Morgan Tiffany M, Press Robert H, Cutrell Patrick K, Zhang Chao, Chen Zhengja, Rahnema Sara, Sanda Martin, Pattaras John, Patel Pretesh R, Jani Ashesh B, Rossi Peter J
Department of Radiation Oncology.
Winship Cancer Institute, Emory University, Atlanta, GA USA.
J Contemp Brachytherapy. 2018 Dec;10(6):495-502. doi: 10.5114/jcb.2018.81024. Epub 2018 Dec 28.
To report our institutional quality of life (QOL) data for low-dose-rate (LDR) monotherapy (LDR mono), high-dose-rate (HDR) monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost).
The charts of 165 patients with localized adenocarcinoma of the prostate treated with LDR monotherapy (LDR mono), HDR monotherapy (HDR mono), and EBRT with an HDR brachytherapy boost (HDR boost) at a single institution between 2012 and 2015 were reviewed. All patients completed the American Urological Association symptom score (AUASS) and Expanded Prostate Index for Prostate Cancer - Clinical Practice (EPIC-CP) quality of life assessments prior to treatment and at least one follow-up survey. Time points included baseline, ≤ 2 months, 2-≤ 6 months, 6-≤ 12 months, 12-≤ 18 months, 18-≤ 24 months, 24-≤ 30 months, and > 30 months. Linear mixed models were performed to test for significant changes and differences in each outcome over time.
Mean follow-up was 19.5 months. All major functional QOL domains were affected after treatment with brachytherapy for localized prostate cancer. All domains improved over time, with the exception of sexual function scores for all groups and urinary incontinence scores for the HDR mono group. Patients treated with LDR did have higher AUA, irritability/obstructive symptoms, incontinence, bowel, and QOL scores acutely compared to the HDR and HDR + boost groups. Vitality scores were significantly worse in the HDR boost group both acutely and at the > 30-month time point.
Patients receiving HDR brachytherapy had lower acute urinary and rectal toxicity compared to the patients receiving LDR, even when combined with EBRT. However, long-term toxicity was similar.
报告我们机构关于低剂量率（LDR）单一疗法（LDR单药治疗）、高剂量率（HDR）单一疗法（HDR单药治疗）以及采用高剂量率近距离放射治疗强化（HDR强化）的外照射放疗（EBRT）的生活质量（QOL）数据。
回顾了2012年至2015年间在单一机构接受LDR单一疗法（LDR单药治疗）、HDR单一疗法（HDR单药治疗）以及采用HDR近距离放射治疗强化的EBRT（HDR强化）的165例局限性前列腺腺癌患者的病历。所有患者在治疗前及至少一次随访调查时完成了美国泌尿外科学会症状评分（AUASS）和前列腺癌扩展前列腺指数 - 临床实践（EPIC-CP）生活质量评估。时间点包括基线、≤2个月、2至≤6个月、6至≤12个月、12至≤18个月、18至≤24个月、24至≤30个月以及>30个月。采用线性混合模型来检验每个结局随时间的显著变化和差异。
平均随访时间为19.5个月。近距离放射治疗局限性前列腺癌后，所有主要功能性生活质量领域均受到影响。除了所有组的性功能评分以及HDR单药治疗组的尿失禁评分外，所有领域均随时间有所改善。与HDR组和HDR + 强化组相比，接受LDR治疗的患者在急性情况下的美国泌尿外科学会（AUA）、易怒/梗阻症状、尿失禁、肠道及生活质量评分更高。HDR强化组在急性情况下以及在>30个月时间点的活力评分均显著更差。
与接受LDR治疗的患者相比，接受HDR近距离放射治疗的患者即使联合EBRT，其急性泌尿和直肠毒性也更低。然而，长期毒性相似。
