Early Proctoscopy is a Surrogate Endpoint of Late Rectal Toxicity in Prostate Cancer Treated With Radiotherapy

Ippolito, Edy; Massaccesi, Mariangela; Digesù, Cinzia; Deodato, Francesco; Macchia, G.; Pirozzi, Giuseppe; Cilla, Savino; Cuscunà, Daniele; Lallo, Alessandra Di; Mattiucci, Gian Carlo; Mantini, Giovanna; Pacelli, Fabio; Valentini, Vincenzo; Cellini, Numa; Ingrosso, M.; Morganti, Alessio Giuseppe

doi:10.1016/j.ijrobp.2011.12.046

Cited by 20 publications

(15 citation statements)

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“…In fact, many of the bleeds were acute and transient suggestive of acute anal irritation or hemorrhoid exacerbation due to bowel frequency [ 38 ]. Furthermore, the incidence of telangiectasia in patients who completed post-SBRT rectal endoscopy for the assessment of rectal bleeding or cancer screening was 11% which is significantly lower than the rates reported in prospective studies that looked at endoscopic outcomes after conventionally fractionated radiation therapy [ 17 , 46 , 47 ].…”

Section: Discussionmentioning

confidence: 76%

Proctitis following stereotactic body radiation therapy for prostate cancer

et al. 2014

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BackgroundProctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer.MethodsBetween February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT.ResultsThe median age was 69 years with a median prostate volume of 39 cc. The median follow-up was 3.9 years with a minimum follow-up of two years. The 2-year actuarial incidence of late rectal bleeding ≥ grade 2 was 1.5%. Endoscopy revealed VRS Grade 2 rectal telangiectasias in 11% of patients. All proctitis symptoms increased at one month post-SBRT but returned to near-baseline with longer follow-up. The most bothersome symptoms were bowel urgency and frequency. At one month post-SBRT, 11.2% and 8.5% of patients reported a moderate to big problem with bowel urgency and frequency, respectively. The EPIC bowel summary scores declined transiently at 1 month and experienced a second, more protracted decline between 6 months and 18 months before returning to near-baseline at two years post-SBRT. Prior to treatment, 4.1% of men felt their bowel function was a moderate to big problem which increased to 11.5% one month post-SBRT but returned to near-baseline at two years post-SBRT.ConclusionsIn this single institution cohort, the rate and severity of proctitis observed following SBRT is low. QOL decreased on follow-up; however, our results compare favorably to those reported for patients treated with alternative radiation modalities. Future prospective randomized studies are needed to confirm these observations.

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Section: Discussionmentioning

confidence: 76%

Proctitis following stereotactic body radiation therapy for prostate cancer

et al. 2014

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“…In fact, many of the bleeds were acute and transient suggestive of acute anal irritation or hemorrhoid exacerbation due to bowel frequency [38]. Furthermore, the incidence of telangiectasia in patients who completed post-SBRT rectal endoscopy for the assessment of rectal bleeding or cancer screening was 11% which is significantly lower than the rates reported in prospective studies that looked at endoscopic outcomes after conventionally fractionated radiation therapy [17,46,47]. These findings are particularly significant given that rectal bleeding is one of the principle dose-limiting toxicities, and is thus a potential barrier to administering radiation at appropriately therapeutic levels.…”

Section: Discussionmentioning

confidence: 99%

Proctitis Following Stereotactic Body Radiation Therapy for Prostate Cancer

Joh

Chen

Porter

et al. 2014

International Journal of Radiation Oncology*Biology*Physics

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Background: Proctitis after radiation therapy for prostate cancer remains an ongoing clinical challenge and critical quality of life issue. SBRT could minimize rectal toxicity by reducing the volume of rectum receiving high radiation doses and offers the potential radiobiologic benefits of hypofractionation. This study sought to evaluate the incidence and severity of proctitis following SBRT for prostate cancer. Methods: Between February 2008 and July 2011, 269 men with clinically localized prostate cancer were treated definitively with SBRT monotherapy at Georgetown University Hospital. All patients were treated to 35-36.25Gy in 5 fractions delivered with the CyberKnife Radiosurgical System (Accuray). Rectal bleeding was recorded and scored using the CTCAE v.4. Telangiectasias were graded using the Vienna Rectoscopy Score (VRS). Proctitis was assessed via the Bowel domain of the Expanded Prostate Index Composite (EPIC)-26 at baseline and at 1, 3, 6, 9, 12, 18 and 24 months post-SBRT.

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“…• cosmesis in breast cancer (FAST trial) 111 • proctoscopy at 1 year for rectal toxicity post radiotherapy for prostate cancer 112 The individual risk of non-malignant tissue toxicity to radiotherapy treatment can be assessed using markers such as serum TGF-β1 levels as a surrogate of fibrosis in breast cancer 113 and pneumonitis in lung cancer 114 . F-FDG-PET • Low post-treatment SUV associated with better overall survival in a meta-analysis (using trial-specified cut-off values) 154 • Decrease in SUV max of ≥50% from baseline to week 1 or 2 (10 or 20 Gy) of CRT was associated with higher 2-year OS 155 Examples of some clinical parameters are provided, as they might represent useful primary or secondary end points for certain patient subgroups or for important areas of clinical need (for example, likelihood of accelerated approval by regulatory agencies).…”

Section: Box 6 | Non-malignant Tissue Toxicitymentioning

confidence: 99%