Feng Li Rebekah, Suy Simeng, Collins Sean P, Lischalk Jonathan W, Yuan Berwin, Saligan Leorey N
National Institute of Nursing Research, National Institutes of Health, Bethesda, MD, USA.
Department of Radiation Medicine, Georgetown University Hospital, Washington, DC, USA.
Curr Urol. 2018 Jun;11(4):218-224. doi: 10.1159/000447222. Epub 2018 Mar 30.
Prostate cancer survivors commonly experience late-onset lower urinary tract symptoms following radiotherapy. We aimed to compare lower urinary tract symptoms in patients treated with stereotactic body radiotherapy (SBRT) to those treated with a combination of lower dose SBRT and supplemental intensity-modulated radiotherapy (SBRT + IMRT).
Subjects with localized prostate carcinoma scheduled to receive SBRT or a combination of SBRT and IMRT were enrolled and followed for up to 2 years after treatment completion. Participants treated with SBRT received 35-36.25 Gy in 5 fractions, while those treated with SBRT + IMRT received 19.5 Gy of SBRT in 3 fractions followed by 45-50.4 Gy of IMRT in 25-28 fractions. Urinary symptoms were measured using the American Urological Association (AUA) Symptom Score.
Two hundred patients received SBRT (52% intermediate risk, 37.5% low risk according to D'Amico classification) and 145 patients received SBRT + IMRT (61.4% high risk, 35.2% intermediate risk). Both groups experienced a transient spike in urinary symptoms 1 month after treatment. More severe late urinary flare (increase in AUA scores ≥ 5 points from baseline to 1 year after treatment completion and an AUA score ≥ 15 at 1 year after treatment) was experienced by patients who received SBRT compared to those treated with SBRT + IMRT.
Participants who received SBRT and supplemental IMRT experienced less severe late urinary flare 1 year after treatment compared to those who received higher dose SBRT alone. This information can be used by clinicians to provide patients with anticipatory counseling to mitigate any psychological burden that comes with unanticipated late urinary toxicities.
前列腺癌幸存者在放疗后常出现迟发性下尿路症状。我们旨在比较接受立体定向体部放疗（SBRT）的患者与接受低剂量SBRT联合补充调强放疗（SBRT+IMRT）的患者的下尿路症状。
纳入计划接受SBRT或SBRT与IMRT联合治疗的局限性前列腺癌患者，并在治疗完成后随访长达2年。接受SBRT治疗的参与者分5次接受35-36.25 Gy照射，而接受SBRT+IMRT治疗的参与者分3次接受19.5 Gy的SBRT照射，随后分25-28次接受45-50.4 Gy的IMRT照射。使用美国泌尿外科学会（AUA）症状评分来测量泌尿症状。
200例患者接受了SBRT（根据达米科分类，52%为中度风险，37.5%为低风险），145例患者接受了SBRT+IMRT（61.4%为高风险，35.2%为中度风险）。两组患者在治疗后1个月均出现泌尿症状短暂激增。与接受SBRT+IMRT治疗的患者相比，接受SBRT治疗的患者出现更严重的晚期泌尿症状突发（从基线到治疗完成后1年AUA评分增加≥5分，且治疗后1年AUA评分≥15分）。
与单独接受高剂量SBRT的参与者相比，接受SBRT和补充IMRT的参与者在治疗后1年出现的晚期泌尿症状突发较轻。临床医生可利用这些信息为患者提供预期咨询，以减轻意外晚期泌尿毒性带来的心理负担。
