Gorovets Daniel, Hopkins Margaret, Goldman Debra A, Abitbol Ruth Levy, Zhang Zhigang, Kollmeier Marisa, McBride Sean, Zelefsky Michael J
Department of Radiation Oncology, Memorial Sloan Kettering Cancer, New York, New York.
Department of Epidemiology and Biostatistics, Memorial Sloan Kettering Cancer, New York, New York.
Adv Radiat Oncol. 2020 Oct 12;6(1):100582. doi: 10.1016/j.adro.2020.09.022. eCollection 2021 Jan-Feb.
There are limited data regarding high-dose stereotactic body radiation therapy (SBRT) for prostate cancer in patients with poor baseline urinary function. The purpose of this study was to evaluate genitourinary (GU) toxicity and changes in patient-reported symptom severity scores after prostate SBRT in men with a high pretreatment International Prostate Symptom Score (IPSS).
Seven hundred fifty-three patients treated with prostate SBRT at our institution from 2012 to 2019 were identified, of whom 72 consecutive patients with baseline IPSS ≥15 were selected for this study. GU toxicity according to Common Terminology Criteria for Adverse Events (CTCAE) v3.0 and IPSS were prospectively documented at each follow-up visit. Univariable logistic regression was used to evaluate for potential predictors of GU toxicity.
Median follow-up in survivors was 26.8 months. The rates of acute grade 2 and 3 GU toxicity were 20.8% and 1.4%, respectively. The rates of late grade 2 and 3 GU toxicity were 37.5% and 5.6%, respectively. The majority of grade 2+ toxicities resolved by last follow-up, and when toxicities were regraded per CTCAE v5.0, there were no longer any grade 3 adverse events. Total IPSS and individual symptom subscores improved over time. Compared with baseline, median total IPSS at 24 ± 6 months was significantly lower (18 vs 12; < .001) and the proportion of patients with severe scores (IPSS ≥20) decreased from 29.2% to 13.9%. Pretreatment urinary urgency was associated with late grade 2+ GU toxicity (odds ratio, 2.10; 95% confidence interval, 1.33-3.31; = .001).
In men with baseline IPSS ≥15 managed with prostate SBRT, the rate of severe GU toxicity was low and patient-reported symptoms generally improved over time. Thus, high pretreatment IPSS should not deter clinicians from offering prostate SBRT.
关于高剂量立体定向体部放射治疗（SBRT）用于基线排尿功能较差的前列腺癌患者的数据有限。本研究的目的是评估高预处理国际前列腺症状评分（IPSS）的男性患者在前列腺SBRT后泌尿生殖系统（GU）毒性以及患者报告的症状严重程度评分的变化。
确定了2012年至2019年在我们机构接受前列腺SBRT治疗的753例患者，其中连续72例基线IPSS≥15的患者被选入本研究。每次随访时前瞻性记录根据不良事件通用术语标准（CTCAE）v3.0的GU毒性和IPSS。使用单变量逻辑回归评估GU毒性的潜在预测因素。
幸存者的中位随访时间为26.8个月。急性2级和3级GU毒性发生率分别为20.8%和1.4%。晚期2级和3级GU毒性发生率分别为37.5%和5.6%。大多数2级及以上毒性在最后一次随访时得到缓解，并且按照CTCAE v5.0重新分级时，不再有任何3级不良事件。总IPSS和各个症状子评分随时间改善。与基线相比，24±6个月时的中位总IPSS显著更低（18对12；P<.001），严重评分（IPSS≥20）的患者比例从29.2%降至13.9%。预处理时的尿急与晚期2级及以上GU毒性相关（比值比，2.10；95%置信区间，1.33 - 3.31；P = .001）。
在接受前列腺SBRT治疗的基线IPSS≥15的男性中，严重GU毒性发生率较低，且患者报告的症状总体随时间改善。因此，高预处理IPSS不应阻碍临床医生提供前列腺SBRT。
