Sexual quality of life following prostate intensity modulated radiation therapy (IMRT) with a rectal/prostate spacer: Secondary analysis of a phase 3 trial.

Autor:	Hamstra DA; The Department of Radiation Oncology, Beaumont Hospital, Dearborn, Michigan. Electronic address: Daniel.Hamstra@Beaumont.org., Mariados N; Associated Medical Professionals of NY PLLC, Syracuse, New York., Sylvester J; 21st Century Oncology, Inc., Lakewood Ranch, East Bradenton, Florida., Shah D; Western New York Urology Associates, LLC /D/B/A Cancer Care of WNY, Cheektowaga, New York., Gross E; The Urology Center of Colorado, Denver, Colorado., Hudes R; Chesapeake Urology Associates d/b/a Chesapeake Urology Research Associates (The Prostate Center), Owings Mills, Maryland., Beyer D; Cancer Centers of Northern Arizona, Sedona, Arizona., Kurtzman S; Urological Surgeons of Northern California Inc., Campbell, California., Bogart J; The Research Foundation of State University of New York/SUNY Upstate Medical University, Syracuse, New York., Hsi RA; Peninsula Cancer Center, Poulsbo, Washington., Kos M; Northern Nevada Radiation Oncology, Reno, Nevada., Ellis R; University Hospitals Case Medical Center, Cleveland, Ohio., Logsdon M; Sutter Health Sacramento Sierra Region d/b/a Sutter Institute for Medical Research, Sacramento, California., Zimberg S; Advanced Radiation Centers of New York, Lake Success, New York., Forsythe K; Oregon Urology Institute, Springfield, Oregon., Zhang H; University of Rochester, Rochester, New York., Soffen E; CentraState Medical Center, Freehold, New Jersey., Francke P; Carolina Regional Cancer Center, LLC/21st Century Oncology, Inc., Myrtle Beach, South Carolina., Mantz C; 21st Century Oncology, Inc., Fort Meyers, Florida., Rossi P; Emory University, Atlanta, Georgia., DeWeese T; The Johns Hopkins University, Baltimore, Maryland., Daignault-Newton S; Department of Biostatistics, University of Michigan, Ann Arbor, Michigan., Fischer-Valuck BW; Washington University School of Medicine, St. Louis, Missouri., Chundury A; Washington University School of Medicine, St. Louis, Missouri., Gay HA; Washington University School of Medicine, St. Louis, Missouri., Bosch W; Washington University School of Medicine, St. Louis, Missouri., Michalski J; Washington University School of Medicine, St. Louis, Missouri.
Jazyk:	angličtina
Zdroj:	Practical radiation oncology [Pract Radiat Oncol] 2018 Jan - Feb; Vol. 8 (1), pp. e7-e15. Date of Electronic Publication: 2017 Jul 19.
DOI:	10.1016/j.prro.2017.07.008
Abstrakt:	Background: We previously reported the results of a phase 3 trial evaluating a prostate/rectal hydrogel spacer during prostate intensity modulated radiation therapy, which resulted in decreased rectal dose and toxicity and less decline in bowel quality of life (QOL). A secondary analysis was performed to correlate penile bulb dose and sexual QOL. Methods and Materials: Sexual QOL was measured with the Expanded Prostate Cancer Index Composite (EPIC) by mean scores, the proportion of patients with a minimal clinically important difference (MID), and analyses of the different items composing the sexual domain. Results: A total of 222 men enrolled with median follow-up of 37 months. Hydrogel reduced penile bulb mean dose, maximum dose, and percentage of penile bulb receiving 10 to 30 Gy (all P < .05) with mean dose indirectly correlated with erections sufficient for intercourse at 15 months (P = .03). Baseline EPIC was low (53 [standard deviation ± 24]) with no difference between arms (P > .1). A total of 41% (88/222) of men had adequate baseline sexual QOL (EPIC >60 (mean, 77 [± 8.3]). This subgroup at 3 years had better sexual function (P = .03) with a spacer with a smaller difference in sexual bother (P = .1), which resulted in a higher EPIC summary on the spacer arm (58 [±24.1] vs control 45 [± 24.4]) meeting threshold for MID without statistical significance (P = .07). There were statistically nonsignificant differences favoring spacer for the proportion of men with MID and 2× MID declines in sexual QOL with 53% vs 75% having an 11-point decline (P = .064) and 41% vs 60% with a 22-point decline (P = .11). At 3 years, more men potent at baseline and treated with spacer had "erections sufficient for intercourse" (control 37.5% vs spacer 66.7%, P = .046) as well as statistically higher scores on 7 of 13 items in the sexual domain (all P < .05). Conclusions: The use of a hydrogel spacer decreased dose to the penile bulb, which was associated with improved erectile function compared with the control group based on patient-reported sexual QOL. (Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
Externí odkaz:	Zobrazit plný text záznamu