Desai J, Stock R G, Stone N N, Iannuzzi C, DeWyngaert J K
Department of Radiation Oncology, Mt. Sinai Medical Center, New York, New York, USA.
Radiat Oncol Investig. 1998;6(3):135-41. doi: 10.1002/(SICI)1520-6823(1998)6:3<135::AID-ROI4>3.0.CO;2-Z.
The objective of this paper was to evaluate the acute urinary morbidity associated with I-125 interstitial implantation of the prostate gland. From 1991-1995, 117 patients underwent ultrasound (U/S)-guided implantation of the prostate gland. Median dose to 90% of the gland (d90) was 14.68 Gy (range = 1.65-21.75 Gy). The patients' urinary symptoms were recorded pre-implantation and at regular intervals after implantation using the International Prostate Symptom Score (IPSS), a self-assessment questionnaire in which patients scored 7 symptoms: incomplete emptying, frequency, intermittency, urgency, weak stream, straining, and nocturia. Median follow-up was 12 months. The natural history of implant-related urinary symptoms was assessed in this manner. In addition, dosimetric factors including U/S prostate volume, total activity, activity per seed, dose volume histogram (DVH) values for dose to gland, and dose area histogram (DAH) values for dose to urethra and bladder were examined for correlation to the severity of each symptom as well as to total IPSS (sum of the individual symptom scores). Total IPSS peaked at 1 month post-implant and gradually returned to approximately baseline at 24 months. Total IPSS directly correlated with total activity and DVH for the prostate. Total IPSS, however, did not correlate with bladder or urethral DAH. With the exception of frequency, individual symptoms did not correlate with dose to gland, bladder, or urethra. Frequency scores did, however, correlate not only with dose to prostate gland but also dose to urethra. The acute urinary side effects of I-125 prostate implantation are transient and peak at 1 month post-implant. The severity of the urinary irritative symptoms developed are closely related to total dose to the gland. Urethral dose appears to affect frequency most significantly. Urinary symptoms, therefore, may be a limiting factor when considering dose escalation with I-125.
本文的目的是评估与前列腺碘-125间质植入相关的急性泌尿系统发病率。1991年至1995年期间，117例患者接受了超声引导下的前列腺植入。腺体90%的中位剂量（d90）为14.68 Gy（范围=1.65 - 21.75 Gy）。使用国际前列腺症状评分（IPSS）在植入前和植入后定期记录患者的泌尿系统症状，IPSS是一份自我评估问卷，患者对7种症状进行评分：排尿不尽、尿频、尿间断、尿急、尿流无力、排尿费力和夜尿。中位随访时间为12个月。以这种方式评估了与植入相关的泌尿系统症状的自然病程。此外，还检查了剂量学因素，包括超声测量的前列腺体积、总活度、每粒籽源的活度、腺体剂量的剂量体积直方图（DVH）值以及尿道和膀胱剂量的剂量面积直方图（DAH）值，以确定它们与每种症状的严重程度以及总IPSS（各症状评分总和）之间的相关性。总IPSS在植入后1个月达到峰值，并在24个月时逐渐恢复到大致基线水平。总IPSS与前列腺的总活度和DVH直接相关。然而，总IPSS与膀胱或尿道的DAH无关。除尿频外，个体症状与腺体、膀胱或尿道的剂量均无相关性。然而，尿频评分不仅与前列腺剂量相关，还与尿道剂量相关。碘-125前列腺植入的急性泌尿系统副作用是短暂的，在植入后1个月达到峰值。所出现的泌尿系统刺激症状的严重程度与腺体的总剂量密切相关。尿道剂量似乎对尿频影响最为显著。因此，在考虑增加碘-125剂量时，泌尿系统症状可能是一个限制因素。
