患者使用低剂量率前列腺近距离放射治疗后，采用国际前列腺症状评分评估下尿路症状。

Patient assessment of lower urinary tract symptoms using the international prostate symptom score following low-dose-rate prostate brachytherapy.

机构信息

Department of Radiation Oncology, Wake Forest School of Medicine, Winston Salem, NC.

出版信息

Brachytherapy. 2021 Nov-Dec;20(6):1107-1113. doi: 10.1016/j.brachy.2021.05.009. Epub 2021 Aug 2.

DOI:10.1016/j.brachy.2021.05.009

PMID:34353749

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9019850/

Abstract

PURPOSE

To correlate changes in urinary patient-reported outcomes including the International Prostate Symptom Score (IPSS), acute urinary retention and urethral stricture with urethral dose in those treated with low dose rate (LDR) prostate brachytherapy.

MATERIALS AND METHODS

Patients treated with prostate LDR between 2012 and 2019 (n=117) completed IPSS urinary symptom assessments prior to treatment and at each follow-up. CT simulation was obtained with urinary catheter 1-month post-implant for dosimetric analysis. 113 patients with pre- and ≥1 post-LDR IPSS score available were analyzed. Urethral dosimetric parameters including U75, U100, U125, U150 and U200 were abstracted from post-implant dosimetry and assessed for association with urinary toxicity using bivariate logistic regression and Spearman correlation. Outcomes included clinically significant change (CSC, defined as 4 or more points or 25% rise above baseline) in IPSS score at 6 and 12 months, acute urinary retention (AUR), and urethral stricture (US).

RESULTS

89 (79%) patients were treated with LDR monotherapy (145 Gy) and 24 (21%) with LDR boost (110 Gy) with external beam radiation therapy. Twenty (18%) had baseline IPSS ≥15. Median IPSS scores were: baseline 6 (3-12; n=113), 1-month 17 (10-25; n=110), 6 months 12 (7-18; n=77), 1 year 8 (5-14; n=52). CSC-6 was observed in 59 (77%), CSC-12 in 26 (50%), AUR in 12 (11%), and US in 4 (4%). No association was identified between urethral dose parameters and CSC-6, CSC-12, AUR, or US. No correlation between urethral dose and IPSS at 6- and 12-months was identified. The IPSS ≥15 group exhibited lower rates of CSC-12 (13% v. 57%, p=0.05) but not CSC-6 (55% v. 80%, p=0.12).

CONCLUSIONS

We did not find a relationship between urethral dose and IPSS elevation, AUR or US. We did identify a significantly lower change in IPSS at 12 months for those with baseline IPSS ≥15 compared to those with low baseline scores.

摘要

目的

探讨低剂量率（LDR）前列腺近距离放射治疗后尿控患者报告结局（包括国际前列腺症状评分（IPSS）、急性尿潴留和尿道狭窄）的变化与尿道剂量的相关性。

材料和方法

2012 年至 2019 年期间接受 LDR 前列腺治疗的 117 例患者在治疗前和每次随访时完成了 IPSS 尿症状评估。植入后 1 个月进行 CT 模拟以进行剂量分析。分析了 113 例具有术前和术后≥1 次 LDR IPSS 评分的患者。从植入后剂量学中提取尿道剂量学参数，包括 U75、U100、U125、U150 和 U200，并使用双变量逻辑回归和 Spearman 相关性评估与尿毒性的关系。结果包括 6 个月和 12 个月时 IPSS 评分的临床显著变化（CSC，定义为 4 分或以上或基线上升 25%）、急性尿潴留（AUR）和尿道狭窄（US）。

结果

89 例（79%）患者接受 LDR 单一疗法（145 Gy）治疗，24 例（21%）接受 LDR 加量（110 Gy）联合外照射治疗。20 例（18%）患者基线 IPSS≥15。中位 IPSS 评分分别为：基线 6（3-12；n=113），1 个月 17（10-25；n=110），6 个月 12（7-18；n=77），1 年 8（5-14；n=52）。6 个月时观察到 CSC-6 59 例（77%），12 个月时观察到 CSC-12 26 例（50%），AUR 12 例（11%），US 4 例（4%）。未发现尿道剂量参数与 CSC-6、CSC-12、AUR 或 US 之间存在相关性。未发现尿道剂量与 6 个月和 12 个月时的 IPSS 之间存在相关性。基线 IPSS≥15 组的 12 个月时 CSC-12 发生率较低（13%比 57%，p=0.05），但 CSC-6 发生率无差异（55%比 80%，p=0.12）。