Shakespeare Thomas P, Westhuyzen Justin, Lim Yew Fai Tracy, Aherne Noel J
Department of Radiation Oncology, Mid-North Coast Cancer Institute, Coffs Harbour, New South Wales, Australia.
Department of Radiation Oncology, North Coast Cancer Institute, Lismore, New South Wales, Australia.
Rep Pract Oncol Radiother. 2020 Mar-Apr;25(2):193-199. doi: 10.1016/j.rpor.2019.12.028. Epub 2020 Jan 9.
To evaluate patient choice of prostate cancer radiotherapy fractionation, using a decision aid.
Recent ASTRO guidelines recommend patients with localised prostate cancer be offered moderately hypofractionated radiation therapy after discussing increased acute toxicity and uncertainty of long-term results compared to conventional fractionation.
A decision aid was designed to outline the benefits and potential downsides of conventionally and moderately hypofractionated radiation therapy. The aid incorporated the ASTRO guideline to outline risks and benefits.
In all, 124 patients with localised prostate cancer were seen from June-December 2018. Median age was 72 (range 50-90), 49.6 % were intermediate risk (50.4 % high risk). All except three patients made a choice using the aid; the three undecided patients were hypofractionated. In all, 33.9 % of patients chose hypofractionation: falling to 25.3 % for patients under 75 years, 24.3 % for patients living within 30 miles of the cancer centre, and 14.3 % for patients with baseline gastrointestinal symptoms. On multivariate analysis, younger age, proximity to the centre, and having baseline gastrointestinal symptoms significantly predicted for choosing conventional fractionation. Insurance status, attending clinician, baseline genitourinary symptoms, work/carer status, ECOG, cancer risk group and driving status did not impact choice. Reasons for choosing conventional fractionation were certainty of long-term results (84 %) and lower acute bowel toxicity (51 %).
Most patients declined the convenience of moderate hypofractionation due to potentially increased acute toxicity, and the uncertainty of long-term outcomes. We advocate that no patient should be offered hypofractionation without a thorough discussion of uncertainty and acute toxicity.
使用决策辅助工具评估前列腺癌放疗分割方案的患者选择。
美国放射肿瘤学会（ASTRO）近期指南建议，在与患者讨论与传统分割放疗相比增加的急性毒性和长期结果的不确定性之后，为局限性前列腺癌患者提供适度超分割放疗。
设计了一种决策辅助工具，以概述传统和适度超分割放疗的益处和潜在缺点。该辅助工具纳入了ASTRO指南以概述风险和益处。
2018年6月至12月共诊治了124例局限性前列腺癌患者。中位年龄为72岁（范围50 - 90岁），49.6%为中危患者（50.4%为高危患者）。除3例患者外，所有患者均使用该辅助工具做出了选择；3例未做决定的患者接受了超分割放疗。总体而言，33.9%的患者选择了超分割放疗：75岁以下患者降至25.3%，居住在距癌症中心30英里以内的患者为24.3%，有基线胃肠道症状的患者为14.3%。多因素分析显示，年龄较小、距离中心较近以及有基线胃肠道症状显著预测选择传统分割放疗。保险状况、主治医生、基线泌尿生殖系统症状、工作/护理状况、东部肿瘤协作组（ECOG）评分、癌症风险组和驾驶状况不影响选择。选择传统分割放疗的原因是长期结果的确定性（84%）和较低的急性肠道毒性（51%）。
由于潜在的急性毒性增加和长期结果的不确定性，大多数患者拒绝了适度超分割放疗带来的便利。我们主张，在未充分讨论不确定性和急性毒性的情况下，不应为任何患者提供超分割放疗。
