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Poźniak-Balicka R, Chomiak B, Wośkowiak P, Nowicki N, Bojarski J, Salagierski M. Does the radiation approach affect acute toxicity in prostate cancer patients? A comparison of four radiation techniques. Cent European J Urol 2020; 73:295-299. [PMID: 33133656 PMCID: PMC7587475 DOI: 10.5173/ceju.2020.0091] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 08/02/2020] [Accepted: 08/09/2020] [Indexed: 01/21/2023] Open
Abstract
Introduction Prostate cancer is treated with increasingly sophisticated radiation techniques. The aim of the study is to compare acute toxicity in patients managed with different therapeutic modalities. Material and methods A total of 60 patients irradiated between 2012 and 2016 were analyzed: A. conformal 3D - 11, B. intensity-modulated radiation therapy (IMRT) 20, C. image-guided radiation therapy (IGRT) - 19 and D. volumetric modulated arc therapy (VMAT) - 10. Patients' age ranged from 46 to 85 years (median 70.5), prostate-specific antigen values at the time of diagnosis were in the range of 3.54-154 ng/ml (median 15.9). Acute toxicity from the genitourinary (GU) and gastrointestinal (GI) tracts according to the European Organization for Research and Treatment of Cancer (EORTC) /Radiation Therapy Oncology Group (RTOG) grading system were assessed. Results All irradiation techniques were well tolerated and neither 3 nor 4 degrees acute toxicity was observed. Importantly, IGRT and IMRT did not lead to Grade 2 GI acute toxicity. There was no relationship between the severity of GU acute toxicity depending on the irradiation technique used (p = 0.8), but a trend towards a significant relationship was noted for GI acute toxicity (p = 0.05). Conclusions All assessed irradiation methods do not lead to severe acute adverse effects. Importantly, patients treated with IGRT and IMRT had only minor GI toxicity.
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Affiliation(s)
- Róża Poźniak-Balicka
- Faculty of Medicine and Health Sciences, Department of Radiotherapy, Zielona Góra, Poland
| | - Beata Chomiak
- Faculty of Medicine and Health Sciences, Department of Radiotherapy, Zielona Góra, Poland
| | - Piotr Wośkowiak
- Faculty of Medicine and Health Sciences, Department of Urology, Zielona Góra, Poland
| | - Norbert Nowicki
- Faculty of Medicine and Health Sciences, Department of Radiotherapy, Zielona Góra, Poland
| | - Jacek Bojarski
- University of Zielona Góra, Faculty of Mathematics, Zielona Góra, Poland
| | - Maciej Salagierski
- Faculty of Medicine and Health Sciences, Department of Urology, Zielona Góra, Poland
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Jellison FC. Evaluation and Treatment of Overactive Bladder after History of Cancer Treatment. CURRENT BLADDER DYSFUNCTION REPORTS 2015. [DOI: 10.1007/s11884-014-0279-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Arcangeli S, Strigari L, Soete G, De Meerleer G, Gomellini S, Fonteyne V, Storme G, Arcangeli G. Clinical and Dosimetric Predictors of Acute Toxicity After a 4-Week Hypofractionated External Beam Radiotherapy Regimen for Prostate Cancer: Results From a Multicentric Prospective Trial. Int J Radiat Oncol Biol Phys 2009; 73:39-45. [DOI: 10.1016/j.ijrobp.2008.04.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2008] [Revised: 04/01/2008] [Accepted: 04/07/2008] [Indexed: 11/17/2022]
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4
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Streszczenie. Rep Pract Oncol Radiother 2007. [DOI: 10.1016/s1507-1367(07)70955-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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5
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Pollack A, Hanlon AL, Horwitz EM, Feigenberg SJ, Konski AA, Movsas B, Greenberg RE, Uzzo RG, Ma CMC, McNeeley SW, Buyyounouski MK, Price RA. Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial. Int J Radiat Oncol Biol Phys 2006; 64:518-26. [PMID: 16242256 PMCID: PMC1892754 DOI: 10.1016/j.ijrobp.2005.07.970] [Citation(s) in RCA: 194] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2005] [Revised: 07/25/2005] [Accepted: 07/26/2005] [Indexed: 11/30/2022]
Abstract
PURPOSE The alpha/beta ratio for prostate cancer is postulated to be between 1 and 3, giving rise to the hypothesis that there may be a therapeutic advantage to hypofractionation. The dosimetry and acute toxicity are described in the first 100 men enrolled in a randomized trial. PATIENTS AND METHODS The trial compares 76 Gy in 38 fractions (Arm I) to 70.2 Gy in 26 fractions (Arm II) using intensity modulated radiotherapy. The planning target volume (PTV) margins in Arms I and II were 5 mm and 3 mm posteriorly and 8 mm and 7 mm in all other dimensions. The PTV D95% was at least the prescription dose. RESULTS The mean PTV doses for Arms I and II were 81.1 and 73.8 Gy. There were no differences in overall maximum acute gastrointestinal (GI) or genitourinary (GU) toxicity acutely. However, there was a slight but significant increase in Arm II GI toxicity during Weeks 2, 3, and 4. In multivariate analyses, only the combined rectal DVH parameter of V65 Gy/V50 Gy was significant for GI toxicity and the bladder volume for GU toxicity. CONCLUSION Hypofractionation at 2.7 Gy per fraction to 70.2 Gy was well tolerated acutely using the planning conditions described.
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Affiliation(s)
- Alan Pollack
- Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, PA 19111, USA.
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van Tol-Geerdink JJ, Stalmeier PFM, Pasker-de Jong PCM, Huizenga H, van Lin ENJT, Schimmel EC, Leer JW, van Daal WAJ. Systematic review of the effect of radiation dose on tumor control and morbidity in the treatment of prostate cancer by 3D-CRT. Int J Radiat Oncol Biol Phys 2005; 64:534-43. [PMID: 16246497 DOI: 10.1016/j.ijrobp.2005.07.974] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2004] [Revised: 06/10/2005] [Accepted: 07/01/2005] [Indexed: 11/19/2022]
Abstract
PURPOSE A higher radiation dose is believed to result in a larger probability of tumor control and a higher risk of side effects. To make an evidence-based choice of dose, the relation between dose and outcome needs to be known. This study focuses on the dose-response relation for prostate cancer. METHODS AND MATERIALS A systematic review was carried out on the literature from 1990 to 2003. From the selected studies, the radiation dose, the associated 5-year survival, 5-year bNED (biochemical no evidence of disease), acute and late gastrointestinal (GI) and genitourinary (GU) morbidity Grade 2 or more, and sexual dysfunction were extracted. With logistic regression models, the relation between dose and outcome was described. RESULTS Thirty-eight studies met our criteria, describing 87 subgroups and involving up to 3000 patients per outcome measure. Between the (equivalent) dose of 70 and 80 Gy, various models estimated an increase in 5-year survival (ranging from 10% to 11%), 5-year bNED for low-risk patients (5-7%), late GI complications (12-16%), late GU complications (8-10%), and erectile dysfunction (19-24%). Only for the overall 5-year bNED, results were inconclusive (range, 0-18%). CONCLUSIONS The data suggest a relationship between dose and outcome measures, including survival. However, the strength of these conclusions is limited by the sometimes small number of studies, the incompleteness of the data, and above all, the correlational nature of the data. Unambiguous proof for the dose-response relationships can, therefore, only be obtained by conducting randomized trials.
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Affiliation(s)
- Julia J van Tol-Geerdink
- Department of Radiation Oncology, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
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Peeters STH, Hoogeman MS, Heemsbergen WD, Slot A, Tabak H, Koper PCM, Lebesque JV. Volume and hormonal effects for acute side effects of rectum and bladder during conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2005; 63:1142-52. [PMID: 15939547 DOI: 10.1016/j.ijrobp.2005.03.060] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2005] [Revised: 03/24/2005] [Accepted: 03/24/2005] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify dosimetric variables predictive of acute gastrointestinal (GI) and genitourinary (GU) toxicity and to determine whether hormonal therapy (HT) is independently associated with acute GI and GU toxicity in prostate cancer patients treated with conformal radiotherapy (RT). METHODS AND MATERIALS This analysis was performed on 336 patients participating in a multicenter (four hospitals) randomized trial comparing 68 Gy and 78 Gy. The clinical target volume consisted of the prostate with or without the seminal vesicles, depending on the risk of seminal vesicle involvement. The margin from the clinical target volume to the planning target volume was 1 cm. For these patients, the treatment plan for a total dose of 68 Gy was used, because nearly all toxicity appeared before the onset of the 10-Gy boost. Acute toxicity (<120 days) was scored according to the Radiation Therapy Oncology Group criteria. The dosimetric parameters were obtained from the relative and absolute dose-volume/surface histograms derived from the rectal wall (rectal wall volume receiving > or =5-65 Gy) and the bladder surface (bladder surface receiving > or =5-65 Gy). Additionally, relative and absolute dose-length histograms of the rectum were created, and the lengths of rectum receiving more than a certain dose over the whole circumference (rectal length receiving > or =5-65 Gy) were computed. The clinical variables taken into account for GI toxicity were neoadjuvant HT, hospital, and dose-volume group; for GU toxicity, the variables pretreatment GU symptoms, neoadjuvant HT, and transurethral resection of the prostate were analyzed. The variable neoadjuvant HT was divided into three categories: no HT, short-term neoadjuvant HT (started < or =3 months before RT), and long-term neoadjuvant HT (started >3 months before RT). RESULTS Acute GI toxicity Grade 2 or worse was seen in 46% of the patients. Patients with long-term neoadjuvant HT experienced less Grade 2 or worse toxicity (27%) compared with those receiving short-term neoadjuvant HT (50%) and no HT (50%). The volumes of the prostate and seminal vesicles were significantly smaller in both groups receiving neoadjuvant HT compared with those receiving no HT. In multivariate logistic regression analysis, including the two statistically significant clinical variables neoadjuvant HT and hospital, a volume effect was found for the relative, as well as absolute, rectal wall volumes exposed to intermediate and high doses. Of all the length parameters, the relative rectal length irradiated to doses of > or =5 Gy and > or =30 Gy and absolute lengths receiving > or =5-15 and 30 Gy were significant. Acute GU toxicity Grade 2 or worse was reported in 56% of cases. For patients with pretreatment GU symptoms, the rate was 93%. The use of short-term and long-term neoadjuvant HT resulted in more GU toxicity (73% and 71%) compared with no HT (50%). In multivariate analysis, containing the variables pretreatment symptoms and neoadjuvant HT, only the absolute dose-surface histogram parameters (absolute surface irradiated to > or =40, 45, and 65 Gy) were significantly associated with acute GU toxicity. CONCLUSION A volume effect was found for acute GI toxicity for relative, as well as absolute, volumes. With regard to acute GU toxicity, an area effect was found, but only for absolute dose-surface histogram parameters. Neoadjuvant HT appeared to be an independent prognostic factor for acute toxicity, resulting in less acute GI toxicity, but more acute GU toxicity. The presence of pretreatment GU symptoms was the most important prognostic factor for GU symptoms during RT.
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Affiliation(s)
- Stephanie T H Peeters
- Department of Radiation Oncology, The Netherlands Cancer Institute-Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Morris DE, Emami B, Mauch PM, Konski AA, Tao ML, Ng AK, Klein EA, Mohideen N, Hurwitz MD, Fraas BA, Roach M, Gore EM, Tepper JE. Evidence-based review of three-dimensional conformal radiotherapy for localized prostate cancer: An ASTRO outcomes initiative. Int J Radiat Oncol Biol Phys 2005; 62:3-19. [PMID: 15850897 DOI: 10.1016/j.ijrobp.2004.07.666] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2004] [Revised: 06/21/2004] [Accepted: 07/02/2004] [Indexed: 12/11/2022]
Abstract
PURPOSE To perform a systematic review of the evidence to determine the efficacy and effectiveness of three-dimensional conformal radiotherapy (3D-CRT) for localized prostate cancer; provide a clear presentation of the key clinical outcome questions related to the use of 3D-CRT in the treatment of localized prostate cancer that may be answered by a formal literature review; and provide concise information on whether 3D-CRT improves the clinical outcomes in the treatment of localized prostate cancer compared with conventional RT. METHODS AND MATERIALS We performed a systematic review of the literature through a structured process developed by the American Society for Therapeutic Radiology and Oncology's Outcomes Committee that involved the creation of a multidisciplinary task force, development of clinical outcome questions, a formal literature review and data abstraction, data review, and outside peer review. RESULTS Seven key clinical questions were identified. The results and task force conclusions of the literature review for each question are reported. CONCLUSION The technological goals of reducing morbidity with 3D-CRT have been achieved. Randomized trials and follow-up of completed trials remain necessary to address these clinical outcomes specifically with regard to patient subsets and the use of hormonal therapy.
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Affiliation(s)
- David E Morris
- Department of Radiation Oncology, University of North Carolina, Chapel Hill, NC 27514, USA.
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Beckendorf V, Guérif S, Le Prisé E, Cosset JM, Lefloch O, Chauvet B, Salem N, Chapet O, Bourdin S, Bachaud JM, Maingon P, Lagrange JLE, Malissard L, Simon JM, Pommier P, Hay MH, Dubray B, Luporsi E, Bey P. The GETUG 70 Gy vs. 80 Gy randomized trial for localized prostate cancer: feasibility and acute toxicity. Int J Radiat Oncol Biol Phys 2004; 60:1056-65. [PMID: 15519775 DOI: 10.1016/j.ijrobp.2004.05.033] [Citation(s) in RCA: 96] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2004] [Revised: 01/09/2004] [Accepted: 05/10/2004] [Indexed: 01/02/2023]
Abstract
PURPOSE To describe treatments and acute tolerance in a randomized trial comparing 70 Gy and 80 Gy to the prostate in patients with localized prostate cancer. METHODS AND MATERIALS Between September 1999 and February 2002, 306 patients were randomized to receive 70 Gy (153 patients) or 80 Gy (153 patients) in 17 institutions. Patients exhibited intermediate-prognosis tumors. If the risk of node involvement was greater than 10%, surgical staging was required. Previous prostatectomy was excluded, and androgen deprivation was not admitted. The treatment was delivered in two steps. PTV1-including seminal vesicles, prostate, and a 1-0.5-cm margin-received 46 Gy given with a 4-field conformal technique. PTV2, reduced to prostate with the same margins, irradiated with at least 5 fields. Dose was prescribed according to ICRU recommendations in the 70 Gy group, but adapted at the 80 Gy level. RESULTS All patients but one in the 80 Gy arm completed the treatment. In the 70 Gy arm, the mean dose to the PTV2 was 69.5 Gy. In the 80 Gy arm, the mean dose in the PTV2 was 78.5 Gy. Acute toxicity according to Radiation Therapy Oncology Group scale during treatment was reported in 306 patients. There was no statistically significant difference between the two arms: 12% had no toxicity, 80% complained of bladder toxicity, and 70% complained of rectal symptoms. Two months after the end of treatment, 43% of the 70 Gy level and 48% of the 80 Gy level complained of side effects, including 24% and 20% of sexual disorders. There was 6% and 2% of Grade 3 urinary and rectal toxicity. Five patients required a 10-29-day suspension of the treatment. Acute Grade 2 and 3 side effects were related to PTV and CTV1 size, which was the only independent predictive factor in multivariate analysis. Toxicity was not related to the center, age, arm of treatment, or selected data from dose-volume histogram of organ at risk. CONCLUSION Treatments were completed in respect to constraints. Acute toxicity was acceptable. Intensity of toxicity depended on target volumes.
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Karlsdóttir A, Johannessen DC, Muren LP, Wentzel-Larsen T, Dahl O. Acute morbidity related to treatment volume during 3D-conformal radiation therapy for prostate cancer. Radiother Oncol 2004; 71:43-53. [PMID: 15066295 DOI: 10.1016/j.radonc.2004.01.014] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2003] [Revised: 12/18/2003] [Accepted: 01/13/2004] [Indexed: 01/27/2023]
Abstract
PURPOSE To investigate the relation between acute toxicity and irradiated volume in the organs at risk during three-dimensional conformal radiation therapy for prostate cancer. METHODS AND MATERIALS From January to December 2001, we treated 132 prostate cancer patients to a prescribed target dose of 70 Gy. Twenty-six patients (20%) received irradiation to the prostate only (Group P), 86 patients (65%) had field arrangements encompassing the prostate and seminal vesicles (Group PSV) while 20 (15%) received modified pelvic fields (Group MPF). A four-field conformal box technique was used. Acute toxicity according to the RTOG scoring system was prospectively recorded throughout the course of treatment. RESULTS Overall, radiation was well tolerated with 11%, 16% and 35% Grade 2 gastro-intestinal (GI) toxicity and 19%, 34% and 35% Grade 2 or higher genito-urinary (GU) toxicity in Groups P, PSV and MPF, respectively. In univariate and multivariate analyses treatment group was a significant predictor for Grade 2 or higher acute morbidity. In multivariate logistic regression, the rectum dose-volume histogram parameters were correlated to the incidence of acute Grade 2 GI toxicity, with the fractional volumes receiving more than 37-40 Gy and above 70 Gy showing the statistically strongest correlation. The fractional bladder volume receiving more than 14-27 Gy showed the statistically strongest correlation with acute GU toxicity. CONCLUSIONS 3D-CRT radiation therapy to 70 Gy for prostate cancer was well tolerated. Only two of the 132 patients in the cohort experienced acute bladder toxicity Grade 3, none had Grade 3 rectal toxicity. Uni- and multivariate analyses indicated that the volume treated was a significant factor for the incidence of Grade 2 or higher acute morbidity.
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Affiliation(s)
- Asa Karlsdóttir
- Section of Oncology, Institute of Medicine, Haukeland University Hospital, University of Bergen, N-5021 Bergen, Norway
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DiBiase SJ, Jacobs SC. Does Radiation Therapy Really Work for Prostate Cancer? Prostate Cancer 2003. [DOI: 10.1016/b978-012286981-5/50042-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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12
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Kang SK, Chou RH, Dodge RK, Clough RW, Kang HSL, Hahn CA, Whitehurst AW, Buckley NJ, Kim JH, Joyner RE, Montana GS, Ingram SS, Anscher MS. Gastrointestinal toxicity of transperineal interstitial prostate brachytherapy. Int J Radiat Oncol Biol Phys 2002; 53:99-103. [PMID: 12007947 DOI: 10.1016/s0360-3016(01)02811-5] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/16/2022]
Abstract
PURPOSE To characterize the severity and time course of rectal toxicity following transperineal prostate brachytherapy using prospectively recorded data, and to determine factors associated with toxicity. METHODS AND MATERIALS One hundred thirty-four patients with prostate cancer treated with transperineal brachytherapy from 1997 to 1999 had rectal toxicity data available for analysis. Patients with Gleason score (GS) > 6, prostate-specific antigen (PSA) > 6, or stage > T2a were treated initially with external beam radiation therapy followed by brachytherapy boost; patients with none of these features were treated with brachytherapy alone. Both iodine-125 and palladium-103 sources were used, and loaded according to a modified Quimby distribution. At each follow-up, toxicity was recorded according to a modified RTOG gastrointestinal scale. RESULTS Thirty-nine percent of patients experienced gastrointestinal toxicity, mostly Grade 1. Median duration of symptoms was 6 months. Two patients experienced Grade 3 toxicity, both of whom had minimal symptoms until their 12-month follow-up. There was no Grade 4 or 5 toxicity. The addition of external beam radiation therapy (p = 0.003), higher clinical stage (p = 0.006), and Caucasian race (p = 0.01) were associated with increased incidence of toxicity. CONCLUSION Most patients with rectal toxicity have very mild symptoms. There is a small risk of severe late toxicity. External beam radiation, higher stage, and race are associated with toxicity.
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Affiliation(s)
- Song K Kang
- Department of Radiation Oncology, Duke University Medical Center, Box 3085, Durham, NC 27710, USA.
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Kang SK, Chou RH, Dodge RK, Clough RW, Kang HL, Bowen MG, Steffey BA, Das SK, Zhou SM, Whitehurst AW, Buckley NJ, Kim JH, Joyner RE, Sarmina I, Montana GS, Ingram SS, Anscher MS. Acute urinary toxicity following transperineal prostate brachytherapy using a modified Quimby loading method. Int J Radiat Oncol Biol Phys 2001; 50:937-45. [PMID: 11429221 DOI: 10.1016/s0360-3016(01)01530-9] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PURPOSE To examine the acute urinary toxicity following transperineal prostate implant using a modified Quimby loading method with regard to time course, severity, and factors that may be associated with a higher incidence of morbidity. METHODS AND MATERIALS One hundred thirty-nine patients with prostate adenocarcinoma treated with brachytherapy from 1997 through 1999 had follow-up records available for review. Patients considered for definitive brachytherapy alone included those with prostate specific antigen (PSA) < or = 6, Gleason score (GS) < or = 6, clinical stage < T2b, and prostate volumes generally less than 40 cc. Patients with larger prostate volumes were given neoadjuvant antiandrogen therapy. Those with GS > 6, PSA > 6, or Stage > T2a were treated with external beam radiation therapy followed by brachytherapy boost. Sources were loaded according to a modified Quimby method. At each follow-up, toxicity was graded based on a modified RTOG urinary toxicity scale. RESULTS Acute urinary toxicity occurred in 88%. Grade I toxicity was reported in 23%, grade II in 45%, and grade III in 20%, with 14% requiring prolonged (greater than 1 week) intermittent or indwelling catheterization. Overall median duration of symptoms was 12 months. There was no difference in duration of symptoms between patients treated with I-125 or Pd-103 sources (p = 0.71). After adjusting for GS and PSA, multivariate logistic regression analysis showed higher incidence of grade 3 toxicity in patients with larger prostate volumes (p = 0.002), and those with more seeds implanted (p < 0.001). Higher incidence of prolonged catheterization was found in patients receiving brachytherapy alone (p = 0.01), with larger prostate volumes (p = 0.01), and those with more seeds implanted (p < 0.001). CONCLUSION Interstitial brachytherapy for prostate cancer leads to a high incidence of acute urinary toxicity, most of which is mild to moderate in severity. A prolonged need for catheterization can occur in some patients. Patients receiving brachytherapy alone, those with prostate volumes greater than 30 cc, and those implanted with a greater number of seeds have the highest incidence of significant toxicity.
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Affiliation(s)
- S K Kang
- Department of Radiation Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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