Patient-reported gastrointestinal symptoms among long-term survivors after radiation therapy for prostate cancer

Alsadius, David; Olsson, Caroline; Pettersson, Niclas; Tucker, Susan L.; Wilderäng, Ulrica; Steineck, Gunnar

doi:10.1016/j.radonc.2014.08.008

Cited by 7 publications

(8 citation statements)

References 20 publications

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“…Rectal bleeding is a well-known side-effect after RT for PCa [21,22] and this was documented also in our study, with an increased risk for inpatient care. However, the need for rectal surgery was not increased, indicating that Grade 3 or Grade 4 toxicities, as per the radiation toxicity grading of the Radiation Therapy Oncology Group (RTOG) and the European Organisation for Research and Treatment of Cancer (EORTC), are uncommon [23].…”

Section: Discussionsupporting

confidence: 83%

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

et al. 2022

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Objective To estimate the long‐term risks of severe late toxicities for radiation therapy (RT) following radical prostatectomy (RP) in an unselected nationwide cohort, as severe side‐effects are rare but may occur years later. Patients and Methods The study population comprised all men undergoing RP between 1997 and 2016 in the Prostate Cancer database Sweden (PCBaSe) (n = 40 962). By (1:2) matching, two cohorts were created: 2789 men exposed to postoperative RT and 5578 unexposed men with comparable age, comorbidities, and year of surgery. Cumulative incidences and rate ratios were calculated for the following outcomes: symptoms and interventions of the urinary or intestinal tract demanding inpatient care, secondary malignancies, and non‐prostate cancer mortality. Results The largest differences were seen for late toxicities affecting the urinary tract. The 10‐year cumulative incidences among those exposed to postoperative RT vs the RP‐only group were: 17.8% vs 10.5% for procedures of the urinary tract (difference 7.3%, 95% confidence interval [CI] 4.4 to 10.3; relative risk [RR] 1.74, 95% CI 1.47 to 2.05); 6.0% vs 1.2% for haematuria (difference 4.8%, 95% CI 3.1 to 6.5; RR 6.50, 95% CI 4.31 to 10.10); and 2.4% vs 1.1% for bladder cancer (difference 1.4%, 95% CI 0.4 to 2.3; RR 2.71, 95% CI 1.72 to 4.33). The groups were similar regarding intestinal toxicity, other secondary malignancies, and non‐prostate cancer mortality. Adjustments for preoperative tumour risk factors did not importantly affect the rate ratios. Conclusion Severe late toxicity after postoperative RT following RP predominately affects the bladder and can appear many years after RT.

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Section: Discussionsupporting

confidence: 83%

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

et al. 2022

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“…A cross sectional study of 989 prostate cancer patients treated with RT showed that defecation urgency was the most common symptom among survivors after 2-14 years' follow-up, followed by faecal leakage and loose stools (16). Similar results have been presented in patients treated with pelvic irradiation, both men and women, where defecation urgency and faecal leakage has been identified as the most disturbing of all radiation-induced symptoms (17)(18)(19)(20)(21).…”

Section: Discussionmentioning

confidence: 57%

Effect on prostate volume following neoadjuvant treatment with an androgen receptor inhibitor monotherapy versus castration plus an androgen receptor inhibitor in prostate cancer patients intended for curative radiation therapy: A randomised study

et al. 2017

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Abstract. To avoid pubic arch interference, prostate cancer patients are treated with neoadjuvant androgen deprivation therapy (ADT) to achieve prostate volume (PV) reduction prior to radiation treatment. The aim of the present randomised study was to compare the effects on PV of two regimens of ADT, an androgen receptor inhibitor monotherapy vs. castration plus an androgen receptor inhibitor. Consecutive patients with non-metastatic prostate cancer were included in a randomised neoadjuvant study, comparing an androgen receptor inhibitor monotherapy vs. castration plus an androgen receptor inhibitor. PV was assessed prior to the start of endocrine neoadjuvant treatment and prior to the start of radiation therapy (RT). PV assessment was performed by transrectal ultrasound. A total of 110 patients were included. Final sample constituted 88 (80%) patients due to lack of PV information. Castration plus an androgen receptor inhibitor was more effective in PV reduction compared with an androgen receptor inhibitor alone (P<0.001). Planning target volume decreased in the combination arm. There was no significant difference in clinical or demographic or length of neoadjuvant hormonal treatment between the groups. Overall, a significantly larger PV reduction was achieved by castration plus androgen receptor inhibitor, as compared with androgen receptor inhibitor monotherapy. The PV reduction, however, appeared not to translate into better health associated quality of life during the subsequently given curative intended combined EBRT and HDR-brachytherapy. Potential differences between these two treatments regarding anti-tumor effects on micro metastatic disease and radiation potentiating effect remains to be addressed in future prospective trials.

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“…Time to follow-up was an individual predictor for Fecal leakage in both cohorts but did not add substantially to the discriminative ability. Many of the GI symptoms, as presented for the SW cohort [26], have previously been reported to have a stable temporal pattern and, therefore, it is not surprising that our final models presented here are not highly time dependent. In the Swedish study, we had access to a reference cohort from the general population where symptom background rates had been assessed.…”

Section: Discussionmentioning

confidence: 84%

Relationships between dose to the gastro-intestinal tract and patient-reported symptom domains after radiotherapy for localized prostate cancer

Thor

Olsson

et al. 2015

Acta Oncologica

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Background Gastrointestinal (GI) morbidity after radiotherapy (RT) for prostate cancer is typically addressed by studying specific single symptoms. The aim of this study was to explore the interplay between domains of patient-reported outcomes (PROs) on GI morbidity, and to what extent these are explained by RT dose to the GI tract. Material and methods The study included men from two Scandinavian studies (N = 211/277) who had undergone primary external beam radiotherapy (EBRT) for localized prostate cancer to 70–78 Gy (2 Gy/fraction). Factor analysis was applied to previously identified PRO-based symptom domains from two study-specific questionnaires. Number of questions: 43; median time to follow-up: 3.6–6.4 years) and dose-response outcome variables were defined from these domains. Dose/volume parameters of the anal sphincter (AS) or the rectum were tested as predictors for each outcome variable using logistic regression with 10-fold cross-validation. Performance was assessed using area under the receiver operating characteristic curve (Az) and model frequency. Results Outcome variables from Defecation urgency (number of symptoms: 2–3), Fecal leakage (4–6), Mucous (4), and Pain (3–6) were defined. In both cohorts, intermediate rectal doses predicted Defecation urgency (mean Az: 0.53–0.54; Frequency: 70–75%), and near minimum and low AS doses predicted Fecal leakage (mean Az: 0.63–0.67; Frequency: 83–99%). In one cohort, high AS doses predicted Mucous (mean Az: 0.54; Frequency: 96%), whereas in the other, low AS doses and intermediate rectal doses predicted Pain (mean Az: 0.69; Frequency: 28–82%). Conclusion We have demonstrated that Defecation urgency, Fecal leakage, Mucous, and Pain following primary EBRT for localized prostate cancer primarily are predicted by intermediate rectal doses, low AS doses, high AS doses, or a combination of low AS and intermediate rectal doses, respectively. This suggests that there is a domain-specific dose-response for the GI tract. To reduce risk of GI morbidity, dose distributions of both the AS region and the rectum should, therefore, be considered when prescribing prostate cancer RT.

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Patient-reported gastrointestinal symptoms among long-term survivors after radiation therapy for prostate cancer

Cited by 7 publications

References 20 publications

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

Risk of severe late toxicity after radiotherapy following radical prostatectomy – a nationwide study

Effect on prostate volume following neoadjuvant treatment with an androgen receptor inhibitor monotherapy versus castration plus an androgen receptor inhibitor in prostate cancer patients intended for curative radiation therapy: A randomised study

Relationships between dose to the gastro-intestinal tract and patient-reported symptom domains after radiotherapy for localized prostate cancer

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