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Abstract：
BACKGROUND: Dysuria following prostate radiation therapy is a common toxicity that adversely affects patients\' quality of life and may be difficult to manage.
METHODS: Two hundred four patients treated with stereotactic body radiation therapy (SBRT) from 2007 to 2010 for localized prostate carcinoma with a minimum follow-up of 3 years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25 Gy in five fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination) of the expanded prostate index composite-26 and the American Urological Association (AUA) Symptom Score at baseline and at routine follow-up.
RESULTS: Two hundred four patients (82 low-, 105 intermediate-, and 17 high-risk according to the D\'Amico classification) at a median age of 69 years (range 48-91) received SBRT for their localized prostate cancer with a median follow-up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at 1 month (p < 0.0001). There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first 2 years of follow-up, it returned to below baseline by 2 years (p = 0.91). The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p < 0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis.
CONCLUSIONS: The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.
METHODS: Two hundred four patients treated with stereotactic body radiation therapy (SBRT) from 2007 to 2010 for localized prostate carcinoma with a minimum follow-up of 3 years were included in this retrospective review of prospectively collected data. All patients were treated to 35-36.25 Gy in five fractions delivered with robotic SBRT with real time fiducial tracking. Dysuria and other lower urinary tract symptoms were assessed via Question 4b (Pain or burning on urination) of the expanded prostate index composite-26 and the American Urological Association (AUA) Symptom Score at baseline and at routine follow-up.
RESULTS: Two hundred four patients (82 low-, 105 intermediate-, and 17 high-risk according to the D\'Amico classification) at a median age of 69 years (range 48-91) received SBRT for their localized prostate cancer with a median follow-up of 47 months. Bother associated with dysuria significantly increased from a baseline of 12% to a maximum of 43% at 1 month (p < 0.0001). There were two distinct peaks of moderate to severe dysuria bother at 1 month and at 6-12 months, with 9% of patients experiencing a late transient dysuria flare. While a low level of dysuria was seen through the first 2 years of follow-up, it returned to below baseline by 2 years (p = 0.91). The median baseline AUA score of 7.5 significantly increased to 11 at 1 month (p < 0.0001) and returned to 7 at 3 months (p = 0.54). Patients with dysuria had a statistically higher AUA score at baseline and at all follow-ups up to 30 months. Dysuria significantly correlated with dose and AUA score on multivariate analysis. Frequency and strain significantly correlated with dysuria on stepwise multivariate analysis.
CONCLUSIONS: The rate and severity of dysuria following SBRT is comparable to patients treated with other radiation modalities.
摘要：
背景：前列腺放射治疗后的排尿困难是一种常见的毒性，会对患者的生活质量产生不利影响，可能难以处理。
方法：纳入了2007年至2010年接受立体定向放射治疗（SBRT）治疗的局部前列腺癌患者，最少随访3年。所有患者均接受了35-36.25Gy的治疗，分五个部分使用具有实时基准跟踪的机器人SBRT进行了治疗。在基线和常规随访时，通过扩展前列腺指数复合26的问题4b（排尿时疼痛或灼热）和美国泌尿外科协会（AUA）症状评分评估排尿困难和其他下尿路症状。
结果：二百四例患者（82例，105中间体-，根据D\'Amico分类，17名高风险患者），中位年龄69岁（48-91岁），因其局限性前列腺癌而接受SBRT，中位随访时间为47个月。与排尿困难相关的神经从基线的12%显著增加至1个月时的最大43%(p<0.0001)。在1个月和6-12个月时有两个明显的中度至重度排尿困难峰，9%的患者出现迟发性短暂性排尿困难。虽然在最初2年的随访中发现了低水平的排尿困难，2年后回到基线以下(p=0.91).基线AUA中位数为7.5，在1个月时显着增加至11（p<0.0001），在3个月时恢复至7（p=0.54）。排尿困难患者在基线和30个月的所有随访中具有统计学上较高的AUA评分。在多变量分析中，排尿困难与剂量和AUA评分显着相关。在逐步多变量分析中，频率和应变与排尿困难显着相关。
结论：SBRT术后排尿困难的发生率和严重程度与接受其他放射治疗的患者相当。
方法：纳入了2007年至2010年接受立体定向放射治疗（SBRT）治疗的局部前列腺癌患者，最少随访3年。所有患者均接受了35-36.25Gy的治疗，分五个部分使用具有实时基准跟踪的机器人SBRT进行了治疗。在基线和常规随访时，通过扩展前列腺指数复合26的问题4b（排尿时疼痛或灼热）和美国泌尿外科协会（AUA）症状评分评估排尿困难和其他下尿路症状。
结果：二百四例患者（82例，105中间体-，根据D\'Amico分类，17名高风险患者），中位年龄69岁（48-91岁），因其局限性前列腺癌而接受SBRT，中位随访时间为47个月。与排尿困难相关的神经从基线的12%显著增加至1个月时的最大43%(p<0.0001)。在1个月和6-12个月时有两个明显的中度至重度排尿困难峰，9%的患者出现迟发性短暂性排尿困难。虽然在最初2年的随访中发现了低水平的排尿困难，2年后回到基线以下(p=0.91).基线AUA中位数为7.5，在1个月时显着增加至11（p<0.0001），在3个月时恢复至7（p=0.54）。排尿困难患者在基线和30个月的所有随访中具有统计学上较高的AUA评分。在多变量分析中，排尿困难与剂量和AUA评分显着相关。在逐步多变量分析中，频率和应变与排尿困难显着相关。
结论：SBRT术后排尿困难的发生率和严重程度与接受其他放射治疗的患者相当。
