#PAGE_PARAMS# #ADS_HEAD_SCRIPTS# #MICRODATA#

Late urinary toxicity after 3D-CRT and IMRT for prostate cancer


Authors: Karel Odrážka 1,2,3;  Martin Doležel 1,3;  Jaroslav Vaňásek 1;  Miloslava Vaculíková 4;  Milan Zouhar 5;  Jana Šefrová 5;  Petr Paluska 5;  Milan Vošmik 5;  Tereza Kohlová 6;  Iveta Kolářová 1;  Miloš Broďák 7 ;  Pavel Navrátil 7;  Petr Prošvic 8;  Petr Hoffmann 9 ;  Abdulbaset Hafuda 8
Authors place of work: Oddělení klinické a radiační onkologie Multiscan s. r. o., Pardubická krajská nemocnice a. s., Pardubice 1;  1. a 3. lékařská fakulta UK, Praha 2;  Katedra radiační onkologie IPVZ, Praha 3;  Oddělení klinické onkologie, Oblastní nemocnice Náchod 4;  Klinika onkologie a radioterapie FN Hradec Králové 5;  Oddělení nukleární medicíny FN, Hradec Králové 6;  Urologická klinika FN, Hradec Králové 7;  Urologické oddělení, Oblastní nemocnice Náchod 8;  Radiologická klinika FN, Hradec Králové 9
Published in the journal: Ces Urol 2010; 14(3): 156-163
Category: Original article

Summary

Aim:
The purpose of this research was to retrospectively compare late urinary toxicity of the three-dimensional conformal radiation therapy (3D-CRT) 74 Gy and intensity-modulated radiation therapy (IMRT) 78 Gy for localized prostate cancer.

Material a method:
A total of 203 patients with T1-3 prostate cancer were treated with 3D-CRT (n = 91) and IMRT (n = 112). The median follow-up time was 5.2 years and 3.0 years, respectively. The prescription dose was 74 Gy for 3D-CRT and 78 Gy for IMRT. Late urinary toxicity was graded according to the Fox Chase modification of the Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria.

Results:
There was no difference between 3D-CRT and IMRT regarding the three-year risk for the development of late urinary toxicity Grade ≥ 2 (14% vs. 11%, p = 0.18). On multivariate analysis, two signifiant toxicity predictors were identified – previous transurethral resection of prostate/open transvesical prostatectomy for benign prostatic hyperplasia TURP/TVPE (relative risk 3.85) and acute urinary toxicity Grade 2 or higher (relative risk 2.35). In the total patient population, there were 22 patients with late urinary toxicity Grade 3. At last follow-up visit, 9 of them (41%) reported no or only minimal symptoms.

Conclusion:
Tolerance of 3D-CRT and IMRT was similar despite the use of high radiation dose 78 Gy with IMRT. Previous TURP/TVPE increased the risk of urinary toxicity.

Key words:
prostate cancer, radiation therapy, urinary toxicity, 3D-CRT, IMRT.


Zdroje

1. Smit WGJM, Helle PA, van Putten WLJ, et al. Late radiation damage in prostate cancer patients treated by high dose external radiotherapy in relation to rectal dose. Int J Radiat Oncol Biol Phys 1990; 18: 23–29.

2. Hanks GE. Conformal radiotherapy for prostate cancer. Ann Med 2000; 32: 57–63.

3. Zelefsky MJ, Yamada Y, Kollmeier MA, Shippy AM, Nedelka MA. Long-term outcome following three-dimensional conformal/intensity-modulated external-beam radiotherapy for clinical stage T3 prostate cancer. Eur Urol 2008; 53: 1172–1179.

4. Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70: 67–74.

5. Al-Mamgani A, van Putten WLJ, Heemsbergen WD, et al. Update of Dutch multicenter dose-escalation trial of radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 72: 980–988.

6. Zelefsky MJ, Chan H, Hunt M, et al. Long-term outcome of high dose intensity modulated radiation therapy for patients with clinically localized prostate cancer. J Urol 2006; 176: 1415–1419.

7. Vora SA, Wong WW, Schild SE, Ezzell GA, Halyard MY. Analysis of biochemical control and prognostic factors in patients treated with either low-dose three-dimensional conformal radiation therapy or high-dose intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2007; 68: 1053–1058.

8. Zelefsky MJ, Levin EJ, Hunt M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2008; 70: 1124–1129.

9. Lips I, Dehnad H, Kruger AB, et al. Health-related quality of life in patients with locally advanced prostate cancer after 76 Gy intensity-modulated radiotherapy vs. 70 Gy conformal radiotherapy in a prospective and longitudinal study. Int J Radiat Oncol Biol Phys 2007; 69: 656–661.

10. Zelefsky MJ, Fuks Z, Hunt M, et al. High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001; 166: 876–881.

11. Pollack A, Zagars GK, Starkschall G, et al. Prostate cancer radiation dose response: results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002; 53: 1097–1105.

12. Odrazka K, Vanasek J, Vaculikova M, et al. Conformal radiotherapy for prostate cancer – longer duration of acute genitourinary toxicity in patients with prior history of invasive urological procedure. Acta Oncol 2001; 40: 810–815.

13. D’Amico AV, Whittington R, Malkowicz SB, et al. Pretreatment nomogram for prostatespecific antigen recurrence after radical prostatectomy or external-beam radiation therapy for clinically localized prostate cancer. J Clin Oncol 1999; 17: 168–172.

14. Hanlon AL, Schultheiss TE, Hunt MA, et al. Chronic rectal bleeding after high-dose conformal treatment of prostate cancer warrants modification of existing morbidity scales. Int J Radiat Oncol Biol Phys 1997; 38: 59–63.

15. Storey MR, Pollack A, Zagars G, et al. Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 2000; 48: 635–642.

16. Peeters ST, Heemsbergen WD, van Putten WL, et al. Acute and late complications after radiotherapy for prostate cancer: results of a multicenter randomized trial comparing 68 Gy to 78 Gy. Int J Radiat Oncol Biol Phys 2005; 61: 1019–1034.

17. De Meerleer GO, Fonteyne VH, Vakaet L, et al. Intensity-modulated radiation therapy for prostate cancer: late morbidity and results on biochemical control. Radiother Oncol 2007; 82: 160–166.

18. Eade TN, Horwitz EM, Ruth K, et al. A comparison of acute and chronic toxicity for men with low-risk prostate cancer treated with intensity-modulated radiation therapy or (125.I permanent implant. Int J Radiat Oncol Biol Phys 2008; 71: 338–345.

19. Lawton CA, Won M, Pilepich MV, et al. Long-term treatment sequelae following external beam irradiation for adenocarcinoma of the prostate: analysis of RTOG studies 7506 and 7706. Int J Radiat Oncol Biol Phys 1991; 21: 935–939.

20. Gardner BG, Zietman AL, Shipley WU, Skowronski UE, McManus P. Late normal tissue sequelae in the second decade after high dose radiation therapy with combined photons and conformal protons for locally advanced prostate cancer. J Urol 2002; 167: 123–126.

21. Rassweiler J, Teber D, Kuntz R, Hofmann R. Complications of transurethral resection of the prostate (TURP. – incidence, management, and prevention. Eur Urol 2006; 50: 969–979.

22. Berge V, Thompson T, Blackamn D. Additional surgical intervention after radical prostatectomy, radiation therapy, androgen-deprivation therapy, or watchful waiting. Eur Urol 2007; 52: 1036–1043.

23. Stephans KL, Xia P, Tendulkar RD, Ciezki JP. The current status of image-guided external beam radiotherapy for prostate cancer. Curr Opin Urol 2010 (Epub ahead of print).

Štítky
Paediatric urologist Nephrology Urology
Prihlásenie
Zabudnuté heslo

Zadajte e-mailovú adresu, s ktorou ste vytvárali účet. Budú Vám na ňu zasielané informácie k nastaveniu nového hesla.

Prihlásenie

Nemáte účet?  Registrujte sa

#ADS_BOTTOM_SCRIPTS#