Departments of Gastrointestinal Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas.
Departments of Gastrointestinal Radiation Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas; Departments of Biostatistics, University of Texas MD Anderson Cancer Center, Houston, Texas.
Pract Radiat Oncol. 2022 Sep-Oct;12(5):e397-e405. doi: 10.1016/j.prro.2022.05.006. Epub 2022 May 25.
Pelvic chemoradiation can have a profound effect on sexual function. Few data exist describing long-term sexual function patient-reported outcomes (PROs) for patients treated with intensity modulated radiation and concurrent chemotherapy (CRT) for squamous cell carcinoma of the anus (SCCA).
We identified 248 patients with SCCA treated with CRT from 2010 to 2018 who were alive and without recurrence. We sent a PRO survey to 148 patients who agreed to participate. The survey was comprised of the PROMIS sexual function and satisfaction questionnaire, the international index of erectile function 5-item questionnaire for men, and the female sexual function index questionnaire for women. Clinical and dosimetric data were collected for each patient. We used multiple regression models to identify factors associated with sexual function PROs.
One-hundred twelve patients (45.2% of all eligible patients, 75.7% of administered surveys) completed the survey; 90 (80.4%) were women, 107 (95.5%) were white. The median (interquartile range [IQR]) age was 61.5 (53.8-66.0) years. The median (IQR) interval since CRT was 51 (37-85) months. Twelve men (54.5%) and 52 women (57.1%) were sexually active. The median (IQR) age of sexually active patients was 58.2 (50.1-64) years compared with 64.8 (59.1-68.8) years for sexually inactive patients (P < .001). The median (IQR) female sexual function index score for sexually active women was 20.2 (13.6-25.1). The median (IQR) international index of erectile function 5-item questionnaire score was 14 (6.5-19).
Patients treated with modern CRT for SCCA experience significant long-term sexual dysfunction as reported using validated PROs. Interventions to reduce sexual toxicities and improve patient support are needed.
盆腔放化疗对性功能有深远影响。目前关于接受调强放疗（IMRT）联合同期化疗（CRT）治疗的肛门鳞癌（SCCA）患者的长期性功能患者报告结局（PRO）的相关数据较少。
我们从 2010 年至 2018 年期间，确定了 248 例接受 CRT 治疗的 SCCA 患者，这些患者存活且无复发。我们向同意参与的 148 例患者发送了 PRO 调查。该调查包括 PROMIS 性功能和满意度问卷、男性国际勃起功能指数 5 项问卷（IIEF-5）和女性性功能指数问卷。为每位患者收集了临床和剂量学数据。我们使用多回归模型来确定与性功能 PRO 相关的因素。
112 例患者（所有合格患者的 45.2%，接受调查的患者的 75.7%）完成了调查；90 例（80.4%）为女性，107 例（95.5%）为白人。中位（四分位距 [IQR]）年龄为 61.5（53.8-66.0）岁。中位（IQR）CRT 后时间为 51（37-85）个月。12 名男性（54.5%）和 52 名女性（57.1%）有性生活。有性生活患者的中位（IQR）年龄为 58.2（50.1-64）岁，无性生活患者为 64.8（59.1-68.8）岁（P<0.001）。有性生活的女性患者的中位（IQR）女性性功能指数评分（FSFI）为 20.2（13.6-25.1）。中位（IQR）IIEF-5 问卷评分为 14（6.5-19）。
使用验证过的 PRO 方法，接受现代 CRT 治疗的 SCCA 患者报告存在严重的长期性功能障碍。需要采取干预措施以减少放化疗毒性并改善患者支持。
