van Son Marieke, Monninkhof Evelyn, Peters Max, Lagendijk Jan, van der Voort van Zyp Jochem
Department of Radiotherapy, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Heidelberglaan 100, 3584 CX Utrecht, the Netherlands.
Clin Transl Radiat Oncol. 2020 Oct 17;25:81-87. doi: 10.1016/j.ctro.2020.10.002. eCollection 2020 Nov.
For patients with a localized prostate cancer recurrence after radiotherapy, focal salvage treatment offers a less toxic alternative to whole-gland treatments, with the potential of preserving health-related quality of life (HR-QoL). With a focus on the patient's perspective of treatment, this study aims to describe HR-QoL after ultrafocal salvage high-dose-rate brachytherapy (HDR-BT), and to explore predictive factors affecting HR-QoL.
We included 100 patients treated with ultrafocal salvage HDR-BT. Prostate cancer-related HR-QoL was assessed by the EORTC QLQ-PR25 questionnaire. Domains were urinary symptoms, bowel symptoms and sexual activity/functioning. For each domain, a mixed effects model was made to estimate HR-QoL trends over time. For domains showing clinically relevant change (≥10 points difference), the mixed effects model was used to explore potential predictors (age, baseline HR-QoL score, T-stage, tumor location, CTV size, dose to organs at risk and history of ADT).
Median follow-up was 20 months (IQR 13-30). Mean questionnaire response rate was 86% (range 72-100%). Median baseline scores were 12 (urinary), 0 (bowel) and 67/50 (sexual activity/functioning). Urinary symptoms and sexual functioning showed clinically relevant deterioration over time (maximum difference of 11 and 12 points, respectively). Worse baseline score and higher administered dose to the urethra (≥16 Gy) were predictive of increased urinary symptoms (p < 0.01 and p = 0.03). Better baseline score was predictive of better sexual functioning (p < 0.01).
Ultrafocal salvage HDR-BT has negligible impact on bowel symptoms but does affect urinary symptoms and sexual functioning. Lower impact is predicted for patients with favorable urinary and sexual function at baseline. Urethral dose constraints should be closely monitored.
对于放射治疗后出现局限性前列腺癌复发的患者，局部挽救性治疗为全腺治疗提供了一种毒性较小的替代方案，有可能保留与健康相关的生活质量（HR-QoL）。本研究以患者对治疗的看法为重点，旨在描述超局部挽救性高剂量率近距离放射治疗（HDR-BT）后的HR-QoL，并探讨影响HR-QoL的预测因素。
我们纳入了100例接受超局部挽救性HDR-BT治疗的患者。通过欧洲癌症研究与治疗组织QLQ-PR25问卷评估前列腺癌相关的HR-QoL。领域包括泌尿系统症状、肠道症状以及性活动/功能。对于每个领域，建立混合效应模型以估计HR-QoL随时间的变化趋势。对于显示出临床相关变化（差异≥10分）的领域，使用混合效应模型来探索潜在的预测因素（年龄、基线HR-QoL评分、T分期、肿瘤位置、临床靶体积大小、危及器官的剂量以及雄激素剥夺治疗史）。
中位随访时间为20个月（四分位间距13 - 30个月）。问卷平均回复率为86%（范围72% - 100%）。基线中位分数分别为：泌尿系统症状12分、肠道症状0分、性活动/功能67/50分。泌尿系统症状和性功能随时间显示出临床相关的恶化（最大差异分别为11分和12分）。基线分数较差以及尿道给予的剂量较高（≥16 Gy）可预测泌尿系统症状增加（p < 0.01和p = 0.03）。基线分数较好可预测性功能较好（p < 0.01）。
超局部挽救性HDR-BT对肠道症状的影响可忽略不计，但确实会影响泌尿系统症状和性功能。对于基线时泌尿系统和性功能良好的患者，预计影响较小。应密切监测尿道剂量限制。
