Olsén Johan Staby, Estefan Dalia, Valachis Antonios, Jakobsson Frida, Karlsson Leif, Johansson Bengt
Department of Oncology, General Hospital of Karlstad, Sweden.
School of Medical Sciences, Örebro University, Örebro, Sweden.
J Contemp Brachytherapy. 2022 Feb;14(1):7-14. doi: 10.5114/jcb.2022.113545. Epub 2022 Feb 18.
Treating localized prostate cancer (PC) with combination radiotherapy consisting of external beam radiotherapy (EBRT) and high-dose-rate brachytherapy (HDR-BT) has been proven to result in better disease outcome than EBRT only. We aimed to evaluate the incidence of toxicities due to combination therapy and identify parameters correlated to acute or late urinary, rectal, and erectile toxicities.
Data on symptoms and tumor/treatment parameters were collected from 359 patients treated between 2008 and 2018 with EBRT (42 Gy in 14 fractions) and HDR-BT (14.5 Gy in one fraction) for localized PC, at the Örebro University Hospital. Urinary, rectal, and erectile symptoms were presented descriptively, and bivariate analyses for correlation between grade ≥ 2 toxicity and potential predictors were performed. To evaluate prognostic models, multivariable analyses were applied.
Urinary toxicity grade ≥ 2 was observed in 154 patients (47% of patients without pre-existing symptoms grade ≥ 2), of which 15 were grade 3. Rectal toxicity grade 2 was observed in 22 (6%) patients. Any grade erectile dysfunction was evident in all patients without pre-existing dysfunction ( = 103), whereas only 7 recovered completely. In bivariate analyses age was correlated with higher risk of acute urinary toxicity, and irradiated volume was associated with both urinary and rectal toxicities. However, we found no multivariable model of clinical and statistical significance to predict the risk of urinary or rectal toxicities.
In our study cohort, the severity of toxicities was in general mild or moderate and temporary, whereas the incidence of severe toxicity was considerably low. Although we found no predictive models for toxicities, our findings are reassuring that this treatment approach as curative therapy for localized PC is well-tolerated.
已证实，采用外照射放疗（EBRT）和高剂量率近距离放疗（HDR-BT）联合放疗治疗局限性前列腺癌（PC），其疾病预后优于单纯EBRT。我们旨在评估联合治疗导致的毒性发生率，并确定与急性或晚期泌尿、直肠及勃起功能毒性相关的参数。
收集了2008年至2018年间在厄勒布鲁大学医院接受EBRT（14次分割，共42 Gy）和HDR-BT（单次分割，14.5 Gy）治疗局限性PC的359例患者的症状及肿瘤/治疗参数数据。对泌尿、直肠和勃起功能症状进行了描述性分析，并对≥2级毒性与潜在预测因素之间的相关性进行了双变量分析。为评估预后模型，应用了多变量分析。
154例患者（47%无≥2级既往症状的患者）出现≥2级泌尿毒性，其中15例为3级。22例（6%）患者出现2级直肠毒性。所有无既往功能障碍的患者（n = 103）均出现任何级别的勃起功能障碍，而只有7例完全恢复。在双变量分析中，年龄与急性泌尿毒性风险较高相关，照射体积与泌尿和直肠毒性均相关。然而，我们未发现具有临床和统计学意义的多变量模型来预测泌尿或直肠毒性风险。
在我们的研究队列中，毒性严重程度总体上为轻度或中度且为暂时性，而严重毒性的发生率相当低。尽管我们未发现毒性预测模型，但我们的研究结果令人放心，即这种治疗方法作为局限性PC的根治性疗法耐受性良好。
