Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided prostate brachytherapy with or without neoadjuvant external beam radiation therapy
Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided prostate brachytherapy with or without neoadjuvant external beam radiation therapy
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DOI：
10.1002/cncr.11595
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发表时间：
2003-09-01
期刊：
影响因子：
6.2
通讯作者：
D'Amico, AV
中科院分区：
文献类型：
--
作者：
Albert, M;Tempany, CM;D'Amico, AV
背景资料。方法：1997年11月至2002年4月，201例TIC前列腺癌(根据2002年美国癌症联合委员会分期标准)、前列腺特异性抗原水平<10 ng/m L、活检Gleason评分3+4疾病患者接受MRI引导下近距离放射治疗或联合外照射治疗。MRI引导的技术旨在通过将处方剂量专门传递到外周区域来避免尿路损伤。使用Kaplan-Meier方法估计晚期胃肠道毒性和直肠毒性的缓解率。结果：在平均2.8年(范围0.5-5.0年)的随访期内，接受植入治疗的患者与接受综合治疗的患者相比，需要凝血的4年估计数分别为8%和30%(LOG-RANK P值=0.0001)。虽然使用柠檬酸西地那非(伟哥(R))的勃起功能障碍很常见(82%-93%)，但据估计，至少三分之二的患者的勃起功能与基线功能相当或高于基线功能，无论他们接受的是单一疗法还是综合疗法(P=0.46)。接受单一治疗的患者和接受综合治疗的患者的4年无放射性膀胱炎的估计分别为100%和95%(P=0.01)。没有观察到尿道狭窄，也没有患者接受术后经尿道前列腺电切术。结论：在目前的研究中，MRI引导的前列腺近距离治疗后直肠出血很少见，而且据报道，尿道和膀胱的毒性也很少见，这可能归因于MRI引导的方法中的保留尿路的技术。(C)2003年美国癌症协会。
BACKGROUND. This study was designed to estimate the rates of late genitourinary (GU) and rectal toxicity after magnetic resonance image (MRI)-guided prostate brachytherapy exclusively or in conjunction with external beam radiation therapy (EBRT).METHODS. Between November 1997 and April 2002, 201 patients with category TIC prostate carcinoma (according to the 2002 American joint Committee on Cancer staging criteria), prostate specific antigen levels < 10 ng/mL, and biopsy Gleason score 3 + 4 disease were treated with MRI-guided brachytherapy exclusively or in conjunction with EBRT. The MRI-guided technique was designed to spare the urethra based on delivery of the prescription dose to the peripheral zone exclusively. The Kaplan-Meier method was used to estimate rates of freedom from late GU and rectal toxicity. Comparisons were made using a log-rank test.RESULTS. At a median follow-up of 2.8 years (range, 0.5-5.0 years), the 4-year estimates of rectal bleeding requiring coagulation for patients who underwent implantation therapy, compared with patients who received combined-modality therapy, were 8% versus 30%, respectively (log-rank P value = 0.0001). Although erectile dysfunction was common (range, 82-93%), with the use of sildenafil citrate (Viagra(R)), it was estimated that at least two-thirds of patients had erectile function comparable to or superior to baseline function, independent of whether they received monotherapy or combined-modality therapy (P = 0.46). The 4-year estimate of freedom from radiation cystitis was 100% verSUS 95% (P = 0.01) for patients who received monotherapy and patients who received combined-modality therapy, respectively. No urethral strictures were observed, and no patients underwent postimplantation transurethral resection of the prostate.CONCLUSIONS. In the current study, rectal bleeding after MRI-guided prostate brachymonotherapy was infrequent, and urethral and bladder toxicity is reported to be rare and may be attributed to the urethral-sparing technique of the MRI-guided approach. (C) 2003 American Cancer Society.