Department of Radiotherapy, RWTH Aachen University, Aachen, Germany.
Int J Radiat Oncol Biol Phys. 2011 Sep 1;81(1):23-8. doi: 10.1016/j.ijrobp.2010.05.054. Epub 2010 Sep 9.
Comparison of health-related quality of life after whole pelvic (WPRT) and prostate-only (PORT) external beam radiotherapy for prostate cancer.
A group of 120 patients (60 in each group) was surveyed prospectively before radiation therapy (RT) (time A), at the last day of RT (time B), at a median time of 2 months (time C) and >1 year after RT (time D) using a validated questionnaire (Expanded Prostate Cancer Index Composite). All patients were treated with 1.8- to 2.0-Gy fractions up to 70.2 to 72.0 Gy with or without WPRT up to 45 to 46 Gy. Pairs were matched according to the following criteria: age±5 years, planning target volume±10 cc (considering planning target volume without pelvic nodes for WPRT patients), urinary/bowel/sexual function score before RT±10, and use of antiandrogens.
With the exception of prognostic risk factors, both groups were well balanced with respect to baseline characteristics. No significant differences were found with regard to urinary and sexual score changes. Mean bladder function scores reached baseline levels in both patient subgroups after RT. However, bowel function scores decreased significantly more for patients after WPRT than in those receiving PORT at all times (p<0.01, respectively). Significant differences were found for most items in the bowel domain in the acute phase. At time D, patients after WPRT reported rectal urgency (>once a day in 15% vs. 3%; p=0.03), bloody stools (≥half the time in 7% vs. 0%; p=0.04) and frequent bowel movements (>two on a typical day in 32% vs. 7%; p<0.01) more often than did patients after PORT.
In comparison to PORT, WPRT (larger bladder and rectum volumes in medium dose levels, but similar volumes in high dose levels) was associated with decreased bowel quality of life in the acute and chronic phases after treatment but remained without adverse long-term urinary effects.
比较全盆腔（WPRT）和前列腺单纯放疗（PORT）治疗前列腺癌的健康相关生活质量。
一组 120 名患者（每组 60 名）在放疗前（时间 A）、放疗最后一天（时间 B）、中位时间 2 个月（时间 C）和放疗后>1 年（时间 D）进行前瞻性调查，使用经过验证的问卷（扩展前列腺癌指数综合量表）。所有患者均接受 1.8-2.0Gy 分次剂量，达到 70.2-72.0Gy，或接受 WPRT 达到 45-46Gy。根据以下标准对患者进行配对：年龄±5 岁，计划靶区体积±10cc（考虑 WPRT 患者的盆腔淋巴结计划靶区），放疗前的尿/便/性功能评分±10，以及使用抗雄激素药物。
除预后危险因素外，两组患者在基线特征方面均具有良好的可比性。在尿和性功能评分变化方面无显著差异。两组患者在放疗后膀胱功能评分均恢复至基线水平。然而，在所有时间点，接受 WPRT 的患者的肠道功能评分均显著低于 PORT 组（分别为 p<0.01）。在急性期，肠域的大多数项目均存在显著差异。在时间 D，接受 WPRT 的患者报告直肠急迫感（每天>1 次的比例为 15%比 3%；p=0.03）、血便（≥一半时间的比例为 7%比 0%；p=0.04）和频繁排便（典型日排便次数>2 次的比例为 32%比 7%；p<0.01）的频率高于 PORT 组患者。
与 PORT 相比，WPRT（中剂量水平膀胱和直肠体积较大，但高剂量水平体积相似）与治疗后急性和慢性阶段的肠道生活质量下降有关，但对长期尿功能无不良影响。
