Pudendal nerve injury impairs anorectal function and health related quality of life measures ≥2 years after 3D conformal radiotherapy for prostate cancer

Figures & data

Figure 1. Flow diagram showing patient cohort selected for the study.

Table 1. Study population demographics and radiation treatment characteristics for symptomatic and asymptomatic patients.

Patient no.	Age (years)	Body weight (kg)	Body mass index (kg/m^2)	Tumor stage	Treatment	Maximum irradiated prostate volume (cm^3)	Mean radiation dose (Dmean) (Gy)	Maximumradiation dose (Dmax) (Gy)	Time since completion of RT (months)
Symptomatic
1	78	84	25.5	2	EBRT	198.36	69.89	70.87	83
2	77	108	36.1	1	EBRT	n/a	n/a	n/a	74
3	69	83	25.9	2	EBRT	221.53	73.64	74.77	47
4	83	91	28.2		EBRT	122.78	72.16	73.66	29
5	73	83	30.5	1	EBRT + HDR Brachytherapy	163.83	47.65	48.66	27
6	82	90	27.8	1	EBRT	n/a	n/a	n/a	109
7	77	89	31.5	2	EBRT	n/a	n/a	n/a	81
8	76	66.2	22.4	2	EBRT	252.42	63.93	65.11	41
9	80	79	23.8	3	EBRT	164.59	74.9	76.17	63
10	72	82	30.5	3	EBRT	221.85	70.48	71.29	52
11	82	92	29	3	EBRT + HDR Brachytherapy	233.02	51.82	56.97	26
12	73	100	32.3	2	EBRT	198.62	73.87	75.22	41
13	78	91	28.1	2	EBRT	n/a	n/a	n/a	52
Asymptomatic
14	83	95	31.3		EBRT	389.78	73.18	74.39	39
15	71	71	24.3	1	EBRT	283.32	70.26	71.86	68
16	71	77	24.9	2	EBRT	208.3	69.44	70.73	61
17	80	85	28.7	2	EBRT	160.14	70.76	71.66	84
18	77	89	27.8	1	EBRT	n/a	n/a	n/a	93
19	76	83	24.8	1	EBRT	236.55	69.26	71.33	83
20	65	93	27.2	3	EBRT	167.56	74.57	75.96	60
21	71	75	26.6	1	EBRT	220.24	70	71.06	70
22	73	82	29.7	1	EBRT	163.85	71.33	69.15	114
23	65	47	17.9	1	EBRT	140.21	69.16	70.66	96
24	80	76	24.8	1	EBRT	n/a	n/a	n/a	156
25	64	99	34.3	1	EBRT	n/a	n/a	n/a	75

Table 2. Comparison of modified LENT-SOMA GI symptoms and EORTC generic (QOL-C30) and disease specific (QLQ-PR25) HRQoL data between symptomatic and asymptomatic patients.

LENT-SOMA	Symptomatic patients	Asymptomatic patients	p Value
Frequency	1 (0–3)	1 (0–1)	ns
Diarrhea	1 (0–2)	0 (0–2)	ns
Pain	0 (0–2)	0 (0–2)	ns
Mucous	1 (0–3)	0 (0–1)	ns
Urgency	3 (1–4)	1 (0–4)	<.01
Bleeding	1 (0–3)	0 (0–1)	<.001
EORTC QLQ-C30
Physical functioning	87 (60–100)	100 (73–100)	ns
Role functioning	100 (50–100)	100 (67–100)	ns
Emotional functioning	75 (58–100)	96 (67–100)	=.05
Cognitive functioning	83 (50–100)	83 (67–100)	ns
Social functioning	83 (50–100)	100 (67–100)	<.001
Global health status	67 (50–83)	83 (17–100)	<.05
Dyspnea	0 (0–33)	0 (0–33)	ns
Insomnia	33 (0–100)	33 (0–33)	ns
Appetite loss	0 (0–33)	0 (0–0)	ns
Nausea and vomiting	0 (0–17)	0 (0–17)	ns
Constipation	33 (0–67)	33 (0–33)	ns
Diarrhea	0 (0–100)	0 (0–33)	=.05
Fatigue	33 (0–44)	11 (0–33)	<.05
Pain	0 (0–33)	0 (0–100)	ns
Financial difficulty	0 (0–33)	0 (0–0)	ns
EORTC QLQ-PR25
Urinary symptoms	25 (0–58)	10 (0–25)	<.05
Bowel symptoms	25 (8–42)	0 (0–25)	<.001
Hormonal treatment-related symptoms	11 (0–50)	6 (0–33)	ns

Table 3. Comparison of anorectal function and anal sphincter morphology data between whole patient group and age matched patients before radiotherapy.

ARM	Whole patient group	Age matched patient group	p Value
Basal pressure (mmHg)	46 ± 4	63 ± 3	<.01
Squeeze pressure (mmHg)	105 ± 8	154 ± 8	<.0001
↑Intra-abdominal pressure (mmHg)	82 ± 5	106 ± 5	<.01
IAS (mm)	2.1 ± 0.1	2.6 ± 0.1	<.05
EAS (mm)	8.0 ± 0.3	9.3 ± 0.3	<.01
Threshold perception (mL)	14 ± 1	16 ± 2	ns
Desire to defecate sensation (mL)	68 ± 8	97 ± 9	<.05
Rectal compliance (mL/mmHg)	3.3 ± 0.3	5.1 ± 0.4	<.01
FI score	2 (0–8)	0 (0–1)	<.001
Urgency score	2 (0–6)	0 (0–3)	<.001
Number of bowel actions/week	10.5 (7–24.5)	7 (3.5–21)	<.05

Table 4. Comparison of anorectal function and anal sphincter morphology data between symptomatic and asymptomatic patients.

ARM	Symptomatic Patients	Asymptomatic Patients	p Value
Basal pressure (mmHg)	42 ± 5	51 ± 6	ns
Squeeze pressure (mmHg)	92 ± 9	119 ± 11	ns
↑Intra-abdominal pressure (mmHg)	78 ± 7	86 ± 8	ns
IAS (mm)	2.3 ± 0.2	2.1 ± 0.2	ns
EAS (mm)	8.4 ± 0.4	7.6 ± 0.3	ns
Threshold perception (mL)	15 ± 2	13 ± 1	ns
Desire to defecate sensation (mL)	55 ± 8	81 ± 14	ns
Rectal compliance (mL/mmHg)	3.4 ± 0.4	3.2 ± 0.4	ns
FI score	3 (0–8)	0 (0–3)	<.01
Urgency score	3 (0–6)	0 (0–5)	ns
Number of bowel actions/week	14 (7–24.5)	10.5 (7–17.5)	ns

Table 5. Median (range) of baseline (planning) dose volume histogram parameters of outer rectal wall, anal wall and pudendal nerve.

Whole group	Outer rectal wall	Anal wall	Pudendal nerve
Volume (cm^3)	59 (28.8–242.4)	33.1 (18.3–52.3)	3.6 (2–5.4)
Dmean (Gy)	49.6 (30.7–63.8)	35.4 (15.8–58.5)	53.1 (25.5–67.3)
Dmax (Gy)	70.9 (48.6–75.3)	69.9 (47.6–75.1)	70.2 (48.2–74.2)
V ≥ 40 Gy (%)	74.2 (28.1–100)	36.2 (6.7–85.3)	82 (17.1–100)
V ≥ 60 Gy (%)	50.5 (14.9–72)	17.78 (0–58.5)	35.5 (0–85)