity from the treatment.
评估805例接受前列腺近距离放射治疗单一疗法的连续患者急性尿潴留（AUR）的发生率及预测因素，并探讨学习曲线可能产生的影响。
1998年7月至2002年11月期间，805例患者接受了前列腺近距离放射治疗。低风险患者（ Gleason评分（GS）≤6；前列腺特异性抗原（PSA）≤10，且≤T2b [UICC 1997]）仅接受植入治疗。前列腺体积≥50 cc、GS = 7或PSA = 10至15的患者在接受近距离放射治疗的同时接受6个月的雄激素抑制（AS）治疗。所检查的患者、治疗和剂量学因素包括基线前列腺症状评分（IPSS）、糖尿病、血管疾病、PSA、Gleason评分、临床分期、AS、超声计划靶体积（PUTV）、植入后前列腺体积（通过植入后“第30天”CT获得）、CT:PUTV比值（植入后水肿的替代指标）、粒子数量、针数、每针粒子数量、剂量学参数（V100、V150和D90）、植入日期（学习曲线）以及植入肿瘤学家。进行了单因素和多因素分析。
前200例患者的急性尿潴留发生率为17%，而最近治疗的200例患者为6.3%（p = 0.002）。总体AUR为12.7%，长期尿路梗阻发生率（> 20天）为5%。多因素分析显示，预测任何AUR的因素包括基线IPSS（p = < 0.004）、CT:PUTV比值（p = < 0.001）、PUTV（p = < 0.001）以及植入顺序（学习曲线）（p = 0.001）。多因素分析预测“长期”导尿（> 20天）的因素包括IPSS（p < 0.01）、针数（p < 0.001）、糖尿病（p = 0.048）以及CT:PUTV比值（p < 0.001）。
多年来，我们的AUR率显著下降（从17%降至6.3%）。多因素分析显示，高度显著的因素包括IPSS、PUTV、CT:PUTV比值（即前列腺水肿程度）以及植入顺序（学习曲线）。在该项目过程中，我们刻意减少了每位患者的针数和手术时间，这可能最大限度地减少了术中创伤，并可能降低了毒性。前列腺近距离放射治疗项目中的学习曲线不仅影响治疗结果，还影响治疗毒性。
