Chan Elisa K, Keyes Mira, Pickles Tom, Lapointe Vincent, Spadinger Ingrid, McKenzie Michael, Morris W James
Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC, Canada.
Brachytherapy. 2014 Jan-Feb;13(1):46-52. doi: 10.1016/j.brachy.2013.10.005. Epub 2013 Nov 7.
To determine whether acute urinary toxicity rates improve with the overall experience of a large prostate brachytherapy program.
From 1998 to 2009, 2937 patients were treated with prostate brachytherapy at the British Columbia Cancer Agency. Baseline patient, treatment, and implant factors were recorded prospectively. Acute urinary toxicity data were prospectively recorded at baseline and each follow-up visit. Patients with ≥2 years of follow-up data were grouped into cohorts of 500 for analysis.
Two thousand eleven patients met the above criteria. Acute urinary retention (AUR) in the acute period (within 6 months of implant) occurred in 9.1% of patients overall and was prolonged (catheterization >20 days) in 3.4%. Both overall AUR and prolonged AUR decreased across implant cohorts (p ≤ 0.001 in both cases). Overall acute Radiation Therapy Oncology Group (RTOG) Grades 0 and 1 urinary toxicity rate was 57.5% and RTOG Grades 2 and 3 urinary toxicity rates were 34.3% and 8.1%, respectively. Acute toxicity improved over time for both RTOG Grades ≥2 and ≥3 toxicity (p < 0.0001). International prostate symptom score resolution to baseline was achieved in 80.5% of patients with a median time of 12.2 months.
Acute AUR and RTOG urinary toxicity rates continue to decline with the increasing experience of our provincial prostate brachytherapy program, despite its expansion to new centers and addition of members. This is likely due to better patient selection, refinement in treatment planning and implantation technique, and mentorship and training process.
确定大型前列腺近距离放射治疗项目的整体经验是否能提高急性泌尿毒性发生率。
1998年至2009年，不列颠哥伦比亚癌症机构对2937例患者进行了前列腺近距离放射治疗。前瞻性记录患者的基线、治疗及植入因素。前瞻性记录基线及每次随访时的急性泌尿毒性数据。将随访数据≥2年的患者按500人一组进行队列分析。
2111例患者符合上述标准。急性期（植入后6个月内）急性尿潴留（AUR）的总体发生率为9.1%，其中留置导尿管时间延长（>20天）的发生率为3.4%。在各植入队列中，总体AUR和延长AUR均有所下降（两种情况p均≤0.001）。总体急性放射治疗肿瘤学组（RTOG）0级和1级泌尿毒性发生率为57.5%，RTOG 2级和3级泌尿毒性发生率分别为34.3%和8.1%。RTOG≥2级和≥3级毒性的急性毒性均随时间改善（p<0.0001）。80.5%的患者国际前列腺症状评分恢复至基线水平，中位时间为12.2个月。
尽管我们省级前列腺近距离放射治疗项目已扩展到新的中心并增加了成员，但随着经验的增加，急性AUR和RTOG泌尿毒性发生率仍在继续下降。这可能归因于更好的患者选择、治疗计划和植入技术的改进，以及指导和培训过程。
