Phase 2 trial of guideline-based postoperative image guided intensity modulated radiation therapy for prostate cancer: Toxicity, biochemical, and patient-reported health-related quality-of-life outcomes

Berlin, Alejandro; Cho, Elizabeth; Kong, Vickie; Howell, Krisha; Lao, Bernadeth; Craig, Tim; Bayley, Andrew; Chung, Peter; Gospodarowicz, Mary K.; Warde, Padraig; Catton, Charles; Bristow, Robert G.; Ménard, Cynthia

doi:10.1016/j.prro.2015.02.015

Cited by 25 publications

(24 citation statements)

References 42 publications

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“… 17 , 18 , 19 A recent prospective phase 2 study of 68 men who were treated with guideline-based post-RP IMRT reported cumulative 5-year CTC late G2 GI and GU toxicity incidences of 12.3% and 10.6%, respectively, with no G3 + toxicities. 20 These and our results compare favorably with the RTOG late G2 + GU toxicity of 21.3% that was reported in European Organisation for Research and Treatment of Cancer study 22911 and the 23.8% complication rate that was reported in Southwest Oncology Group study 8794 (both studies used conventional radiation therapy techniques). 2 , 7 Several studies also demonstrated no significant long-term changes in patient-reported quality of life after PPRT.…”

Section: Discussionsupporting

confidence: 88%

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Akthar

Wong

Parekh

et al. 2018

Advances in Radiation Oncology

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PurposeDose-volume histogram (DVH) toxicity relationships are poorly defined in men who receive radiation after radical prostatectomy (RP). We evaluated Radiation Therapy Oncology Group (RTOG) study 0534 and institutional intact normal-tissue sparing guidelines, as well as dose to bladder trigone, for ability to minimize late toxicity.Methods and materials164 men received intensity modulated radiation therapy (RT) to a median prostate bed dose of 66.6 Gy at a median of 22 months after RP. 46% of men were prescribed androgen deprivation therapy and pelvic lymph node irradiation to a median dose of 50.4 Gy. DVH relationships for the rectum, bladder, trigone, and bladder excluding the clinical target volume (bladder-CTV) were analyzed against the Common Terminology Criteria for Adverse Events late grade 2 + (G2+) gastrointestinal (GI) and genitourinary (GU) toxicity by log-rank test. RTOG 0534 (rectum V65, 40 Gy ≤35, 55%, and bladder-CTV V65, 40 ≤50, 70%) and intact prostate RT institutional guidelines (rectum V70, 65, 40 ≤20, 40, 80% and bladder V70, 65, 40 ≤30, 60, 80%, respectively) guidelines were evaluated.ResultsWith a median follow-up time of of 33 months, the 4-year freedom from G2 + GI and GU toxicity were both 91%. G2 + GI (n = 12) and GU (n = 15) toxicity included 4% diarrhea (n = 6), 4% hemorrhage (n = 6), 1% proctitis (n = 1), and 4% urinary frequency (n = 7), 1% obstructive (n = 2), 2% cystitis (n = 3), and 3% incontinence (n = 5), respectively. RTOG 0534 rectum and bladder goals were not achieved in 65% and 41% of cases, while the institutional intact prostate goals were not achieved in 21% and 25% of cases, respectively. Neither dose to the bladder trigone nor any of the proposed normal tissue goals were associated with late toxicity (P > .1). In the univariate analysis, age, pelvic RT, RT dose, anticoagulation use, androgen deprivation therapy, time from RP to RT, and tobacco history were not associated with toxicity.ConclusionsMore than 90% of men were free from late G2 + toxicity 4 years after post-RP intensity modulated RT. No tested parameters were associated with late toxicity. In the absence of established normal-tissue DVH guidelines in the postoperative setting, the use of intact guidelines is reasonable.

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Section: Discussionsupporting

confidence: 88%

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Akthar

Wong

Parekh

et al. 2018

Advances in Radiation Oncology

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“…Incidence of any late grade 2–3 sexual toxicity was 34.3%, with 20.2% of these new compared to baseline. Nevertheless, prevalence of grade 2–3 sexual toxicity was 16.5% at 4 years after PPRT, decreasing from a baseline prevalence of 43.7%, potentially due to decreased bother as patients become accustomed to sexual dysfunction . ART showed a non‐significant trend towards worse sexual toxicity compared to SRT on Kaplan–Meier analysis, in keeping with the improved erectile function recovery with SRT compared to ART seen in other series .…”

Section: Discussionsupporting

confidence: 63%

“…The prevalence of late grade 2–3 GU symptoms remained stable from baseline to 4 years after PPRT at approximately 21%, predominantly driven by urinary incontinence. The cumulative incidence of late grade 2–3 GU toxicity (32.9% at 4 years) was higher than some series, with a Memorial Sloan Kettering Cancer Centre (MSKCC) series reporting a 16.8% incidence at 5 years and a Princess Margaret Hospital series reporting a 13.2% incidence at 5 years . However, the former did not report whether baseline toxicities were considered, and the latter reported new toxicities.…”

Section: Discussionmentioning

confidence: 85%

“…In addition, many patients during late follow‐up after PPRT experience an improvement in urinary and sexual function over baseline. Furthermore, quality of life seems stable after PPRT . For these reasons, we question whether cumulative incidence is the best way to report toxicity in this situation.…”

Section: Discussionmentioning

confidence: 99%

“…Despite this, published details of toxicity evaluation in comparison to baseline are often missing. Use of image‐guided intensity‐modulated radiotherapy (IG‐IMRT) may reduce toxicity, with a recent series reporting low levels of new acute and late toxicity rates with IG‐IMRT, although other series using IMRT report GU grade 2–3 toxicity rates of approximately 20% without stating whether these are new compared to baseline . Understanding patterns and rates of treatment toxicity before, during and after post‐prostatectomy radiotherapy (PPRT) is important in counselling patients and referring doctors regarding its benefits and risks.…”

Section: Introductionmentioning

confidence: 99%

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Toxicity after post‐prostatectomy image‐guided intensity‐modulated radiotherapy using Australian guidelines

et al. 2017

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Post-prostatectomy IG-IMRT using Australian contouring guidelines appears to have tolerable acute and late toxicity. The 4-year prevalence of grade ≥2 GU and GI toxicity was virtually unchanged compared to baseline, and sexual toxicity improved over baseline. This should reassure radiation oncologists following these guidelines. Late toxicity rates of surgery and PPRT are higher than following definitive IG-IMRT, and this should be taken into account if patients are considering surgery and likely to require PPRT.

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Multimodale Therapie des lokal fortgeschrittenen Prostatakarzinoms

Heidenreich

Böhmer

2016

Urologe

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Locally advanced prostate cancer (LAPCA) comprises about 5-10 % of all newly diagnosed prostate cancers and is associated with the highest prostate cancer specific mortality (approximately 8-20 %). LAPCA is defined by the presence of extraprostatic extension, seminal vesicle invasion, and bladder neck infiltration of pelvic lymph node metastases. It is evident that prognosis can only be improved by interdisciplinary multimodality treatment strategies. Adequate local staging by multiparametric MRI is one of the cornerstones for an individualized, risk-adapted treatment approach. This might consist of extended radical prostatectomy with an extended pelvic lymphadenectomy or intensity-modulated radiation therapy with androgen deprivation as the primary local therapeutic approach. Both treatment strategies may be combined with neoadjuvant or adjuvant radiation therapy or salvage surgery. Combination with neoadjuvant or adjuvant chemotherapy and new androgen receptor pathway inhibitors might also be possible. This article summarizes the current treatment strategies for LAPCA.

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Phase 2 trial of guideline-based postoperative image guided intensity modulated radiation therapy for prostate cancer: Toxicity, biochemical, and patient-reported health-related quality-of-life outcomes

Cited by 25 publications

References 42 publications

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Late toxicity after post-prostatectomy intensity modulated radiation therapy: Evaluating normal-tissue sparing guidelines

Toxicity after post‐prostatectomy image‐guided intensity‐modulated radiotherapy using Australian guidelines

Multimodale Therapie des lokal fortgeschrittenen Prostatakarzinoms

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