Urethral Pain Among Prostate Cancer Survivors 1 to 14 Years After Radiation Therapy

作者：Pettersson Niclas^*; Olsson Caroline; Tucker Susan L; Alsadius David; Wilderang Ulrica; Johansson Karl Axel; Steineck Gunnar

来源：International Journal of Radiation Oncology, Biology, Physics, 2013, 85(1): E29-E37.

DOI：10.1016/j.ijrobp.2012.08.037

Purpose: To investigate how treatment-related and non-treatment-related factors impact urethral pain among long-term prostate cancer survivors. %26lt;br%26gt;Methods and Materials: Men treated for prostate cancer with radiation therapy at the Sahlgrenska University Hospital in Goteborg, Sweden from 1993 to 2006 were approached with a study-specific postal questionnaire addressing symptoms after treatment, including urethral burning pain during urination (n=985). The men had received primary or salvage external-beam radiation therapy (EBRT) or EBRT in combination with brachytherapy (BT). Prescribed doses were commonly 70 Gy in 2.0-Gy fractions for primary and salvage EBRT and 50 Gy plus 2 x 10.0 Gy for EBRT + BT. Prostatic urethral doses were assessed from treatment records. We also recruited 350 non-pelvic-irradiated, population-based controls matched for age and residency to provide symptom background rates. %26lt;br%26gt;Results: Of the treated men, 16%(137 of 863) reported urethral pain, compared with 11%(27 of 242) of the controls. The median time to follow-up was 5.2 years (range, 1.1-14.3 years). Prostatic urethral doses were similar to prescription doses for EBRT and 100% to 115% for BT. Fractionation-corrected dose and time to follow-up affected the occurrence of the symptom. For a follow-up %26gt;= 3 years, 19% of men (52 of 268) within the 70-Gy EBRT + BT group reported pain, compared with 10% of men (23 of 222) treated with 70 Gy primary EBRT (prevalence ratio 1.9; 95% confidence interval 1.2-3.0). Of the men treated with salvage EBRT, 10% (20 of 197) reported urethral pain. %26lt;br%26gt;Conclusions: Survivors treated with EBRT + BT had a higher risk for urethral pain compared with those treated with EBRT. The symptom prevalence decreased with longer time to follow-up. We found a relationship between fractionation-corrected urethral dose and pain. Among long-term prostate cancer survivors, the occurrence of pain was not increased above the background rate for prostatic urethral doses up to 70 Gy3.

• 出版日期2013-1-1