Proctitis following stereotactic body radiation therapy for prostate cancer

Joh, Daniel Y.; Chen, Leonard N.; Porter, Gerald; Bhagat, Aditi; Sood, S; Kim, Joy S.; Moures, Rudy; Yung, Thomas M.; Lei, Siyuan; Collins, Brian T.; Ju, Andrew; Suy, Simeng; Carroll, J.E.; Lynch, John H.; Dritschilo, Anatoly; Collins, Sean P.

doi:10.1186/s13014-014-0277-4

Cited by 25 publications

(16 citation statements)

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“…The same authors report 0-29% of GU G2 and 1.3% of GU G3 late effects. Joh et al report 11.5% of moderate and 8.5% of severe acute GI reactions (diarrhea) and only 1.5% of late GI events (2 years after treatment) in the group of 269 patients irradiated to a TD of 35.0–36.25 Gy [ 17 ]. However, Bhathasalli et al describe 14.5% of GU late effects in a group of 228 patients with a minimum FU of 24 months [ 18 ].…”

Section: Discussionmentioning

confidence: 99%

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

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Napieralska

Namysł-Kaletka

et al. 2015

CEJU

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IntroductionProstrate cancer (PC) is one of the most common malignancies and is frequently treated with an 8-week course of radiotherapy. CyberKnife (CK) based radioablation enables completion of therapy within 5-9 days. The aim of this study is an evaluation of the effectiveness and tolerance of CyberKnife-based radioablation in prostate cancer patients.Material and methods200 PC patients (94 low risk [LR], 106 intermediate risk [IR]) underwent CK irradiation every other day (fraction dose [fd] 7.25 Gy, total dose [TD] 36.25 Gy, time 9 days). PSA varied from 1.1 to 19.5 (median 7.7) and T stage from T1c to T2c. The percentage of patients with Androgen Deprivation Therapy (ADT), GI (gastrointestinal) and GU (genitourinary) toxicity (EORTC/RTOG scale), and PSA were checked at 1, 4 and 8 months, and thereafter every 6 months – up to a total of 26 months – post-treatment.ResultsThe percentage of patients without ADT increased from 47.5% to 94.1% after 26 months. The maximum percentage of acute G3 adverse effects was 0.6% for GI, 1% for GU and G2 – 2.1% for GI and 8.5% for GU. No late G3 toxicity was observed. The maximum percentage of late G2 toxicity was 0.7% for GI and 3.4% for GU. Median PSA decreased from 7.7 to 0.1 ng/ml during FU. One patient relapsed and was treated with salvage brachytherapy.ConclusionsWe conclude that CK-based radioablation in low and intermediate risk PC patients is an effective treatment modality enabling OTT reduction and presents a very low percentage of adverse effects.

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Section: Discussionmentioning

confidence: 99%

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

Miszczyk

Napieralska

Namysł-Kaletka

et al. 2015

CEJU

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“…For some patients, the advantage of a hypofractionated treatment outweighs the transient urinary toxicity that may occur 1 year following SBRT [27,32,33]. The late onset urinary toxicities following SBRT treatment will become a more important issue as SBRT gains popularity as a primary treatment option for localized PCa.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Late Urinary Symptoms Following SBRT and SBRT with IMRT Supplementation for Prostate Cancer

et al. 2018

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Background: Prostate cancer survivors commonly experience late-onset lower urinary tract symptoms following radiotherapy. We aimed to compare lower urinary tract symptoms in patients treated with stereotactic body radiotherapy (SBRT) to those treated with a combination of lower dose SBRT and supplemental intensity-modulated radiotherapy (SBRT + IMRT). Methods: Subjects with localized prostate carcinoma scheduled to receive SBRT or a combination of SBRT and IMRT were enrolled and followed for up to 2 years after treatment completion. Participants treated with SBRT received 35-36.25 Gy in 5 fractions, while those treated with SBRT + IMRT received 19.5 Gy of SBRT in 3 fractions followed by 45-50.4 Gy of IMRT in 25-28 fractions. Urinary symptoms were measured using the American Urological Association (AUA) Symptom Score. Results: Two hundred patients received SBRT (52% intermediate risk, 37.5% low risk according to D'Amico classification) and 145 patients received SBRT + IMRT (61.4% high risk, 35.2% intermediate risk). Both groups experienced a transient spike in urinary symptoms 1 month after treatment. More severe late urinary flare (increase in AUA scores ≥ 5 points from baseline to 1 year after treatment completion and an AUA score ≥ 15 at 1 year after treatment) was experienced by patients who received SBRT compared to those treated with SBRT + IMRT. Conclusion: Participants who received SBRT and supplemental IMRT experienced less severe late urinary flare 1 year after treatment compared to those who received higher dose SBRT alone. This information can be used by clinicians to provide patients with anticipatory counseling to mitigate any psychological burden that comes with unanticipated late urinary toxicities.

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“…What is the appropriate time point and recall period to assess acute bowel symptoms following prostate SBRT such that clinically meaningful symptoms are captured fully and accurately? Early results with prostate SBRT (35–40 Gy in four to five fractions) have suggested very low rates of acute rectal toxicity ( 22 – 24 ). However, such studies did not collect outcomes until 1 month after treatment.…”

Section: Discussionmentioning

confidence: 99%

“…Early results suggest that prostate SBRT with 35–40 Gy in four to five fractions confers rates of biochemical relapse-free survival and late rectal toxicity which are comparable to alternative radiation modalities ( 22 – 24 ). However, little data exist on acute bowel morbidity prior to the 1-month interval, creating a potential for recall bias in patient-reported outcomes.…”

Section: Introductionmentioning

confidence: 99%

Proctitis 1 Week after Stereotactic Body Radiation Therapy for Prostate Cancer: Implications for Clinical Trial Design

et al. 2016

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BackgroundProctitis following prostate cancer radiation therapy is a primary determinant of quality of life (QOL). While previous studies have assessed acute rectal morbidity at 1 month after stereotactic body radiotherapy (SBRT), little data exist on the prevalence and severity of rectal morbidity within the first week following treatment. This study reports the acute bowel morbidity 1 week following prostate SBRT.Materials and methodsBetween May 2013 and August 2014, 103 patients with clinically localized prostate cancer were treated with 35–36.25 Gy in five fractions using robotic SBRT delivered on a prospective clinical trial. Bowel toxicity was graded using the Common Terminology Criteria for Adverse Events version 4.0 (CTCAEv.4). Bowel QOL was assessed using the EPIC-26 questionnaire bowel domain at baseline, 1 week, 1 month, and 3 months. Time-dependent changes in bowel symptoms were statistically compared using the Wilcoxon signed-rank test. Clinically significant change was assessed by the minimally important difference (MID) in EPIC score. This was defined as a change of 1/2 standard deviation (SD) from the baseline score.ResultsOne-hundred and three patients with a minimum of 3 months of follow-up were analyzed. The cumulative incidence of acute grade 2 gastrointestinal (GI) toxicity was 23%. There were no acute ≥ grade 3 bowel toxicities. EPIC bowel summary scores maximally declined at 1 week after SBRT (−13.9, p < 0.0001) before returning to baseline at 3 months after SBRT (+0.03, p = 0.94). Prior to treatment, 4.9% of men reported that their bowel bother was a moderate to big problem. This increased to 28.4% (p < 0.0001) 1 week after SBRT and returned to baseline at 3 months after SBRT (0.0%, p = 0.66). Only the bowel summary and bowel bother score declines at 1 week met the MID threshold for clinically significant change.ConclusionThe rate and severity of acute proctitis following prostate SBRT peaked at 1 week after treatment and returned to baseline by 3 months. Toxicity assessment at 1 week can therefore minimize recall bias and should aid in the design of future clinical trials focused on accurately capturing and minimizing acute morbidity following SBRT.

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Proctitis following stereotactic body radiation therapy for prostate cancer

Cited by 25 publications

References 49 publications

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

CyberKnife-based prostate cancer patient radioablation – early results of irradiation in 200 patients

Comparison of Late Urinary Symptoms Following SBRT and SBRT with IMRT Supplementation for Prostate Cancer

Proctitis 1 Week after Stereotactic Body Radiation Therapy for Prostate Cancer: Implications for Clinical Trial Design

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