Ong Wee Loon, Matheson Bronwyn, Millar Jeremy
Alfred Health Radiation Oncology Service, Melbourne, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
Alfred Health Radiation Oncology Service, Melbourne, Australia.
Brachytherapy. 2017 Mar-Apr;16(2):313-322. doi: 10.1016/j.brachy.2016.11.010. Epub 2016 Dec 21.
To evaluate the incidence of acute urinary toxicity after permanent seed prostate brachytherapy (BT) over a 15-year period.
The study consisted of 782 prostate cancer patients treated with BT. All patients completed self-administered International Prostate Symptoms Score (IPSS) at baseline and during regular follow-up. We evaluated the risk of acute urinary retention (AUR) up to 3 months post-BT and lower urinary tract symptom (LUTS) resolution (defined as return to within two points of baseline IPSS score) at regular intervals, up to 24 months post-BT. Univariate and multivariate logistic regressions were used to evaluate the effect of various patient, tumor, and treatment factors on the risk of AUR and the likelihood of LUTS resolution.
Ninety-six patients (12%) developed AUR at a median of 1 day post-BT. Increased peak urinary flow is independently associated with lower risk of AUR (odds ratio [OR] = 0.94; 95% confidence interval [CI] = 0.91-0.97). Decline in incidence of AUR was observed over time with increased institutional experience (p = 0.03). Of the 646 patients with a minimum of 24-month follow-up, 29%, 49%, and 72% had LUTS resolution at 6, 12, and 24 months, respectively. Patients who had pre-BT transurethral resection of prostate (OR = 2.4; 95% CI = 1.5-4.0), cytoreductive neo-adjuvant androgen deprivation (OR = 2.0; 95% CI = 1.0-4.0), and higher baseline IPSS (OR = 1.1; 95% CI = 1.07-1.19) are more likely to report LUTS resolution at 24 months.
We reported decline in AUR over time with increased institutional experience in one of the largest Australasian BT series. Approximately three-quarters of patients achieved LUTS resolution at 24-month follow-up.
评估15年间永久性前列腺籽源近距离放射治疗（BT）后急性尿路毒性的发生率。
本研究纳入了782例接受BT治疗的前列腺癌患者。所有患者在基线期和定期随访期间均完成了自我管理的国际前列腺症状评分（IPSS）。我们评估了BT后3个月内急性尿潴留（AUR）的风险，以及在BT后24个月内定期评估下尿路症状（LUTS）缓解情况（定义为IPSS评分恢复到基线评分的2分以内）。采用单因素和多因素逻辑回归分析来评估各种患者、肿瘤和治疗因素对AUR风险和LUTS缓解可能性的影响。
96例患者（12%）在BT后中位1天发生AUR。尿流峰值增加与AUR风险降低独立相关（比值比[OR]=0.94；95%置信区间[CI]=0.91-0.97）。随着机构经验的增加，AUR的发生率随时间下降（p=0.03）。在646例至少随访24个月的患者中，分别有29%、49%和72%在6个月、12个月和24个月时LUTS得到缓解。BT前接受经尿道前列腺切除术（OR=2.4；95%CI=1.5-4.0）、减瘤新辅助雄激素剥夺治疗（OR=2.0；95%CI=1.0-4.0）以及基线IPSS较高（OR=1.1；95%CI=1.07-1.19）的患者在24个月时更有可能报告LUTS缓解。
在澳大利亚最大的BT系列研究之一中，我们报告随着机构经验的增加，AUR随时间下降。约四分之三的患者在24个月随访时LUTS得到缓解。
