Purpose:
To evaluate the impact of neoadjuvant hormonal therapy (NHT) on quality of life after external-beam radiotherapy (EBRT) for prostate cancer.
Patients and Methods:
A group of 170 patients (85 with and 85 without NHT) has been surveyed prospectively before EBRT (70.2–72 Gy), at the last day of EBRT, a median time of 2 months and 15 months after EBRT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Pairs with and without NHT (median treatment time of 3.5 months before EBRT) were matched according to the respective planning target volume and prostate volume.
Results:
Before EBRT, significantly lower urinary function/bother, sexual function and hormonal function/bother scores were found for patients with NHT. More than 1 year after EBRT, only sexual function scores remained lower. In a multivariate analysis, NHT and adjuvant hormonal therapy (HT) versus NHT only (hazard ratio 14; 95% confidence interval 2.7–183; p = 0.02) and luteinizing hormone-releasing hormone (LHRH) agonists versus antiandrogens (hazard ratio 3.6; 95% confidence interval 1.1–12; p = 0.04) proved to be independent risk factors for long-term erectile dysfunction (no or very poor ability to have an erection).
Conclusion:
With the exception of sexual function (additional adjuvant HT and application of LHRH analog independently adverse), short-term NHT was not found to decrease quality of life after EBRT for prostate cancer.
Ziel:
Untersuchung des Einflusses einer neoadjuvanten Hormontherapie (NHT) auf die Lebensqualität nach perkutaner Radiotherapie (EBRT) beim Prostatakarzinom.
Patienten und Methodik:
In einer Gruppe von 170 Patienten (85 mit und 85 ohne NHT) wurde die Lebensqualität prospektiv vor EBRT (70,2–72 Gy), am letzten Tag der EBRT, median 2 Monate und 15 Monate nach EBRT mittels eines validierten Fragebogens (Expanded Prostate Cancer Index Composite) erfasst. Paare mit und ohne NHT (median 3,5 Monate vor EBRT verabreicht) wurden entsprechend dem jeweiligen Planungszielvolumen und Prostatavolumen gematcht.
Ergebnisse:
Vor EBRT zeigten sich bei Patienten mit NHT signifikant schlechtere Funktions- und Belastungswerte in den Domänen Wasserlassen, Sexualität und hormonelle Beschwerden. Über 1 Jahr nach Ende der EBRT blieb nur noch die sexuelle Funktion signifikant schlechter. In einer multivariaten Analyse zeigte sich der unabhängige Einfluss der NHT mit adjuvanter Hormontherapie (HT) versus alleiniger NHT (relatives Risiko 14; 95%-Konfidenzintervall 2,7–183; p = 0,02) und der Gonadotropin-releasing-Hormon-(GnRH-)Analoga versus Antiandrogene (relatives Risiko 3,6; 95%-Konfidenzintervall 1,1–12; p = 0,04) als Risikofaktoren für die längerfristige erektile Dysfunktion (keine oder sehr geringe Erektionsfähigkeit).
Schlussfolgerung:
Mit Ausnahme des Einflusses auf die sexuellen Funktionswerte (zusätzliche adjuvante HT und Verwendung von GnRH-Analoga unabhängig voneinander nachteilig) zeigte die kurzzeitige NHT keine negativen Auswirkungen auf die Lebensqualität nach EBRT des Prostatakarzinoms.
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Pinkawa, M., Piroth, M.D., Asadpour, B. et al. Neoadjuvant hormonal therapy and external-beam radiotherapy versus external-beam irradiation alone for prostate cancer. Strahlenther Onkol 185, 101–108 (2009). https://doi.org/10.1007/s00066-009-1894-y
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DOI: https://doi.org/10.1007/s00066-009-1894-y