- 作者：Gerard C. Morton M.B. ; F.R.C.P.C.* ; gerard.morton@sunnybrook.ca"" rel=""nofollow ; D. Andrew Loblaw M.D. ; M.Sc. ; F.R.C.P.C.* ; Hans Chung M.D. ; F.R.C.P.C.* ; Gail Tsang M.D. ; F.R.A.N.Z.C.R.† ; ; Raxa Sankreacha M.Sc.‡ ; ; Andrea Deabreu§ ; ; Liying Zhang Ph.D.§ ; ; Alexandre Mamedov§ ; ; Patrick Cheung M.D. ; F.R.C.P.C.* ; Deidre Batchelar Ph.D.‡ ; ; Cyril Danjoux M.D. ; F.R.C.P.C.* ; Ewa Szumacher M.D. ; M.Ed. ; F.R.C.P.C.*
- 刊名：International Journal of Radiation Oncology*Biology*Physics
- 出版年：2011
- 出版时间：1 August 2011
- 年：2011
- 卷：80
- 期：5
- 页码：1299-1305
- 全文大小：206 K
Purpose
To investigate the change in health-related quality of life for men after high-dose-rate brachytherapy and external beam radiotherapy for prostate cancer and the factors associated with this change.Methods and Materials
Eligible patients had clinically localized intermediate-risk prostate cancer. The patients received high-dose-rate brachytherapy as a single 15-Gy implant, followed by external beam radiotherapy to 37.5 Gy in 15 fractions. The patients were monitored prospectively for toxicity (Common Terminology Criteria for Adverse Events, version 3.0) and health-related quality of life (Expanded Prostate Cancer Index Composite [EPIC]). The proportion of patients developing a clinically significant difference in the EPIC domain score (minimally important difference of >0.5 standard deviation) was determined and correlated with the baseline clinical and dosimetric factors. The study accrued 125 patients, with a median follow-up of 24 months.
Results
By 24 months, 23 % had Grade 2 urinary toxicity and only 5 % had Grade 2 bowel toxicity, with no Grade 3 toxicity. The proportion of patients reporting a significant decrease in EPIC urinary, bowel, sexual, and hormonal domain scores was 53 % , 51 % , 45 % , and 40 % at 12 months and 57 % , 65 % , 51 % , and 30 % at 24 months, respectively. The proportion with a >1 standard deviation decrease in the EPIC urinary, bowel, sexual, and hormonal domain scores was 38 % , 36 % , 24 % , and 20 % at 12 months and 46 % , 48 % , 19 % , and 8 % at 24 months, respectively. On multivariate analysis, the dose to 10 % of the urethra was associated with a decreasing EPIC urinary domain score (p = .0089) and, less strongly (p = .0312) with a decreasing hormonal domain score. No association was found between the prostate volume, bladder dose, or high-dose volume and urinary health-related quality of life. A high baseline International Index of Erectile Function score was associated (p = .0019) with a decreasing sexual domain score. The optimal maximal dose to 10 % of the urethra cutpoint for urinary health-related quality of life was 120 % of the prescription dose.
Conclusion
EPIC was a more sensitive tool for detecting the effects on function and bother than were the generic toxicity scales. The urethral dose had the strongest association with a deteriorating urinary quality of life.