Long term clinical toxicity of radiation therapy in prostate cancer patients with Inflammatory Bowel Disease

Gestaut, M.M.; Swanson, Gregory P.

doi:10.1016/j.rpor.2016.10.005

Cited by 19 publications

(18 citation statements)

References 25 publications

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“…In addition, in patients undergoing CMT, inferior outcomes were noted in those with hydronephrosis [19]. There have been mixed reports of patients with inflammatory bowel disease (IBD) being at increased risk of GI toxicities with radiation therapy, but a report by Gestaut et al reviewed patients over a 23 year period in patients with IBD and prostate cancer who underwent radiation therapy and found minimal GI toxicity in the IMRT era [20]. Therefore, just as surgery requires preoperative evaluation, review of patient candidacy for CMT is warranted as well.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of patients undergoing radiation therapy for bladder cancer

Hasan

Galvan

Shaver

et al. 2018

Bladder

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OBJECTIVES: To review our two institutional experiences regarding the historical referral patterns of bladder cancer patients to receive radiation therapy, characteristics of these referred patients, and their treatment outcomes. METHODS: A retrospective review was performed analyzing patients who underwent radiation therapy for bladder cancer from 2005 to 2015 (n = 69) at two regional referral institutions. The age-adjusted Charlson comorbidity index (AACCI) was calculated for each patient. Patients were divided into three groups: definitive concurrent chemoradiation (CCR), aggressive radiation (AR) alone ≥ 50 Gy, or palliative radiation alone (PR) < 50 Gy. Gastrointestinal (GI) and genitourinary (GU) acute toxicities were recorded. RESULTS: The median overall AACCI score was 7, which correlates to a two-year expected survival of 55% ± 11%. Thirty-five (50.7%) patients received CCR, 19 (27.5%) received AR, and 15 (21.7%) received PR. Patients presented with hematuria (n = 43, 62%), pain (n = 18, 26%), or obstruction (n = 12, 17%). Of symptomatic patients, treatment improved hematuria in 86%, pain in 75%, and obstruction in 42%. Twenty-two recurrences (32%) were identified at follow-up. Local, regional, and distant recurrences developed in 20%, 14%, and 17% of patients who received CCR. There were two grade 3 GU toxicities and one grade 3 GI toxicity; all grade 3 toxicities were in patients receiving CCR. CONCLUSIONS: Bladder preservation is possible with chemoradiation therapy; however, urologists rarely refer patients for consideration of chemoradiation. The limited patients who are referred for radiation generally have limited life expectancy, significant comorbidities, or have advanced disease amenable only to palliation. Palliative radiation improves symptoms with minimal toxicity.

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Section: Discussionmentioning

confidence: 99%

Outcomes of patients undergoing radiation therapy for bladder cancer

Hasan

Galvan

Shaver

et al. 2018

Bladder

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“…Notably, the patient presented in this case was not on pharmacologic therapy and, as such, had a favorable prognosis with regards to toxicity stemming from RT. Similarly, Gestaut et al reported no incidences of > Grade 1 diarrhea or proctitis following IMRT without any post-radiation strictures at an average follow-up of 12 years [ 3 ].…”

Section: Discussionmentioning

confidence: 99%

“…This is especially relevant for PCa patients with inflammatory bowel disease (IBD), as IBD is considered to be a relative contraindication of RT because of the possible increased risk of GI toxicity and subsequent disease exacerbation [ 2 ]. With the advent of intensity-modulated radiation therapy (IMRT), less irradiation to the surrounding tissue and acceptable GI toxicity rates can be achieved as compared to conventional RT techniques for IBD patients with PCa [ 3 ]. Additionally, the recent introduction of hydrogel rectal spacers in clinical practice provides a novel approach for further minimizing radiation to the rectum for PCa patients at a higher risk of late toxicities.…”

Section: Introductionmentioning

confidence: 99%

Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer

Singh

Jackson²,

Blake³

et al. 2017

Cureus

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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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“…Radiation enteritis and proctitis are the most serious side effects of abdominopelvic cancers in the gastrointestinal system [ 2 ]. In addition to these cancers, the lower parts of the gastrointestinal system are affected by exposure to radiation by radiotherapy for other tumors such as prostate, colorectal and urinary cancers [ 3 , 4 ]. Exposure of the lower parts of the intestine including ileum and colon, to high doses of ionizing radiation may lead to acute and late effects such as damage to villous, inflammation, pain, ulcer and bleeding.…”

Section: Introductionmentioning

confidence: 99%

Protection from Radiation-induced Damage in Rat’s Ileum and Colon by Combined Regimens of Melatonin and Metformin: A Histopathological Study

Najafi

Cheki

Hassanzadeh

et al. 2020

AIAAMC

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Background: Radiation-induced enteritis and proctitis are common side effects of abdominopelvic cancers among patients that undergo radiotherapy for prostate, colorectal or urinary cancers. Exposure of these tissues to high doses of radiation leads to damage to villous, inflammation, pain, ulcer and bleeding, which may cause malabsorption and gastrointestinal disorders. To date, several procedures such as pharmaceutical treatment have been proposed for protection and mitigation of gastrointestinal toxicity following radiotherapy. Aims: In the current study, we aimed to investigate the possible radioprotection of ileum and colon in rats using a combination of melatonin and metformin. Methods: In this experimental study, 30 male Wistar rats were randomly assigned to six groups: control, melatonin (100 mg/kg) treatment, melatonin (100 mg/kg) plus metformin (100 mg/kg) treatment, radiation (10 Gy to whole body) group, radiation + melatonin (100 mg/kg) treatment, and radiation + melatonin (100 mg/kg) plus metformin (100 mg/kg) treatment. After 3.5 days, rats were sacrificed and their ileum and colon tissues carefully removed. Histopathological evaluations were conducted on these tissue samples. Results: Histological evaluations reported moderate to severe damages to ileum and colon following whole body irradiation. Melatonin administration was able to protect the ileum remarkably, while the combination of melatonin and metformin was less effective. Interestingly, for the colon, melatonin was less effective while its combination with metformin was able to protect against radiation toxicity completely. Conclusion: For the ileum, melatonin was a more effective radioprotector compared to its combination with metformin. However, the combination of melatonin and metformin can be proposed as an ideal radioprotector for the colon.

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Long term clinical toxicity of radiation therapy in prostate cancer patients with Inflammatory Bowel Disease

Abstract: Radiation induced bowel toxicity a b s t r a c tAim: 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;

Cited by 19 publications

References 25 publications

Outcomes of patients undergoing radiation therapy for bladder cancer

Outcomes of patients undergoing radiation therapy for bladder cancer

Minimal Rectal Toxicity in the Setting of Comorbid Crohn’s Disease Following Prostate Cancer Radiotherapy with a Hydrogel Rectal Spacer

Protection from Radiation-induced Damage in Rat’s Ileum and Colon by Combined Regimens of Melatonin and Metformin: A Histopathological Study

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