Danner Malika, Hung Ming-Yang, Yung Thomas M, Ayoob Marilyn, Lei Siyuan, Collins Brian T, Suy Simeng, Collins Sean P
Department of Radiation Medicine, MedStar Georgetown University Hospital, Washington, DC, United States.
Front Oncol. 2017 Oct 16;7:227. doi: 10.3389/fonc.2017.00227. eCollection 2017.
Utilization of patient-reported outcomes (PROs) to guide symptom management during radiation therapy is increasing. This study focuses on the use of the Expanded Prostate Cancer Index Composite for Clinical Practice (EPIC-CP) as a tool to assess urinary and bowel bother during stereotactic body radiation therapy (SBRT) and its utility in guiding medical management.
Between September 2015 and January 2017, 107 patients with clinically localized prostate cancer were treated with 35-36.25 Gy SBRT in five fractions. PROs were assessed using EPIC-CP 1 h prior to the first fraction and after each subsequent fraction. Symptom management medications were prescribed based on the physician clinical judgment or if patients reported a moderate to big problem. Clinical significance was assessed using a minimally important difference of 1/2 SD from baseline score.
A median baseline EPIC-CP urinary symptom score of 1.5 significantly increased to 3.7 on the day of the final treatment ( < 0.0001). Prior to treatment, 9.3% of men felt that their overall urinary function was a moderate to big problem that increased to 28% by the end of the fifth treatment. A median baseline EPIC-CP bowel symptom score of 0.3 significantly increased to 1.4 on the day of the final treatment ( < 0.0001). Prior to treatment, 1.9% of men felt that their overall bowel function was a moderate to big problem that increased to 3.7% by the end of the fifth treatment. The percentage of patients requiring an increased dose of alpha-antagonist increased to 47% by the end of treatment, and an additional 28% of patients required a short steroid taper to manage moderate to big urinary problems. Similarly, the percentage of patients requiring antidiarrheals reached 12% by the fifth treatment.
During the course of SBRT, an increasing percentage of patients experienced clinically significant symptoms many of which required medical management. Monitoring patient symptoms during treatment allowed for prompt detection and management of acute urinary and bowel symptoms. The usage of symptom management medications was high in this study compared to historical controls and may be due to increased physician awareness of moderate to big patient problems.
利用患者报告结局（PROs）来指导放射治疗期间的症状管理的情况正在增加。本研究重点关注临床实践中扩展前列腺癌指数综合量表（EPIC-CP）作为评估立体定向体部放射治疗（SBRT）期间泌尿和肠道困扰的工具及其在指导医疗管理方面的效用。
在2015年9月至2017年1月期间，107例临床局限性前列腺癌患者接受了5次分割的35 - 36.25 Gy的SBRT治疗。在第一次分割前1小时以及随后每次分割后使用EPIC-CP评估PROs。根据医生的临床判断或患者报告有中度至严重问题时开具症状管理药物。使用与基线评分相差1/2标准差的最小重要差异来评估临床意义。
EPIC-CP泌尿症状基线中位数评分1.5在最后一次治疗当天显著增加至3.7（<0.0001）。治疗前，9.3%的男性认为其总体泌尿功能存在中度至严重问题，到第五次治疗结束时这一比例增加到28%。EPIC-CP肠道症状基线中位数评分0.3在最后一次治疗当天显著增加至1.4（<0.0001）。治疗前，1.9%的男性认为其总体肠道功能存在中度至严重问题，到第五次治疗结束时这一比例增加到3.7%。到治疗结束时，需要增加α-拮抗剂剂量的患者比例增加到47%，另外28%的患者需要短期使用类固醇逐渐减量来处理中度至严重的泌尿问题。同样，到第五次治疗时，需要止泻药的患者比例达到12%。
在SBRT过程中，越来越多的患者出现具有临床意义的症状，其中许多需要医疗管理。在治疗期间监测患者症状有助于及时发现和处理急性泌尿和肠道症状。与历史对照相比，本研究中症状管理药物的使用频率较高，这可能是由于医生对患者中度至严重问题的认识提高。
