Keyes Mira, Miller Stacy, Moravan Veronika, Pickles Tom, McKenzie Michael, Pai Howard, Liu Mitchell, Kwan Winkle, Agranovich Alexander, Spadinger Ingrid, Lapointe Vincent, Halperin Ross, Morris W James
Vancouver Cancer Center, Vancouver, BC, Canada.
Int J Radiat Oncol Biol Phys. 2009 Mar 15;73(4):1023-32. doi: 10.1016/j.ijrobp.2008.05.022. Epub 2008 Dec 26.
To describe the frequency of acute and late Radiation Therapy Oncology Group (RTOG) urinary toxicity, associated predictive factors, and resolution of International Prostate Symptom Score (IPSS) in 712 consecutive prostate brachytherapy patients.
Patients underwent implantation between 1998 and 2003 (median follow-up, 57 months). The IPSS and RTOG toxicity data were prospectively collected. The patient, treatment, and implant factors were examined for an association with urinary toxicity. The time to IPSS resolution was examined using Kaplan-Meier curves, and multivariate modeling of IPSS resolution was done using Cox proportional hazards regression analysis. Logistic regression analysis was used to examine the factors associated with urinary toxicity.
The IPSS returned to baseline at a median of 12.6 months. On multivariate analysis, patients with a high baseline IPSS had a quicker resolution of their IPSS. Higher prostate D90 (dose covering 90% of the prostate), maximal postimplant IPSS, and urinary retention slowed the IPSS resolution time. The rate of the actuarial 5-year late urinary (>12 months) RTOG Grade 0, 1, 2, 3, and 4 was 32%, 36%, 24%, 6.2%, and 0.1%, respectively. At 7 years, the prevalence of RTOG Grade 0-1 was 92.5%. Patients with a larger prostate volume, greater number of needles, greater baseline IPSS, and use of hormonal therapy had more acute toxicity. On multivariate analysis, the significant predictors for late greater than or equal to RTOG toxicity 2 were a greater baseline IPSS, maximal postimplant IPSS, presence of acute toxicity, and higher prostate V150 (volume of the prostate covered by 150% of the dose). More recently implanted patients had less acute urinary toxicity and patients given hormonal therapy had less late urinary toxicity (all p < 0.02).
Most urinary symptoms resolved within 12 months after prostate brachytherapy, and significant long-term urinary toxicity was very low. Refined patient selection and greater technical experience in prostate brachytherapy were associated with less urinary toxicity.
描述712例连续性前列腺近距离放射治疗患者中急性和晚期放射治疗肿瘤学组（RTOG）泌尿系统毒性的发生率、相关预测因素以及国际前列腺症状评分（IPSS）的缓解情况。
患者于1998年至2003年间接受植入治疗（中位随访时间为57个月）。前瞻性收集IPSS和RTOG毒性数据。检查患者、治疗和植入因素与泌尿系统毒性之间的关联。使用Kaplan-Meier曲线检查IPSS缓解时间，并使用Cox比例风险回归分析对IPSS缓解进行多变量建模。采用逻辑回归分析检查与泌尿系统毒性相关的因素。
IPSS在中位时间12.6个月时恢复至基线水平。多变量分析显示，基线IPSS高的患者IPSS缓解更快。较高的前列腺D90（覆盖前列腺90%的剂量）、植入后最大IPSS以及尿潴留会延长IPSS缓解时间。精算5年晚期泌尿系统（>12个月）RTOG 0、1、2、3和4级的发生率分别为32%、36%、24%、6.2%和0.1%。在7年时，RTOG 0-1级的患病率为92.5%。前列腺体积较大、针数较多、基线IPSS较高以及使用激素治疗的患者急性毒性更大。多变量分析显示，晚期大于或等于RTOG 2级毒性的显著预测因素为基线IPSS较高、植入后最大IPSS、存在急性毒性以及较高的前列腺V150（接受150%剂量覆盖的前列腺体积）。近期植入的患者急性泌尿系统毒性较小，接受激素治疗的患者晚期泌尿系统毒性较小（所有p<0.02）。
大多数泌尿系统症状在前列腺近距离放射治疗后12个月内得到缓解，严重的长期泌尿系统毒性非常低。优化患者选择以及在前列腺近距离放射治疗方面积累更丰富的技术经验与更低的泌尿系统毒性相关。
