前列腺癌根治术后的盆腔照射放疗不会影响尿失禁的恢复

Pelvic irradiation after radical prostatectomy does not affect the recovery of urinary incontinence

目的探讨前列腺癌根治术后盆腔照射放疗对患者尿失禁恢复及排尿功能的影响。方法自2012年3月至2016年7月,共纳入28例行前列腺癌根治术及术后辅助调强放疗的患者。其中17例于术后接受单纯瘤床区的调强放疗(单纯瘤床组),中位放疗剂量为72 Gy (64～74 Gy);11例接受瘤床联合盆腔淋巴引流区的调强放疗(联合组)。瘤床和盆腔淋巴引流区的中位照射剂量分别为70 Gy (50～74 Gy)和50 Gy (24～55 Gy)。在术后2个月及放疗后2、6、12、18、24、36个月使用扩大前列腺癌指数(EPCI)工具的排尿部分对患者的尿失禁恢复情况及排尿功能进行前瞻式的随访。最后比较两组患者尿失禁的恢复情况及排尿功能的差异。结果两种放疗范围下对应的术后尿失禁恢复情况无统计学差异(P=0.454)。单纯瘤床组和联合组在放疗前使用EPCI工具所测得的基线排尿功能评分分别为39.76±9.88、38.09±7.74;放疗2年后分别测得为37.82±9.18、37.18±8.05,各组放疗前与放疗后的排尿功能无统计学差异(P=0.851)。联合组放疗过程中白细胞降低的发生率显著上升(P=0.023)。结论前列腺癌根治术后瘤床联合盆腔淋巴结引流区调强放疗与单纯瘤床调强放疗相比,不会影响术后尿失禁的恢复且不会降低术后排尿功能。但前者在放疗过程中可能会增加白细胞减低的风险。

Objective To investigate the effects of intensity modulated radiation therapy(IMRT) in the pelvic lymph nodes drainage area on the recovery of urinary incontinence and urinary function.Methods Between March 2012 and July 2016,the urinary incontinence and urinary function of 28 patients after radical prostatectomy were identified.Altogether 17 patients received IMRT(prostate bed group) for the prostate bed alone,and the median radiotherapy dose was 72 Gy(64-74 Gy);11 treated with IMRT for prostate bed and pelvic lymph nodes drainage area(combination group),and the median doses for the tumor bed and lymph nodes drainage area were 70 Gy(50-74 Gy) and 50 Gy(24-55 Gy),respectively.The urinary function was scored with the urinary part of the expanded prostate cancer index composite(EPCI) tool 2 months after surgery and 2,6,12,18,24 and 36 months after radiotherapy.The incontinence recovery and urinary function of combination group and prostate bed group were compared.Results There was no significant difference in the incontinence recovery between the two groups(P=0.454).The baseline urinary function measured with the EPCI tool were 39.76±9.88 and 38.09±7.74 for the prostate bed group and combination group respectively.After 2 years of radiotherapy,the urinary function was 37.82±9.18 and 37.18±8.05 for the prostate bed group and combination group respectively,and there was no statistically significant difference between the two groups(P=0.851).The incidence of leukopenia was significantly increased during radiotherapy in the combination group(P=0.023).Conclusion Compared with IMRT for prostate bed alone,IMRT for prostate bed and pelvic lymph nodes drainage area will not affect the recovery of urinary incontinence,nor reduce postoperative urinary function.However,the IMRT for prostate bed and pelvic lymph nodes drainage area may increase the risk of leukopenia during radiotherapy.