Department of Radiation Oncology, Stanford University School of Medicine, CA, USA.
Int J Radiat Oncol Biol Phys. 2010 Oct 1;78(2):442-8. doi: 10.1016/j.ijrobp.2009.07.1748. Epub 2010 Feb 4.
To study the sexual quality of life for prostate cancer patients after stereotactic body radiotherapy (SBRT).
Using the Expanded Prostate Cancer Index Composite (EPIC)-validated quality-of-life questionnaire, the sexual function of 32 consecutive patients who received prostate SBRT in a prospective Phase II clinical trial were analyzed at baseline, and at median times of 4, 12, 20, and 50 months after treatment. SBRT consisted of 36.25 Gy in five fractions of 7.25 Gy using the Cyberknife. No androgen deprivation therapy was given. The use of erectile dysfunction (ED) medications was monitored. A comprehensive literature review for radiotherapy-alone modalities based on patient self-reported questionnaires served as historical comparison.
Median age at treatment was 67.5 years, and median follow-up was 35.5 months (minimum 12 months). The mean EPIC sexual domain summary score, sexual function score, and sexual bother score decreased by 45%, 49%, and 25% respectively at 50 months follow-up. These differences reached clinical relevance by 20 months after treatment. Baseline ED rate was 38% and increased to 71% after treatment (p = 0.024). Use of ED medications was 3% at baseline and progressed to 25%. For patients aged <70 years at follow-up, 60% maintained satisfactory erectile function after treatment compared with only 12% aged ≥70 years (p = 0.008). Penile bulb dose was not associated with ED.
The rates of ED after treatment appear comparable to those reported for other modalities of radiotherapy. Given the modest size of this study and the uncertainties in the physiology of radiotherapy-related ED, these results merit further investigations.
研究立体定向体放射治疗（SBRT）后前列腺癌患者的生活质量。
使用经过验证的前列腺癌指数综合量表（EPIC）生活质量问卷，对 32 例连续接受前列腺 SBRT 的患者进行分析，这些患者在前瞻性 II 期临床试验中接受治疗，在基线时以及治疗后 4、12、20 和 50 个月时进行分析。SBRT 采用 Cyberknife 进行，共 5 次，每次 7.25Gy，共 36.25Gy。未给予雄激素剥夺治疗。监测使用勃起功能障碍（ED）药物的情况。对基于患者自我报告问卷的放射治疗单一模式的综合文献复习作为历史对照。
中位治疗年龄为 67.5 岁，中位随访时间为 35.5 个月（最短 12 个月）。50 个月随访时，EPIC 性领域综合评分、性功能评分和性困扰评分分别下降了 45%、49%和 25%。这些差异在治疗后 20 个月达到临床相关。基线 ED 发生率为 38%，治疗后增加至 71%（p=0.024）。基线时 ED 药物使用率为 3%，进展至 25%。对于随访时年龄<70 岁的患者，60%在治疗后保持满意的勃起功能，而年龄≥70 岁的患者仅为 12%（p=0.008）。阴茎球部剂量与 ED 无关。
治疗后的 ED 发生率似乎与其他放射治疗方式报告的发生率相当。鉴于本研究规模较小，以及放射治疗相关 ED 的生理学存在不确定性，这些结果值得进一步研究。
