Diao Kevin, Lobos Emily A, Yirmibesoglu Eda, Basak Ram, Hendrix Laura H, Barbosa Brittney, Miller Seth M, Pearlstein Kevin A, Goldin Gregg H, Wang Andrew Z, Chen Ronald C
Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina; Harvard Medical School, Boston, Massachusetts.
Department of Radiation Oncology, University of North Carolina at Chapel Hill, North Carolina.
Pract Radiat Oncol. 2017 Mar-Apr;7(2):e117-e124. doi: 10.1016/j.prro.2016.08.004. Epub 2016 Aug 12.
The importance of patient-reported outcomes is well-recognized. Long-term patient-reported symptoms have been described for individuals who completed radiation therapy (RT) for prostate cancer. However, the trajectory of symptom development during the course of treatment has not been well-described in patients receiving modern, image-guided RT.
Quality-of-life data were prospectively collected for 111 prostate cancer patients undergoing RT using the validated Prostate Cancer Symptom Indices, which assessed 5 urinary obstructive/irritative and 6 bowel symptoms. Patients who received definitive RT (N = 73) and postprostatectomy RT (N = 38) were analyzed separately. The frequency and severity of symptoms over multiple time points are reported.
An increasing number of patients had clinically meaningful urinary and bowel symptoms over the course of RT. A greater proportion of patients undergoing definitive RT reported clinically meaningful urinary symptoms at the end of RT compared with baseline in terms of flow (33% vs 19%) and frequency (39% vs 18%). Individuals receiving postprostatectomy radiation also reported an increase in symptoms including frequency (29% vs 3%) and nocturia (50% vs 21%). Clinically meaningful bowel symptoms were less commonly reported. Patients receiving definitive RT reported an increase in diarrhea (9% vs 4%) and urgency (12% vs 6%) at the completion of RT compared with baseline. Both bowel and urinary symptoms approached their baseline levels by the time of first follow-up after treatment completion. The majority of patients who had clinically meaningful urinary or bowel symptoms during RT did not have them at 2 years or beyond, and development of new symptoms in the long term was uncommon.
There is a modest increase in urinary and bowel symptoms over the course of treatment for individuals receiving definitive and postprostatectomy image-guided RT. These data can help inform both providers and patients regarding the trajectory of symptoms and allow for reasonable expectations regarding toxicity under treatment.
患者报告结局的重要性已得到充分认可。已有研究描述了完成前列腺癌放射治疗（RT）的个体的长期患者报告症状。然而，在接受现代图像引导RT的患者中，治疗过程中症状发展的轨迹尚未得到很好的描述。
前瞻性收集了111例接受RT的前列腺癌患者的生活质量数据，使用经过验证的前列腺癌症状指数，该指数评估了5种尿路梗阻/刺激性症状和6种肠道症状。分别分析了接受根治性RT（N = 73）和前列腺切除术后RT（N = 38）的患者。报告了多个时间点症状的频率和严重程度。
在RT过程中，越来越多的患者出现了具有临床意义的尿路和肠道症状。与基线相比，接受根治性RT的患者在RT结束时报告具有临床意义的尿路症状的比例在流量方面（33%对19%）和频率方面（39%对18%）更高。接受前列腺切除术后放疗的个体也报告症状增加，包括频率（29%对3%）和夜尿症（50%对21%）。具有临床意义的肠道症状报告较少。与基线相比，接受根治性RT的患者在RT完成时腹泻（9%对4%）和尿急（12%对6%）增加。治疗完成后首次随访时，肠道和尿路症状均接近基线水平。大多数在RT期间出现具有临床意义的尿路或肠道症状的患者在2年或更长时间后没有这些症状，长期出现新症状的情况并不常见。
对于接受根治性和前列腺切除术后图像引导RT的个体，在治疗过程中尿路和肠道症状有适度增加。这些数据可以帮助医护人员和患者了解症状的发展轨迹，并对治疗毒性有合理的预期。
