Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Department of Oncology, Aarhus University Hospital, Aarhus, Denmark.
Radiother Oncol. 2021 May;158:300-308. doi: 10.1016/j.radonc.2020.10.003. Epub 2020 Oct 14.
To identify patient- and treatment-related risk factors and dose-effects for urinary frequency and incontinence in locally advanced cervical cancer (LACC) treated with radio(chemo)therapy and image-guided adaptive brachytherapy (IGABT).
Physician-assessed (CTCAE) and patient-reported (EORTC) frequency and incontinence recorded in the EMBRACE-I study were analysed. Risk factors analysis was performed in patients without bladder infiltration and with baseline morbidity available. Cox regression was used for CTCAE grade (G) ≥ 3 and G ≥ 2 and for EORTC "very much" and "quite a bit" or worse. Logistic regression was used for late persistent morbidity defined when CTCAE G ≥ 1 or EORTC ≥ "quite a bit" were scored in at least half of follow-ups.
Longitudinal data on 1153 and 884 patients were available for CTCAE and EORTC analysis, respectively. Median follow-up was 48[3-120] months. Crude incidence rates of G≥2 were 13% and 11% for frequency and incontinence, respectively. Baseline morbidity and overweight-obesity were risk factors for both symptoms. Elderly patients were at higher risk for incontinence. Patients receiving conformal-radiotherapy were at higher risk for frequency. ICRU bladder point (ICRU-BP) dose was a stronger predictor for incontinence than bladder D. The 5-year actuarial estimate of G ≥ 2 incontinence increased from 11% to 20% with ICRU-BP doses > 75 Gy compared to ≤ 65 Gy. Frequency showed weaker associations with dose.
ICRU-BP dose, in addition to clinical parameters, is a risk factor for urinary incontinence and shows a dose-effect after radio(chemo)therapy and IGABT. ICRU-BP dose should be monitored during treatment planning alongside volumetric parameters. Frequency seems associated with larger irradiated volumes.
确定接受放射（化疗）治疗和图像引导自适应近距离放射治疗（IGABT）的局部晚期宫颈癌（LACC）患者的与患者和治疗相关的风险因素及剂量效应，这些患者存在尿频繁和尿失禁的情况。
分析 EMBRACE-I 研究中记录的医生评估的（CTCAE）和患者报告的（EORTC）频率和尿失禁。在没有膀胱浸润且基线发病率可用的患者中进行风险因素分析。使用 Cox 回归分析 CTCAE 分级（G）≥3 和 G≥2，以及 EORTC“非常”和“相当多”或更差。使用逻辑回归分析当 CTCAE G≥1 或 EORTC≥“相当多”在至少一半的随访中评分时定义晚期持续发病率。
分别有 1153 名和 884 名患者的纵向数据可用于 CTCAE 和 EORTC 分析。中位随访时间为 48[3-120]个月。G≥2 的粗发生率分别为频率和尿失禁的 13%和 11%。基线发病率和超重肥胖是这两种症状的危险因素。老年患者尿失禁风险较高。接受适形放疗的患者发生频率的风险较高。与膀胱 D 相比，ICRU 膀胱点（ICRU-BP）剂量是尿失禁的更强预测因子。与 ICRU-BP 剂量≤65Gy 相比，ICRU-BP 剂量>75Gy 时，5 年累积估计 G≥2 尿失禁的发生率从 11%增加到 20%。频率与剂量的相关性较弱。
除了临床参数外，ICRU-BP 剂量也是尿失禁的危险因素，并在放射（化疗）治疗和 IGABT 后显示出剂量效应。在治疗计划中，除了体积参数外，还应监测 ICRU-BP 剂量。频率似乎与更大的受照体积相关。
