Department of Radiation Oncology, The Netherlands Cancer Institute -Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Radiother Oncol. 2013 Nov;109(2):251-5. doi: 10.1016/j.radonc.2013.07.019. Epub 2013 Sep 20.
To investigate possible relationships between the dose to the sub-segments of the lower urinary tract and lower urinary tract symptoms (LUTS) after brachytherapy of the prostate.
This study involved 225 patients treated for prostate cancer with I-125 seeds. Post-implant dose-volume histograms of the prostate, urethra, bladder wall, bladder neck and external sphincter were determined. Endpoints were the mean and the maximum International Prostate Symptom Score (IPSS) during the first 3months after the treatment. For binary analysis the patients were stratified in a group with enhanced LUTS and a group with non-enhanced LUTS.
The dose to 0.5cm(3) of the bladder neck 'D0.5cc-blne' (p=0.002 and p=0.005), the prostate volume prior to treatment 'Vpr-0' (p=0.005 and p=0.024) and the pre-treatment IPSS (both p<0.001) were independently correlated with mean and maximum IPSS, respectively. Of the patients with a D0.5cc-blne⩾175Gy and a Vpr-0⩾42cm(3), 68% suffered from enhanced LUTS, against just 30% of the other patients (p<0.0001).
Pre-treatment IPSS, prostate volume and dose to the bladder neck are correlated with post-implant IPSS. A combination of a large prostate and a high dose to the bladder neck is highly predictive for enhanced early LUTS.
探讨前列腺近距离放疗后，下尿路亚段剂量与下尿路症状（LUTS）之间的可能关系。
本研究纳入了 225 例接受 I-125 种子治疗的前列腺癌患者。对前列腺、尿道、膀胱壁、膀胱颈部和外括约肌的植入后剂量-体积直方图进行了测定。终点为治疗后 3 个月内的平均和最大国际前列腺症状评分（IPSS）。为了进行二元分析，将患者分为 LUTS 加重组和非 LUTS 加重组。
膀胱颈部 0.5cm(3)处的剂量（D0.5cc-blne）（p=0.002 和 p=0.005）、治疗前前列腺体积（Vpr-0）（p=0.005 和 p=0.024）和治疗前 IPSS（均 p<0.001）与平均和最大 IPSS 分别独立相关。D0.5cc-blne ⩾175Gy 和 Vpr-0 ⩾42cm(3)的患者中，68%出现 LUTS 加重，而其他患者仅为 30%（p<0.0001）。
治疗前 IPSS、前列腺体积和膀胱颈部剂量与植入后 IPSS 相关。前列腺体积大且膀胱颈部剂量高的组合对早期 LUTS 加重有高度预测性。
