Baradaran-Ghahfarokhi Milad, Amouheidari Alireza, Shahbazi-Gahrouei Daryoush, Baradaran-Ghahfarokhi Hamid Reza, Tanderup Kari, Dörr Wolfgang, Shokrani Parvaneh
Department of Medical Physics and Medical Engineering, School of Medicine, Isfahan University of Medical Sciences, Isfahan, Iran; Medical Image and Signal Processing Research Center, Isfahan University of Medical Sciences, Isfahan, Iran.
Department of Radiation Oncology, Milad Hospital, Isfahan, Iran.
Int J Radiat Oncol Biol Phys. 2017 Nov 15;99(4):963-971. doi: 10.1016/j.ijrobp.2017.06.007. Epub 2017 Jun 20.
To evaluate the effects of radiation dose in prostate radiation therapy (RT) on occludin expression and ultrasonography characteristics of the bladder.
Urine samples of 64 prostate RT patients were collected before, at regular intervals during, and 3 months after RT. Occludin expression analysis was performed, and bladder wall echogenicity and echotexture were investigated by ultrasound and the gray-scale histogram analysis method. The bladder equivalent uniform dose (EUD) was derived from individually produced dose treatment plan for each patient. Clinical scoring for bladder-specific symptoms was done using the Radiation Therapy Oncology Group Acute Radiation Morbidity Scoring Criteria Scale.
Thirty patients (47%) experienced at least 1 of the studied bladder symptoms (grade ≥1 endpoints), including urinary pain, frequency, urgency, straining, incontinence, hematuria, dysuria, and nocturia. For these patients there were significant changes in urine occludin levels after starting the treatment compared with the baseline urine samples (P=.023). The mean bladder EUD that caused a significant change in occludin level, which occurred after the 15th RT session, was 26.9 Gy (range, 13.2-36.5 Gy, P=.020). In all patients a significant reduction in bladder echogenicity (P=.0137) and a significant change in its echotexture (P=.047) was found after the 10th RT session, after which the EUD to the bladder reached 17.9 Gy (range, 8.8-24.3 Gy).
Significant changes in occludin expression level and bladder wall echogenicity and echotexture occurred during prostate RT. Our findings suggest that a significant reduction in bladder echogenicity and increase in occludin expression during treatment can be associated with acute urinary complications.
评估前列腺放射治疗（RT）中的辐射剂量对紧密连接蛋白表达及膀胱超声特征的影响。
收集64例前列腺RT患者放疗前、放疗期间定期及放疗后3个月的尿液样本。进行紧密连接蛋白表达分析，并通过超声和灰度直方图分析法研究膀胱壁回声性和回声纹理。膀胱等效均匀剂量（EUD）源自为每位患者单独制定的剂量治疗计划。使用放射肿瘤学组急性放射病评分标准量表对膀胱特异性症状进行临床评分。
30例患者（47%）经历了至少1种所研究的膀胱症状（≥1级终点），包括尿痛、尿频、尿急、排尿困难、失禁、血尿、排尿障碍和夜尿症。与基线尿液样本相比，这些患者在开始治疗后尿液中紧密连接蛋白水平有显著变化（P = 0.023）。导致紧密连接蛋白水平发生显著变化的平均膀胱EUD在第15次放疗疗程后出现，为26.9 Gy（范围13.2 - 36.5 Gy，P = 0.020）。在所有患者中，第10次放疗疗程后发现膀胱回声性显著降低（P = 0.0137）及其回声纹理有显著变化（P = 0.047），此时膀胱的EUD达到17.9 Gy（范围8.8 - 24.3 Gy）。
前列腺RT期间紧密连接蛋白表达水平以及膀胱壁回声性和回声纹理发生了显著变化。我们的研究结果表明，治疗期间膀胱回声性显著降低和紧密连接蛋白表达增加可能与急性泌尿系统并发症有关。
