Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia.
Department of Urological Surgery, Barwon Health, University Hospital Geelong, School of Medicine, Deakin University, Geelong, Victoria, Australia.
Urol Oncol. 2024 Jun;42(6):165-174. doi: 10.1016/j.urolonc.2024.02.011. Epub 2024 Mar 19.
When compared with conventional external beam radiotherapy, hypofractionated radiotherapy has led to less treatment sessions and improved quality of life without compromising oncological outcomes for men with prostate cancer. Evidence has shown transurethral prostatic resection prior to brachytherapy and external beam radiotherapy is associated with worsening genitourinary toxicity. However, there is no review of genitourinary toxicity when TURP occurs prior to definitive hypofractionated radiotherapy. In this review, we seek to illustrate the genitourinary outcomes for men with localized prostate cancer who underwent transurethral resection of the prostate prior to receiving definitive hypofractionated radiotherapy. Genitourinary outcomes are explored, and any predictive risk factors for increased genitourinary toxicity are described.
PubMed, Medline (Ovid), EMBASE and Cochrane Library were all searched for relevant articles published in English within the last 25 years. This scoping review identified a total of 579 articles. Following screening by authors, 11 articles were included for analysis.
Five studies reported on acute and late toxicity. One article reported only acute toxicity while 5 documented late toxicity only. While most articles found no increased risk of acute toxicity, the risk of late toxicity, particularly hematuria was noted to be significant. Risk factors including poor baseline urinary function, prostate volume, number of prior transurethral prostatic resections, timing of radiotherapy following transurethral prostatic resection, volume of the intraprostatic resection cavity and mean dose delivered to the cavity were all found to influence genitourinary outcomes.
For those who have undergone prior TURP hypofractionated radiotherapy may increase the risk of late urinary toxicity, particularly hematuria. Those with persisting bladder dysfunction following TURP are at greatest risk and careful management of these men is required. Close collaboration between urologists and radiation oncologists is recommended to discuss the management of patients with residual baseline bladder dysfunction prior to commencing hypofractionated radiotherapy.
与常规外束放射治疗相比，前列腺癌患者接受分割剂量放射治疗可减少治疗次数，提高生活质量，同时不影响肿瘤治疗效果。有证据表明，近距离放射治疗和外束放射治疗前经尿道前列腺切除术与泌尿生殖毒性恶化有关。然而，对于 TURP 发生在根治性分割剂量放射治疗之前的患者，尚无关于泌尿生殖毒性的综述。在本综述中，我们旨在阐明接受根治性分割剂量放射治疗前接受经尿道前列腺切除术的局限性前列腺癌患者的泌尿生殖结局。探讨了泌尿生殖结局，并描述了任何增加泌尿生殖毒性的预测风险因素。
在过去 25 年内，通过 PubMed、Medline（Ovid）、EMBASE 和 Cochrane Library 搜索了以英文发表的相关文章。这项范围界定综述共确定了 579 篇文章。经作者筛选后，纳入 11 篇文章进行分析。
五项研究报告了急性和晚期毒性。一篇文章仅报告了急性毒性，而 5 篇文章仅记录了晚期毒性。虽然大多数文章发现急性毒性风险没有增加，但晚期毒性（尤其是血尿）的风险显著增加。风险因素包括基线尿功能差、前列腺体积、经尿道前列腺切除术次数、经尿道前列腺切除术后放射治疗时间、前列腺内切除腔体积和腔内平均剂量等均被认为会影响泌尿生殖结局。
对于那些已经接受过 TURP 的患者，分割剂量放射治疗可能会增加晚期尿毒性的风险，特别是血尿。那些在 TURP 后仍存在膀胱功能障碍的患者风险最大，需要对这些患者进行仔细管理。建议泌尿科医生和放射肿瘤学家密切合作，在开始分割剂量放射治疗前，讨论管理具有残留基线膀胱功能障碍的患者。
