Urothelial Carcinoma After External Beam Radiation Therapy for Prostate Cancer

Shah, Satyan K.; Lui, Paul D.; Baldwin, D. Duane; Ruckle, Herbert C.

doi:10.1016/s0022-5347(06)00324-7

Cited by 55 publications

(34 citation statements)

References 18 publications

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“…As more than 70% of all prostate cancers in the U.S. are diagnosed in males over age 65, the benefit of the integral dose reduction with protons may not be as appreciable as in younger age groups. However, recent reports of the increased risk of secondary malignancies in the older population, following prostate cancer radiotherapy (35)(36)(37), indicate that the dose reduction may be practical in that demographic group as well.…”

Section: Discussionmentioning

confidence: 99%

Radiotherapy Treatment of Early-Stage Prostate Cancer with IMRT and Protons: A Treatment Planning Comparison

Trofimov

Nguyen

Coen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

199

163

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Purpose-To compare intensity-modulated photon radiotherapy (IMRT) with 3D-conformal proton therapy (3D-CPT) for early stage prostate cancer, and explore the potential utility of intensitymodulated proton therapy (IMPT).Methods-Ten patients were planned with both 3D-CPT (2 parallel-opposed lateral fields) and IMRT (7 equally spaced coplanar fields). Prescribed dose was 79.2 Gy (or cobalt Gray-equivalent, CGE for protons) to the prostate gland. Dose-volume histograms, dose conformity, and equivalent uniform dose (EUD) were compared. Additionally, plans were optimized for 3D-CPT with nonstandard beam configuration, and for IMPT assuming delivery with beam scanning.Results-At least 98% of the PTV received the prescription dose. IMRT plans yielded better dose conformity to the target, while proton plans achieved higher dose homogeneity, and better sparing of rectum and bladder in the range below 30 Gy/CGE. Bladder volumes receiving over 70 Gy/CGE (V 70 ) were reduced, on average, by 34% with IMRT vs. 3D-CPT, while rectal V 70 were equivalent. EUD from 3D-CPT and IMRT plans were indistinguishable within uncertainties, for both bladder and rectum. With the use of small-angle lateral-oblique fields in 3D-CPT and IMPT, the rectal V 70 was reduced by up to 35% compared to the standard lateral configuration, while the bladder V 70 increased by less than 10%.Conclusions-In the range over 60 Gy/CGE, IMRT achieved significantly better sparing of the bladder, while rectal sparing was similar with 3D-CPT and IMRT. Dose to healthy tissues in the range below 50% of the target prescription was substantially lower with proton therapy.

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Section: Discussionmentioning

confidence: 99%

Radiotherapy Treatment of Early-Stage Prostate Cancer with IMRT and Protons: A Treatment Planning Comparison

Trofimov

Nguyen

Coen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

199

163

View full text Add to dashboard Cite

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“…Our median 4.9 year latency between radiation exposure and urothelial carcinoma is in agreement with other contemporary reports by Shah et al (4.0 years), Chrouser et al (4.9 years), and Bostrom et al (5.0 years). 9,11,21 The median time from prostate to bladder cancer diagnosis was 2 years in the nonirradiated group, supporting the assumption that bladder cancer in nonirradiated patients develops spontaneously and unrelated to prostate cancer therapy. It also suggests that the shorter time to bladder cancer diagnosis may be related to improved surveillance in nonirradiated patients.…”

Section: Discussionmentioning

confidence: 57%

“…As in previous reports of prostate cancer patients treated with radiotherapy, the majority of our patients presented with high grade urothelial carcinoma and progressed to muscle invasive disease. 19,21 In our series of bladder cancer patients, cystectomy was performed in 57% (47/83) of patients previously treated with prostate cancer radiotherapy. This was similar to the Loma Linda series, where 64% (7/11) of patients previously treated with EBRT underwent radical cystectomy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Previous Radiotherapy for Prostate Cancer on Clinical Outcomes of Bladder Cancer Patients

Yee¹,

Shariat²,

Lowrance³

et al. 2009

Journal of Urology

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Purpose-The impact of prostate cancer radiotherapy on the biological behavior of bladder cancer remains unclear. We compared outcomes of bladder cancer patients previously treated for prostate cancer with radiotherapy versus other treatment modalities.Materials and Methods-We identified 144 patients diagnosed with bladder cancer between January 1992 and June 2007 with a previous prostate cancer diagnosis. Clinicopathologic data and outcomes were compared between irradiated (brachytherapy and/or external beam radiation therapy; n = 83) and nonirradiated (androgen deprivation therapy, radical prostatectomy, and/or surveillance; n = 61) patients.Results-Median time between prostate and bladder cancer diagnoses was longer in irradiated versus nonirradiated patients (59 months versus 24 months [IQR 2-87], p = 0.007). Irradiated patients presented with higher tumor grade (high: 92% versus 77%, p = 0.016) and progressed to higher stage (muscle-invasive: 70% versus 43%, p = 0.001) than nonirradiated patients. In patients undergoing cystectomy, irradiated patients had a numerically higher rate of non-organ confined disease (75% versus 56% for nonirradiated patients, p = 0.1). Among all bladder cancer patients, 5-year cancer-specific survival was 73% (95% CI 59-87) for irradiated patients versus 83% (95% CI 71-95) for nonirradiated patients (p = 0.07). Median followup was 53 months (IQR 24-75).Conclusions-More time elapsed between prostate and bladder cancer diagnoses for irradiated patients, and irradiated patients presented with more advanced disease. Future studies are needed to further establish clinical differences in bladder cancer between irradiated and nonirradiated patients and whether biological differences exist.

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“…In a study of patients who underwent RT for prostate cancer, Shah et al noted an increase in the rates of urothelial carcinoma, but also an increased likelihood of presenting with high-grade disease and sarcomatoid features. 7 Similarly, RT-induced sarcomas are typically high-grade, with a tendency toward distant metastasis and local recurrence following resection. 8 The risk of secondary malignancy following RT is related to overall survival time.…”

Section: Discussionmentioning

confidence: 99%

Multiple secondary malignancies following radiation therapy for testicular cancer

Neufeld

Kroczak

Drachenberg

2015

CUAJ

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Testicular germ cell tumours (TGCT) are a rare malignancy that affect primarily young men. We present an interesting case of nonseminoma testicular cancer treated with external beam radiation therapy (RT), which subsequently resulted in two separate secondary malignancies decades after initial treatment. Case reportAt the age of 16, the patient underwent surgical correction of bilateral undescended testicles. Ten years later, he was found to have a left testicular mass and underwent a left radical inguinal orchiectomy revealing a malignant teratoma. Surgery and 25 rounds of adjuvant RT resulted in cure. He has been managed uneventfully with testosterone throughout his adult life due to an atrophic right testicle.Forty four (44) years after orchiectomy and RT, the patient presented to the emergency department with gross hematuria and flank pain. A computed tomography (CT) scan was performed, demonstrating a 2.8 x 1.7 cm mass in the renal pelvis consistent with urothelial carcinoma, and a small pulmonary nodule was noted in the lower right lung. Cystoscopy revealed no evidence of lower tract pathology. The patient underwent a laparoscopic left radical nephroureterectomy and retroperitoneal lymph node dissection with endoscopic bladder cuff excision. Pathology revealed a pT1b, N1, MX, high-grade urothelial tumour with focal necrosis. Three of 11 nodes were positive for urothelial carcinoma; lymphovascular invasion was not noted.In light of the poor prognosis and high risk of recurrence, adjuvant chemotherapy of cisplatin/gemtabicine was offered, but was declined by the patient. The patient recovered quite well apart from noting intermittent hematochezia that began approximately 10 weeks after his surgery. Follow up CT scan performed two months after surgery identified enlargement of the small pulmonary nodule from 5 to 8 mm, along with a new 6 mm nodule. A soft tissue mass at the recto-sigmoid junction measuring 2.2 x 2.2 cm was also identified. Potential treatment options were discussed with the patient, including the fact that worsening findings on subsequent scans would preclude surgical management.The pulmonary and rectal lesions were identified again three months later. At this time, diffuse thickening of the psoas muscle at the level of the left renal bed and suspicious aortocaval and para-aortic lymph nodes were also noted. Colonoscopy identified a 7 cm mass approximately 7 cm from the anus consistent with leiomyosarcoma. Positron emission tomography (PET) scan identified diffuse disease, including the left psoas and pulmonary nodules, as well as cervical and para-aortic lymph nodes. It was unclear whether the lymph nodes and pulmonary nodules represented metastasis from an urothelial or mesenchymal tumour.The patient was averse to any kind of colostomy and would only consent to anterior resection of the tumour. The patient underwent laparascopic biopsy of a single retroperitoneal lymph node that identified metastatic urothelial carcinoma. The procedure was then converted to an open laparotomy and lo...

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Urothelial Carcinoma After External Beam Radiation Therapy for Prostate Cancer

Abstract: Urothelial carcinoma in patients with previous radiation therapy for prostate cancer is often high grade, and the majority of patients have cancer progression requiring cystectomy. A high incidence of urothelial carcinoma with sarcomatoid features was seen in these patients.

Cited by 55 publications

References 18 publications

Radiotherapy Treatment of Early-Stage Prostate Cancer with IMRT and Protons: A Treatment Planning Comparison

Radiotherapy Treatment of Early-Stage Prostate Cancer with IMRT and Protons: A Treatment Planning Comparison

Impact of Previous Radiotherapy for Prostate Cancer on Clinical Outcomes of Bladder Cancer Patients

Multiple secondary malignancies following radiation therapy for testicular cancer

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