Mayer Erik N, Tward Jonathan D, Bassett Mitchell, Lenherr Sara M, Hotaling James M, Brant William O, Lowrance William T, Myers Jeremy B
Department of Surgery, Center for Reconstructive Urology and Huntsman Cancer Institute, University of Utah, Salt Lake City, UT, USA.
BJU Int. 2017 May;119(5):700-708. doi: 10.1111/bju.13607. Epub 2016 Aug 30.
To describe the management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa).
We conducted a single-centre retrospective review, over a 6-year period (2010-2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [RP] followed by external beam radiotherapy [EBRT], EBRT + low-dose-rate [LDR] brachytherapy, EBRT + high-dose-rate [HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs.
We identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT (n = 19), HDR brachytherapy + EBRT (n = 19), LDR brachytherapy + EBRT (n = 5), and other combined RT (n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT (n = 4), HDR brachytherapy (n = 11), LDR brachytherapy (n = 12), or proton beam therapy (n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (UD) in 23 men (32%). Reconstruction included: ureteric (n = 4), recto-urethral fistula repair (n = 2), and posterior urethroplasty (n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful.
Although the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.
描述前列腺癌（PCa）放疗（RT）后放射治疗肿瘤学组（RTOG）4级泌尿系统不良事件（UAEs）的处理情况。
我们进行了一项为期6年（2010 - 2015年）的单中心回顾性研究，以确定PCa放疗后发生RTOG 4级UAEs的男性患者。放疗分为联合治疗（根治性前列腺切除术[RP]后行体外束放疗[EBRT]、EBRT + 低剂量率[LDR]近距离放疗、EBRT + 高剂量率[HDR]近距离放疗或其他放疗联合方案）或单纯放疗。UAEs分为出口型（尿道狭窄、膀胱颈挛缩、前列腺坏死或直肠尿道瘘）或膀胱型（挛缩、坏死、瘘、输尿管狭窄或出血）UAEs。
我们确定了73名平均年龄为73岁的男性患者。其中，44名（60%）接受联合治疗，包括RP + EBRT（n = 19）、HDR近距离放疗 + EBRT（n = 19）、LDR近距离放疗 + EBRT（n = 5）以及其他联合放疗（n = 1）。29名（40%）患者接受单纯放疗，包括EBRT（n = 4）、HDR近距离放疗（n = 11）、LDR近距离放疗（n = 12）或质子束治疗（n = 2）。6名男性（8%）的UAEs仅累及膀胱，52名男性（71%）仅累及出口，15名男性（21%）两者均累及。UAEs的处理方式包括：21名（29%）采取保守治疗，12名（16%）留置导尿管，19名（26%）进行重建手术，23名男性（32%）进行尿流改道（UD）。重建手术包括：输尿管重建（n = 4）、直肠尿道瘘修补（n = 2）和后尿道成形术（n = 13），其中随访时间>90天的14/16例手术（88%）成功。
虽然PCa放疗后RTOG 4级UAEs的发生率尚不明确，但其相关发病率较高，约三分之一发生这些高级别并发症的患者需要进行尿流改道。相反，只有约四分之一的患者可采用保守策略或局部手术治疗。重建手术在部分患者中取得成功。
