Delayed rectal and urinary symptomatotogy in patients treated for prostate cancer by radiotherapy with or without short term neo-adjuvant androgen deprivation
Delayed rectal and urinary symptomatotogy in patients treated for prostate cancer by radiotherapy with or without short term neo-adjuvant androgen deprivation
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DOI：
10.1016/j.radonc.2005.10.005
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发表时间：
2005-11-01
影响因子：
5.7
通讯作者：
Bill, D
中科院分区：
文献类型：
--
作者：
Christie, D;Denham, J;Bill, D
背景和目的：在一项随机试验中，比较局部晚期前列腺癌放疗前给予不同持续时间的最大雄激素剥夺（MAD），以确定迟发性直肠和泌尿系统症状的影响因素。在1996年至2000年期间，818名T2b、c、3和4期前列腺癌患者参加了一项试验，放疗前和放疗期间的3个月和6个月MAD。他们的治疗医生使用标准化量表记录了他们的延迟正常组织效应，患者定期使用自我评估问卷。发生时间和患病率数据进行了analysed.Results：直肠和泌尿系统症状水平观察到显着变化，随着时间的推移，在至少80%的患者，与一些表示持久的解决症状。发现流行率大大低于精算概率。基线症状水平和最大急性症状水平都是非常有力的预测因子。在放疗后的前4年，每个治疗组中约有60%的病例的下尿路梗阻症状得到改善。然而，在其他单变量或多变量分析中，治疗组本身并没有影响这些改善。MAD显示可减少迟发性直肠病变症状的发生时间和患病率，但仅在3个月治疗组中统计学证实了该效应。多变量模型表明，更高水平的血红蛋白之前，任何治疗可能会以某种方式保护对延迟proctopathic symptoms.Conclusions：患病率数据提供了更有临床意义的估计，在正常组织中的评估基本上依赖于报告的症状水平的延迟效应的风险。在这些组织中，考虑基线症状水平和病理学的影响，以及延迟效应分析中的最大急性症状水平似乎是强制性的。未来的研究可以解决直肠毒性是否受初始血红蛋白水平的影响，以及由于MAD而导致的血红蛋白水平下降。(c)2005年由Elsevier爱尔兰有限公司出版
Background and purpose: To identify contributing factors to delayed rectal and urinary symptoms in a randomised trial comparing different durations of maximal androgen deprivation (MAD), given prior to radiotherapy, for locally advanced prostate cancer.Patients and methods: Between 1996 and 2000, 818 patients with stages T2b,c, 3 and 4 prostate cancer were entered into a trial comparing 0, 3 and 6 months of MAD prior to and during radiotherapy. Their delayed normal tissue effects were recorded by their treating doctors using standardised scales and by the patients using a self-assessment questionnaire regularly. Time to occurrence and prevalence data were analysed.Results: Rectal and urinary symptom levels were observed to vary markedly over time in at least 80% of patients, with some indicating lasting resolution of symptoms. Prevalence rates were found to be substantially lower than actuarial probability rates. Baseline symptom levels and greatest acute symptom levels were both very powerful predictors.Obstructive lower urinary tract symptoms were noted to improve during the first 4 years after radiotherapy in approximately 60% of cases in each treatment arm. However, the treatment arm itself was not shown to influence these improvements in other univariate or multivariate analyses. MAD was shown to reduce both time to occurrence and prevalence of delayed proctopathic symptoms, but this effect was confirmed statistically in the 3 month treatment arm only. Multivariate models indicated that higher levels of haemoglobin prior to any treatment may in some way protect against delayed proctopathic symptoms.Conclusions: Prevalence data provide more clinically meaningful estimates of risk of delayed effects in normal tissues where assessment relies substantially on reported symptom levels. In these tissues consideration of the impact of baseline symptom levels and pathologies, and greatest acute symptom levels in analyses of delayed effects appears mandatory.Obstructive lower urinary symptoms improve over several years in the majority of patients treated for locally advanced prostate cancer by radiotherapy. Future research could address whether rectal toxicity is affected by initial haemoglobin levels and declines in it due to MAD. (c) 2005 Published by Elsevier Ireland Ltd.