a Department of Radiation Oncology , Royal Adelaide Hospital , Adelaide , Australia.
b Discipline of Medicine , University of Adelaide , Adelaide , Australia.
Acta Oncol. 2018 Apr;57(4):456-464. doi: 10.1080/0284186X.2017.1400690. Epub 2017 Nov 15.
To compare GI symptoms, measures of generic and disease specific health related quality of life (HRQoL), anorectal and pudendal nerve function and anal sphincter morphology between (i) patients ≥2 years after 3D conformal radiotherapy (3D-CRT)±high dose rate (HDR) brachytherapy for carcinoma of the prostate and aged matched patients before radiotherapy and (ii) symptomatic and asymptomatic patients ≥2 years after 3D-CRT ± HDR brachytherapy.
Methodology included: (i) modified LENT-SOMA scales for GI symptoms, (ii) EORTC QLQ-C30 and EORTC QLQ-PR25 questionnaires for generic and disease specific HRQoL, (iii) anorectal manometry and terminal motor latency for anorectal and pudendal nerve function and (iv) endorectal ultrasound for anal sphincter morphology. GI symptoms, parameters of HRQoL, anorectal and pudendal nerve function and anal sphincter morphology were compared using Mann-Whitney's U, unpaired t and χ tests.
Impairment of HRQoL bowel symptoms in the patients ≥2 years after 3D-CRT ± HDR brachytherapy was associated with worse anorectal motor and sensory function, internal and external anal sphincter morphology and 5× greater prevalence of pudendal nerve dysfunction compared with age matched patients before radiotherapy. Symptomatic patients had worse (i) HRQoL measures including global quality of life and bowel and urinary symptom scores, (ii) rectal bleeding, fecal urgency and incontinence scores and (iii) a 2× higher prevalence of pudendal nerve dysfunction compared with asymptomatic patients. Rectal and anal (i) V 40 Gy >65%, (ii) Dmax >60 Gy, (iii) pudendal nerve Dmax >60 Gy and (iv) Anal V 60 Gy >40% were associated with a greater prevalence of pudendal nerve dysfunction.
3D-CRT ± HDR brachytherapy for prostate carcinoma, impairs late functional measures including HRQoL, anorectal and pudendal nerve function. Rectal, anal and pudendal nerve radiation dose constraints are proposed for reducing the prevalence of pudendal nerve dysfunction.
比较（i）接受过 3 维适形放疗（3D-CRT）+高剂量率（HDR）近距离放疗 2 年以上的前列腺癌患者和放疗前年龄匹配的患者，以及（ii）3D-CRT+HDR 近距离放疗 2 年以上的有症状和无症状患者之间的胃肠道症状、一般和疾病特异性健康相关生活质量（HRQoL）的衡量指标、肛直肠和阴部神经功能以及肛门括约肌形态。
方法包括：（i）胃肠道症状改良 LENT-SOMA 量表，（ii）EORTC QLQ-C30 和 EORTC QLQ-PR25 问卷用于一般和疾病特异性 HRQoL，（iii）肛直肠测压和末端运动潜伏期用于肛直肠和阴部神经功能，以及（iv）直肠内超声用于肛门括约肌形态。使用 Mann-Whitney U 检验、非配对 t 检验和 χ 检验比较胃肠道症状、HRQoL 指标、肛直肠和阴部神经功能以及肛门括约肌形态。
3D-CRT+HDR 近距离放疗 2 年以上的患者 HRQoL 排便症状受损与肛直肠运动和感觉功能、内外括约肌形态以及阴部神经功能障碍的发生率增加 5 倍有关，与放疗前的年龄匹配患者相比。有症状的患者（i）HRQoL 指标包括整体生活质量和排便和泌尿系统症状评分、（ii）直肠出血、排便急迫和失禁评分以及（iii）阴部神经功能障碍的发生率增加 2 倍与无症状患者相比。直肠和肛门（i）V40Gy >65%，（ii）Dmax >60Gy，（iii）阴部神经 Dmax >60Gy 和（iv）AnalV60Gy >40%与阴部神经功能障碍的发生率增加有关。
前列腺癌的 3D-CRT+HDR 近距离放疗会损害包括 HRQoL、肛直肠和阴部神经功能在内的晚期功能指标。建议限制直肠、肛门和阴部神经的放射剂量，以降低阴部神经功能障碍的发生率。
