Department of Radiation Oncology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL.
Department of Radiology, Loyola University Chicago, Loyola University Medical Center, Stritch School of Medicine, Maywood, IL.
Brachytherapy. 2021 Jan-Feb;20(1):66-74. doi: 10.1016/j.brachy.2020.09.002. Epub 2020 Nov 5.
High-dose-rate (HDR) prostate brachytherapy uses volumetric imaging for treatment planning. Our institution transitioned from computed tomography (CT)-based planning to MRI-based planning with the hypothesis that improved visualization could reduce treatment-related toxicity. This study aimed to compare the patient-reported health-related quality of life (hrQOL) and physician-graded toxicity outcomes of CT-based and MRI-based HDR prostate brachytherapy.
From 2016 to 2019, 122 patients with low- or intermediate-risk prostate cancer were treated with HDR brachytherapy as monotherapy. Patients underwent CT only or CT and MRI imaging for treatment planning and were grouped per treatment planning imaging modality. Patient-reported hrQOL in the genitourinary (GU), gastrointestinal (GI), and sexual domains was assessed using International Prostate Symptom Score and Expanded Prostate Cancer Index Composite Short Form-26 questionnaires. Baseline characteristics, changes in hrQOL scores, and physician-graded toxicities were compared between groups.
The median follow-up was 18 months. Patient-reported GU, GI, and sexual scores worsened after treatment but returned toward baseline over time. The CT cohort had a lower baseline mean International Prostate Symptom Score (5.8 vs. 7.8, p = 0.03). The other patient-reported GU and GI scores did not differ between groups. Overall, sexual scores were similar between the CT and MRI cohorts (p = 0.08) but favored the MRI cohort at later follow-up with a smaller decrease in Expanded Prostate Cancer Index Composite Short Form-26 sexual score from baseline at 18 months (4.9 vs. 19.8, p = 0.05). Maximum physician-graded GU, GI, and sexual toxicity rates of grade ≥2 were 68%, 3%, and 53%, respectively, with no difference between the cohorts (p = 0.31).
Our study shows that CT- and MRI-based HDR brachytherapy results in similar rates of GU and GI toxicity. MRI-based planning may result in improved erectile function recovery compared with CT-based planning.
高剂量率（HDR）前列腺近距离治疗采用容积成像进行治疗计划。我们的机构从基于计算机断层扫描（CT）的计划过渡到基于 MRI 的计划，假设改善可视化可以降低与治疗相关的毒性。本研究旨在比较 CT 基和 MRI 基 HDR 前列腺近距离治疗的患者报告的健康相关生活质量（HRQOL）和医生分级毒性结果。
2016 年至 2019 年，122 例低危或中危前列腺癌患者接受 HDR 近距离治疗作为单一疗法。患者接受 CT 仅或 CT 和 MRI 成像进行治疗计划，并根据治疗计划成像方式进行分组。使用国际前列腺症状评分和扩展前列腺癌指数综合短表单-26 问卷评估患者报告的泌尿生殖（GU）、胃肠道（GI）和性功能领域的 HRQOL。比较组间基线特征、HRQOL 评分变化和医生分级毒性。
中位随访时间为 18 个月。治疗后患者报告的 GU、GI 和性功能评分恶化，但随着时间的推移恢复到基线。CT 组的基线平均国际前列腺症状评分较低（5.8 与 7.8，p = 0.03）。其他患者报告的 GU 和 GI 评分在组间无差异。总体而言，GU 和 MRI 组的性功能评分相似（p = 0.08），但在后期随访中 MRI 组更有利，18 个月时扩展前列腺癌指数综合短表单-26 性功能评分的基线下降幅度较小（4.9 与 19.8，p = 0.05）。最大医生分级 GU、GI 和性功能毒性发生率为≥2 级，分别为 68%、3%和 53%，两组间无差异（p = 0.31）。
我们的研究表明，CT 基和 MRI 基 HDR 近距离治疗的 GU 和 GI 毒性发生率相似。与 CT 基计划相比，MRI 基计划可能导致勃起功能恢复改善。
