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首页> 外文期刊>European urology >Patterns and predictors of amelioration of genitourinary toxicity after high-dose intensity-modulated radiation therapy for localized prostate cancer: Implications for defining postradiotherapy urinary toxicity
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Patterns and predictors of amelioration of genitourinary toxicity after high-dose intensity-modulated radiation therapy for localized prostate cancer: Implications for defining postradiotherapy urinary toxicity

机译：大剂量强度调节放射治疗局限性前列腺癌后泌尿生殖系统毒性改善的模式和预测指标：定义放射治疗后尿毒症的意义

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Background Treatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa). Objective To determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT). Design, setting, and participants A total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3-7.7 yr). Intervention Patients underwent IMRT to a total dose of 86.4 Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy. Outcome measurements and statistical analysis Patients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied. Results and limitations The overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p < 0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p < 0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol. Conclusions Late GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling.
机译：背景当咨询局部前列腺癌（PCa）患者时，与治疗相关的毒性和生活质量（QoL）的考虑因素很重要。目的确定大剂量强度调节放疗（IMRT）后晚期泌尿生殖系统（GU）毒性和QoL的发生率和纵向模式。设计，设置和参与者2004年6月至2008年12月之间，在三级转诊中心共治疗了268例局部PCa患者。中位随访时间为5年（范围：3-7.7年）。干预患者接受IMRT的总剂量为86.4 Gy; 50％的患者接受了新辅助疗法和同时进行的雄激素剥夺治疗。结果测量和统计分析用预期获得的国际前列腺症状评分（IPSS）问卷对患者进行评估。也使用《不良事件通用术语标准》（CTCAE）v.4.0对GU毒性进行了评分;毒性事件定义为超过基线。使用Kruskal-Wallis和Mann-Whitney检验分析了基线IPSS总和与QoL指数组之间IPSS总和和QoL指数增加的差异。应用单变量和多元Cox回归模型。结果与局限性随访期间，IPSS总中位总和增加为3，与基线症状较轻的患者相比，基线症状较重的患者不明显（中位数增加：0 vs 4; p <0.0001）。 IMRT后总体QoL指数没有变化，但与满意的基线QoL相比，基线QoL不满意的患者似乎有所改善（p <0.0001）。分别有55名（20％）和2名（1％）患者发展出2级和3级晚期GU毒性。但是，在57例患者中有28例（49％）在随访期间毒性消失。即使IPSS数据是前瞻性获得的，大多数患者也未在前瞻性方案内接受治疗。结论大剂量IMRT治疗后的GU毒性较轻。重度，晚期GU毒性罕见。 IPSS总和和QoL指数的变化取决于基线GU功能，这可能对将来的患者咨询有用。

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