Quality of Life after post-prostatectomy intensity modulated radiation therapy to the prostate bed with or without the use of gold fiducial markers for image guidance or higher total radiotherapy doses

ABSTRACT Purpose To evaluate quality of life (QoL) after post-prostatectomy intensity modulated radiation therapy (IMRT) in the “adjuvant” setting starting within 4 months of radical prostatectomy for adverse features; and “salvage” setting for a PSA≥0.2ng/mL. Materials and Methods Retrospective review of 130 patients who underwent IMRT to the prostate bed±gold fiducial marker placement for image guidance to 64.8-72.0Gy (median, 70.2Gy) between 2004 and 2013. Higher doses were defined as 70.2-72.0Gy and lower doses were defined as 64.8-68.4Gy. Androgen deprivation therapy (ADT) was given to 4/48 (8%) adjuvant patients and 9/82 (11%) salvage patients. International Prostate Symptom Score (IPSS), Sexual Health Inventory for Men (SHIM), and Expanded Prostate Cancer Index Composite-26-bowel (EPIC-26-bowel) questionnaires were used to assess urinary, sexual, and bowel QoL, respectively. Results Median follow-up was 46 months. There were better urinary (p=0.03) and sexual (p=0.002) QoL scores with adjuvant IMRT relative to salvage IMRT. The use of prostate bed fiducial markers did not significantly affect urinary, sexual, or bowel QoL (p=0.39, p=0.49, and p=0.40, respectively). Higher total radiotherapy doses did not significantly affect urinary, sexual, or bowel QoL (p=0.21, p=0.61, and p=0.36, respectively). Conclusions There was no significant change in urinary, sexual, and bowel sexual QoL with post-prostatectomy IMRT regardless of whether prostate bed fiducial markers or higher total radiotherapy doses were used. QoL with IMRT in the present study compares favorably with prior reports for three-dimensional conformal radiation therapy.

摘要
目的：本研究旨在评估前列腺切除术后调强放射治疗（intensity modulated radiation therapy, IMRT）在两种临床场景下的生活质量（quality of life, QoL）：一是针对根治性前列腺切除术后出现不良预后特征、且于术后4个月内启动治疗的辅助治疗场景，二是针对前列腺特异性抗原（prostate-specific antigen, PSA）≥0.2ng/mL的挽救治疗场景。
材料与方法：回顾性分析2004年至2013年间130例接受联合或不联合金参考标记置入以实现图像引导的前列腺床调强放射治疗的患者，处方剂量为64.8~72.0Gy（中位剂量70.2Gy）。其中，高剂量组定义为70.2~72.0Gy，低剂量组定义为64.8~68.4Gy。辅助治疗组48例患者中4例（8%）接受了雄激素剥夺治疗（androgen deprivation therapy, ADT），挽救治疗组82例患者中9例（11%）接受了该治疗。分别采用国际前列腺症状评分（International Prostate Symptom Score, IPSS）、男性性健康问卷（Sexual Health Inventory for Men, SHIM）以及扩展前列腺癌指数复合量表-26项肠道维度（Expanded Prostate Cancer Index Composite-26-bowel, EPIC-26-bowel）评估泌尿、性功能及肠道生活质量。
结果：中位随访时间为46个月。相较于挽救性IMRT，辅助性IMRT患者的泌尿（p=0.03）及性功能（p=0.002）生活质量评分更优。前列腺床金参考标记的使用对泌尿、性功能及肠道生活质量均无显著影响（分别对应p=0.39、p=0.49及p=0.40）。较高的总放疗剂量同样未对上述三类生活质量维度产生显著影响（分别对应p=0.21、p=0.61及p=0.36）。
结论：无论是否使用前列腺床金参考标记或采用较高的总放疗剂量，前列腺切除术后IMRT患者的泌尿、性功能及肠道生活质量均无显著变化。本研究中IMRT相关的生活质量结局优于既往三维适形放射治疗的相关报道。