Harris Alexander A, Yasuda Mayuri, Wu Megan S, Deirmenjian Jacqueline M, Farooq Ahmer, Baldea Kristin G, Flanigan Robert, Harkenrider Matthew M, Welsh James S, Solanki Abhishek A
is a Resident Physician; , , and are Medical Students; is an Associate Professor; and are Associate Professors; is an Assistant Professor; and and are Professors; all at Loyola University Medical Center and Edward Hines Jr. Veterans Affairs Hospital in Illinois.
Fed Pract. 2021 Aug;38(Suppl 3):S52-S56. doi: 10.12788/fp.0147.
High-dose-rate (HDR) brachytherapy (BT) is a well-tolerated and effective treatment for prostate cancer. There is limited research, however, investigating toxicity outcomes with HDRBT treatment among veterans. The objective of this study is to assess the impact on health-related quality of life (hrQOL) and physician-graded toxicities associated with HDRBT as monotherapy among veterans treated at Edward Hines, Jr. Veterans Affairs Hospital in Hines, Illinois.
Between 2016 and 2019, 74 veterans with low- or intermediate-risk prostate cancer were treated with HDRBT as monotherapy with 27 Gy in 2 fractions, delivered over 2 implants. Veteran-reported hrQOL in the genitourinary (GU), gastrointestinal (GI), and sexual domains was assessed using the International Prostate Symptoms Score (IPSS) and Expanded Prostate Cancer Index Composite (EPIC-26) questionnaire. Mixed linear effect models were used to assess differences in the hrQOL scores at follow-up compared with baseline scores. Statistically significant differences in hrQOL scores from baseline were further assessed for clinical significance, using minimal clinically important difference (MCID) evaluations.
Median follow-up was 18 months. Veterans reported declines in GU, GI, and sexual hrQOL scores immediately after treatment, with the IPSS and EPIC-26 hrQOL scores all displaying significant decrease from baseline over time. The majority of the declines in hrQOL scores met criteria for MCID. These hrQOL scores trended toward a return to baseline, with the EPIC-26 urinary obstruction score returning to baseline at the 18-month follow-up assessment and the EPIC-26 bowel score returning to baseline at the 12-month follow-up. The IPSS, urinary incontinence, and sexual scores did not return to baseline at 18 months. The grade 2 maximum physician-graded GU, GI, and sexual toxicity rates were 65%, 5%, and 53%, respectively. There was 1 incidence of grade 3 GU toxicity but no grade 3 GI or sexual toxicity.
HDRBT as monotherapy is a well-tolerated treatment option for veterans with low- or intermediate-risk prostate cancer, with favorable veteran-reported and physician-graded toxicities. Veterans should be educated about HDRBT as an option when counseled regarding treatment for localized prostate cancer.
高剂量率（HDR）近距离放射治疗（BT）是一种耐受性良好且有效的前列腺癌治疗方法。然而，针对退伍军人接受HDRBT治疗后的毒性结果的研究有限。本研究的目的是评估在伊利诺伊州海恩斯的小爱德华·海因斯退伍军人事务医院接受治疗的退伍军人中，HDRBT作为单一疗法对健康相关生活质量（hrQOL）以及医生分级毒性的影响。
2016年至2019年期间，74例低危或中危前列腺癌退伍军人接受了HDRBT单一疗法治疗，分2次给予27 Gy，通过2次植入完成。使用国际前列腺症状评分（IPSS）和扩展前列腺癌指数综合问卷（EPIC-26）评估退伍军人报告的泌尿生殖系统（GU）、胃肠道（GI）和性功能领域的hrQOL。使用混合线性效应模型评估随访时的hrQOL评分与基线评分的差异。使用最小临床重要差异（MCID）评估进一步评估hrQOL评分与基线相比具有统计学显著差异的临床意义。
中位随访时间为18个月。退伍军人报告治疗后立即出现GU、GI和性功能hrQOL评分下降，IPSS和EPIC-26 hrQOL评分均显示随时间从基线显著下降。hrQOL评分的大多数下降符合MCID标准。这些hrQOL评分有恢复到基线的趋势，EPIC-26尿路梗阻评分在18个月随访评估时恢复到基线，EPIC-26肠道评分在12个月随访时恢复到基线。IPSS、尿失禁和性功能评分在18个月时未恢复到基线。2级医生分级的GU、GI和性功能毒性发生率分别为65%、5%和53%。有1例3级GU毒性事件，但无3级GI或性功能毒性。
HDRBT作为单一疗法是低危或中危前列腺癌退伍军人耐受性良好的治疗选择，退伍军人报告的毒性和医生分级毒性均良好。在为局限性前列腺癌患者提供治疗咨询时，应向退伍军人介绍HDRBT这一选择。
