Patterns and predictors of amelioration of genitourinary toxicity after high-dose intensity-modulated radiation therapy for localized prostate cancer : Implications for defining postradiotherapy urinary toxicity

Abstract

Background Treatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa). Objective To determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT). Design, setting, and participants A total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3-7.7 yr). Intervention Patients underwent IMRT to a total dose of 86.4 Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy. Outcome measurements and statistical analysis Patients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied. Results and limitations The overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p < 0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p < 0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol. Conclusions Late GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling.

• author: Ghadjar, Pirus ; Jackson, Andrew ; Spratt, Daniel E. ; Oh, Jung Hun ; Munck Af Rosenschöld, Per ; Kollmeier, Marisa ; Yorke, Ellen ; Hunt, Margie ; Deasy, Joseph O. and Zelefsky, Michael J.
• publishing date: 2013-12
• type: Contribution to journal
• publication status: published
• subject: Radiology, Nuclear Medicine and Medical Imaging; Cancer and Oncology
• keywords: Prostatic neoplasms, Radiotherapy, Toxicity, Urogenital abnormalities
• in: European Urology
• volume: 64
• issue: 6
• pages: 931 - 938
• publisher: Elsevier
• external identifiers: pmid:23522772; scopus:84887405249
• ISSN: 0302-2838
• DOI: 10.1016/j.eururo.2013.02.001
• language: English
• LU publication?: no
• additional info: Funding Information: Our findings may help to counsel patients with localized PCa, who can be reassured that the risk of late GU toxicity and worsening of QoL after our protocol of high-dose IMRT was low. Moreover, the risk for development of late GU toxicity or worsening of QoL was dependent on baseline function such that patients with excellent baseline function were more prone to experience worsening, and patients with impaired baseline function are more likely to experience improvement after therapy. Author contributions: Michael J. Zelefsky had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: Ghadjar, Jackson, Zelefsky. Acquisition of data: Ghadjar, Jackson. Analysis and interpretation of data: Ghadjar, Jackson, Oh, Munck af Rosenschöld, Deasy, Zelefsky. Drafting of the manuscript: Ghadjar, Jackson, Zelefsky. Critical revision of the manuscript for important intellectual content: Ghadjar, Jackson, Spratt, Oh, Munck af Rosenschöld, Kollmeier, Yorke, Hunt, Deasy, Zelefsky. Statistical analysis: Ghadjar, Oh. Obtaining funding: None. Administrative, technical, or material support: None. Supervision: Jackson, Zelefsky. Other (specify): None. Financial disclosures: Michael J. Zelefsky certifies that all conflicts of interest, including specific financial interests and relationships and affiliations relevant to the subject matter or materials discussed in the manuscript (eg, employment/affiliation, grants or funding, consultancies, honoraria, stock ownership or options, expert testimony, royalties, or patents filed, received, or pending), are the following: None. Funding/Support and role of the sponsor: P. Ghadjar was supported financially by the Swiss Foundation for Medical-Biological Scholarships and the Eugen and Elisabeth Schellenberg Foundation. A. Jackson was supported by US National Institutes of Health project number R01CA129182.
• id: d6812566-0f02-4ecd-88b6-fc2d84992ab8
• date added to LUP: 2023-07-19 17:02:37
• date last changed: 2024-01-05 03:31:28