University Medical Centre Utrecht, Utrecht, The Netherlands; The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands.
Eur Urol. 2016 Nov;70(5):751-757. doi: 10.1016/j.eururo.2016.03.010. Epub 2016 Mar 22.
The impact of salvage radiotherapy (SRT) and its timing on health-related quality of life (HRQoL) in prostate cancer patients is still unclear.
To compare the HRQoL of patients who underwent SRT with that of patients who underwent radical prostatectomy (RP) only and to investigate whether SRT timing is associated with HRQoL.
DESIGN, SETTING, AND PARTICIPANTS: All SRT patients (n=241) and all RP-only patients (n=1005) were selected from a prospective database (2004-2015). The database contained HRQoL and prostate problem assessments up to 2 yr after last treatment.
Mixed effects growth modelling adjusting for significant differences in patient characteristics and baseline HRQoL was used to analyze the association between: (1) "treatment" (RP-only vs SRT) and (2) "timing of SRT" with changes in HRQoL.
SRT patients showed significantly (p<0.05) poorer recovery from urinary, bowel, and erectile function after their last treatment (clinically meaningful difference for urinary and erectile function). Patients with a longer interval (≥ 7 mo) between RP and SRT reported significantly better sexual satisfaction after SRT (p=0.02), and a better urinary function recovery (p=0.03). Limitations of the study include the nonrandom design and the variability in timing of HRQoL measurements.
Up to 2 yr after treatment, SRT patients reported poorer HRQoL in several HRQoL domains compared with RP-only patients, but not in overall HRQoL. Delaying the start of SRT after RP may limit the incidence and duration of urinary and sexual problems. Nevertheless, decisions regarding SRT timing should also be based on the potential benefits in disease recurrence.
Patients who receive radiotherapy after surgery may experience poorer urinary, bowel, and erectile function compared with patients who undergo surgery only. Although more research is needed, delaying radiotherapy seems to limit its impact on urinary and sexual functioning.
挽救性放疗（SRT）及其时机对前列腺癌患者的健康相关生活质量（HRQoL）的影响仍不清楚。
比较接受 SRT 的患者与仅接受根治性前列腺切除术（RP）的患者的 HRQoL，并探讨 SRT 时机是否与 HRQoL 相关。
设计、设置和参与者：从一个前瞻性数据库（2004-2015 年）中选择所有 SRT 患者（n=241）和所有仅 RP 患者（n=1005）。该数据库包含最后一次治疗后长达 2 年的 HRQoL 和前列腺问题评估。
使用混合效应增长模型，根据患者特征和基线 HRQoL 的显著差异进行调整，分析以下因素之间的关联：（1）“治疗”（仅 RP 与 SRT）和（2）“SRT 时机”与 HRQoL 变化之间的关系。
SRT 患者在最后一次治疗后，尿、肠和性功能的恢复明显较差（尿和性功能有临床意义的差异）（p<0.05）。RP 和 SRT 之间间隔时间较长（≥7 个月）的患者在 SRT 后报告的性满意度显著提高（p=0.02），且尿功能恢复更好（p=0.03）。该研究的局限性包括非随机设计和 HRQoL 测量时间的可变性。
在治疗后 2 年内，与仅接受 RP 的患者相比，SRT 患者在几个 HRQoL 领域报告的 HRQoL 较差，但总体 HRQoL 没有差异。延迟 RP 后开始 SRT 可能会限制尿和性功能问题的发生率和持续时间。然而，SRT 时机的决策也应基于疾病复发的潜在益处。
与仅接受手术的患者相比，接受手术后放疗的患者可能会出现更差的尿、肠和性功能。尽管需要进一步研究，但延迟放疗似乎会限制其对尿和性功能的影响。
