放射治疗 1 至 14 年后前列腺癌幸存者的尿道疼痛。
Urethral pain among prostate cancer survivors 1 to 14 years after radiation therapy.
机构信息
Department of Physics and Biomedical Engineering, Sahlgrenska University Hospital, and Department of Oncology, Institute of Clinical Sciences, Sahlgrenska Academy at University of Gothenburg, Göteborg, Sweden.
出版信息
Int J Radiat Oncol Biol Phys. 2013 Jan 1;85(1):e29-37. doi: 10.1016/j.ijrobp.2012.08.037.
PURPOSE
To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors.
METHODS AND MATERIALS
Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Göteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2×10.0 Gy for EBRT+BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates.
RESULTS
Of the treated men, 16% (137 of 863) reported urethral pain, compared with 11% (27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up≥3 years, 19% of men (52 of 268) within the 70-Gy EBRT+BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain.
CONCLUSIONS
Survivors treated with EBRT+BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral doses up to 70 Gy3.
目的
探讨治疗相关因素和非治疗相关因素对长期前列腺癌幸存者尿道疼痛的影响。
方法和材料
瑞典哥德堡萨尔格伦斯卡大学医院于 1993 年至 2006 年采用放射治疗治疗前列腺癌的男性患者，通过特定的研究邮寄问卷进行治疗后症状调查，包括排尿时尿道灼痛（n=985）。这些男性接受了原发性或挽救性外照射放疗（EBRT）或 EBRT 联合近距离放射治疗（BT）。常用的处方剂量为原发性和挽救性 EBRT 时 70 Gy/2.0 Gy 分次，EBRT+BT 时为 50 Gy+2×10.0 Gy。从治疗记录中评估前列腺尿道剂量。我们还招募了 350 名未进行盆腔照射的、年龄和居住地点相匹配的人群对照，以提供症状背景率。
结果
接受治疗的男性中，16%（137/863）报告有尿道疼痛，而对照组为 11%（27/242）。中位随访时间为 5.2 年（1.1-14.3 年）。前列腺尿道剂量与 EBRT 的处方剂量相似，BT 则为 100%至 115%。分次校正剂量和随访时间影响症状的发生。对于随访≥3 年的患者，70 Gy EBRT+BT 组有 19%（52/268）的男性报告疼痛，而 70 Gy 原发性 EBRT 组有 10%（23/222）的男性报告疼痛（流行率比 1.9；95%置信区间 1.2-3.0）。接受挽救性 EBRT 治疗的男性中，有 10%（20/197）报告有尿道疼痛。
结论
与接受 EBRT 治疗的患者相比，接受 EBRT+BT 治疗的患者发生尿道疼痛的风险更高。随着随访时间的延长，症状的流行率下降。我们发现分次校正的尿道剂量与疼痛之间存在关系。在长期前列腺癌幸存者中，对于前列腺尿道剂量高达 70 Gy3，疼痛的发生并未高于背景率。
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