Coquet Jean-Baptiste, Delage Francky, Fourcade Alexandre, Callerot Pierre, Goasduff Gaelle, Boussion Nicolas, Rousseau Benoit, Serey-Eiffel Sophie, Malhaire Jean-Pierre, Pradier Olivier, Schick Ulrike, Fournier Georges, Valeri Antoine
CHU Brest, Service Urologie, Brest, France; Université de Brest, Faculté de Médecine et des Sciences de la Santé, Brest, France; Université de Bretagne Occidentale, Bretagne, France.
CHU Brest, Service Urologie, Brest, France.
Brachytherapy. 2018 Sep-Oct;17(5):782-787. doi: 10.1016/j.brachy.2018.05.007. Epub 2018 Jun 21.
"Quadrella" index has been recently developed to assess oncological and functional outcomes after prostate brachytherapy (PB). We aimed to evaluate this index at 1, 2, and 3 years, using validated questionnaires, assessed prospectively.
From 08/2007 to 01/2013, 193 patients underwent Iodine PB for low-risk or favorable intermediate-risk prostate adenocarcinoma. Inclusion criteria were as follows: no incontinence (International Continence Society Index initial score = 0) and good erectile function (International Index of Erectile Function-5 items: >16). One hundred patients were included (mean age: 64 y). Postimplantation intake of phosphodiesterase inhibitors was not considered as failure. The "Quadrella" index was defined by the absence of biochemical recurrence (Phoenix criteria), significant erectile dysfunction (ED) (Index of Erectile Function-5 items: >16), urinary toxicity (UT) (International Prostate Score Symptom [IPSS] <15 or IPSS> 15 with ΔIPSS <5), and rectal toxicity (RT) (Radiation Therapy Oncology Group = 0).
At 12 months, 90 patients were evaluable: 42/90 (46.7%) achieved Quadrella. The main criteria for failure were as follows: ED in 77.1% (37/48) of cases, RT in 20.8% (10/48) of cases, and UT in 12.5% (9/57) of cases. At 24 and 36 months, 59.3% (48/81) and 61.1% (44/72) of patients achieved Quadrella, respectively. The main cause of failure was ED in 69.7% (23/33) and 85.7% (24/28) of cases, while RT was involved in 21.2% (7/33) and in 3.6% (1/28) of cases, and UT in 9.1% (3/33) and 3.6% (1/28) of cases. Only one case of biochemical recurrence was observed (i.e., 1/28 = 3.6% at 3 y).
The Quadrella can be used at 1, 2, and 3 years after PB. It allows to take into account the urinary and RT specific to PB. ED was the main cause of failure. This index will be useful to assess midterm and long-term results.
“Quadrella”指数最近被开发出来用于评估前列腺近距离放射治疗（PB）后的肿瘤学和功能结果。我们旨在使用经过验证的问卷，对前瞻性评估的1年、2年和3年的该指数进行评估。
从2007年8月至2013年1月，193例患者因低风险或有利的中风险前列腺腺癌接受碘PB治疗。纳入标准如下：无尿失禁（国际尿失禁学会指数初始评分=0）且勃起功能良好（国际勃起功能指数-5项：>16）。纳入100例患者（平均年龄：64岁）。植入后服用磷酸二酯酶抑制剂不被视为失败。“Quadrella”指数的定义为无生化复发（凤凰标准）、无显著勃起功能障碍（ED）（勃起功能指数-5项：>16）、无泌尿毒性（UT）（国际前列腺症状评分[IPSS]<15或IPSS>15且ΔIPSS<5）以及无直肠毒性（RT）（放射治疗肿瘤学组=0）。
在12个月时，90例患者可评估：42/90（46.7%）达到Quadrella。失败的主要标准如下：77.1%（37/48）的病例为ED，20.8%（10/48）的病例为RT，12.5%（9/57）的病例为UT。在24个月和36个月时，分别有59.3%（48/81）和61.1%（44/72）的患者达到Quadrella。失败的主要原因在69.7%（23/33）和85.7%（24/28）的病例中为ED，而在21.2%（7/33）和3.6%（1/28）的病例中涉及RT，在9.1%（3/33）和3.6%（1/28）的病例中涉及UT。仅观察到1例生化复发（即3年时1/28 = 3.6%）。
Quadrella可在PB后的1年、2年和3年使用。它考虑到了PB特有的泌尿和直肠方面。ED是失败的主要原因。该指数将有助于评估中期和长期结果。
