Impact of Body Mass Index on Outcomes After Conformal Radiotherapy in Patients With Prostate Cancer

Geinitz, Hans; Thamm, Reinhard; Mueller, Tobias; Jess, K; Zimmermann, Frank; Molls, M.; Nieder, Carsten

doi:10.1016/j.ijrobp.2010.05.059

Cited by 19 publications

(14 citation statements)

References 36 publications

(41 reference statements)

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“…11 The majority of patients in these studies were treated to 70Gy or less with the traditional four-field technique or 3D-conformal radiation therapy. Multiple studies have shown the cancer control benefit of dose escalation 12 , 13 and studies using brachytherapy for primary treatment of localized prostate cancer have not shown BMI to be associated with PSA failure.…”

Section: Introductionmentioning

confidence: 99%

Impact of obesity on outcomes after definitive dose‐escalated intensity‐modulated radiotherapy for localized prostate cancer

Wang

Murphy

Ruth

et al. 2015

Cancer

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INTRODUCTION Previous publications have shown conflicting results regarding body mass index (BMI) and prostate cancer (CaP) outcomes after definitive radiotherapy prior to the dose escalation era. Our goal is to determine whether increasing BMI is associated with CaP outcomes in men with localized CaP treated with dose escalated radiotherapy. METHODS We identified patients with localized (T1b-T4N0M0) CaP treated with definitive intensity modulated radiation therapy (IMRT) and image guidance (IGRT) from 2001–2010. BMI was analyzed as a continuous variable. Adjusting for confounders, multivariable competing risk and Cox proportional hazards regression models were used to assess the association between BMI category and the risk of biochemical failure (BF), distant metastasis (DM), cause-specific mortality (CSM) and overall mortality (OM). RESULTS Of the 1,442 patients identified, there were 20% with BMI<25 kg/m2, 48% with BMI 25–29.9 kg/m2, 23% with BMI 30–34.9 kg/m2, 6% with 35–39.9 kg/m2, and 4% with BMI≥40 kg/m2. Median follow-up was 47.6 months (range 1–145) with median age of 68 years (range 36–89). Median dose was 78Gy (range 76–80) and 30% of patients received androgen deprivation therapy. Increasing BMI was inversely associated with age (p<0.001) and pre-treatment PSA (p=0.018). On multivariable analysis, increasing BMI was associated with increased risk of BF (HR=1.03[95% CI 1.00–1.07], p=0.042), DM (HR=1.07[1.02–1.11], p=0.004), CSM (HR=1.15[1.07–1.23], p<0.001), and OM (HR=1.05[1.02–1.08], p=0.004). CONCLUSION For CaP patients receiving dose-escalated IMRT with IGRT, increasing BMI appears to be associated with an increased risk of biochemical failure, distant metastases development, cause-specific and overall survival.

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Section: Introductionmentioning

confidence: 99%

Impact of obesity on outcomes after definitive dose‐escalated intensity‐modulated radiotherapy for localized prostate cancer

Wang

Murphy

Ruth

et al. 2015

Cancer

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“…It has been previously reported that obesity is associated with the incidence of more aggressive, higher grade prostate cancer and greater prostate-specific antigen (PSA) failure rates following radical prostatectomy or external beam RT (EBRT) (8–14). However, Efstathiou et al (15) previously reported that BMI is not associated with PSA failure in males with prostate cancer treated with brachytherapy.…”

Section: Introductionmentioning

confidence: 99%

Body mass index can affect gastrointestinal and genitourinary toxicity in patients with prostate cancer treated with external beam radiation therapy

et al. 2013

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The aim of the present study was to determine the impact of obesity on radiation-induced gastrointestinal (GI) and genitourinary (GU) toxicity. The cases of 54 patients with prostate cancer, treated with three-dimensional conformal radiation therapy (RT), were reviewed. For each patient, the body mass index (BMI), distance between the prostate and rectum (D) on a computerised tomography scan and the dosimetric parameters of the rectum and bladder in the planning data of RT, were analyzed. GI and GU toxicity was assessed during and following RT. The results of the patients with a BMI of <25 (lower BMI) were compared with those of the patients with a BMI of ≥25 (higher BMI). The higher BMI group exhibited significantly lower doses of V60 and V65 in the rectum than the lower BMI group. No significant differences were found in D and bladder doses between the two groups. The incidence of acute GI and GU toxicity and late GI and GU toxicity were 41.7, 19.4, 35.3 and 5.7% in the lower BMI group, respectively, and 27.8, 27.8, 5.9 and 35.3% in the higher BMI group, respectively. In addition, a significant difference was found in the incidence of late GU toxicity between the two groups. Among patients who underwent RT for prostate cancer, those with higher BMIs had a tendency to show lower incidences of GI toxicity and higher incidences of GU toxicity than patients with lower BMIs. To conclude, an increased effort must be made to reduce rectal doses in patients with lower BMIs. Conversely, increased care for GU toxicity must be provided for overweight patients.

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“…Similarly, body mass index (BMI) has been correlated with random positioning uncertainty [7]. BMI was a predictor of decreased bPFS in one study [8], but data were conflicting in another [9]. …”

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confidence: 99%

Modeling positioning uncertainties of prostate cancer external beam radiation therapy using pre-treatment data

Rosenschöld¹,

Desai²,

Oh³

et al. 2014

Radiotherapy and Oncology

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Purpose To investigate the influence of treatment plan data and image guidance (IG) on positioning uncertainty during prostate cancer (PCa) radiotherapy (RT). Methods Body mass index (BMI), planning target volume (PTV), bladder volume (BV), and rectal cross section area (RCS) were collected for 267 consecutive PCa patients undergoing daily IGRT. Radiographic isocenter corrections to intra-prostatic fiducials for 12,490 treatment fractions were used to derive random (RE) and systematic (SE) inter-fraction uncertainties for the cardinal axes. These data were used to simulate RE and SE for weekly IG and Action Level (AL)-IG treatment protocols. Results SE and RE were 2–5 and 3–4 mm in the cardinal axes, respectively, during simulation of no IG. Without IG, positive correlations (p < 0.01) were noted for (1) anterior-posterior RE vs. RCS and BV and (2) cranio-caudal RE vs. RCS, BV and BMI. The RE increase was 3 mm for the highest quartile of RCS, BV and BMI. Daily IGRT eliminated this relationship. 3D IG corrections of 1 cm or more occured in 27% of treatment fractions and in 97% of patients. Conclusion PCa patients with elevated pre-treatment BV, RCS and BMI have increased inter-fractionation positioning uncertainty and appear the primary candidates for daily IGRT.

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Impact of Body Mass Index on Outcomes After Conformal Radiotherapy in Patients With Prostate Cancer

Cited by 19 publications

References 36 publications

Impact of obesity on outcomes after definitive dose‐escalated intensity‐modulated radiotherapy for localized prostate cancer

Impact of obesity on outcomes after definitive dose‐escalated intensity‐modulated radiotherapy for localized prostate cancer

Body mass index can affect gastrointestinal and genitourinary toxicity in patients with prostate cancer treated with external beam radiation therapy

Modeling positioning uncertainties of prostate cancer external beam radiation therapy using pre-treatment data

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