对于局限性前列腺癌，在确定性放射治疗中添加雄激素剥夺治疗后的决策遗憾与困扰。
Decision Regret and Bother With the Addition of Androgen Deprivation Therapy to Definitive Radiation Treatment for Localized Prostate Cancer.
作者信息
Booth Victoria, Eade Thomas, Hruby George, Lieng Hester, Brown Chris, Guo Linxin, Dhillon Haryana, Kneebone Andrew
机构信息
Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia.
Northern Clinical School, University of Sydney, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; Northern Sydney Cancer Centre, Radiation Oncology Unit, Royal North Shore Hospital, St Leonards, Sydney, New South Wales, Australia; Central Coast Cancer Centre, Gosford, New South Wales, Australia.
出版信息
Pract Radiat Oncol. 2023 Sep-Oct;13(5):e400-e408. doi: 10.1016/j.prro.2023.04.009. Epub 2023 May 10.
PURPOSE
Androgen deprivation therapy (ADT) combined with radiation treatment (RT) is recommended by the National Comprehensive Cancer Network guidelines for unfavorable intermediate and high-risk localized prostate cancer. Although there is a variable survival benefit conferred by ADT, there are potential side effects to consider for patient decision-making. We aimed to assess the side effects and bother of adding ADT to RT, the degree of regret, and what overall survival (OS) benefit men would want to justify adding or extending the duration of ADT, after their experience with this treatment.
METHODS AND MATERIALS
Men receiving ADT with definitive RT completed a questionnaire asking about the side effects and degree of bother from ADT using a 4-point scale. They were also asked about regret, and what survival benefit would warrant ADT.
RESULTS
In the study, 846 patients received definitive RT, of whom 356 received ADT and were asked about their experience with ADT. Of these, 234 responded (66%). In 54%, ADT caused some bother, most commonly hot flushes (32%), fatigue (29%), and sexual problems (29%). Five percent regretted receiving ADT "quite a lot" or "very much." Approximately one-third of men deemed a 1% OS benefit from ADT worthwhile, whereas one-third (34%) would want a >10% OS benefit enough to justify choosing ADT again. In addition, 49% of patients who received short-term ADT would accept longer duration ADT for a 6% OS benefit.
CONCLUSIONS
Significant regret for ADT was low (5%). There was a clear dichotomy between those who deemed any OS benefit from ADT worthwhile versus those who needed a significant survival benefit to justify the side effects. Given that some men may change their opinion on the relative value of ADT after experiencing its effects, this study emphasizes the importance of revisiting patients after 6 months to given patients an opportunity to renegotiate their treatment.
目的
美国国立综合癌症网络（National Comprehensive Cancer Network）指南推荐，对于预后不良的中高危局限性前列腺癌患者，采用雄激素剥夺疗法（ADT）联合放射治疗（RT）。尽管ADT可带来不同程度的生存获益，但在患者做决策时，仍需考虑其潜在的副作用。我们旨在评估在放疗基础上加用ADT的副作用、困扰程度、后悔程度，以及男性患者在接受这种治疗后，认为加用或延长ADT疗程能带来何种总生存期（OS）获益才是合理的。
方法和材料
接受根治性放疗联合ADT的男性患者完成一份问卷，问卷使用4分制询问ADT的副作用及困扰程度。还询问了他们的后悔程度，以及何种生存获益能使ADT变得合理。
结果
在该研究中，846例患者接受了根治性放疗，其中356例接受了ADT，并被询问了他们接受ADT的体验。其中，234例做出了回应（66%）。54%的患者表示ADT带来了一些困扰，最常见的是潮热（32%）、疲劳（29%）和性功能问题（29%）。5%的患者“相当”或“非常”后悔接受ADT。约三分之一的男性认为ADT带来1%的OS获益是值得的，而三分之一（34%）的男性希望OS获益>10%才足以证明再次选择ADT是合理的。此外，49%接受短期ADT的患者会为了6%的OS获益而接受更长疗程的ADT。
结论
对ADT的显著后悔率较低（5%）。对于那些认为ADT带来的任何OS获益都是值得的患者，与那些需要显著生存获益来抵消副作用的患者之间，存在明显的差异。鉴于一些男性在体验到ADT的效果后可能会改变对其相对价值的看法，本研究强调了在6个月后回访患者的重要性，以便让患者有机会重新协商他们的治疗方案。
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