Edwards Michael H, Nicklawsky Andrew, Beltran Gemma, Stein Elizabeth, Pyrzanowski Jennifer, Rove Kyle, Boone Karlie, Milgrom Sarah, Cost Nicholas G
Center for Cancer and Blood Disorders, Children's Hospital Colorado, Aurora, Colorado, USA.
University of Colorado Biostatistics, Aurora, Colorado, USA.
Pediatr Blood Cancer. 2025 Nov;72(11):e31996. doi: 10.1002/pbc.31996. Epub 2025 Aug 26.
Pediatric patients with pelvic solid tumors often receive multimodal treatment, but the long-term effects of this treatment on lower urinary tract (LUT) function are not well-described. This prospective cohort study (NCT05818462) investigates the effect of external beam radiation therapy (EBRT) on LUT function by comparing patient-reported outcome measures, non-invasive urodynamic studies, and post-void residuals (PVRs) amongst childhood cancer survivors (CCS).
All subjects were CCS greater than 1 year off-therapy for a pediatric solid tumor. Subjects were divided into cohorts by whether they had received pelvic EBRT. Research subjects completed the Dysfunctional Voiding Scoring system (DVSS) survey, uroflow testing, and PVR bladder scan.
Thirty-two patients enrolled; half received pelvic EBRT (mean 30.0 Gy). There was an equal number of patients exposed to alkylators (69%) in each cohort. Radiation cohort was further off therapy (5.3 vs. 4.0 years). The pelvic radiation cohort was more likely to have abnormal uroflow patterns (81% vs. 56%, p = 0.12). The flow pattern distribution differed between groups (p = 0.03); the pelvic radiation cohort was more likely to have a "plateau"-shaped curve (44% vs. 6%) and abnormal PVR (odds ratio [OR] 9.0, p = 0.002). Exploratory conditional likelihood ratio models yielded potential associations between pelvic EBRT and LUTD, as well as a potential dose-response. There was no difference in DVSS scores between cohorts.
EBRT appears to affect LUT function in CCS who received pelvic EBRT. DVSS does not appear useful as a screening tool in this population. Further study is needed to better appreciate the impact of EBRT on LUT function and develop more accurate screening tools.
患有盆腔实体瘤的儿科患者通常接受多模式治疗，但这种治疗对下尿路（LUT）功能的长期影响尚无详尽描述。这项前瞻性队列研究（NCT05818462）通过比较儿童癌症幸存者（CCS）的患者报告结局指标、非侵入性尿动力学研究和排尿后残余尿量（PVR），调查外照射放疗（EBRT）对LUT功能的影响。
所有受试者均为完成儿科实体瘤治疗1年以上的CCS。根据是否接受盆腔EBRT将受试者分为不同队列。研究对象完成排尿功能障碍评分系统（DVSS）调查、尿流率测试和PVR膀胱扫描。
32名患者入组；其中一半接受盆腔EBRT（平均30.0 Gy）。每个队列中接触烷化剂的患者数量相等（69%）。放疗队列停止治疗的时间更长（5.3年对4.0年）。盆腔放疗队列更有可能出现异常尿流模式（81%对56%，p = 0.12）。两组之间的尿流模式分布不同（p = 0.03）；盆腔放疗队列更有可能出现“平台”形曲线（44%对6%）和异常PVR（优势比[OR] 9.0，p = 0.002）。探索性条件似然比模型得出盆腔EBRT与下尿路功能障碍（LUTD）之间的潜在关联以及潜在的剂量反应。队列之间的DVSS评分没有差异。
EBRT似乎会影响接受盆腔EBRT的CCS的LUT功能。在该人群中，DVSS似乎不是一个有用的筛查工具。需要进一步研究以更好地了解EBRT对LUT功能的影响，并开发更准确的筛查工具。
