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Lynn PB, Cronin C, Rangarajan S, Widmar M. Rectal Cancer and Radiation in Colitis. Clin Colon Rectal Surg 2024; 37:30-36. [PMID: 38188064 PMCID: PMC10769583 DOI: 10.1055/s-0043-1762561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2024]
Abstract
Inflammatory bowel disease (IBD) is associated with an increased risk of colorectal cancer. When IBD patients develop a rectal cancer, this should be treated with the same oncological principles and guidelines as the general population. Rectal cancer treatment includes surgery, chemotherapy, and radiation therapy (RT). Many IBD patients will require a total proctocolectomy with an ileal-pouch anal anastomosis (IPAA) and others, restoration of intestinal continuity may not be feasible or advisable. The literature is scarce regarding outcomes of IPAA after RT. In the present review, we will summarize the evidence regarding RT toxicity in IBD patients and review surgical strategies and outcomes of IPAA after RT.
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Affiliation(s)
- Patricio B. Lynn
- Division of Colorectal Surgery, Department of General Surgery, New York Presbyterian – Weill-Cornell, New York, New York
| | - Catherine Cronin
- Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Sriram Rangarajan
- Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Maria Widmar
- Colorectal Surgery Service, Department of Surgical Oncology, Memorial Sloan Kettering Cancer Center, New York, New York
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2
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Trotta M, Patel KR, Singh S, Verma V, Ryckman J. Safety of Radiation Therapy in Patients With Prostate Cancer and Inflammatory Bowel Disease: A Systematic Review. Pract Radiat Oncol 2023; 13:454-465. [PMID: 37100389 PMCID: PMC10527639 DOI: 10.1016/j.prro.2023.04.006] [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: 02/07/2023] [Revised: 04/11/2023] [Accepted: 04/13/2023] [Indexed: 04/28/2023]
Abstract
PURPOSE Inflammatory bowel disease (IBD) has historically been considered a relative contraindication for pelvic radiation therapy (RT). To date, no systematic review has summarized the toxicity profile of RT for patients with prostate cancer and comorbid IBD. METHODS AND MATERIALS A PRISMA-guided systematic search was conducted on PubMed/Embase for original investigations that reported gastrointestinal (GI; rectal/bowel) toxicity in patients with IBD undergoing RT for prostate cancer. The substantial heterogeneity in patient population, follow-up, and toxicity reporting practices precluded a formal meta-analysis; however, a summary of the individual study-level data and crude pooled rates was described. RESULTS Twelve retrospective studies with 194 patients were included: 5 examined predominantly low-dose-rate brachytherapy (BT) monotherapy, 1 predominantly high-dose-rate BT monotherapy, 3 mixed external beam RT (3-dimensional conformal or intensity modulated RT [IMRT]) + low-dose-rate BT, 1 IMRT + high-dose-rate BT, and 2 stereotactic RT. Among these studies, patients with active IBD, patients receiving pelvic RT, and patients with prior abdominopelvic surgery were underrepresented. In all but 1 publication, the rate of late grade 3+ GI toxicities was <5%. The crude pooled rate of acute and late grade 2+ GI events was 15.3% (n = 27/177 evaluable patients; range, 0%-100%) and 11.3% (n = 20/177 evaluable patients; range, 0%-38.5%), respectively. Crude rates of acute and late grade 3+ GI events were 3.4% (6 cases; range, 0%-23%) and 2.3% (4 cases; range, 0%-15%). CONCLUSIONS Prostate RT in patients with comorbid IBD appears to be associated with low rates of grade 3+ GI toxicity; however, patients must be counseled regarding the possibility for lower-grade toxicities. These data cannot be generalized to the underrepresented subpopulations mentioned above, and individualize decision-making is recommended for those high-risk cases. Several strategies should be considered to minimize the probability of toxicity in this susceptible population, including careful patient selection, minimizing elective (nodal) treatment volumes, using rectal sparing techniques, and employing contemporary RT advancements to minimize exposure to GI organs at risk (eg, IMRT, magnetic resonance imaging-based target delineation, and high-quality daily image guidance).
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Affiliation(s)
- Matthew Trotta
- Department of Radiation Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Krishnan R Patel
- Radiation Oncology Branch, National Cancer Institute, National Institutes of Health, Bethesda, Maryland
| | - Sarah Singh
- Department of Radiation Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Vivek Verma
- Department of Radiation Oncology, West Virginia University Cancer Institute, Morgantown, West Virginia
| | - Jeffrey Ryckman
- Department of Radiation Oncology, West Virginia University Cancer Institute, Parkersburg, West Virginia.
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3
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Garcia JL, Rosa I, da Silva JP, Moleiro J, Claro I. Incidence and risk factors for neoplasia in inflammatory bowel disease. Asia Pac J Clin Oncol 2023. [PMID: 36915954 DOI: 10.1111/ajco.13908] [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: 04/28/2022] [Revised: 10/22/2022] [Accepted: 11/24/2022] [Indexed: 03/15/2023]
Abstract
INTRODUCTION Inflammatory Bowel Disease (IBD) patients may have an increased risk of neoplasia. The aim was to evaluate the incidence of malignant neoplasia in IBD patients, associated risk factors and therapy adjustments. METHODS Unicentric retrospective cohort study. All patients followed for IBD in a tertiary portuguese hospital and oncological centre during 2015-2020 were included. RESULTS 318 patients were included female 55.0%, age at diagnosis = 37.24(±15,28), Crohn's disease 52.5%, Primary Sclerosing Cholangitis n = 7, family history of cancer n = 12, previous diagnosis of neoplasia n = 23(7.2%). 42 cancers were diagnosed in 35 patients (11.0%) - median of 12.0(IQR = 7.5-21.0) years after IBD diagnosis. Most affected organs were the skin (n = 15 in 11 patients; melanoma = 1), colon/rectum (n = 8 in 6 patients), prostate (n = 4), breast (n = 3) and anal canal (n = 2). In those with non-melanoma skin cancer, 6 were under active treatment with azathioprine and 2 had stopped it for more than two years. In the univariate analysis, the occurrence of neoplasia was positively associated with tobacco exposure (p = 0.022), age at IBD diagnosis (p = 0.021), and negatively with infliximab exposure (p = 0.046). In 9 cases, cancer treatment was different because of the IBD, while IBD treatment was changed in 9 patients. In those affected by cancer, in the univariate analysis, its cure/remission was negatively associated with tobacco exposure (p = 0.004) and positively with salicylates use (p = 0.007). CONCLUSION In IBD patients, cancer mostly affected the skin and the lower digestive system. As in the general population, tobacco exposure was a risk factor for the development of neoplasia.
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Affiliation(s)
- Joana Lemos Garcia
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isadora Rosa
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | | | - Joana Moleiro
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
| | - Isabel Claro
- Instituto Português de Oncologia de Lisboa Francisco Gentil, Lisboa, Portugal
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4
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Pommier P, Ferré M, Blanchard P, Martin É, Peiffert D, Robin S, Hannoun-Lévi JM, Marchesi V, Cosset JM. Prostate cancer brachytherapy: SFRO guidelines 2021. Cancer Radiother 2021; 26:344-355. [PMID: 34955422 DOI: 10.1016/j.canrad.2021.11.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Prostate brachytherapy techniques are described, concerning both permanent seed implant and high dose rate brachytherapy. The following guidelines are presented: brachytherapy indications, implant procedure for permanent low dose rate implants and high dose rate with source projector, as well as dose and dose-constraints objectives, immediate postoperative management, post-treatment evaluation, and long-term follow-up.
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Affiliation(s)
- P Pommier
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France.
| | - M Ferré
- Département de physique médicale, institut Paoli-Calmettes, 232, boulevard Sainte-Marguerite, 13009 Marseille, France
| | - P Blanchard
- Département de radiothérapie, institut Gustave-Roussy, 114, rue Édouard-Vaillant, 94805 Villejuif cedex, France
| | - É Martin
- Département de radiothérapie, centre Georges-François-Leclerc, 1, rue du Pr-Marion, BP 77980, 21079 Dijon cedex, France
| | - D Peiffert
- Service universitaire de radiothérapie, Institut de cancérologie de Lorraine centre Alexis-Vautrin, 6, avenue de Bourgogne, CS 30519, 54519 Vandœuvre-lès-Nancy cedex, France
| | - S Robin
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69373 Lyon cedex 08, France
| | - J-M Hannoun-Lévi
- Département de radiothérapie, centre Antoine-Lacassagne, 33, avenue de Valombrose, 06189 Nice cedex 2, France
| | - V Marchesi
- Unité de physique médicale, Institut de cancérologie de Lorraine centre Alexis-Vautrin, avenue de Bourgogne, 54519 Vandœuvre-lès-Nancy, France
| | - J M Cosset
- Centre de radiothérapie Charlebourg/La Défense, groupe Améthyst, 65, avenue Foch, 92250 La Garenne-Colombes, France
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5
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Juarez JE, Romero T, Mantz CA, Pepin A, Aghdam N, Suy S, Steinberg ML, Levin-Epstein RG, Nickols NG, Kaplan ID, Meier RM, Pham HT, Linson PW, Hong RL, Buyyounouski MK, Bagshaw HP, Fuller DB, Katz AJ, Loblaw A, Collins SP, Kishan AU. Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series. Adv Radiat Oncol 2021; 6:100759. [PMID: 34585025 PMCID: PMC8453194 DOI: 10.1016/j.adro.2021.100759] [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: 03/30/2021] [Revised: 06/29/2021] [Accepted: 07/07/2021] [Indexed: 02/07/2023] Open
Abstract
Purpose To evaluate the safety of stereotactic body radiation therapy (SBRT) for prostate cancer in men with inflammatory bowel disease (IBD). Methods and Materials We queried a consortium database for patients with IBD receiving SBRT for prostate cancer between 2006 and 2012. Identified patients were matched with patients without a history of IBD in a 3:1 fashion based on dose, fractionation, use of androgen deprivation therapy, and age distribution. Logistic regression was used to evaluate the association between having IBD and experiencing acute and late gastrointestinal (GI) and genitourinary (GU) toxicities as scored on the Common Terminology Criteria for Adverse Events scale. Time to late toxicity was evaluated using proportional hazard Cox models. Our study was limited by absence of data on prostate size, baseline International Prostate Symptom Score, and rectal dose-volume histogram parameters. Results Thirty-nine patients with flare-free IBD at time of treatment (median follow-up 83.9 months) and 117 matched controls (median follow-up 88.7 months) were identified. A diagnosis of IBD was associated with increased odds of developing any late grade GI toxicity (odds ratio [OR] 6.11, P <.001) and GU toxicity (odds ratio 6.14, P < .001), but not odds of developing late grade ≥2 GI (P = .08) or GU toxicity (P = .069). Acute GI and GU toxicity, both overall and for grade ≥2 toxicities, were more frequent in men with IBD (P < .05). Time to late GI and GU toxicity of any grade was significantly shorter in patients with IBD (P < .001). Time to late grade ≥2 GU, but not grade ≥2 GI toxicity, was also shorter in patients with IBD (P = .044 for GU and P = .144 for GI). Conclusions Patients with IBD who received SBRT for PCa had a higher likelihood of developing acute GI and GU toxicity, in addition to experiencing lower grade late toxicities that occurred earlier. However, patients with IBD did not have a higher likelihood for late grade ≥2 GI or GU toxicity after SBRT compared with the control cohort. Interpretation of this data are limited by the small sample size. Thus, men with IBD in remission should be properly counseled about these risks when considering SBRT.
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Affiliation(s)
- Jesus E Juarez
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | - Tahmineh Romero
- Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California
| | | | - Abigail Pepin
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.,Department of Radiation Oncology, George Washington School of Medicine and Health Sciences, Washington, DC
| | - Nima Aghdam
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Simeng Suy
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Michael L Steinberg
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California
| | | | - Nicholas G Nickols
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, California
| | - Irving D Kaplan
- Department of Radiation Oncology, Beth Israel Deaconess, Boston, Massachusetts
| | | | - Huong T Pham
- Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington
| | - Patrick W Linson
- Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, California
| | - Robert L Hong
- Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia
| | | | - Hilary P Bagshaw
- Department of Radiation Oncology, Stanford University, Stanford, California
| | - Donald B Fuller
- Division of Genesis Health care Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California
| | - Alan J Katz
- Flushing Radiation Oncology Services, New York
| | - Andrew Loblaw
- Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada
| | - Sean P Collins
- Department of Radiation Medicine, Georgetown University Hospital, Washington, DC
| | - Amar U Kishan
- Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.,Department of Urology, University of California, Los Angeles, California
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6
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Lischalk JW, Blacksburg S, Mendez C, Repka M, Sanchez A, Carpenter T, Witten M, Garbus JE, Evans A, Collins SP, Katz A, Haas J. Stereotactic body radiation therapy for the treatment of localized prostate cancer in men with underlying inflammatory bowel disease. Radiat Oncol 2021; 16:126. [PMID: 34243797 PMCID: PMC8267228 DOI: 10.1186/s13014-021-01850-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Accepted: 06/24/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Historically, IBD has been thought to increase the underlying risk of radiation related toxicity in the treatment of prostate cancer. In the modern era, contemporary radiation planning and delivery may mitigate radiation-related toxicity in this theoretically high-risk cohort. This is the first manuscript to report clinical outcomes for men diagnosed with prostate cancer and underlying IBD curatively treated with stereotactic body radiation therapy (SBRT). METHODS A large institutional database of patients (n = 4245) treated with SBRT for adenocarcinoma of the prostate was interrogated to identify patients who were diagnosed with underlying IBD prior to treatment. All patients were treated with SBRT over five treatment fractions using a robotic radiosurgical platform and fiducial tracking. Baseline IBD characteristics including IBD subtype, pre-SBRT IBD medications, and EPIC bowel questionnaires were reviewed for the IBD cohort. Acute and late toxicity was evaluated using the CTCAE version 5.0. RESULTS A total of 31 patients were identified who had underlying IBD prior to SBRT for the curative treatment of prostate cancer. The majority (n = 18) were diagnosed with ulcerative colitis and were being treated with local steroid suppositories for IBD. No biochemical relapses were observed in the IBD cohort with early follow up. High-grade acute and late toxicities were rare (n = 1, grade 3 proctitis) with a median time to any GI toxicity of 22 months. Hemorrhoidal flare was the most common low-grade toxicity observed (n = 3). CONCLUSION To date, this is one of the largest groups of patients with IBD treated safely and effectively with radiation for prostate cancer and the only review of patients treated with SBRT. Caution is warranted when delivering therapeutic radiation to patients with IBD, however modern radiation techniques appear to have mitigated the risk of GI side effects.
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Affiliation(s)
- Jonathan W Lischalk
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA.
| | - Seth Blacksburg
- Department of Radiation Medicine, Lenox Hill Hospital - Northwell Health, New York, NY, 10075, USA
| | - Christopher Mendez
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
| | - Michael Repka
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
| | - Astrid Sanchez
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
| | - Todd Carpenter
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
| | - Matthew Witten
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
| | - Jules E Garbus
- Department of Surgery, New York University Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Andrew Evans
- Department of Radiation Oncology, New York University School of Medicine, New York, NY, USA
| | - Sean P Collins
- Department of Radiation Medicine, Medstar Georgetown University Hospital, Washington, DC, 20007, USA
| | - Aaron Katz
- Department of Urology, New York University Long Island School of Medicine, Mineola, NY, 11501, USA
| | - Jonathan Haas
- Department of Radiation Oncology, NYCyberKnife at Perlmutter Cancer Center - Manhattan, Perlmutter Cancer Center at New York University Langone Hospital - Long Island, 150 Amsterdam Ave, New York, NY, 11501, USA
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7
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Wang K, Mavroidis P, Royce TJ, Falchook AD, Collins SP, Sapareto S, Sheets NC, Fuller DB, El Naqa I, Yorke E, Grimm J, Jackson A, Chen RC. Prostate Stereotactic Body Radiation Therapy: An Overview of Toxicity and Dose Response. Int J Radiat Oncol Biol Phys 2020; 110:237-248. [PMID: 33358229 DOI: 10.1016/j.ijrobp.2020.09.054] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 09/26/2020] [Indexed: 01/10/2023]
Abstract
PURPOSE Ultrahypofractionationed radiation therapy for prostate cancer is increasingly studied and adopted. The American Association of Physicists in Medicine Working Group on Biological Effects of Hypofractionated Radiotherapy therefore aimed to review studies examining toxicity and quality of life after stereotactic body radiation therapy (SBRT) for prostate cancer and model its effect. METHODS AND MATERIALS We performed a systematic PubMed search of prostate SBRT studies published between 2001 and 2018. Those that analyzed factors associated with late urinary, bowel, or sexual toxicity and/or quality of life were included and reviewed. Normal tissue complication probability modelling was performed on studies that contained detailed dose/volume and outcome data. RESULTS We found 13 studies that examined urinary effects, 6 that examined bowel effects, and 4 that examined sexual effects. Most studies included patients with low-intermediate risk prostate cancer treated to 35-40 Gy. Most patients were treated with 5 fractions, with several centers using 4 fractions. Endpoints were heterogeneous and included both physician-scored toxicity and patient-reported quality of life. Most toxicities were mild-moderate (eg, grade 1-2) with a very low overall incidence of severe toxicity (eg, grade 3 or higher, usually <3%). Side effects were associated with both dosimetric and non-dosimetric factors. CONCLUSIONS Prostate SBRT appears to be overall well tolerated, with determinants of toxicity that include dosimetric factors and patient factors. Suggested dose constraints include bladder V(Rx Dose)Gy <5-10 cc, urethra Dmax <38-42 Gy, and rectum Dmax <35-38 Gy, though current data do not offer firm guidance on tolerance doses. Several areas for future research are suggested.
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Affiliation(s)
- Kyle Wang
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | - Trevor J Royce
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Sean P Collins
- Department of Radiation Oncology, Georgetown University Hospital, Washington, DC
| | - Stephen Sapareto
- Department of Medical Physics, Banner Health System, Phoenix, Arizona
| | - Nathan C Sheets
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, North Carolina
| | | | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, Florida
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Ronald C Chen
- Department of Radiation Oncology, University of Kansas, Kansas City, Kansas.
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Should inflammatory bowel disease be a contraindication to radiation therapy: a systematic review of acute and late toxicities. JOURNAL OF RADIOTHERAPY IN PRACTICE 2020. [DOI: 10.1017/s1460396920000783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractBackground:Inflammatory bowel disease (IBD) [i.e., Crohn’s disease (CD) and ulcerative colitis (UC)] has been considered a relative contraindication for radiation therapy (RT) to the abdomen or pelvis, potentially preventing patients with a diagnosis of IBD from receiving definitive therapy for their malignancy.Method:Using Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) conventions, a PubMed/MEDLINE literature search was conducted using the keywords RT, brachytherapy, inflammatory bowel disease, Crohn’s disease, ulcerative colitis and toxicity.Results:A total of 1,206 publications were screened with an addition of 8 studies identified through hand searching. Nineteen studies met the inclusion criteria for quantitative analysis. The total population across all studies was 497 patients, 50·5% having UC, 37% having CD and an additional 12·5% having unspecified IBD. Primary gastrointestinal malignancy (55%) followed by prostate cancer (40%) composed the bulk of the population. Acute and late grade 3 or greater gastrointestinal specific toxicity ranged from 0–23% to 0–13% respectively for those patients with IBD treated with RT to the abdomen or pelvis. In the literature reviewed, RT does not appear to increase fistula or stricture formation or IBD flares; however, one study did note RT to be a statistically significant risk factor for subsequent IBD flare on multivariate analysis.Conclusions:A review of reported acute and late toxicities suggests that patients with IBD should still be considered for definitive radiotherapy. Patient characteristics including IBD distribution relative to the irradiated field, inflammatory activity at the time of radiation, overall disease severity and disease phenotype in the case of CD (fistulising versus stricturing versus inflammatory only) should be considered on an individual basis when evaluating potential patients. When possible, advanced techniques with strict organ at risk dose constraints should be employed to limit toxicity in this patient population.
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Goldberg IP, Chang SL, Kundu SD, Chung BI, Singer EA. Impact of inflammatory bowel disease on radical prostatectomy outcomes and costs of care. Prostate Int 2020; 9:66-71. [PMID: 34386447 PMCID: PMC8322805 DOI: 10.1016/j.prnil.2020.08.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Revised: 08/13/2020] [Accepted: 08/20/2020] [Indexed: 12/31/2022] Open
Abstract
Background Recent studies suggest an association between prostate cancer and inflammatory bowel disease (IBD). Our objectives were to investigate clinical and financial impacts of IBD on radical prostatectomy (RP) and to determine the impact of surgical approach on our findings. Methods The Premier Hospital Database was queried for patients who underwent RP from 2003 to 2017. Multivariable logistic regression models were used to determine the independent impact of IBD on complications and readmission rates. We determined 90-day readmissions and examined 90-day hospital costs adjusted to 2019 US dollars with multivariable quantile regression models. Results Our study population included 262,189 men with prostate cancer, including 3,408 (1.3%) with IBD. There were higher odds for any complication for IBD patients compared with non-IBD controls for RP (15.64% vs. 10.66%). Patients with IBD had overall complication rates of 14.1% (P < 0.05) for open surgery and 17.2% for minimally invasive surgery (MIS) (P < 0.01). Between 2013 and 2017, the IBD cohort had significantly more complications (odds ratios (ORs): 2; 95% confidence interval (CI): 1.5 to 2.67; P < 0.0001), was more likely to have surgical costs in the top quartile (OR: 1.6; 95% CI: 1.23 to 2.1; P < 0.01), and had higher readmission rates (OR: 1.51; 95% CI: 1.1 to 2.06; P = 0.01). Conclusions The IBD cohort who underwent MIS had the highest complication rates. Hospital readmissions and surgical costs were significantly higher for the IBD cohort who underwent RP between 2013 and 2017, when a minimally invasive approach was more prevalent than an open approach. These findings may be important when deciding which surgical approach to take when performing RP on men with IBD.
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Affiliation(s)
| | - Steven L Chang
- Division of Urology, Brigham and Women's Hospital, Boston, MA, USA
| | - Shilajit D Kundu
- Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Benjamin I Chung
- Department of Urology, Stanford University Medical Center, Stanford, CA, USA
| | - Eric A Singer
- Section of Urologic Oncology, Rutgers Cancer Institute of New Jersey and Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, USA
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10
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Kim J, Feagins LA. Managing Patients with Inflammatory Bowel Disease Who Develop Prostate Cancer. Dig Dis Sci 2020; 65:22-30. [PMID: 31713121 DOI: 10.1007/s10620-019-05934-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 11/01/2019] [Indexed: 02/06/2023]
Abstract
Prostate cancer is the most common cancer among men in the USA. Interestingly, recent studies suggest that patients with inflammatory bowel disease (IBD) are at increased risk of developing prostate cancer. Importantly, patients with IBD who develop prostate cancer require thoughtful care when using immunosuppressants to treat the IBD in the setting of malignancy. Further, consideration must be given to the proximity of the prostate to the gastrointestinal tract when treating with radiation where there is concern for the effects of inadvertent exposure of radiation to the diseased bowel. In general, management of immunosuppression after diagnosis of prostate cancer is contingent on the specific immunosuppressive agents, the duration of cancer remission and/or plans for cancer treatment, and the potential risks and benefits of stopping or altering the administration of those agents. Concerns that patients with IBD would have increased risk of disease exacerbation and gastrointestinal toxicity have previously limited the use of radiation. While currently no consensus has been reached regarding the safety of radiation therapy in patients with IBD, recent studies suggest that radiation therapy may be used safely in patients with IBD who develop prostate cancer, especially brachytherapy and intensity-modulated radiation therapy which may have less bowel toxicity compared to conventional methods of external beam radiation therapy. A multidisciplinary team approach including gastroenterologists, urologists, radiation oncologists, and medical oncologists should be undertaken to best treat patients with IBD and prostate cancer.
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Affiliation(s)
- Jaehyun Kim
- Department of Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Linda A Feagins
- Department of Internal Medicine, Dell Medical School, University of Texas at Austin, Z0900, 1601 Trinity Street, Building B, Austin, TX, 78712, USA.
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SpaceOAR to improve dosimetric outcomes for monotherapy high-dose-rate prostate implantation in a patient with ulcerative colitis. J Contemp Brachytherapy 2018; 10:577-582. [PMID: 30662483 PMCID: PMC6335554 DOI: 10.5114/jcb.2018.81001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022] Open
Abstract
High-dose-rate (HDR) brachytherapy is an attractive option for patients receiving definitive radiation therapy for prostate cancer with decreased overall dose to the pelvis. However, ulcerative colitis increases rectal toxicity risk and may be a contraindication. A synthetic hydrogel, SpaceOAR (Augmentix Inc., Waltham, MA, USA), can facilitate the use of HDR brachytherapy for patients where rectal toxicity is a limiting factor. SpaceOAR gel (13.19 cc) was utilized in a monotherapy HDR prostate treatment with Ir-192 under transrectal ultrasound guidance, with the intention of decreasing rectal dose. SpaceOAR gel was inserted transperineally into the patient 18 days prior to the procedure. The HDR brachytherapy procedure was tolerated without incident. All planning constraints were met, and the following dosimetry was achieved: Prostate - V100% = 97.3%, V150% = 35%, V200% = 14.5%; Urethra - V118% = 0%; Rectum - D2 cc = 51.6%, V75% = 0 cc. The rectum-catheter spacing was on average between 6-8 mm. Average spacing for our 10 most recent patients without SpaceOAR was 3 mm. SpaceOAR did not hinder or distort ultrasound imaging or increase treatment time. SpaceOAR successfully increases catheter-rectal wall spacing and decreases rectal dose due to improved planning capabilities, while decreasing the likelihood of rectal perforation. One application of this tool is presented to mitigate potential toxicities associated with ulcerative colitis. At five months, one week, and one day follow-up, the patient reported no bowel issues following HDR brachytherapy.
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12
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Short-term Toxicity of High Dose Rate Brachytherapy in Prostate Cancer Patients with Inflammatory Bowel Disease. Clin Oncol (R Coll Radiol) 2018; 30:534-538. [DOI: 10.1016/j.clon.2018.06.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2017] [Revised: 05/08/2018] [Accepted: 05/30/2018] [Indexed: 02/04/2023]
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13
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Vanneste BGL, Van Limbergen EJ, van de Beek K, van Lin E, Lutgens L, Lambin P. A biodegradable rectal balloon implant to protect the rectum during prostate cancer radiotherapy for a patient with active Crohn's disease. Tech Innov Patient Support Radiat Oncol 2018; 6:1-4. [PMID: 32095571 PMCID: PMC7033750 DOI: 10.1016/j.tipsro.2018.01.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 01/26/2018] [Indexed: 12/22/2022] Open
Abstract
Active inflammatory bowel disease is an exclusion criterion for high-dose radiotherapy. A rectum spacer was inserted between the prostate and the rectal wall. The rectum spacer pushes the rectum outside of the high-dose area. No rectal toxicity of the radiotherapy or toxicity flare of the IBD was observed.
Background Radiotherapy in patients with active inflammatory bowel disease (IBD) is usually considered an absolute exclusion criterion for prostate cancer radiotherapy treatment. There are no reports available on the use of a biodegradable rectal balloon implantation (RBI) in patients with active IBD for prostate cancer radiotherapy. Case presentation We report on a patient with high-risk prostate cancer with the comorbidity of an active IBD with pancolitis location. He was treated with neo-adjuvant hormonal therapy and high-dose external beam radiotherapy to the prostate and the seminal vesicles. Before radiotherapy treatment, a biodegradable RBI was implanted between the prostate and the anterior rectal wall to push the rectum outside of the high-dose area. This patient at high-risk for rectal toxicity was successfully irradiated to his prostate with only a grade I urinary toxicity, no acute rectal toxicity or toxicity flare of the IBD. Conclusions This case describes the use of a RBI implantation in patients with active IBD for prostate cancer radiotherapy. The use of a biodegradable RBI proved to be a promised solution for such patients, and have to be further investigated.
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Affiliation(s)
- Ben G L Vanneste
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Evert J Van Limbergen
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Kees van de Beek
- Department of Urology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | | | - Ludy Lutgens
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Philippe Lambin
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center+, Maastricht, The Netherlands
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14
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Singh R, Jackson PS, Blake M, Cutlip J, Sharma S. Minimal Rectal Toxicity in the Setting of Comorbid Crohn's Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer. Cureus 2017; 9:e1533. [PMID: 28983442 PMCID: PMC5624568 DOI: 10.7759/cureus.1533] [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] [Indexed: 11/05/2022] Open
Abstract
We present one of the first cases of a prostate cancer (PCa) patient with inflammatory bowel disease (IBD) treated with intensity-modulated radiotherapy (IMRT) and a hydrogel rectal spacer. A 73-year-old male with a past medical history significant for Crohn’s disease (CD) and the recent diagnosis of T1cN0M0 high-risk PCa was referred for definitive radiotherapy. Given the patient’s history of CD and the possible increased risk of gastrointestinal (GI) toxicity and disease exacerbation, prior to IMRT, a hydrogel spacer was placed between the prostate and the anterior rectal wall to further minimize irradiation to the rectum. The patient then received IMRT (78 Gy/2 Gy fractions at a 100 percent isodose line). Over the course of treatment, Radiation Therapy Oncology Group (RTOG) Grade 1 GI toxicities of mild diarrhea were noted during the fifth and sixth weeks of treatment as well as an RTOG Grade 1 genitourinary (GU) toxicity of a decrease in the urinary stream that resolved with tamsulosin. At the 3, 6, 9, and 12-month follow-ups, bowel movements and urinary stream were reported to be at baseline with prostate-specific antigen (PSA) levels of 0.18 ng/mL and 0.03 ng/mL at the three and nine-month follow-ups, respectively. As such, this case report suggests that IBD patients with localized PCa may be viable candidates for radiotherapy given the promising results of hydrogel spacers in combination with IMRT in limiting rectal toxicity.
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Affiliation(s)
- Raj Singh
- Department of Radiation Oncology, Joan C. Edwards School of Medicine, Marshall University
| | | | - Mollie Blake
- Department of Radiation Oncology, St. Mary's Medical Center
| | - James Cutlip
- Department of Radiation Oncology, St. Mary's Medical Center
| | - Sanjeev Sharma
- Department of Radiation Oncology, St. Mary's Medical Center
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15
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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 for external beam radiation therapy treatment planning for clinically localized prostate cancer, part II of II. Adv Radiat Oncol 2017; 2:437-454. [PMID: 29114613 PMCID: PMC5605284 DOI: 10.1016/j.adro.2017.03.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2017] [Accepted: 03/10/2017] [Indexed: 12/21/2022] Open
Abstract
PURPOSE To present the most updated American College of Radiology (ACR) Appropriateness Criteria formed by an expert panel on the appropriate delivery of external beam radiation to manage stage T1 and T2 prostate cancer (in the definitive setting and post-prostatectomy) and to provide clinical variants with expert recommendations based on accompanying Appropriateness Criteria for target volumes and treatment planning. METHODS AND MATERIALS The ACR Appropriateness Criteria are evidence-based guidelines for specific clinical conditions that are reviewed annually by a panel of multidisciplinary experts. The guideline development and revision process includes an extensive analysis of current medical literature from peer-reviewed journals and the application of well-established methodologies (RAND/UCLA Appropriateness Method and Grading of Recommendations Assessment, Development, and Evaluation) to rate the appropriateness of imaging and treatment procedures for specific clinical scenarios. In instances in which evidence is lacking or equivocal, expert opinion may supplement available evidence to recommend imaging or treatment. RESULTS The panel summarizes the most recent and relevant literature on the topic, including organ motion and localization methods, image guidance, and delivery techniques (eg, 3-dimensional conformal intensity modulation). The panel presents 7 clinical variants, including (1) a standard case and cases with (2) a distended rectum, (3) a large-volume prostate, (4) bilateral hip implants, (5) inflammatory bowel disease, (6) prior prostatectomy, and (7) a pannus extending into the radiation field. Each case outlines the appropriate techniques for simulation, treatment planning, image guidance, dose, and fractionation. Numerical rating and commentary is given for each treatment approach in each variant. CONCLUSIONS External beam radiation is a key component of the curative management of T1 and T2 prostate cancer. By combining the most recent medical literature, these Appropriateness Criteria can aid clinicians in determining the appropriate treatment delivery and personalized approaches for individual patients.
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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
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16
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Kirk PS, Govani S, Borza T, Hollenbeck BK, Davis J, Shumway D, Waljee AK, Skolarus TA. Implications of Prostate Cancer Treatment in Men With Inflammatory Bowel Disease. Urology 2017; 104:131-136. [PMID: 28163082 PMCID: PMC5520802 DOI: 10.1016/j.urology.2017.01.030] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Revised: 01/24/2017] [Accepted: 01/27/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the influences of inflammatory bowel disease (IBD), a rare but morbid disease with increasing incidence, on prostate cancer management decisions. We examined whether prostate cancer treatment differed for men with IBD, and whether treatment choice was associated with risk of IBD flare. MATERIALS AND METHODS Using Veterans Health Administration cancer registry and administrative data, we identified 52,311 men diagnosed with prostate cancer from 2005 to 2008. We used International Classification of Diseases-9 codes and pharmacy and utilization data to identify IBD diagnoses, IBD-directed therapy, and flares (glucocorticoid escalation, hospitalization, and surgical intervention). We compared characteristics across men with and without IBD, and used multivariable regression to examine IBD flares after treatment according to treatment type. RESULTS Two hundred and forty men (0.5%) had IBD prior to prostate cancer diagnosis. Compared to non-IBD patients, IBD patients were more likely Caucasian (P < .001) with lower-risk cancer (P = .02). Surgery was more common in IBD patients (41% vs 28%, P < .001). In the year following prostate cancer treatment, 18% of IBD patients experienced flares. After adjustment, the only predictor of flare in the year after treatment was flare in the year prior to treatment (adjusted odds ratio, 12.5; 95% confidence interval, 5.4-29.2). CONCLUSION IBD patients were more likely to have lower-risk disease and be treated with surgery. Choice of prostate cancer treatment did not predict flares in the subsequent year. Better understanding of the intersection of IBD and prostate cancer can help inform treatment decisions for the increasing number of men managing both diseases.
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Affiliation(s)
- Peter S Kirk
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Shail Govani
- Department of Gastroenterology, Division of Internal Medicine, University of Michigan Health System, Ann Arbor, MI
| | - Tudor Borza
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Brent K Hollenbeck
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI
| | - Jennifer Davis
- VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Dean Shumway
- Department of Radiation Oncology, University of Michigan Health System, Ann Arbor, MI
| | - Akbar K Waljee
- Department of Gastroenterology, Division of Internal Medicine, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI
| | - Ted A Skolarus
- Dow Division of Health Services Research, Department of Urology, University of Michigan Health System, Ann Arbor, MI; VA Health Services Research and Development, Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI.
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17
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Gestaut MM, Swanson GP. Long term clinical toxicity of radiation therapy in prostate cancer patients with Inflammatory Bowel Disease. Rep Pract Oncol Radiother 2017; 22:77-82. [PMID: 27920612 PMCID: PMC5126147 DOI: 10.1016/j.rpor.2016.10.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2016] [Revised: 08/05/2016] [Accepted: 10/21/2016] [Indexed: 11/19/2022] Open
Abstract
AIM The study's aim was to examine the clinical impact of radiation therapy (RT) on GI toxicity in Inflammatory Bowel Disease (IBD) patients. BACKGROUND IBD has long been considered a risk factor for increased bowel toxicity from RT; however, minimal evidence exists on patients with prostate cancer (PC) and IBD. MATERIALS AND METHODS The tumor registry was queried for patients with IBD and PC from the years 1990-2013. A retrospective review was conducted for patients who received RT. Radiation treatment and toxicity data were collected. RESULTS Average length of follow-up was 12 years (median 9.54, range 0.42-19.9). The majority had well controlled baseline bowel function on medical management. Prior to radiation, 60% of patients (9/15) and 40% (6/15) reported grade 0 (G0) and grade (G1) diarrhea at baseline, respectively. No baseline proctitis existed. Following radiation treatment, 78% (14/18) of patients experienced G0 diarrhea while 22% (4/18) reported G1 diarrhea. No patients suffered from greater than G1 diarrhea. Sixty-six percent (12/18), 17% (3/18) and 17% (3/18) of patients experienced G0, G1, and G2 proctitis, respectively. No patients suffered post-radiation stricture formation, and all patients with G2 proctitis received 3dCRT. CONCLUSIONS Limited published data is available exploring RT for patients with PC and IBD. This analysis offers valuable insight into appropriate counseling for a rare patient subset. Radiation improved late G1 diarrhea rates. Grade 2 proctitis was only encountered in 3dCRT patients. No post-radiation complications occurred. Our findings suggest that IBD patients experience minimal toxicity in the era of IMRT based RT.
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Affiliation(s)
- Matthew M. Gestaut
- Department of Radiation Oncology, Scott and White Memorial Hospital, Texas A&M University School of Medicine, Temple, TX 76508, USA
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18
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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
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19
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Shaikh T, Wang L, Ruth K, Hallman M, Chen DY, Greenberg RE, Li J, Crawford K, Horwitz EM. The impact of trainee involvement on outcomes in low-dose-rate brachytherapy for prostate cancer. Brachytherapy 2016; 15:156-62. [PMID: 26832675 DOI: 10.1016/j.brachy.2015.12.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 12/09/2015] [Accepted: 12/29/2015] [Indexed: 11/19/2022]
Abstract
PURPOSE To determine the impact of fellow, resident, or medical student (MS) involvement on outcomes in patients undergoing permanent (125)I prostate seed implant. METHODS AND MATERIALS The study population consisted of men with clinically localized low/intermediate-risk prostate cancer treated with low-dose-rate permanent interstitial brachytherapy. Cases were stratified according to resident, fellow, MS, or attending involvement. Outcomes were compared using analysis of variance, logistic regression, and log rank tests. RESULTS A total of 291 patients were evaluated. Fellows, residents, and MS were involved in 47 (16.2%), 231 (79.4%), and 34 (11.7%) cases, respectively. Thirteen (4.4%) cases were completed by an attending physician alone. There was no difference in freedom from biochemical failure when comparing the resident, fellow, or attending alone groups (p = 0.10). There was no difference in V100 (volume of the prostate receiving 100% of the prescription dose) outcomes when comparing resident cases to fellow cases (p = 0.72) or attending alone cases (p = 0.78). There was no difference in D90 (minimum dose covering 90% of the postimplant volume) outcomes when comparing resident cases to fellow cases (p = 0.74) or attending alone cases (p = 0.58). When examining treatment toxicity, fellow cases had higher rates of acute Grade 2 + GU toxicity (p = 0.028). With the exception of higher urethra D90 among PGY 2-3 cases (p = 0.02), dosimetric outcomes were similar to cases with PGY 4-5 resident participation. There was no difference in outcomes for cases with and without MS participation. CONCLUSIONS Interstitial prostate seed implants can be safely performed by trainees with appropriate supervision. Hands-on brachytherapy training is effective and feasible for trainees.
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Affiliation(s)
- Talha Shaikh
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Lora Wang
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Karen Ruth
- Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, PA
| | - Mark Hallman
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - David Y Chen
- Department of Surgical Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | | | - Jinsheng Li
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Kevin Crawford
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA
| | - Eric M Horwitz
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA.
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