School of Health Sciences, National University of Malaysia, Kuala Lumpur, Malaysia; School of Physics, University of Western Australia, Perth, Western Australia, Australia.
School of Physics, University of Western Australia, Perth, Western Australia, Australia; Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia.
Int J Radiat Oncol Biol Phys. 2017 Feb 1;97(2):420-426. doi: 10.1016/j.ijrobp.2016.10.024. Epub 2016 Oct 21.
We assessed the association of the spatial distribution of dose to the bladder surface, described using dose-surface maps, with the risk of urinary dysfunction.
The bladder dose-surface maps of 754 participants from the TROG 03.04-RADAR trial were generated from the volumetric data by virtually cutting the bladder at the sagittal slice, intersecting the bladder center-of-mass through to the bladder posterior and projecting the dose information on a 2-dimensional plane. Pixelwise dose comparisons were performed between patients with and without symptoms (dysuria, hematuria, incontinence, and an International Prostate Symptom Score increase of ≥10 [ΔIPSS10]). The results with and without permutation-based multiple-comparison adjustments are reported. The pixelwise multivariate analysis findings (peak-event model for dysuria, hematuria, and ΔIPSS10; event-count model for incontinence), with adjustments for clinical factors, are also reported.
The associations of the spatially specific dose measures to urinary dysfunction were dependent on the presence of specific symptoms. The doses received by the anteroinferior and, to lesser extent, posterosuperior surface of the bladder had the strongest relationship with the incidence of dysuria, hematuria, and ΔIPSS10, both with and without adjustment for clinical factors. For the doses to the posteroinferior region corresponding to the area of the trigone, the only symptom with significance was incontinence.
A spatially variable response of the bladder surface to the dose was found for symptoms of urinary dysfunction. Limiting the dose extending anteriorly might help reduce the risk of urinary dysfunction.
我们评估了使用剂量-曲面图描述的膀胱表面剂量分布与尿功能障碍风险之间的关联。
从 TROG 03.04-RADAR 试验的 754 名参与者中生成了膀胱剂量-曲面图，通过在矢状切片处虚拟切割膀胱，穿过膀胱质心到膀胱后壁，并将剂量信息投影到二维平面上，从而生成这些图。对有症状（排尿困难、血尿、尿失禁和国际前列腺症状评分增加≥10 [ΔIPSS10]）和无症状患者的膀胱剂量-曲面图进行了像素间剂量比较。报告了有无基于置换的多重比较调整的结果。还报告了经临床因素调整后的像素间多变量分析结果（排尿困难、血尿和ΔIPSS10 的峰值事件模型；尿失禁的事件计数模型）。
与特定症状相关的特定部位剂量测量与尿功能障碍的关联取决于特定症状的存在。膀胱前下和后上表面（程度较轻）接受的剂量与排尿困难、血尿和ΔIPSS10 的发生率之间具有最强的关系，无论是否调整临床因素都是如此。对于与三角区相对应的后下区域的剂量，唯一具有统计学意义的症状是尿失禁。
膀胱表面对剂量的空间变化反应与尿功能障碍的症状有关。限制向前延伸的剂量可能有助于降低尿功能障碍的风险。
