Pinkawa Michael, Piroth Marc D, Fischedick Karin, Holy Richard, Klotz Jens, Nussen Sandra, Krenkel Barbara, Eble Michael J
Department of Radiotherapy, RWTH Aachen, Aachen, Germany.
Strahlenther Onkol. 2009 Nov;185(11):724-30. doi: 10.1007/s00066-009-2008-6. Epub 2009 Nov 10.
To evaluate the impact of the clinical target volume (CTV) and fraction dose on quality of life (QoL) after external-beam radiotherapy (EBRT) for prostate cancer.
A group of 283 patients has been surveyed prospectively before, at the last day, at a median time of 2 months and 15 months after EBRT (70.2-72 Gy) using a validated questionnaire (Expanded Prostate Cancer Index Composite). EBRT of prostate alone (P, n = 70) versus prostate with seminal vesicles (PS, n = 213) was compared. Differences of fraction doses (1.8 Gy, n = 80, vs. 2.0 Gy, n = 69) have been evaluated in the patient group receiving a total dose of 72 Gy.
Significantly higher bladder and rectum volumes were found at all dose levels for the patients with PS versus P within the CTV (p < 0.001). Similar volumes resulted in the groups with different fraction doses. Paradoxically, bowel function scores decreased significantly less 2 and 15 months after EBRT of PS versus P. 2 months after EBRT, patients with a fraction dose of 2.0 Gy versus 1.8 Gy reported pain with urination (> or = once a day in 12% vs. 3%; p = 0.04) and painful bowel movements (> or = rarely in 46% vs. 29%; p = 0.05) more frequently. No long-term differences were found.
The risk of adverse QoL changes after EBRT for prostate cancer cannot be derived from the dose-volume histogram alone. Seminal vesicles can be included in the CTV up to a moderate total dose without adverse effects on QoL. Apart from a longer recovery period, higher fraction doses were not associated with higher toxicity.
评估临床靶区（CTV）和分次剂量对前列腺癌外照射放疗（EBRT）后生活质量（QoL）的影响。
使用经过验证的问卷（扩展前列腺癌指数综合问卷），对283例患者在EBRT（70.2 - 72 Gy）前、最后一天、EBRT后中位时间2个月和15个月进行前瞻性调查。比较单纯前列腺放疗（P，n = 70）与前列腺加精囊放疗（PS，n = 213）的情况。在接受总剂量72 Gy的患者组中评估了分次剂量差异（1.8 Gy，n = 80，与2.0 Gy，n = 69）。
在CTV内，PS组患者在所有剂量水平下的膀胱和直肠体积均显著高于P组（p < 0.001）。不同分次剂量组的体积相似。矛盾的是，PS组EBRT后2个月和15个月时肠道功能评分的下降明显少于P组。EBRT后2个月，分次剂量为2.0 Gy的患者与1.8 Gy的患者相比，排尿疼痛（每天≥1次的比例为12%对3%；p = 0.04）和排便疼痛（≥很少的比例为46%对29%；p = 0.05）更为频繁。未发现长期差异。
前列腺癌EBRT后生活质量发生不良变化的风险不能仅从剂量体积直方图得出。精囊可纳入CTV至中等总剂量，而不会对生活质量产生不良影响。除了恢复时间较长外，较高的分次剂量与更高的毒性无关。
