Fabian Alexander, Öztürk Bilgesu Sahin, Haack Lars, Rodler Severin, van der Horst Christof, Schulz Christian, Schmalz Claudia, Huttenlocher Stefan, Wittenstein Olaf, Blanck Oliver, Siebert Frank-André, Krug David
Department of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany.
Saphir Radiosurgery Center Northern Germany, Kiel, Germany.
Clin Transl Radiat Oncol. 2025 Jul 19;54:101019. doi: 10.1016/j.ctro.2025.101019. eCollection 2025 Sep.
A subset of prostate cancer patients develops local relapse at the primary site after radiotherapy. The optimal local salvage strategy is unknown. Therefore, we aimed to explore prevalence and determinants of decision regret among patients after reirradiation of the primary site.
We surveyed 31 patients in a cross-sectional bi-centre exploratory study. Reirradiation was high dose-rate brachytherapy (HDR-BT) in 21 and stereotactic body radiotherapy (SBRT) in 10 patients. Decision regret (DR) was measured using the Decision Regret Scale (DRS) (range: 0-100; higher values higher regret). Further patient-reported outcomes (PRO) included the EPIC-26, EORTC QLQ-C30, PRO-CTCAE, and PSCC questionnaires. Univariable associations of decision regret and potential determinants were assessed by one-way ANOVA or Pearson's correlation.
Median age at reirradiation was 75 years. Median time intervals from initial radiotherapy to reirradiation was 8 years and 4 years from reirradiation to survey. The mean DRS score was 10 (SD: 14). No (0 points), mild (1-25 points), or strong regret (>25 points) was reported by 45 % (14/31), 48 % (15/31), and 7 % (2/31) of the patients, respectively. DR was significantly associated with PRO of urinary symptom burden and toxicity as well as levels of shared-decision making and patient satisfaction. HDR-BT vs. SBRT, further local relapse, and progression-free survival were not associated with DR.
DR was mild among prostate cancer patients after reirradiation to the primary site. PRO on symptom burden and shared decision making may be associated with DR. These findings should be validated and may inform treatment decisions on local salvage therapy.
一部分前列腺癌患者在放疗后会在原发部位出现局部复发。最佳的局部挽救策略尚不清楚。因此，我们旨在探讨原发部位再次放疗后患者决策后悔的发生率及其决定因素。
在一项跨中心探索性研究中，我们对31例患者进行了调查。21例患者接受了高剂量率近距离放疗（HDR-BT），10例患者接受了立体定向体部放疗（SBRT）。使用决策后悔量表（DRS）（范围：0-100；分数越高，后悔程度越高）来衡量决策后悔（DR）。患者报告的其他结局（PRO）包括EPIC-26、欧洲癌症研究与治疗组织核心问卷（EORTC QLQ-C30）、PRO-CTCAE和PSCC问卷。通过单因素方差分析或Pearson相关性分析评估决策后悔与潜在决定因素之间的单变量关联。
再次放疗时的中位年龄为75岁。从初次放疗到再次放疗的中位时间间隔为8年，从再次放疗到调查的时间间隔为4年。DRS平均得分为10分（标准差：14）。分别有45%（14/31）、48%（15/31）和7%（2/31）的患者报告无（0分）、轻度（1-25分）或强烈后悔（>25分）。DR与泌尿系统症状负担和毒性的PRO以及共同决策水平和患者满意度显著相关。HDR-BT与SBRT、进一步的局部复发以及无进展生存期与DR均无关联。
前列腺癌患者在原发部位再次放疗后的决策后悔程度较轻。症状负担和共同决策方面的PRO可能与DR有关。这些发现应得到验证，并可能为局部挽救治疗的决策提供参考。
