1
|
Perennec T, Rogé M, Hetet JF, Colls P, Guimas V, Rio E, Vaugier L, Supiot S. Salvage prostate intensity modulated radiation therapy after cryotherapy failure. Sci Rep 2024; 14:9148. [PMID: 38644367 PMCID: PMC11033268 DOI: 10.1038/s41598-024-59406-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2023] [Accepted: 04/10/2024] [Indexed: 04/23/2024] Open
Abstract
Cryotherapy is an ablative therapy that can be used to treat localized prostate cancer. In case of recurrence, treatment options are not well-defined, and their outcomes are unknown. We therefore collected all patients treated with radiotherapy after cryotherapy for prostate cancer recurrence in Nantes (France) between 2012 and 2019. We identified ten patients. After a median follow-up of 5 years, two patients presented late grade 3 toxicities; one patient presented a grade 3 rectal hemorrhage, and one had a grade 3 hematuria. Two patients relapsed at 61 and 62 months, and three patients died of other causes. Radiotherapy to treat local prostate cancer recurrence after cryotherapy seems feasible and effective in local control. These results do not allow us to recommend this technique in current practice but are encouraging for the conduct of prospective trials.
Collapse
Affiliation(s)
- Tanguy Perennec
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France.
| | - Maximilien Rogé
- Department of Radiation Oncology, Centre Henri Becquerel, 1 Rue d'Amiens, 76000, Rouen, France
| | - Jean-François Hetet
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Philippe Colls
- Department of Urology, Clinique Jules Verne, 2-4 Route de Paris, 44300, Nantes, France
| | - Valentine Guimas
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Emmanuel Rio
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Loïg Vaugier
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| | - Stéphane Supiot
- Department of Radiation Oncology, Institut de Cancérologie de L'Ouest, Bd Professeur Jacques Monod, 44800, Saint-Herblain, France
| |
Collapse
|
2
|
Dotan E, Lynch SM, Ryan JC, Mitchell EP. Disparities in care of older adults of color with cancer: A narrative review. Cancer Med 2024; 13:e6790. [PMID: 38234214 PMCID: PMC10905558 DOI: 10.1002/cam4.6790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2023] [Revised: 10/06/2023] [Accepted: 11/23/2023] [Indexed: 01/19/2024] Open
Abstract
This review describes the barriers and challenges faced by older adults of color with cancer and highlights methods to improve their overall care. In the next decade, cancer incidence rates are expected to increase in the United States for people aged ≥65 years. A large proportion will be older adults of color who often have worse outcomes than older White patients. Many issues contribute to racial disparities in older adults, including biological factors and social determinants of health (SDOH) related to healthcare access, socioeconomic concerns, systemic racism, mistrust, and the neighborhood where a person lives. These disparities are exacerbated by age-related challenges often experienced by older adults, such as decreased functional status, impaired cognition, high rates of comorbidities and polypharmacy, poor nutrition, and limited social support. Additionally, underrepresentation of both patients of color and older adults in cancer clinical research results in a lack of adequate data to guide the management of these patients. Use of geriatric assessments (GA) can aid providers in uncovering age-related concerns and personalizing interventions for older patients. Research demonstrates the ability of GA-directed care to result in fewer treatment-related toxicities and improved quality of life, thus supporting the routine incorporation of validated GA into these patients' care. GA can be enhanced by including evaluation of SDOH, which can help healthcare providers understand and address the needs of older adults of color with cancer who face disparities related to their age and race.
Collapse
Affiliation(s)
- Efrat Dotan
- Department of Hematology/OncologyFox Chase Cancer CenterPhiladelphiaPennsylvaniaUSA
| | | | | | - Edith P. Mitchell
- Clinical Professor of Medicine and Medical OncologySidney Kimmel Cancer Center at JeffersonPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
3
|
Hasterok M, Szołtysik M, Nowicka Z, Goc B, Gräupner D, Majewski W, Rasławski K, Rajwa P, Jabłońska I, Magrowski Ł, Przydacz M, Krajewski W, Masri O, Miszczyk M. Rectum and Bladder Toxicity in Postoperative Prostate Bed Irradiation: Dose-Volume Parameters Analysis. Cancers (Basel) 2023; 15:5334. [PMID: 38001594 PMCID: PMC10670737 DOI: 10.3390/cancers15225334] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2023] [Accepted: 11/01/2023] [Indexed: 11/26/2023] Open
Abstract
Although prostate cancer treatment is increasingly effective, its toxicities pose a major concern. The aim of our study was to assess the rate of adverse events (AEs) and the prognostic value of dose-volume histogram (DVH) parameters for the occurrence of treatment toxicity in patients treated with post-prostatectomy prostate bed radiotherapy (RT). The AEs were scored according to the CTCAE v.5.0. The rectum and bladder were contoured according to the RTOG Guidelines. The DVH parameters were assessed using data exported from the ECLIPSE treatment-planning system. Genitourinary (GU) and gastrointestinal (GI) toxicity were analysed using consecutive dose thresholds for the percentage of an organ at risk (OAR) receiving a given dose and the QUANTEC dose constraints. A total of 213 patients were included in the final analysis. Acute grade 2 or higher (≥G2) GU AEs occurred in 18.7% and late in 21.3% of patients. Acute ≥G2 GI toxicity occurred in 11.7% and late ≥G2 in 11.2% of the patients. Five patients experienced grade 4 AEs. The most common adverse effects were diarrhoea, proctitis, cystitis, and dysuria. The most significant predictors of acute ≥G2 GI toxicity were rectum V47 and V46 (p < 0.001 and p < 0.001) and rectum wall V46 (p = 0.001), whereas the most significant predictors of late ≥G2 GI AEs were rectum wall V47 and V48 (p = 0.019 and p = 0.021). None of the bladder or bladder wall parameters was significantly associated with the risk of acute toxicity. The minimum doses to bladder wall (p = 0.004) and bladder (p = 0.005) were the most significant predictors of late ≥G2 GU toxicity. Postoperative radiotherapy is associated with a clinically relevant risk of AEs, which is associated with DVH parameters, and remains even in patients who fulfil commonly accepted dose constraints. Considering the lack of survival benefit of postoperative adjuvant RT, our results support delaying treatment through an early salvage approach to avoid or defer toxicity.
Collapse
Affiliation(s)
- Maja Hasterok
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Monika Szołtysik
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Zuzanna Nowicka
- Department of Biostatistics and Translational Medicine, Medical University of Lodz, Mazowiecka 15, 92-215 Lodz, Poland;
| | - Bartłomiej Goc
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Donata Gräupner
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Wojciech Majewski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Konrad Rasławski
- Radiotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (B.G.); (W.M.); (K.R.)
| | - Paweł Rajwa
- Department of Urology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria;
- Department of Urology, Medical University of Silesia, 3-go Maja 13-15, 41-800 Zabrze, Poland
| | - Iwona Jabłońska
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Łukasz Magrowski
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Mikołaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Macieja Jakubowskiego 2, 30-688 Krakow, Poland;
| | - Wojciech Krajewski
- Department of Minimally Invasive and Robotic Urology, Wrocław Medical University, 50-556 Wrocław, Poland;
| | - Oliwia Masri
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| | - Marcin Miszczyk
- IIIrd Radiotherapy and Chemotherapy Department, Maria Skłodowska-Curie National Research Institute of Oncology, Wybrzeże Armii Krajowej 15, 44-102 Gliwice, Poland; (M.H.); (M.S.); (D.G.); (I.J.); (Ł.M.); (O.M.)
| |
Collapse
|
4
|
Gregucci F, Carbonara R, Surgo A, Ciliberti MP, Curci D, Ciocia A, Branà L, Ludovico GM, Scarcia M, Portoghese F, Caliandro M, Ludovico E, Paulicelli E, Di Guglielmo FC, Bonaparte I, Fiorentino A. Extreme hypofractionated stereotactic radiotherapy for elderly prostate cancer patients: side effects preliminary analysis of a phase II trial. LA RADIOLOGIA MEDICA 2023; 128:501-508. [PMID: 36952115 DOI: 10.1007/s11547-023-01618-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/07/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE Aim of this study is to evaluate safety and efficacy of SBRT in elderly patients affected by localized prostate cancer (PC). MATERIAL AND METHODS Men aged 70 years or older were enrolled and analyzed. The SBRT schedule was 35 Gy in 5 fractions administered in 1-2 weeks. According to risk group, androgen deprivation therapy (ADT) was prescribed. Urinary symptoms were evaluated at baseline using the International Prostate Symptom Score (IPSS). Genitourinary (GU) and gastrointestinal (GI) toxicities were assessed at the end of treatment, 2 weeks after SBRT and during follow-up using the Common Terminology Criteria for Adverse Events (CTCAE). PSA values were recorded before treatment and during follow-up as biochemical response criteria. RESULTS Between 07/2019 and 09/2021, 111 patients were enrolled. Median age was 77 years. At the end of treatment, no acute GU/GI toxicities ≥ G2 were observed. At 2-3 weeks after treatment, 3 patients reported G2 GU toxicity, while 14 patients referred G2 GI toxicity. During the last follow up, 26 and 2 patients reported, respectively, G1 and G2 GU toxicity, while 22 and 1 cases described, respectively, G1 and G2 GI toxicity. No late toxicities ≥ G3 were recorded. GU toxicity is related to absence of urethra sparing, increasing PTV volume, Dmax PTV and IPSS; GI toxicity is related to RT schedule (each other day is better than consecutive day), Dmax rectum and IPSS, At a median follow-up of 24 months, excellent biochemical disease control was achieved in all cases with median PSA of 0.5 ng/ml. CONCLUSION SBRT in elderly patients affected by PC is feasible and well tolerated with excellent biochemical disease control. Longer follow-up is needed to assess late toxicity profile and long-term clinical outcome.
Collapse
Affiliation(s)
- Fabiana Gregucci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Roberta Carbonara
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alessia Surgo
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy.
| | - Maria Paola Ciliberti
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Domenico Curci
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Annarita Ciocia
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Luciana Branà
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Marcello Scarcia
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Filippo Portoghese
- Urology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Morena Caliandro
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Elena Ludovico
- Radiology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Eleonora Paulicelli
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | | | - Ilaria Bonaparte
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
| | - Alba Fiorentino
- Radiation Oncology Department, General Regional Hospital F. Miulli, Acquaviva Delle Fonti, Bari, Italy
- Department of Medicine, LUM Giuseppe Degennaro University, Casamassima, Bari, Italy
| |
Collapse
|
5
|
Ong AL, Knight K, Panettieri V, Dimmock M, Tuan JK, Tan HQ, Wright C. Dose-volume analysis of planned versus accumulated dose as a predictor for late gastrointestinal toxicity in men receiving radiotherapy for high-risk prostate cancer. Phys Imaging Radiat Oncol 2022; 23:97-102. [PMID: 35879938 PMCID: PMC9307677 DOI: 10.1016/j.phro.2022.07.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2022] [Revised: 07/02/2022] [Accepted: 07/06/2022] [Indexed: 11/26/2022] Open
Abstract
Interfractional variations in organs at risk were observed in prostate radiotherapy. Rectal accumulated dose was significantly higher at the intermediate-high dose region. Rectal planned dose was significantly higher at the very high dose region. Dose>78.2 Gy to 0.03 cc of rectum was predictive of late Grade 2 toxicity. Patient age>72 years was predictive of late Grade 2 rectal toxicity.
Background and purpose Significant dose deviations have been reported between planned (DP) and accumulated (DA) dose in prostate radiotherapy. This study aimed to develop multivariate analysis (MVA) models associating Grade 1 and 2 gastrointestinal (GI) toxicity with clinical and DP or DA dosimetric variables separately. Materials and methods Dose volume (DV) metrics were compared between DA and DP for 150 high-risk prostate cancer patients. MV models were generated from significant clinical and dosimetric variables (p < 0.05) at univariate level. Dose-based-region of interest (DB-ROI) metrics were included. Model performance was measured, and additional subgroup analysis were performed. Results Rectal DA demonstrated a higher intermediate-high dose (V30-65 Gy and DB-ROI at 15–50 mm) compared to DP. Conversely, at the very high dose region, rectal DA (V75 Gy and DB-ROI at 5–10 mm) were significantly lower. In MVA, rectal DB-ROI at 10 mm was predictive for Grade ≥ 1 GI toxicity for DA and DP. Age, rectal DA for D0.03 cc, and rectal DP for DB-ROI 10 mm were predictors for Grade 2 GI toxicity. Subgroup analysis revealed that patients ≥ 72 years old and a rectal DA of ≥ 78.2 Gy were highly predictive of Grade 2 GI toxicity. Conclusions The dosimetric impact of a higher dose rectal dose in DA due to volumetric changes was minimal and was not predictive of detrimental clinical toxicity apart from rectal D0.03 cc ≥ 78.2 Gy for Grade 2 GI toxicity. The use of the DB-ROI method can provide equivalent predictive power as the DV method in toxicity prediction.
Collapse
|
6
|
Nigogosyan Z, Ippolito JE, Collins SP, Wang EC. Prostate MRI in Stereotactic Body Radiation Treatment Planning and Delivery for Localized Prostate Cancer. Radiographics 2022; 42:1251-1264. [PMID: 35714039 DOI: 10.1148/rg.210114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Prostate MRI is increasingly being used to make diagnoses and guide management for patients receiving definitive radiation treatment for prostate cancer. Radiologists should be familiar with the potential uses of prostate MRI in radiation therapy planning and delivery. Radiation therapy is an established option for the definitive treatment of localized prostate cancer. Stereotactic body radiation therapy (SBRT) is an external-beam radiation therapy method used to deliver a high dose of radiation to an extracranial target in the body, often in five or fewer fractions. SBRT is increasingly being used for prostate cancer treatment and has been recognized by the National Comprehensive Cancer Network as an acceptable definitive treatment regimen for low-, intermediate-, and high-risk prostate cancer. MRI is commonly used to aid in prostate radiation therapy. The authors review the uses of prostate MRI in SBRT treatment planning and delivery. Specific topics discussed include the use of prostate MRI for identification of and dose reduction to the membranous and prostatic urethra, which can decrease the risk of acute and late toxicities. MRI is also useful for identification and appropriate dose coverage of the prostate apex and areas of extraprostatic extension or seminal vesicle invasion. In prospective studies, prostate MRI is being validated for identification of and dose intensification to dominant intraprostatic lesions, which potentially can improve oncologic outcomes. It also can be used to evaluate the placement of fiducial markers and hydrogel spacers for radiation therapy planning and delivery. ©RSNA, 2022.
Collapse
Affiliation(s)
- Zack Nigogosyan
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (Z.N., J.E.I.); and Department of Radiation Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (S.P.C., E.C.W.)
| | - Joseph E Ippolito
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (Z.N., J.E.I.); and Department of Radiation Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (S.P.C., E.C.W.)
| | - Sean P Collins
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (Z.N., J.E.I.); and Department of Radiation Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (S.P.C., E.C.W.)
| | - Edina C Wang
- From the Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, MO (Z.N., J.E.I.); and Department of Radiation Medicine, MedStar Georgetown University Hospital, 3800 Reservoir Rd NW, Washington, DC 20007 (S.P.C., E.C.W.)
| |
Collapse
|
7
|
Kim TG, Park B, Song YG, Lee HW, Oh TH, Ryu DS, Jeong SC, Cho D, Oh J, Kim KM, Lee JW, Lee HS, Kong SM, Kim JY, Kim H. Patient-related risk factors for late rectal bleeding after hypofractionated radiotherapy for localized prostate cancer: a single-center retrospective study. Radiat Oncol 2022; 17:30. [PMID: 35139869 PMCID: PMC8827292 DOI: 10.1186/s13014-022-01998-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 01/26/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Several studies have reported patient-related risk factors for late rectal bleeding following conventionally fractionated radiotherapy for prostate cancer. We investigated patient-related risk factors for late rectal bleeding after hypofractionated radiotherapy.
Methods
A total of 231 patients with local or locally advanced prostate cancer treated with hypofractionated radiotherapy (70 or 67.2 Gy in 28 fractions) were evaluated retrospectively. All patients received intensity-modulated radiotherapy with daily image guidance. The relationships between late rectal bleeding and risk factors like diabetes, hypertension, cirrhosis, and anticoagulant use were analyzed.
Results
During a median follow-up of 23 months, the crude rates of grade ≥ 1, grade ≥ 2, and grade ≥ 3 late rectal bleeding were 23.8%, 16.9%, and 9.5%, respectively. Cirrhosis and anticoagulant use predicted an increased risk of grade ≥ 3 rectal bleeding in multivariable analyses (hazard ratio [HR] 14.37, 95% confidence interval [CI] 3.09–66.87, P = 0.001, and HR 2.93, 95% CI 1.14–7.55, P = 0.026, respectively). The non-anticoagulant group had a significantly superior 5-year freedom from grade ≥ 3 bleeding compared to the anticoagulant group in a propensity-weighted log-rank analysis (88.0% vs. 76.7%, P = 0.041). A receiver operating characteristic curve analysis revealed that rectal bleeding was minimized in the anticoagulant group if the equivalent dose at fractionation of 2 Gy (EQD2) V77 Gy of the rectum was < 4.5% or if the EQD2 V8.2 Gy was < 71.0%.
Conclusions
Patients taking anticoagulants or those with cirrhosis had a significantly higher risk of severe late rectal bleeding than other patients after hypofractionated radiotherapy for prostate cancer in the present study. The bleeding risk could be lowered by minimizing hotspots in patients taking anticoagulants.
Collapse
|
8
|
MRI-Based Radiotherapy Planning to Reduce Rectal Dose in Excess of Tolerance. Prostate Cancer 2022; 2022:7930744. [PMID: 35154830 PMCID: PMC8831048 DOI: 10.1155/2022/7930744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 12/15/2021] [Accepted: 12/28/2021] [Indexed: 11/18/2022] Open
Abstract
Materials and Methods This prospective single-arm study enrolled 15 men treated with IG-IMRT for localized prostate cancer. All participants received a dedicated 3 Tesla MRI examination of the prostate in addition to a pelvic CT examination for treatment planning. Two volumetric modulated arc therapy (VMAT) plans with a prescription dose of 79.2 Gy were designed using identical constraints based on CT- and MRI-defined consensus volumes. The volume of rectum exposed to 70 Gy or more was compared using the Wilcoxon paired signed rank test. Results For CT-based treatment plans, the median volume of rectum receiving 70 Gy or more was 9.3 cubic centimeters (cc) (IQR 7.0 to 10.2) compared with 4.9 cc (IQR 4.1 to 7.8) for MRI-based plans. This resulted in a median volume reduction of 2.1 cc (IQR 0.5 to 5.3, P < .001). Conclusions Using MRI to plan prostate IG-IMRT to a dose of 79.2 Gy reduces the volume of rectum receiving radiation dose in excess of tolerance (70 Gy or more) and should be considered in men who are at high risk for late rectal toxicity and are not good candidates for other rectal sparing techniques such as hydrogel spacer. This trial is registered with NCT02470910.
Collapse
|
9
|
Tang J, Zhang Y, Zhang D, Zhang C, Jin K, Ji D, Peng W, Feng Y, Sun Y. Total Mesorectal Excision vs. Transanal Endoscopic Microsurgery Followed by Radiotherapy for T2N0M0 Distal Rectal Cancer: A Multicenter Randomized Trial. Front Surg 2022; 9:812343. [PMID: 35178428 PMCID: PMC8844472 DOI: 10.3389/fsurg.2022.812343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/10/2022] [Indexed: 11/29/2022] Open
Abstract
Introduction Transanal endoscopic microsurgery (TEM) is an organ-preserving treatment alternative for patients with early rectal cancer. However, TEM alone is associated with greater risk of local recurrence and inferior survival in comparison with total meso-rectal excision (TME). As an important adjuvant therapy, radiotherapy can effectively reduce the local recurrence rate of rectal cancer. This study aimed to investigate whether TEM followed by radiotherapy can be a valid alternative to TME in T2N0M0 distal rectal cancer treatment. Methods We plan to recruit 168 participants meeting established inclusion criteria. Following informed consent, participants will randomly receive treatment protocols of TEM followed by radiotherapy (a total dose of 45–50.4 Gy given in 25–28 factions) or TME. Depending on post-operative pathology, the participants will receive either long-term follow-up or further treatment. The primary endpoint of this trial is 3-year local recurrence rate. The secondary end points include 3-year disease-free survival rate, 3-year overall survival rate, 3-year mortality rate, post-operative quality of life, post-operative safety index, intraoperative evaluation index and post-operative short-term evaluation index. Discussion This trial is the first prospective randomized trial to investigate the rectum preserving treatment by using transanal local excision followed by radiotherapy. Clinical trial registration The trial was prospectively registered at ClinicalTrials.gov NCT04098471 on September 20, 2019.
Collapse
|
10
|
Pisani R, Bezzina P, Couto JG. Effect of patient thickness on acute gastrointestinal toxicities following radiotherapy for prostate cancer. ACTA ACUST UNITED AC 2021; 26:352-359. [PMID: 34277088 PMCID: PMC8281905 DOI: 10.5603/rpor.a2021.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 02/23/2021] [Indexed: 11/25/2022]
Abstract
Background There is conflicting literature regarding the effect of patient size on radiotherapy toxicities. This study aimed to determine whether there is any association between patient thickness and severity and incidence of acute GI toxicities of prostate cancer patients receiving VMAT radiotherapy. The impact of confounding factors was also examined: rectal dose, age and lymph node irradiation. Materials and methods This study used a non-experimental, retrospective, descriptive and cross-sectional design. All patients who complied with the inclusion criteria (n = 96) were included. GI toxicity scores (baseline and last week of radiotherapy), rectal dose, lymph nodes irradiation and patient age at diagnosis were collected from the treatment file. Patient separations were measured from the CT-Simulator images. Statistical tests were performed to analyse the influence of these factors on acute GI toxicities. Results Patient thickness was shown to have no statistically significant effect on the incidence (p = 0.947 for antero-posterior and p = 0.839 for lateral thicknesses), and severity (p = 0.986 and 0.905, respectively) of acute GI toxicities. Severity of GI toxicities increased following radiotherapy: the Expanded Prostate Cancer Index Composite (EPIC) score increased by 2.64 from baseline (p < 0.001). The confounding factors had no statistically significant effect on toxicities (p > 0.05). Conclusion As expected, most patients experienced an increase in GI toxicity following radiotherapy. No relationship was established between patient thickness and the severity or incidence of acute GI toxicities, adding to the existing body of knowledge. Therefore, all patients should receive adequate follow up, irrespective of size. Side-effect recording tools should be implemented systematically for continuous assessment of this relationship.
Collapse
Affiliation(s)
- Robert Pisani
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Paul Bezzina
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| | - Jose Guilherme Couto
- Department of Radiography, Faculty of Health Sciences, University of Malta, Msida, Malta
| |
Collapse
|
11
|
Ghanem AI, Elsaid AA, Elshaikh MA, Khedr GA. Volumetric-Modulated Arc Radiotherapy with Daily Image-Guidance Carries Better Toxicity Profile for Higher Risk Prostate Cancer. Asian Pac J Cancer Prev 2021; 22:61-68. [PMID: 33507680 PMCID: PMC8184174 DOI: 10.31557/apjcp.2021.22.1.61] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Indexed: 11/25/2022] Open
Abstract
PURPOSE To compare radiotherapy-induced toxicity for localized prostate-cancer (PCa) treated with versus without daily image-guidance. PATIENTS AND METHODS We identified consecutive intermediate and high-risk localized PCa patients treated with definitive radiotherapy using intensity-modulated radiotherapy (IMRT) with variable duration of androgen-deprivation therapy (ADT) within 2015-2016 (Arm-A) and 2005-2007 (Arm-B). Arm-A cases received daily online imaging guidance (IGRT) using cone-beam computed tomography (CBCT) unlike Arm-B candidates with no daily IGRT. After reporting demographic, clinico-pathological features and treatment details, we compared acute (within 3 months post-therapy) and late RT-induced toxicities between study groups graded by RTOG/CTCAE criteria. Uni/multivariate analyses (UVA/MVA) were performed to identify independent predictors for RT-related side-effects. RESULTS We were able to identify 257 cases who met our inclusion criteria. Overall, median age was 73 years (48-85), 67% had intermediate-risk and 47% received ADT. Arm-A included 72 patients who received IMRT delivered using volumetric-modulated arc therapy (VMAT), whereas, Arm-B was formed of 185 cases who utilized step-and-shoot static IMRT. Clinico-pathological features and treatment details were non-different across study arms except that Arm-A had more Grade Group 3, higher median total dose (79.2 vs. 74 Gy) and more pelvic lymph-nodes RT (p <0.05). Although acute toxicity was similar across groups, Arm-B encountered higher late toxicity score, more intense late genitourinary side-effects (P=0.008), with non-different late lower-gastrointestinal toxicities. On MVA, lack of daily CBCT, African-American race and higher comorbidities were independently predictive for late toxicities. Conclusion: IMRT with daily CBCT permitted safe delivery of dose-escalated IMRT with improved toxicity profile for higher-risk prostate cancer.
Collapse
Affiliation(s)
- Ahmad I Ghanem
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan, USA.,Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Egypt
| | - Amr A Elsaid
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Egypt
| | - Mohamed A Elshaikh
- Department of Radiation Oncology, Henry Ford Cancer Institute, Detroit, Michigan, USA
| | - Gehan A Khedr
- Department of Clinical Oncology, Faculty of Medicine, Alexandria University, Egypt
| |
Collapse
|
12
|
Turchan WT, Gutiontov SI, Spiotto MT, Liauw SL. Prostate Cancer Radiotherapy: Increased Biochemical Control and Late Toxicity in Men With Medication Allergies. JNCI Cancer Spectr 2020; 4:pkaa081. [PMID: 33409456 PMCID: PMC7771007 DOI: 10.1093/jncics/pkaa081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background
Given similarities in the mediators of medication allergy (MA) and tissue response to radiotherapy, we assessed whether outcomes following prostate radiotherapy differ in patients with MAs.
Methods
A total 587 men with known MA history and nonmetastatic prostate cancer underwent radiotherapy from 1989 to 2006. Clinicopathologic and treatment variables were analyzed for association with freedom from biochemical failure (FFBF) and late treatment–related, physician-defined Radiation Therapy Oncology Group gastrointestinal (GI) and genitourinary (GU) toxicity. Covariates identified on univariate analysis for toxicity and disease control were examined on multivariable analysis. All statistical tests were 2-sided, and a P less than .05 was considered statistically significant.
Results
A total of 155 of 587 men (26.4%) had 1 or more MAs, most commonly to penicillin (n = 71), sulfa (n = 35), and aspirin or nonsteroidal antiinflammatory drugs (n = 28). On univariate analysis, men with MAs had superior 10-y FFBF (71.5% vs 63.5%, P = .02) and higher incidence of late GI grade 2 or higher (G2+; 20.6% vs 13.2%, P = .04) and grade 3 or higher (G3+; 7.5% vs 3.9%, P = .08) as well as late GU G2+ (42.5% vs 33.2%, P = .04) and G3+ (7.5% vs 3.0%, P = .02) toxicity than men without MAs. On multivariable analysis, MA history remained a statistically significant predictor of FFBF (hazard ratio [HR] = 0.64, 95% confidence interval [CI] = 0.43 to 0.93, P = .02), late G2+ GI (HR = 1.76, 95% CI = 1.06 to 2.90, P=.03), and G3+ GU (HR = 2.69, 95% CI = 1.16 to 6.27, P = .02) toxicity after controlling for corresponding covariates in each model.
Conclusions
Men with MAs had improved FFBF and increased treatment-related toxicity following radiotherapy for prostate cancer. MA history could be a relevant consideration in the management of men with localized prostate cancer.
Collapse
Affiliation(s)
- William Tyler Turchan
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Stanley I Gutiontov
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| | - Michael T Spiotto
- Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX, USA
| | - Stanley L Liauw
- Department of Radiation and Cellular Oncology, University of Chicago, Chicago, IL, USA
| |
Collapse
|
13
|
Roy S, Grimes S, Morgan SC, Spratt DE, Eapen L, Mac Rae RM, Malone J, Craig J, Malone S. Impact of Treating Physician on Radiation Therapy Related Severe Toxicities in Men with Prostate Cancer. Pract Radiat Oncol 2020; 11:e292-e300. [PMID: 33068792 DOI: 10.1016/j.prro.2020.09.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/24/2020] [Accepted: 09/28/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE The impact of treating physician on radiation therapy (RT) related toxicity is unclear. We carried out a secondary analysis of a randomized controlled study to determine whether the risk of RT-related late toxicities in patients with prostate cancer varies depending on the treating radiation oncologist. METHODS AND MATERIALS This is a secondary analysis of a phase 3 randomized controlled study in which patients with prostate cancer with Gleason score ≤7, clinical stage T1b-T3a, and prostate-specific antigen <30 ng/mL were randomized to receive androgen suppression for 6 months, starting either 4 months before or concurrently with definitive prostate radiation therapy. Incidence of late RT-related toxicity was estimated using Kaplan-Meier methods. We applied multivariable semiparametric shared frailty models with gamma distribution to determine the between-physician variation in the hazard of late RT-related grade ≥3 gastrointestinal, genitourinary, or overall toxicity. Patient level covariables included age, risk group, year of enrollment, and treatment regimen. Frailty variance, a measure of unexplained heterogeneity, was estimated with 95% confidence intervals (CIs). Statistical significance was suggested when the lower limit of the 95% CI for the frailty variance was >0. The Commenges-Andersen test was used for P value estimation. RESULTS Overall, 426 patients were treated by 9 radiation oncologists. On log-rank test, there was a significant difference in the cumulative incidence of overall grade ≥3 toxicities (P = .001) and grade ≥3 gastrointestinal toxicity (P = .01) among the physician-based clusters. The frailty variance for overall late grade ≥3 toxicity was 0.31 (95% CI, 0.02-1.39; P = .01). The frailty variance for the grade ≥3 gastrointestinal and genitourinary toxicity was 0.84 (95% CI, 0.00-4.20; P = .11) and 0.11 (95% CI, 0.00-1.13; P = .31), respectively. CONCLUSIONS In our study, the hazard of overall RT-related late grade ≥3 toxicity varied significantly depending on treating radiation oncologist. Further studies are required to explore the underlying processes that lead to such variations in clinical trials involving radiation therapy in prostate cancer.
Collapse
Affiliation(s)
- Soumyajit Roy
- New York Medical College, New York, New York; The Ottawa Hospital Cancer Centre, Ottawa, Canada; Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada
| | - Scott Grimes
- The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Scott C Morgan
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada
| | - Daniel E Spratt
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Libni Eapen
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada
| | - Robert M Mac Rae
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada
| | - Julia Malone
- The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Julia Craig
- The Ottawa Hospital Cancer Centre, Ottawa, Canada
| | - Shawn Malone
- The Ottawa Hospital Cancer Centre, Ottawa, Canada; Division of Radiation Oncology, Department of Radiology, University of Ottawa, Ontario, Canada.
| |
Collapse
|
14
|
Ozkan EE, Ozseven A, Cerkesli ZAK. Evaluating the predictive value of quantec rectum tolerance dose suggestions on acute rectal toxicity in prostate carcinoma patients treated with IMRT. Rep Pract Oncol Radiother 2019; 25:50-54. [PMID: 31889921 DOI: 10.1016/j.rpor.2019.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2019] [Revised: 09/23/2019] [Accepted: 12/04/2019] [Indexed: 12/01/2022] Open
Abstract
Aim To investigate the predictive value of convenience of rectum dosimetry with Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) dose limits, maximum rectum dose (Dmax), total rectal volume (TVrectum), rectal volume included in PTV (VrectumPTV) on Grade 2-3 acute rectal toxicity for utilization in clinical practice. Background Numerous previous data have reported frequent acute proctitis after external-beam RT of prostate cancer. Predicting toxicity limited with dose information is inadequate in clinical practice due to comorbidities and medications used. Materials and Method Sixty-four non-metastatic prostate cancer patients treated with IMRT were enrolled. Patients were treated to a total dose of 70-76 Gy. Rectal dose volume histograms (DVH) of all patients were evaluated retrospectively, and a QUANTEC Score between 0 and 5 was calculated for each patient. The correlation between the rectal DVH data, QUANTEC score, TVrectum, VrectumPTV, rectum Dmax and Grade 2-3 rectal toxicity was investigated. Results In the whole group grade 1, 2 and 3 acute rectal toxicities were 25%, 18.8% and 3.1%, respectively. In the DVH data, rectum doses of all patients were under RTOG dose limits. Statistically significant correlation was found between grade 2-3 rectal toxicity and TVrectum (p = 0,043); however. It was not correlated with QUANTEC score, VrectumPTV and Dmax. Conclusion Our results were not able to show any significant correlation between increasing convenience with QUANTEC limits and lower rectal toxicity. Conclusively, new dosimetric definitions are warranted to predict acute rectal toxicity more accurately in prostate cancer patients during IMRT treatment.
Collapse
Affiliation(s)
- E Elif Ozkan
- Suleyman Demirel University, Department of Radiation Oncology, Isparta, Turkey
| | - Alper Ozseven
- Suleyman Demirel University, Department of Radiation Oncology, Isparta, Turkey
| | | |
Collapse
|
15
|
Mangan S, Leech M. Proton therapy- the modality of choice for future radiation therapy management of Prostate Cancer? Tech Innov Patient Support Radiat Oncol 2019; 11:1-13. [PMID: 32095544 PMCID: PMC7033803 DOI: 10.1016/j.tipsro.2019.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 08/09/2019] [Accepted: 08/30/2019] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Proton Therapy (PR) is an emerging treatment for prostate cancer (Pca) patients. However, limited and conflicting data exists regarding its ability to result in fewer bladder and rectal toxicities compared to Photon Therapy (PT), as well as its cost efficiency and plan robustness. MATERIALS AND METHODS An electronic literature search was performed to acquire eligible studies published between 2007 and 2018. Studies comparing bladder and rectal dosimetry or Gastrointestinal (GI) and Genitourinary (GU) toxicities between PR and PT, the plan robustness of PR relative to motion and its cost efficiency for Pca patients were assessed. RESULTS 28 studies were eligible for inclusion in this review. PR resulted in improved bladder and rectal dosimetry but did not manifest as improved GI/GU toxicities clinically compared to PT. PR plans were considered robust when specific corrections, techniques, positioning or immobilisation devices were applied. PR is not cost effective for intermediate risk Pca patients; however PR may be cost effective for younger or high risk Pca patients. CONCLUSION PR offers improved bladder and rectal dosimetry compared to PT but this does not specifically translate to improved GI/GU toxicities clinically. The robustness of PR plans is acceptable under specific conditions. PR is not cost effective for all Pca patients.
Collapse
Key Words
- 3DC-PR, 3D Conformal- Proton Therapy
- BT, Brachytherapy
- CT, Computed Tomography
- CTCAE, Common Terminology Criteria Adverse Effects
- EPIC, Expanded Prostate Cancer Index Composite
- GI, Gastrointestinal
- GU, Genitourinary
- HT, Helical Tomography
- IGRT, Image Guidance Radiation Therapy
- IMPR, Intensity Modulated Proton Therapy
- IMRT, Intensity Modulated Radiation Therapy
- IPSS, International Prostate Symptom Scale
- ITV, Internal Target Volume
- LR, Low Risk
- MFO-IMPR, Multi Field Optimisation-Intensity Modulated Proton Therapy
- PBS, Pencil Beam Scanning
- PR, Proton Therapy
- PT, Photon Therapy
- Photon therapy
- Prostate cancer
- Proton therapy
- QALY, Quality-Adjusted Life Year
- RA, Rapid Arc
- RBE, Radiobiological Effectiveness
- RTOG, Radiation Therapy Oncology Group
- SBRT, Stereotactic Body Radiation
- SFUD, Single Field Uniform-Dose
- SW, Sliding Window
- US, Uniform Scanning
- USPT, Uniform Scanning Proton Therapy
- VMAT, Volumetric Modulated Arc Therapy
- int/HR, intermediate/High risk
Collapse
Affiliation(s)
| | - Michelle Leech
- Applied Radiation Therapy Trinity, Discipline of Radiation Therapy, Trinity College Dublin, Dublin 2, Ireland
| |
Collapse
|
16
|
Grewal AS, Schonewolf C, Min EJ, Chao HH, Both S, Lam S, Mazzoni S, Bekelman J, Christodouleas J, Vapiwala N. Four-Year Outcomes From a Prospective Phase II Clinical Trial of Moderately Hypofractionated Proton Therapy for Localized Prostate Cancer. Int J Radiat Oncol Biol Phys 2019; 105:713-722. [PMID: 31199994 DOI: 10.1016/j.ijrobp.2019.05.069] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Revised: 05/21/2019] [Accepted: 05/25/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Moderately hypofractionated radiation therapy represents an effective treatment for localized prostate cancer (PC). Although large randomized trials have reported the efficacy of photon-based hypofractionated therapy, hypofractionated proton therapy (HFPT) has not been extensively studied. This study was performed to determine the clinical and patient-reported outcomes for patients with PC treated with HFPT. METHODS AND MATERIALS Between 2010 and 2017, 184 men were enrolled on a trial of 70 Gy in 28 fractions of HFPT for low- to intermediate-risk PC. Acute and late toxicity was evaluated using National Cancer Institute Common Terminology Criteria for Adverse Events version 4.0. Patient-reported outcomes were measured by International Prostate Symptom Score, International Index of Erectile Function Questionnaire, and Expanded Prostate Cancer Index Composite scores. RESULTS Median follow-up was 49.2 months. Enrolled patients had low-risk (n = 18), favorable intermediate-risk (n = 78), and unfavorable intermediate-risk (n = 88) PC. Four-year rates of biochemical-clinical failure-free survival were 93.5% (95% confidence interval, 89%-98%), 94.4% (89%-100%), 92.5% (86%-100%), and 93.8% (88%-100%) in the overall group and the low-risk, favorable intermediate-risk, and unfavorable intermediate-risk cohorts, respectively (log-rank P > .4). The incidence of acute grade 2 or higher gastrointestinal (GI) and urologic toxicities were 3.8% and 12.5%, respectively. The 4-year incidence of late grade 2 or higher urologic and GI toxicity was 7.6% (4%-13%) and 13.6% (9%-20%), respectively. One late grade 3 GI toxicity was reported. All late toxicities were transient. Patient-reported International Prostate Symptom, International Index of Erectile Function, and Expanded Prostate Cancer Index Composite scores had no significant long-term changes after completion of HFPT (Supplementary Table 1, available at https://doi.org/10.1016/j.ijrobp.2019.05.069). CONCLUSIONS HFPT is associated with low rates of toxicity and does not appear to negatively affect 4-year patient reported urinary and bowel health. Further comparative analyses are warranted to better understand differences between proton and photon HFRT.
Collapse
Affiliation(s)
- Amardeep S Grewal
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Caitlin Schonewolf
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Eun Jeong Min
- Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Hann-Hsiang Chao
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Stefan Both
- Department of Radiation Oncology, University Medical Center of Groningen, University of Groningen, Groningen, The Netherlands
| | - Sarah Lam
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Susan Mazzoni
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Justin Bekelman
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - John Christodouleas
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Neha Vapiwala
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania.
| |
Collapse
|
17
|
Zhang Y, Li P, Yu Q, Wu S, Chen X, Zhang Q, Fu S. Preliminary exploration of clinical factors affecting acute toxicity and quality of life after carbon ion therapy for prostate cancer. Radiat Oncol 2019; 14:94. [PMID: 31164172 PMCID: PMC6549341 DOI: 10.1186/s13014-019-1303-3] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2019] [Accepted: 05/22/2019] [Indexed: 12/26/2022] Open
Abstract
Purpose To assess toxicity and quality-of-life (QOL) after carbon ion radiotherapy (CIRT) at the Shanghai Proton and Heavy Ion Center (SPHIC) and identify clinical factors that correlate with urinary, bowel and sexual function. Methods Sixty-four patients with localized prostate cancer admitted from July 2015 to January 2018 underwent CIRT. At baseline and 5 time-points after radiotherapy, we assessed patients’ QOL using the 26-item edition of the Expanded Prostate Cancer Index-Composite (EPIC-26) Chinese version. Logistic regression was performed to identify clinical factors associated with acute genitourinary (GU) toxicity and relative QOL. Results By the end of CIRT, urinary irritation/obstruction temporarily declined (− 7.92 ± 1.76, p < .001). For urinary incontinence, bowel and sexual QOL, the scores remained stable at 2-year follow-up. The occurrences of acute Grade 1 and 2 GU toxicity were 20.3 and 10.9%, respectively, and of late Grade 1 and 2 GU toxicity were 3.1 and 1.6%, respectively. No acute or late gastrointestinal (GI) toxicity occurred. Transurethral resection of the prostate (TURP) was a risk factor that predicted a decline in urinary related QOL, and age made a difference to bowel-related QOL. For sexual QOL, castration status was a remarkable risk factor. An international prostate symptom score (IPSS) ≥8 increased the risk of Grade 1–2 acute GU toxicity 5.3-fold. Conclusion Patients with prostate cancer had favorable QOL after CIRT. IPSS ≥8 was a risk factor to acute GU toxicity, and TURP predicted a decline in urinary QOL. Age was related to bowel QOL, and castration status was associated with sexual QOL. Trial registration Carbon Ion Radiotherapy for the Treatment of Localized Prostate Cancer, NCT02739659. Registered April 15, 2016.
Collapse
Affiliation(s)
- Yafang Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Fudan University Cancer Hospital, No.4365 Kang Xin Road, Shanghai, 201321, China.,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China
| | - Ping Li
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Shanghai, 201321, China.,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China
| | - Qi Yu
- Department of Radiation Oncology, Fudan University Cancer Hospital, Shanghai, 200020, China
| | - Shuang Wu
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Fudan University Cancer Hospital, No.4365 Kang Xin Road, Shanghai, 201321, China.,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China
| | - Xue Chen
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Fudan University Cancer Hospital, No.4365 Kang Xin Road, Shanghai, 201321, China.,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China
| | - Qing Zhang
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Shanghai, 201321, China. .,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China.
| | - Shen Fu
- Department of Radiation Oncology, Shanghai Proton and Heavy lon Center, Fudan University Cancer Hospital, No.4365 Kang Xin Road, Shanghai, 201321, China. .,Shanghai Engineering Research Center of Proton and Heavy lon Radiation Therapy, Shanghai, 201321, China. .,Key Laboratory of Nuclear Physics and lon-Beam Application (MOE), Fudan University, Shanghai, 200433, China. .,Department of Radiation Oncology, Shanghai Concord Cancer Hospital, Shanghai, 200020, China.
| |
Collapse
|
18
|
Cekani E, López-Guerra JL, Barrientos R, Tavera P, Praena-Fernandez JM, Rivin Del Campo E, Azinovic I, Matute R. Late toxicity for prostate cancer patients treated with hypofractionated helical tomotherapy. Rep Pract Oncol Radiother 2019; 24:298-305. [PMID: 31192999 DOI: 10.1016/j.rpor.2019.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Revised: 01/17/2019] [Accepted: 04/20/2019] [Indexed: 01/06/2023] Open
Abstract
AIM The purpose of this study is to evaluate the long term tolerability of hypofractionated helical tomotherapy (HT) in localized prostate cancer patients. BACKGROUND Previous hypofractionated schedules with conventional RT were associated with excessive toxicity, likely due to inadequate sophistication of treatment delivery. There are few data about late toxicity after HT. MATERIALS AND METHODS We evaluated 38 patients with primary adenocarcinoma of the prostate. There were 9 (24%), 15 (39%), and 14 (37%) patients with high, intermediate, and low risk, respectively. Patients were treated with hypofractionated HT from May 2008 to February 2011. Hypofractionation regimens included: 68.04 Gy at 2.52 Gy/fraction (N = 25; 66%), 70 Gy at 2.5 Gy/fraction (N = 4; 11%) and 70.2 Gy at 2.6 Gy/fraction (N = 9; 23%). Late genitourinary (GU) and gastrointestinal (GI) toxicity was scored using the Radiation Therapy Oncology Group scoring system. RESULTS Median age at diagnosis was 70 years (range 49-80) and median follow-up, 5.8 years. Late grade 1, 2 and 3 GI toxicity were 13%, 24%, and 2.6%, respectively. Late grade 1, 2, 3 GU toxicity were 29%, 21%, and 8%, respectively. Sexual toxicity was evaluated in 19 patients to be grade 1, 2 in 11% and grade 3 in 16%. Multivariate analysis showed that patients with higher values of rectum V50 associated with late GI toxicity (P = 0.025). Patients with PSA ≤8 (P = 0.048) or comorbidities (P = 0.013) at diagnosis were associated with higher late GU toxicity. Additionally, PSA ≤8 also associated with moderate (grade ≥2) late GU toxicity in the multivariate analysis (P = 0.028). CONCLUSIONS Hypofractionated HT can be delivered safely with limited rates of moderate and severe late toxicity. The proportion of the rectum that receives a moderate and high dose, having comorbidities, and PSA at diagnosis seem to associate with long term toxicity.
Collapse
Affiliation(s)
- Elona Cekani
- Máster Internacional en Aplicaciones Tecnológicas Avanzadas en Oncología Radioterápica de la Universidad de Murcia, GenesisCare Fundación, Madrid, Spain
| | | | - Rodrigo Barrientos
- Máster Internacional en Aplicaciones Tecnológicas Avanzadas en Oncología Radioterápica de la Universidad de Murcia, GenesisCare Fundación, Madrid, Spain
| | - Patricia Tavera
- Department of Radiation Oncology, GenesisCare, Madrid, Spain
| | | | | | | | - Raul Matute
- Department of Radiation Oncology, University Hospital La Paz, Madrid, Spain
| |
Collapse
|
19
|
Lee HJ, Macomber MW, Spraker MB, Bowen SR, Hippe D, Fung A, Russell KJ, Laramore GE, Rengan R, Liao J, Apisarnthanarax S, Zeng J. Analysis of Gastrointestinal Toxicity in Patients Receiving Proton Beam Therapy for Prostate Cancer: A Single-Institution Experience. Adv Radiat Oncol 2018; 4:70-78. [PMID: 30706013 PMCID: PMC6349581 DOI: 10.1016/j.adro.2018.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Revised: 08/01/2018] [Accepted: 08/02/2018] [Indexed: 02/06/2023] Open
Abstract
Purpose We characterized both physician- and patient-reported rates of gastrointestinal (GI) toxicity in patients treated with proton beam therapy (PBT) at our institution for prostate adenocarcinoma and identified factors associated with toxicity. Methods and materials We treated 192 patients with PBT between July 2013 and July 2016. Included patients had ≥1 year of follow-up. Potential preexisting clinical and treatment-related risk factors for GI toxicity were recorded. Common Terminology Criteria for Adverse Events version 4.0 was used to score toxicity. Expanded Prostate Cancer Index Composite (EPIC) bowel domain questionnaires assessed patient-reported quality of life. Associations between grade (GR) 2+ toxicity and clinical, treatment, and dosimetric factors were assessed using Cox models and corresponding hazard ratios. Results The median follow-up was 1.7 years. Most of the observed GI toxicity (>90%) was in the form of rectal bleeding (RB). GR2+ GI toxicity and RB actuarial rates specifically at 2 years were 21.3% and 20.4%, respectively. GR3 toxicity was rare, with only 1 observed RB event. No GR4/5 toxicity was seen. The EPIC bowel domain median score was 96 (range, 61-100) pretreatment, 93 (range, 41-100) at 1 year, 89 (range, 57-100) at 1.5 years, and 89 (range, 50-100) at 2 years. Anticoagulation use was the only factor selected during multivariate analysis for predicting GR2+ RB, with a resulting concordance index of 0.59 (95% confidence interval, 0.48-0.68; P = .088). Type of proton technology (pencil beam scanning vs uniform scanning) and number of fields treated per day (1 vs 2) showed no significant difference in toxicity rate. Conclusions PBT was associated with acceptable rates of GR2+ transient GI toxicity, mostly in the form of RB, which correlated with anticoagulation use. High EPIC bowel domain quality of life was maintained in the 2 years after treatment.
Collapse
Affiliation(s)
- Howard J Lee
- Duke University School of Medicine, Durham, North Carolina
| | - Meghan W Macomber
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Matthew B Spraker
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Stephen R Bowen
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Daniel Hippe
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Angela Fung
- Seattle Cancer Care Alliance Proton Therapy Center, Seattle, Washington
| | - Kenneth J Russell
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - George E Laramore
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Ramesh Rengan
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jay Liao
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Smith Apisarnthanarax
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| | - Jing Zeng
- Department of Radiation Oncology, University of Washington School of Medicine, Seattle, Washington
| |
Collapse
|
20
|
Maebayashi T, Ishibashi N, Aizawa T, Sakaguchi M, Sato H, Sato K, Matsui T, Yamaguchi K, Takahashi S. Factors Predicting Late Rectal Disorders after Radiation Therapy for Prostate Cancer. Chin Med J (Engl) 2017; 130:2441-2446. [PMID: 29052565 PMCID: PMC5684637 DOI: 10.4103/0366-6999.216406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Background: Methods: Results: Conclusions:
Collapse
|
21
|
O'Callaghan ME, Raymond E, Campbell JM, Vincent AD, Beckmann K, Roder D, Evans S, McNeil J, Millar J, Zalcberg J, Borg M, Moretti K. Patient-Reported Outcomes After Radiation Therapy in Men With Prostate Cancer: A Systematic Review of Prognostic Tool Accuracy and Validity. Int J Radiat Oncol Biol Phys 2017; 98:318-337. [DOI: 10.1016/j.ijrobp.2017.02.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 02/02/2017] [Accepted: 02/14/2017] [Indexed: 11/28/2022]
|
22
|
Zaorsky NG, Showalter TN, Ezzell GA, Nguyen PL, Assimos DG, D'Amico AV, Gottschalk AR, Gustafson GS, Keole SR, Liauw SL, Lloyd S, McLaughlin PW, Movsas B, Prestidge BR, Taira AV, Vapiwala N, Davis BJ. ACR Appropriateness Criteria ® external beam radiation therapy treatment planning for clinically localized prostate cancer, part I of II. Adv Radiat Oncol 2016; 2:62-84. [PMID: 28740916 PMCID: PMC5514238 DOI: 10.1016/j.adro.2016.10.002] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/12/2016] [Indexed: 12/24/2022] Open
Affiliation(s)
| | | | | | - Gary A Ezzell
- Mayo Clinic, Phoenix, Arizona (research author, contributing)
| | - Paul L Nguyen
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (panel vice-chair)
| | - Dean G Assimos
- University of Alabama School of Medicine, Birmingham, Alabama (American Urological Association)
| | - Anthony V D'Amico
- Dana-Farber Cancer Institute/Brigham and Women's Hospital, Boston, Massachusetts (American Society of Clinical Oncology)
| | | | | | | | | | - Shane Lloyd
- Huntsman Cancer Hospital, Salt Lake City, Utah
| | | | | | | | - Al V Taira
- Mills Peninsula Hospital, San Mateo, California
| | - Neha Vapiwala
- University of Pennsylvania, Philadelphia, Pennsylvania
| | | |
Collapse
|
23
|
Who will benefit most from hydrogel rectum spacer implantation in prostate cancer radiotherapy? A model-based approach for patient selection. Radiother Oncol 2016; 121:118-123. [DOI: 10.1016/j.radonc.2016.08.026] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2016] [Revised: 08/05/2016] [Accepted: 08/29/2016] [Indexed: 12/11/2022]
|
24
|
Landoni V, Fiorino C, Cozzarini C, Sanguineti G, Valdagni R, Rancati T. Predicting toxicity in radiotherapy for prostate cancer. Phys Med 2016; 32:521-32. [PMID: 27068274 DOI: 10.1016/j.ejmp.2016.03.003] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2015] [Revised: 02/15/2016] [Accepted: 03/02/2016] [Indexed: 02/08/2023] Open
Abstract
This comprehensive review addresses most organs at risk involved in planning optimization for prostate cancer. It can be considered an update of a previous educational review that was published in 2009 (Fiorino et al., 2009). The literature was reviewed based on PubMed and MEDLINE database searches (from January 2009 up to September 2015), including papers in press; for each section/subsection, key title words were used and possibly combined with other more general key-words (such as radiotherapy, dose-volume effects, NTCP, DVH, and predictive model). Publications generally dealing with toxicity without any association with dose-volume effects or correlations with clinical risk factors were disregarded, being outside the aim of the review. A focus was on external beam radiotherapy, including post-prostatectomy, with conventional fractionation or moderate hypofractionation (<4Gy/fraction); extreme hypofractionation is the topic of another paper in this special issue. Gastrointestinal and urinary toxicity are the most investigated endpoints, with quantitative data published in the last 5years suggesting both a dose-response relationship and the existence of a number of clinical/patient related risk factors acting as dose-response modifiers. Some results on erectile dysfunction, bowel toxicity and hematological toxicity are also presented.
Collapse
Affiliation(s)
- Valeria Landoni
- Medical Physics, Istituto Nazionale Tumori Regina Elena, Rome, Italy
| | - Claudio Fiorino
- Medical Physics, Raffaele Scientific Institute IRCCS, Milan, Italy
| | | | | | - Riccardo Valdagni
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Clinical Sciences and Community Health, University of Milan, Milan, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
| |
Collapse
|
25
|
Musunuru HB, Davidson M, Cheung P, Vesprini D, Liu S, Chung H, Chu W, Mamedov A, Ravi A, D'Alimonte L, Commisso K, Helou J, Deabreu A, Zhang L, Loblaw A. Predictive Parameters of Symptomatic Hematochezia Following 5-Fraction Gantry-Based SABR in Prostate Cancer. Int J Radiat Oncol Biol Phys 2016; 94:1043-51. [DOI: 10.1016/j.ijrobp.2015.12.010] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 12/07/2015] [Accepted: 12/09/2015] [Indexed: 02/07/2023]
|
26
|
Markovina S, Michalski J. Counterpoint: Unfair comparisons lead to unwarranted conclusions-Can treatment modalities for localized prostate cancer truly be compared without bias? Brachytherapy 2015. [PMID: 26219833 DOI: 10.1016/j.brachy.2015.06.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Stephanie Markovina
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri
| | - Jeff Michalski
- Department of Radiation Oncology, Washington University School of Medicine, St. Louis, Missouri.
| |
Collapse
|
27
|
Liu HX, Du L, Yu W, Cai BN, Xu SP, Xie CB, Ma L. Hypofractionated Helical Tomotherapy for Older Aged Patients With Prostate Cancer: Preliminary Results of a Phase I-II Trial. Technol Cancer Res Treat 2015; 15:546-54. [PMID: 26152749 DOI: 10.1177/1533034615593189] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Accepted: 05/28/2015] [Indexed: 11/16/2022] Open
Abstract
In our center, the feasibility and related acute toxicities of hypofractionated helical tomotherapy have been evaluated in older aged patients with prostate cancer . Between February 2009 and February 2014, 67 patients (older than 65 years) were enrolled in a prospective phase I-II study (registered number, ChiCTR-ONC-13004037). Patients in cohort 1 (n = 33) and cohort 2 (n = 34) received 76 Gy in 34 fractions (2.25 Gy/F) and 71.6 Gy in 28 fractions (2.65 Gy/F), respectively, to the prostate and seminal vesicles, while 25 patients in cohort 2 also received integrated elective lymph node irradiation (50.4 Gy). All patients were treated with helical tomotherapy, and daily image guidance was performed before each treatment. Acute toxicities were assessed with Radiation Therapy Oncology Group (RTOG)/European Organization for Research on Treatment of Cancer (EORTC) criteria. No significant difference was detected between the 2 cohorts in the incidence of acute toxicities. In cohort 1, the incidences of grade 1 and 2 genitourinary and gastrointestinal toxicities were 45.5% and 45.4%, respectively, and without grade 3 and 4 toxicities. In cohort 2, the incidences of acute grade 1 and 2 genitourinary and gastrointestinal toxicities were 47.1% and 55.9%, respectively, and grade 3 genitourinary toxicity (hematuria) was noted only in 1 patient. No significant difference was detected in the incidence of acute toxicities between the patients receiving integrated elective lymph node irradiation and those receiving irradiation to prostate and seminal vesicle in cohort 2. Univariate and multivariate analyses were performed with clinical parameters. Only the baseline weight was found negatively correlated with genitourinary toxicities at a weak level (relative risk = 0.946, 95% confidence interval 0.896-0.998], P = .043). This study shows that 2 hypofractionation regimens (76 Gy/34F and 71.6 Gy/28F) delivered with HT are well tolerated in older aged patients having prostate cancer without significant difference for acute toxicities between the 2 cohorts. Late toxicities and treatment outcomes for these patients are under investigation.
Collapse
Affiliation(s)
- Hai-Xia Liu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Lei Du
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| | - Wei Yu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Bo-Ning Cai
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Shou-Ping Xu
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Chuan-Bin Xie
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China
| | - Lin Ma
- Department of Radiation Oncology, Chinese PLA General Hospital, Beijing, China Department of Radiation Oncology, Hainan Branch of Chinese PLA General Hospital, Sanya, China
| |
Collapse
|
28
|
Ling DC, Kabolizadeh P, Heron DE, Ohr JP, Wang H, Johnson J, Kubicek GJ. Incidence of hospitalization in patients with head and neck cancer treated with intensity-modulated radiation therapy. Head Neck 2015; 37:1750-5. [PMID: 24986324 DOI: 10.1002/hed.23821] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2014] [Revised: 05/30/2014] [Accepted: 06/29/2014] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Patients with primary head and neck cancer managed with radiation therapy (RT) +/- chemotherapy may experience significant treatment-related toxicities. We assessed hospitalization as a metric for severe treatment-related toxicities and evaluated patient and treatment factors for possible association. METHODS A retrospective review was performed on 147 patients with head and neck cancer treated with definitive or adjuvant intensity-modulated radiation therapy (IMRT) +/- chemotherapy. Multiple Poisson regression model was used to analyze relationships between patient or treatment factors and number of hospital stays during RT and within 8 weeks after RT. RESULTS Multivariate analysis showed preexisting diabetes or pulmonary disease, primary carcinoma of oral cavity, and prescribed radiation dose (p < .05) were associated with increased number of patient hospital stays during or shortly after RT. CONCLUSION We found that 34.7% of patients experienced a chemoradiation toxicity-related hospitalization during or shortly after treatment. Prior pulmonary disease, diabetes, and increasing prescribed radiation dose were associated with increased hospital stays.
Collapse
Affiliation(s)
- Diane C Ling
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Peyman Kabolizadeh
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Dwight E Heron
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania.,Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - James P Ohr
- Department of Medicine, Division of Medical Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| | - Hong Wang
- Department of Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Jonas Johnson
- Department of Otolaryngology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Gregory J Kubicek
- Department of Radiation Oncology, University of Pittsburgh Cancer Institute, Pittsburgh, Pennsylvania
| |
Collapse
|
29
|
D'Avino V, Palma G, Liuzzi R, Conson M, Doria F, Salvatore M, Pacelli R, Cella L. Prediction of gastrointestinal toxicity after external beam radiotherapy for localized prostate cancer. Radiat Oncol 2015; 10:80. [PMID: 25890376 PMCID: PMC4404272 DOI: 10.1186/s13014-015-0389-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Accepted: 03/25/2015] [Indexed: 11/10/2022] Open
Abstract
Background Gastrointestinal (GI) toxicity is a common effect following radiation therapy (RT) for prostate cancer. Purpose of the present work is to compare two Normal Tissue Complication Probability (NTCP) modelling approaches for prediction of late radio-induced GI toxicity after prostate external beam radiotherapy. Methods The study includes 84 prostate cancer patients evaluated for late rectal toxicity after 3D conformal radiotherapy. Median age was 72 years (range 53-85). All patients received a total dose of 76 Gy to the prostate gland with daily fractions of 2 Gy. The acute and late radio-induced GI complications were classified according to the RTOG/EORTC scoring system. Rectum dose-volume histograms were extracted for Lyman-Kutcher-Burman (LKB) NTCP model fitting using Maximum Likelihood Estimation. The bootstrap method was employed to test the fit robustness. The area under the receiver operating characteristic curve (AUC) was used to evaluate the predictive power of the LKB and to compare it with a multivariate logistic NTCP model previously determined. Results At a median follow-up of 36 months, 42% (35/84) of patients experienced grade 1-2 (G1-2) acute GI events while 25% (21/84) of patients developed G1-2 late GI events. The best-estimate of fitting parameters for LKB NTCP model for mild\moderate GI toxicity resulted to be: D50 = 87.3 Gy, m = 0.37 and n = 0.10. Bootstrap result showed that the parameter fit was robust. The AUC values for the LKB and for the multivariate logistic models were 0.60 and 0.75, respectively. Conclusions We derived the parameters of the LKB model for mild\moderate GI toxicity prediction and we compared its performance with that of a data-driven multivariate model. Compared to LKB, the multivariate model confirmed a higher predictive power as showed by the AUC values.
Collapse
Affiliation(s)
- Vittoria D'Avino
- Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy.
| | - Giuseppe Palma
- Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy.
| | - Raffaele Liuzzi
- Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy.
| | - Manuel Conson
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy.
| | - Francesca Doria
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy.
| | - Marco Salvatore
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy.
| | - Roberto Pacelli
- Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy.
| | - Laura Cella
- Institute of Biostructure and Bioimaging, National Council of Research (CNR), Naples, Italy.
| |
Collapse
|
30
|
Verma R, Treasure P, Hughes R. Development and evaluation of radiographer led telephone follow up following radical radiotherapy to the prostate. A report of a Macmillan Cancer Support Sponsored Pilot project at Mount Vernon Hospital. Radiography (Lond) 2015. [DOI: 10.1016/j.radi.2014.05.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
31
|
Rectal Toxicity After Proton Therapy For Prostate Cancer: An Analysis of Outcomes of Prospective Studies Conducted at the University of Florida Proton Therapy Institute. Int J Radiat Oncol Biol Phys 2015; 91:172-81. [DOI: 10.1016/j.ijrobp.2014.08.353] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 08/27/2014] [Accepted: 08/28/2014] [Indexed: 01/06/2023]
|
32
|
Joh DY, Chen LN, Porter G, Bhagat A, Sood S, Kim JS, Moures R, Yung T, Lei S, Collins BT, Ju AW, Suy S, Carroll J, Lynch JH, Dritschilo A, Collins SP. Proctitis following stereotactic body radiation therapy for prostate cancer. Radiat Oncol 2014; 9:277. [PMID: 25497602 PMCID: PMC4272823 DOI: 10.1186/s13014-014-0277-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2014] [Accepted: 11/26/2014] [Indexed: 11/26/2022] Open
Abstract
Background Proctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer. Methods Between February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT. Results The median age was 69 years with a median prostate volume of 39 cc. The median follow-up was 3.9 years with a minimum follow-up of two years. The 2-year actuarial incidence of late rectal bleeding ≥ grade 2 was 1.5%. Endoscopy revealed VRS Grade 2 rectal telangiectasias in 11% of patients. All proctitis symptoms increased at one month post-SBRT but returned to near-baseline with longer follow-up. The most bothersome symptoms were bowel urgency and frequency. At one month post-SBRT, 11.2% and 8.5% of patients reported a moderate to big problem with bowel urgency and frequency, respectively. The EPIC bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 6 months and 18 months before returning to near-baseline at two years post-SBRT. Prior to treatment, 4.1% of men felt their bowel function was a moderate to big problem which increased to 11.5% one month post-SBRT but returned to near-baseline at two years post-SBRT. Conclusions In this single institution cohort, the rate and severity of proctitis observed following SBRT is low. QOL decreased on follow-up; however, our results compare favorably to those reported for patients treated with alternative radiation modalities. Future prospective randomized studies are needed to confirm these observations.
Collapse
Affiliation(s)
- Daniel Y Joh
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Leonard N Chen
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Gerald Porter
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Aditi Bhagat
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Sumit Sood
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Joy S Kim
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Rudy Moures
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Thomas Yung
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Siyuan Lei
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Brian T Collins
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Andrew W Ju
- Department of Radiation Oncology, East Carolina University, Greenville, NC, 27834, USA.
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - John Carroll
- Department of Gastroenterology, Georgetown University Hospital, Washington, DC, 20007, USA.
| | - John H Lynch
- Department of Urology, Georgetown University Hospital, Washington, DC, 20007, USA.
| | - Anatoly Dritschilo
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Medical Center, 3800 Reservoir Road, N.W, Washington, DC, 20007, USA.
| |
Collapse
|
33
|
Skolarus TA, Wittmann D, Northouse L, An LC, Olson KB, Rew KT, Jimbo M, Heidelbaugh JJ, Phillips J, Holmes-Rovner M. Recommendations for Prostate Cancer Survivorship Care: An Update to the 2009 Michigan Cancer Consortium Guidelines for the Primary Care Management of Prostate Cancer Post-Treatment Sequelae. JOURNAL OF MEN'S HEALTH 2014. [DOI: 10.1089/jomh.2014.0026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
|
34
|
Nguyen ML, Willows B, Khan R, Chi A, Kim L, Nour SG, Sroka T, Kerr C, Godinez J, Mills M, Karlsson U, Altdorfer G, Nguyen NP, Jendrasiak G. The potential role of magnetic resonance spectroscopy in image-guided radiotherapy. Front Oncol 2014; 4:91. [PMID: 24847443 PMCID: PMC4017160 DOI: 10.3389/fonc.2014.00091] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2013] [Accepted: 04/14/2014] [Indexed: 11/17/2022] Open
Abstract
Magnetic resonance spectroscopy (MRS) is a non-invasive technique to detect metabolites within the normal and tumoral tissues. The ability of MRS to diagnose areas of high metabolic activity linked to tumor cell proliferation is particularly useful for radiotherapy treatment planning because of better gross tumor volume (GTV) delineation. The GTV may be targeted with higher radiation dose, potentially improving local control without excessive irradiation to the normal adjacent tissues. Prostate cancer and glioblastoma multiforme (GBM) are two tumor models that are associated with a heterogeneous tumor distribution. Preliminary studies suggest that the integration of MRS into radiotherapy planning for these tumors is feasible and safe. Image-guided radiotherapy (IGRT) by virtue of daily tumor imaging and steep dose gradient may allow for tumor dose escalation with the simultaneous integrated boost technique (SIB) and potentially decrease the complications rates in patients with GBM and prostate cancers.
Collapse
Affiliation(s)
- Mai Lin Nguyen
- Department of Psychology, Stanford University , Palo Alto, CA , USA
| | - Brooke Willows
- School of Medicine, University of Arizona , Phoenix, AZ , USA
| | - Rihan Khan
- Department of Radiology, University of Arizona , Tucson, AZ , USA
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Lyndon Kim
- Division of Neuro-Oncology, Department of Neurosurgery and Medical Oncology, Thomas Jefferson University , Philadelphia, PA , USA
| | - Sherif G Nour
- Department of Radiology, Emory University , Atlanta, GA , USA
| | - Thomas Sroka
- Department of Radiation Oncology, Darmouth College , New Lebanon, NH , USA
| | - Christine Kerr
- Department of Radiation Oncology, Centre Val d'Aurelle , Montpellier , France
| | - Juan Godinez
- Department of Radiation Oncology, Florida Radiation Oncology Group , Jacksonville, FL , USA
| | - Melissa Mills
- Department of Radiation Oncology, University of Arizona , Tucson, AZ , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Gabor Altdorfer
- Department of Radiation Oncology, Camden Clark Cancer Center , Parkersburg, WV , USA
| | - Nam Phong Nguyen
- Department of Radiation Oncology, Howard University Hospital , Washington DC , USA
| | - Gordon Jendrasiak
- Department of Radiation Oncology, East Carolina University , Greenville, NC , USA
| | | |
Collapse
|
35
|
Hoppe BS, Michalski JM, Mendenhall NP, Morris CG, Henderson RH, Nichols RC, Mendenhall WM, Williams CR, Regan MM, Chipman JJ, Crociani CM, Sandler HM, Sanda MG, Hamstra DA. Comparative effectiveness study of patient-reported outcomes after proton therapy or intensity-modulated radiotherapy for prostate cancer. Cancer 2014; 120:1076-82. [PMID: 24382757 PMCID: PMC4103169 DOI: 10.1002/cncr.28536] [Citation(s) in RCA: 72] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 11/21/2013] [Accepted: 11/25/2013] [Indexed: 11/07/2022]
Abstract
BACKGROUND Data continue to emerge on the relative merits of different treatment modalities for prostate cancer. The objective of this study was to compare patient-reported quality-of-life (QOL) outcomes after proton therapy (PT) and intensity-modulated radiation therapy (IMRT) for prostate cancer. METHODS A comparison was performed of prospectively collected QOL data using the Expanded Prostate Cancer Index Composite (EPIC) questionnaire. QOL data were collected during the first 2 years after treatment for men who received PT and IMRT. PT was delivered to 1243 men at a single center at doses from 76 grays (Gy) to 82 Gy. IMRT was delivered to 204 men who were included in the Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA) study in doses from 75.6 Gy to 79.4 Gy. The Wilcoxon rank-sum test was used to compare EPIC outcomes by modality using baseline-adjusted scores at different time points. Individual questions were assessed by converting to binary outcomes and testing with generalized estimating equations. RESULTS No differences were observed in summary score changes for bowel, urinary incontinence, urinary irritative/obstructive, and sexual domains between the 2 cohorts. However, more men who received IMRT reported moderate/big problems with rectal urgency (P = 0.02) and frequent bowel movements (P = 0.05) than men who received PT. CONCLUSIONS There were no differences in QOL summary scores between the IMRT and PT cohorts during early follow-up (up to 2-years). Response to individual questions suggests possible differences in specific bowel symptoms between the 2 cohorts. These outcomes highlight the need for further comparative studies of PT and IMRT.
Collapse
Affiliation(s)
- Bradford S Hoppe
- University of Florida Proton Therapy Institute, Jacksonville, Florida
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Stenmark MH, Conlon AS, Johnson S, Daignault S, Litzenberg D, Marsh R, Ritter T, Vance S, Kazzi N, Feng FY, Sandler H, Sanda MG, Hamstra DA. Dose to the inferior rectum is strongly associated with patient reported bowel quality of life after radiation therapy for prostate cancer. Radiother Oncol 2014; 110:291-7. [DOI: 10.1016/j.radonc.2014.01.007] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2013] [Revised: 12/17/2013] [Accepted: 01/05/2014] [Indexed: 11/24/2022]
|
37
|
Cella L, D'Avino V, Liuzzi R, Conson M, Doria F, Faiella A, Loffredo F, Salvatore M, Pacelli R. Multivariate normal tissue complication probability modeling of gastrointestinal toxicity after external beam radiotherapy for localized prostate cancer. Radiat Oncol 2013; 8:221. [PMID: 24053357 PMCID: PMC3852304 DOI: 10.1186/1748-717x-8-221] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2013] [Accepted: 09/15/2013] [Indexed: 11/10/2022] Open
Abstract
Background The risk of radio-induced gastrointestinal (GI) complications is affected by several factors other than the dose to the rectum such as patient characteristics, hormonal or antihypertensive therapy, and acute rectal toxicity. Purpose of this work is to study clinical and dosimetric parameters impacting on late GI toxicity after prostate external beam radiotherapy (RT) and to establish multivariate normal tissue complication probability (NTCP) model for radiation-induced GI complications. Methods A total of 57 men who had undergone definitive RT for prostate cancer were evaluated for GI events classified using the RTOG/EORTC scoring system. Their median age was 73 years (range 53–85). The patients were assessed for GI toxicity before, during, and periodically after RT completion. Several clinical variables along with rectum dose-volume parameters (Vx) were collected and their correlation to GI toxicity was analyzed by Spearman’s rank correlation coefficient (Rs). Multivariate logistic regression method using resampling techniques was applied to select model order and parameters for NTCP modeling. Model performance was evaluated through the area under the receiver operating characteristic curve (AUC). Results At a median follow-up of 30 months, 37% (21/57) patients developed G1-2 acute GI events while 33% (19/57) were diagnosed with G1-2 late GI events. An NTCP model for late mild/moderate GI toxicity based on three variables including V65 (OR = 1.03), antihypertensive and/or anticoagulant (AH/AC) drugs (OR = 0.24), and acute GI toxicity (OR = 4.3) was selected as the most predictive model (Rs = 0.47, p < 0.001; AUC = 0.79). This three-variable model outperforms the logistic model based on V65 only (Rs = 0.28, p < 0.001; AUC = 0.69). Conclusions We propose a logistic NTCP model for late GI toxicity considering not only rectal irradiation dose but also clinical patient-specific factors. Accordingly, the risk of G1-2 late GI increases as V65 increases, it is higher for patients experiencing previous acute toxicity and it is lower for patients who take AH/AC drugs. The developed NTCP model could represent a potentially useful tool to be used in prospective trial and for comparison among different RT techniques.
Collapse
Affiliation(s)
- Laura Cella
- Institute of Biostructures and Bioimaging, National Council of Research (CNR), Naples, Italy.
| | | | | | | | | | | | | | | | | |
Collapse
|
38
|
Multi-institutional prospective evaluation of bowel quality of life after prostate external beam radiation therapy identifies patient and treatment factors associated with patient-reported outcomes: the PROSTQA experience. Int J Radiat Oncol Biol Phys 2013; 86:546-53. [PMID: 23561651 DOI: 10.1016/j.ijrobp.2013.01.036] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2012] [Revised: 01/29/2013] [Accepted: 01/31/2013] [Indexed: 11/21/2022]
Abstract
PURPOSE To evaluate patients treated with external beam radiation therapy as part of the multicenter Prostate Cancer Outcomes and Satisfaction with Treatment Quality Assessment (PROSTQA), to identify factors associated with posttreatment patient-reported bowel health-related quality of life (HRQOL). METHODS AND MATERIALS Pretreatment characteristics and treatment details among 292 men were evaluated using a general linear mixed model for their association with measured HRQOL by the Expanded Prostate Cancer Index Composite instrument through 2 years after enrollment. RESULTS Bowel HRQOL had a median score of 100 (interquartile range 91.7-100) pretreatment and 95.8 (interquartile range 83.3-100) at 2 years, representing new moderate/big problems in 11% for urgency, 7% for frequency, 4% for bloody stools, and 8% for an overall bowel problems. Baseline bowel score was the strongest predictor for all 2-year endpoints. In multivariable models, a volume of rectum ≥25% treated to 70 Gy (V70) yielded a clinically significant 9.3-point lower bowel score (95% confidence interval [CI] 16.8-1.7, P=.015) and predicted increased risks for moderate to big fecal incontinence (P=.0008). No other radiation therapy treatment-related variables influenced moderate to big changes in rectal HRQOL. However, on multivariate analyses V70 ≥25% was associated with increases in small, moderate, or big problems with the following: incontinence (3.9-fold; 95% CI 1.1-13.4, P=.03), rectal bleeding (3.6-fold; 95% CI 1.3-10.2, P=.018), and bowel urgency (2.9-fold; 95% CI 1.1-7.6, P=.026). Aspirin use correlated with a clinically significant 4.7-point lower bowel summary score (95% CI 9.0-0.4, P=.03) and an increase in small, moderate, or big problems with bloody stools (2.8-fold; 95% CI 1.2-6.4, P=.018). Intensity modulated radiation therapy was associated with higher radiation therapy doses to the prostate and lower doses to the rectum but did not independently correlate with bowel HRQOL. CONCLUSION After contemporary dose-escalated external beam radiation therapy up to 11% of patients have newly identified moderate/big problems with bowel HRQOL 2 years after treatment. Bowel HRQOL is related to baseline function, rectal V70, and aspirin use. Finally, our findings validate the commonly utilized cut-point of rectal V70 ≥25% as having significant impact on patient-reported outcomes.
Collapse
|