Department of Radiation Oncology, University of Florida, Gainesville, FL, United States; University of Florida Health Proton Therapy Center, Jacksonville, FL, United States.
Department of Radiation Oncology, Moffitt Cancer Center, Tampa, FL, United States.
Radiother Oncol. 2019 May;134:204-210. doi: 10.1016/j.radonc.2019.01.029. Epub 2019 Feb 27.
To help guide individualized treatment, we sought to identify baseline predictive factors that impact long-term erectile function following high-dose image-guided radiotherapy (HD-IGRT).
Potent men with localized prostate cancer treated with radiotherapy alone were enrolled in an institutional review board-approved prospective cohort study. Men received HD-IGRT as primary treatment of prostate cancer. Patient-reported inventories were used to assess erectile function at baseline, 6 months, 2 years, and 5 years after treatment. Long-term potency rates were compared to validated models, and baseline factors were used to create a novel, internally validated nomogram for predicting long-term function.
1,159 men were treated with HD-IGRT. Among 676 men who were potent at baseline and did not receive hormone therapy, the potency rates at 6 months, 2 years, and 5 years were 81%, 68%, and 61%. Recursive partitioning categorized patients into 3 groups based on two factors: baseline response to EPIC Q57 (ability to have an erection) and pre-existing heart disease. At 5 years, the most favorable group reported "very good" on Q57 and had an 80% potency rate (n = 137; p = 0.83); the intermediate group reported "good" on Q57 and had no baseline cardiac disease with a 62% potency rate (n = 145; p = 0.86); and the remaining poor risk group had a 37% potency rate (n = 117; p = 0.19).
Patient-reported pretreatment sexual function and comorbidities enables stratification and prediction of erectile function. EPIC subset questions with baseline comorbidities may potentially serve as a quick and practical clinical tool for predicting sexual survivorship.
为了帮助指导个体化治疗，我们试图确定影响高强度聚焦放疗（HD-IGRT）后长期勃起功能的基线预测因素。
在机构审查委员会批准的前瞻性队列研究中，纳入接受单纯放疗的局部前列腺癌强力男性患者。男性接受 HD-IGRT 作为前列腺癌的主要治疗方法。使用患者报告量表在治疗后 6 个月、2 年和 5 年评估勃起功能。将长期勃起功能恢复率与验证模型进行比较，并使用基线因素创建一个新的、内部验证的预测长期功能的列线图。
1159 名男性接受 HD-IGRT 治疗。在 676 名基线勃起功能正常且未接受激素治疗的男性中，6 个月、2 年和 5 年时的勃起功能恢复率分别为 81%、68%和 61%。递归分区根据基线 EPIC Q57（勃起能力）和预先存在的心脏病两种因素将患者分为 3 组。在 5 年时，最有利组 Q57 报告“非常好”，勃起功能恢复率为 80%（n=137；p=0.83）；中间组 Q57 报告“好”且无基线心脏病，勃起功能恢复率为 62%（n=145；p=0.86）；其余风险较差组勃起功能恢复率为 37%（n=117；p=0.19）。
患者报告的治疗前性功能和合并症可进行分层和勃起功能预测。具有基线合并症的 EPIC 子量表问题可能是预测性功能恢复的快速实用临床工具。
