Pinkawa Michael, Fischedick Karin, Gagel Bernd, Piroth Marc D, Borchers Holger, Jakse Gerhard, Eble Michael J
Department of Radiation Oncology, RWTH Aachen University, Aachen, Germany.
Urology. 2006 Jul;68(1):104-9. doi: 10.1016/j.urology.2006.01.063. Epub 2006 Jun 27.
To characterize the influence of neoadjuvant hormonal therapy (NHT) on health-related quality of life after permanent iodine-125 brachytherapy (BT) for prostate cancer.
A cross-sectional survey using the Expanded Prostate Cancer Index Composite health-related quality-of-life instrument was administered to 134 consecutive patients a median of 29 months after BT. A separate group of 111 patients with comparable demographic characteristics without any prior treatment for prostate cancer rendered the baseline information (control group). The scores and symptom rates were compared. The effect of NHT was tested for independence in a multivariate analysis.
In contrast to patients who received NHT, prostatic edema was hardly detectable 30 days after implantation in patients who received BT alone (comparing median preimplant and postimplant volumes), resulting in a greater dose to the prostate and anterior rectal wall. However, compared with the control group and the patients who received BT alone, the addition of NHT to BT led to lower health-related quality-of-life scores in all domains. Score differences of more than 10 points with a statistical significance were found for the urinary bother, sexual function/bother, and hormonal function/bother domains. Apart from the sexual function scores (patient age shown to be the crucial factor), the influence of NHT remained independent on multivariate analysis.
The results stress the need for well-considered administration of NHT before BT and the need for reporting the use of NHT in studies dealing with BT-related toxicity.
阐述新辅助激素治疗（NHT）对前列腺癌永久性碘-125近距离放射治疗（BT）后健康相关生活质量的影响。
采用扩展前列腺癌指数综合健康相关生活质量量表，对134例连续接受BT治疗的患者进行横断面调查，调查时间为BT治疗后中位数29个月。另一组111例具有可比人口统计学特征且未接受过前列腺癌任何先前治疗的患者提供基线信息（对照组）。比较两组的得分和症状发生率。在多变量分析中测试NHT的效果是否具有独立性。
与接受NHT的患者相比，单纯接受BT治疗的患者在植入后30天几乎检测不到前列腺水肿（比较植入前和植入后的中位数体积），从而使前列腺和直肠前壁接受的剂量更大。然而，与对照组和单纯接受BT治疗的患者相比，BT联合NHT治疗导致所有领域的健康相关生活质量得分更低。在泌尿困扰、性功能/困扰和激素功能/困扰领域发现得分差异超过10分且具有统计学意义。除性功能得分外（患者年龄显示为关键因素），NHT的影响在多变量分析中仍具有独立性。
结果强调在BT治疗前需要谨慎考虑使用NHT，以及在处理BT相关毒性的研究中需要报告NHT的使用情况。
