Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect

被引：22

作者：

Cozzarini, Cesare ^{[1
]}

Rancati, Tiziana ^{[2
]}

Palorini, Federica ^{[2
]}

Avuzzi, Barbara ^{[3
]}

Garibaldi, Elisabetta ^{[4
]}

Balestrini, Damiano ^{[5
]}

Cante, Domenico ^{[6
]}

Munoz, Fernando ^{[7
]}

Franco, Pierfrancesco ^{[7
]}

Girelli, Giuseppe ^{[6
]}

Sini, Carla ^{[8
]}

Vayassori, Vittorio ^{[9
]}

Valdagni, Riccardo ^{[2
,3
,10
]}

Fiorino, Claudio ^{[8
]}

机构：

[1] Ist Sci San Raffaele, Radiotherapy, Milan, Italy

[2] Fdn IRCCS, Ist Nazl Tumori, Prostate Canc Program, Milan, Italy

[3] Fdn IRCCS, Ist Nazl Tumori, Radiat Oncol 1, Milan, Italy

[4] Fdn Piemonte Oncol, IRCCS, Ist Candiolo, Radiotherapy, Bologna, Italy

[5] Osped Bellaria, Radiotherapy, Bologna, Italy

[6] ASL TO4, Ivrea Community Hosp, Radiotherapy, Chivasso, Italy

[7] Osped Reg U Parini AUSL Valle Aosta, Radiotherapy, Aosta, AO, Italy

[8] Ist Sci San Raffaele, Med Phys, Milan, Italy

[9] Clin Gavazzeni Humanitas, Radiotherapy, Bergamo, Italy

[10] Univ Milan, Dipartimento Oncol & Ematooncol, Milan, Italy

来源：

RADIOTHERAPY AND ONCOLOGY | 2017年 / 125卷 / 01期

关键词：

Prostate cancer; Radiotherapy; Incontinence; Predictive models; MODULATED RADIATION-THERAPY; MULTIVARIABLE MODELS; LATE TOXICITY; IMPACT; SYMPTOMS; SURVIVAL; OUTCOMES; TRIAL;

D O I：

10.1016/j.radonc.2017.07.029

中图分类号：

R73 [肿瘤学];

学科分类号：

100214 ;

摘要：

Background and purpose: Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). Methods and materials: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2 Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6 months. Patients were treated with conventional (74-80 Gy, 1.8-2 Gy/fr) or moderately hypo fractionated RT (65-75.2 Gy, 2.2-2.7 Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. Results: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF > 12) was 5.1%. EQD2 calculated with alpha-beta = 0.8 Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2 > 80 Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. Conclusions: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI. (C) 2017 Elsevier B.V. All rights reserved.

引用

页码：101 / 106

页数：6