Nakai Yasushi, Tanaka Nobumichi, Asakawa Isao, Anai Satoshi, Miyake Makito, Hori Shunta, Morizawa Yosuke, Tatsumi Yoshihiro, Hasegawa Masatoshi, Fujii Tomomi, Fujimoto Kiyohide
Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, Japan.
Department of Radiation Oncology, Nara Medical University, 840 Shijo-cho, Kashihara-shi, Nara, Japan.
J Radiat Res. 2019 Mar 1;60(2):270-280. doi: 10.1093/jrr/rry101.
The purpose of this study was to evaluate quality of life (QOL) in prostate cancer patients treated with 125I brachytherapy (BT), 125I brachytherapy combined with 3D conformal radiation therapy (BT+3D-CRT), or intensity-modulated radiation therapy (IMRT). We evaluated disease-related QOL in patients who underwent BT, BT+3D-CRT, or IMRT, using the Expanded Prostate Cancer Index Composite questionnaire before treatment and at 3 and 24 months post-treatment. Multivariate analyses were conducted to determine factors associated with a minimum important difference (MID) in urinary, bowel, sexual, and hormone domain scores at 3 and 24 months post-treatment. Of 558 enrolled patients (IMRT, 123; BT, 230; and BT+3D-CRT, 205), urinary domain scores showed a MID after BT, BT+3D-CRT and IMRT at 3 months in 69%, 84% and 25% of patients, respectively, and at 24 months in 43%, 54% and 28% of patients, respectively. On multivariate analysis, BT+3D-CRT [3 months: odds ratio (OR) = 12.7; P < 0.001; 24 months: OR = 3.29; P = 0.001] and BT (3 months: OR = 6.28; P < 0.001 and 24 months: OR = 2.22; P = 0.027) were associated with more severely worsened urinary QOL than IMRT. Bowel domain scores showed a MID at 3 months after BT, BT+3D-CRT, and IMRT in 37%, 68% and 41% of patients, respectively, and at 24 months in 29%, 46% and 43% of patients, respectively. On multivariate analysis, BT+3D-CRT (3 months: OR = 4.20; P < 0.001 and 24 months: OR = 2.63; P < 0.001) and IMRT (24 months: OR = 1.98; P = 0.029) were associated with more severely worsened bowel QOL than was BT. Information about the changes in QOL outcomes associated with radiotherapy modalities could guide treatment decisions.
本研究的目的是评估接受¹²⁵I近距离放射治疗（BT）、¹²⁵I近距离放射治疗联合三维适形放射治疗（BT + 3D - CRT）或调强放射治疗（IMRT）的前列腺癌患者的生活质量（QOL）。我们使用扩展前列腺癌指数综合问卷，在治疗前以及治疗后3个月和24个月，对接受BT、BT + 3D - CRT或IMRT的患者的疾病相关生活质量进行了评估。进行多变量分析以确定与治疗后3个月和24个月时泌尿、肠道、性功能和激素领域得分的最小重要差异（MID）相关的因素。在558名入组患者中（IMRT组123例、BT组230例、BT + 3D - CRT组205例），泌尿领域得分在治疗后3个月时，分别有69%、84%和25%的BT组、BT + 3D - CRT组和IMRT组患者显示出MID，在治疗后24个月时，分别有43%、54%和28%的患者显示出MID。多变量分析显示，与IMRT相比，BT + 3D - CRT（3个月：比值比[OR] = 12.7；P < 0.001；24个月：OR = 3.29；P = 0.001）和BT（3个月：OR = 6.28；P < 0.001；24个月：OR = 2.22；P = 0.027）与泌尿生活质量更严重恶化相关。肠道领域得分在治疗后3个月时，分别有37%、68%和41%的BT组、BT + 3D - CRT组和IMRT组患者显示出MID，在治疗后24个月时，分别有29%、46%和43%的患者显示出MID。多变量分析显示，与BT相比，BT + 3D - CRT（3个月：OR = 4.20；P < 0.001；24个月：OR = 2.63；P < 0.001）和IMRT（24个月：OR = 1.98；P = 0.029）与肠道生活质量更严重恶化相关。有关放疗方式与生活质量结果变化的信息可指导治疗决策。
