The effect of anaemia on normal tissue toxicity and survival outcomes in prostate cancer treated with radical radiotherapy and neo-adjuvant androgen deprivation

Abstract

Objective: It has been established that survival and toxicity outcomes in some cancer types could be influenced by haemoglobin (Hb) levels. This study aims to determine if pre-treatment Hb is associated with late toxicity or survival outcomes in prostate cancer. Methods: Data from one Phase III randomised controlled trial and one single arm translational trial were analysed. Patients had localized prostate cancer and received ≥70 Gy radiotherapy and neo-adjuvant androgen deprivation between 1997 and 2013. Results: 302 males were included. Median follow-up was 6.8 years for toxicity and 10.3 years for survival outcomes. Patients with Hb below the reference range were more likely to experience Grade 2–3 late gastrointestinal toxicity than patients with Hb within the range (p = 0.050). Neither late genitourinary toxicity, erectile function toxicity, prostate-specific antigen relapse free survival nor overall survival of patients were statistically significantly different between groups. Conclusion: Anaemia in prostate cancer is found in the minority of patients and is usually mild. Prostate cancer patients undergoing radiotherapy with low Hb were more likely to experience Grade 2–3 late gastrointestinal toxicity. Advances in knowledge: This study is one of the first in the published literature to investigate the role of Hb in prostate cancer toxicity and survival. We have found an association between Hb below the reference range and late GI toxicity. Consideration should be given to further investigating patients with iron deficiency anaemia to guide management options and outrule underlying GI pathology before proceeding with radiotherapy treatment.

Impacto Dos Níveis De Hemoglobina No Escore Isup Em Pacientes Com Câncer De Próstata Com Indicação De Radioterapia Radical

“…Adotou-se, então, Gleason 6 (3+3) como grau 1, o que melhor refletiu o comportamento predominantemente indolente desses tumores, Gleason 7 (3+4) como grau 2, Gleason 7 (4+3) como grau 3, Gleason 8 (4+4) como grau 4 e sendo o grau 5 ISUP para Gleason 9 e 10 (SRIGLEY et al, 2019). Embora existam dados emergentes sobre a importância dos níveis de hemoglobina em alguns tipos de câncer, há poucos dados publicados sobre seu papel no câncer de próstata e muito menos sobre a influência dos níveis de hemoglobina na agressividade ou prognóstico dos pacientes com câncer de próstata (KEENAN et al, 2020). Este é um dos primeiros trabalhos a propor uma melhor avaliação dos níveis plasmáticos de Hg e sua relação com o escore ISUP em pacientes com câncer de próstata com indicação de radioterapia radical.METODOLOGIAEstudo retrospectivo, descritivo e longitudinal dos participantes admitidos na Clínica de Radioterapia do Ingá (CRI), por meio de revisão de prontuários de participantes com diagnóstico de neoplasia maligna de próstata, pelos alunos de iniciação cientifica da Faculdade de Medicina da Universidade Estácio de Sá (UNESA-IDOMED) Campus Angra dos Reis.Foram avaliados os níveis de hemoglobina antes do tratamento radioterápico e o escore ISUP de cada paciente.…”