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Chin S, Hayden AJ, Gebski V, Cross S, Turner SL. Long Term Patient Reported Urinary Function Following External Beam Radiotherapy for Prostate Cancer. Clin Oncol (R Coll Radiol) 2017; 29:421-428. [PMID: 28202212 DOI: 10.1016/j.clon.2017.01.043] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/21/2016] [Accepted: 01/21/2017] [Indexed: 02/07/2023]
Abstract
INTRODUCTION This study reports long-term patient reported urinary function and urinary-related quality of life (uQoL) after external beam radiotherapy (EBRT) for localized prostate cancer. METHODS 574 men underwent definitive prostate EBRT to 70-78 Gy±androgen deprivation therapy between 2000 and 2009. The median follow-up from EBRT was 44 months. Patients were evaluated at baseline (pre-EBRT) and at intervals post-treatment using the International Prostate Symptom Score (IPSS) instrument. RESULTS Patients with mild IPSS at baseline (total 0-7) reported median total scores of 3, 4 and 3 at baseline, 6 and 48 months respectively post-EBRT. For patients with moderate IPSS at baseline (total 8-19), median total IPSS was 12 at baseline and 9 at both 6 and 48 months. For the severe IPSS group at baseline (total 20-35), the median total IPSS was 24, 12 and 14 at baseline, 6 and 48 months post-EBRT. The cumulative risk of persistent IPSS increase (greater than 5 points above baseline) at 48 months was 16%, 10% and 6% for patients with mild, moderate and severe baseline IPSS respectively. 94%, 54% and 11% of patients with mild, moderate and severe baseline IPSS reported good uQoL at baseline respectively, with these proportions increasing to 95%, 83% and 69% at 48 months. CONCLUSION Urinary symptoms and uQoL as measured by the IPSS instrument remained stable or improved for the majority of men after definitive EBRT with or without ADT for prostate cancer. This was especially notable for the group of men with worse baseline symptoms or uQoL, with risk of persistent worsening of urinary symptoms decreasing with higher baseline IPSS category. Understanding the expected pattern of urinary symptoms and related uQoL in the months and years following EBRT taking into account baseline urinary function is highly valuable for counselling men as part of the therapeutic decision-making process.
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Affiliation(s)
- S Chin
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia.
| | - A J Hayden
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - V Gebski
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia; NHMRC Clinical Trials Centre, University of Sydney, NSW, Australia
| | - S Cross
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
| | - S L Turner
- Sydney West Radiation Oncology Network, Westmead/Nepean Hospitals, Sydney, NSW, Australia
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Sia J, Joon DL, Viotto A, Mantle C, Quong G, Rolfo A, Wada M, Anderson N, Rolfo M, Khoo V. Toxicity and Long-Term Outcomes of Dose-Escalated Intensity Modulated Radiation Therapy to 74Gy for Localised Prostate Cancer in a Single Australian Centre. Cancers (Basel) 2011; 3:3419-31. [PMID: 24212961 PMCID: PMC3759203 DOI: 10.3390/cancers3033419] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2011] [Revised: 08/24/2011] [Accepted: 08/25/2011] [Indexed: 12/22/2022] Open
Abstract
Purpose To report the toxicity and long-term outcomes of dose-escalated intensity-modulated radiation therapy (IMRT) for patients with localised prostate cancer. Methods and Materials From 2001 to 2005, a total of 125 patients with histologically confirmed T1-3N0M0 prostate cancer were treated with IMRT to 74Gy at the Austin Health Radiation Oncology Centre. The median follow-up was 5.5 years (range 0.5–8.9 years). Biochemical prostate specific antigen (bPSA) failure was defined according to the Phoenix consensus definition (absolute nadir + 2ng/mL). Toxicity was scored according to the RTOG/EORTC criteria. Kaplan-Meier analysis was used to calculate toxicity rates, as well as the risks of bPSA failure, distant metastases, disease-specific and overall survival, at 5 and 8-years post treatment. Results All patients completed radiotherapy without any treatment breaks. The 8-year risks of ≥ Grade 2 genitourinary (GU) and gastrointestinal (GI) toxicity were 6.4% and 5.8% respectively, and the 8-year risks of ≥ Grade 3 GU and GI toxicity were both < 0.05%. The 5 and 8-year freedom from bPSA failure were 76% and 58% respectively. Disease-specific survival at 5 and 8 years were 95% and 91%, respectively, and overall survival at 5 and 8 years were 90% and 71%, respectively. Conclusions These results confirm existing international data regarding the safety and efficacy of dose-escalated intensity-modulated radiation therapy for localised prostate cancer within an Australian setting.
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Affiliation(s)
- Joseph Sia
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Daryl Lim Joon
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Angela Viotto
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Carmel Mantle
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - George Quong
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Aldo Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Radiation Oncology Victoria, East Melbourne, Victoria 3002, Australia
| | - Morikatsu Wada
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Nigel Anderson
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Maureen Rolfo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
| | - Vincent Khoo
- Austin Health Radiation Oncology Centre, Heidelberg Repatriation Hospital, 300 Waterdale Road, Heidelberg West, Victoria 3081, Australia; E-Mails: (J.S.); (D.L.J.); (A.V.); (C.M.); (G.Q.); (A.R.); (M.W.); (N.A.); (M.R.)
- Department of Medicine, University of Melbourne, Melbourne Victoria 3053, Australia
- Royal Marsden Hospital & Institute of Cancer Research, London SW3 6JJ, UK
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +61-3-9496 2800; Fax: +61-3-9496 2826
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Coburn N, Beldham-Collins R, Westling J, Trovato J, Gebski V. Evaluation of flexible and rigid (class solution) radiation therapy conformal prostate planning protocols. Med Dosim 2011; 37:5-8. [PMID: 21459568 DOI: 10.1016/j.meddos.2010.12.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2010] [Accepted: 12/13/2010] [Indexed: 10/18/2022]
Abstract
Protocols commonly implemented in radiotherapy work areas may be classified as being either rigid (class solution) or flexible. Because formal evaluation of these protocol types has not occurred within the literature, we evaluated the efficiency of a rigid compared with flexible prostate planning protocol by assessing a series of completed 3D conformal prostate plans. Twenty prostate cancer patients with an average age of 70 years (range, 52-77) and sizes comprising 8 small, 10 medium, and 2 large were planned on the Phillips Pinnacle treatment planning system 6 times by radiation therapists with <2 years, 2-5 years, and >5 years of experience using a rigid and flexible protocol. Plans were critiqued using critical organ doses, confirmation numbers, and conformity index. Plans were then classified as being acceptable or not. Plans produced with the flexible protocol were 53% less likely to require modification (OR 0.47, 95% CI: 0.26, 0.84, p = 0.01). Planners with >5 years of experience were 78% more likely to produce plans requiring modification (OR 1.78, 95% CI: 1.12, 2.83, P = 0.02). Plans according to the flexible protocol took longer (112 min) compared with the time taken using a rigid protocol (68 min) (p < 0.001). The results suggest that further studies are needed; however, we propose that all radiation therapy planners should start with the same limitations, and if an acceptable plan is not reached, then flexibility should be given to improve the plan to meet the desired results.
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Affiliation(s)
- Natalie Coburn
- Radiation Oncology Network, Nepean Cancer Care Centre, University of Sydney, Sydney, New South Wales, Australia.
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Kertesz T, Herrmann MKA, Zapf A, Christiansen H, Hermann RM, Pradier O, Schmidberger H, Hess CF, Hille A. Effect of a prostaglandin--given rectally for prevention of radiation-induced acute proctitis--on late rectal toxicity. Results of a phase III randomized, placebo-controlled, double-blind study. Strahlenther Onkol 2009; 185:596-602. [PMID: 19756426 DOI: 10.1007/s00066-009-1978-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2008] [Accepted: 05/11/2009] [Indexed: 11/28/2022]
Abstract
BACKGROUND AND PURPOSE To assess the late effect of a prostaglandin, given rectally during irradiation, on late rectal toxicity. In the acute treatment setting no significant differences in reducing the incidence of acute proctitis symptoms in patients receiving misoprostol, however, significantly more rectal bleeding had been reported. PATIENTS AND METHODS A total of 100 patients who had undergone radiotherapy for prostate cancer had been entered into this phase III randomized, placebo-controlled, double-blind study with misoprostol or placebo suppositories. The toxicity was evaluated yearly after cessation of irradiation by the RTOG/LENT-SOMA scale. RESULTS The median follow-up was 50 months. 20 patients suffered from grade 1, four patients from grade 2 as well, and three patients only from grade 2 toxicity. Frequency, bleeding and urgency were the most commonly reported symptoms. In keeping with other studies and clinical experience, the symptoms peaked within the first 2 years with a median for grade 1 of 13 months and for grade 2 of 15 months. The presence of acute toxicity grade 2 showed a correlation with the development of any late toxicity (p = 0.03). Any acute rectal bleeding was significant correlated with any late rectal bleeding (p = 0.017). CONCLUSION Misoprostol given as once-daily suppository for prevention of acute radiation-induced proctitis does neither influence the incidence and severity of radiation-induced acute nor late rectal toxicity. Misoprostol has no negative impact on the incidence and severity of late rectal bleeding, in contrast to acute rectal bleeding. The routine clinical use of misoprostol suppositories cannot be recommended.
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Affiliation(s)
- Tereza Kertesz
- Department of Radiotherapy and Radiooncology, University of Göttingen, Robert-Koch-Strasse 40, Göttingen, Germany
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