Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series

Juarez, Jesus E.; Romero, Tahmineh; Mantz, C.A.; Pepin, Abigail; Aghdam, Nima; Suy, Simeng; Steinberg, Michael L.; Levin-Epstein, Rebecca; Nickols, Nicholas G.; Kaplan, Irving; Meier, R.; Pham, Huong; Linson, Patrick W.; Hong, Robert; Buyyounouski, Mark K.; Bagshaw, H.P.; Fuller, Donald B.; Katz, Alan J.; Loblaw, Andrew; Collins, Sean P.; Kishan, Amar U.

doi:10.1016/j.adro.2021.100759

Cited by 3 publications

(3 citation statements)

References 19 publications

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“…Moreover, a control-matched review of 39 males with inactive IBD who were treated with prostate SBRT showed that IBD was not associated with increased odds of late grade ≥2 GI or GU toxicity (median follow-up time of 89 months). There was, however, an increased acute risk of low-grade GI/GU toxicity in those with dormant IBD [ 23 ]. This data offers encouraging insight into the outcomes of those who received radiation with dormant IBD; however, it is still generally recommended to avoid pelvic radiation, if possible, during an acute IBD flare-up.…”

Section: Discussionmentioning

confidence: 99%

Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning

Ching,

Bourne,

Kearney

et al. 2024

Cureus

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Prostate-specific membrane antigen (PSMA) imaging has become a mainstay diagnostic tool in staging unfavorable primary prostate cancer (PC) and identifying sites of recurrence in previously treated PC. One of the biggest pitfalls of PSMA imaging is rapid radionucleotide excretion in the urine via the kidneys, ureters, and bladder. The positron-emission tomography (PET) images obtained show increased radiotracer activity in these structures, which can occlude or even mimic true malignant disease. We describe the diagnostic challenges encountered in differentiating benign versus malignant disease with PSMA scans. A 78-year-old male presented to our outpatient radiation oncology office with high-risk prostate cancer. His medical history was significant for ulcerative colitis (UC). Magnetic resonance imaging (MRI) revealed an enlarged prostate and a Prostate Imaging Reporting and Data System (PI-RADS) class 4 lesion. A subsequent transperineal biopsy confirmed unilateral Gleason 8 adenocarcinoma. A PSMA PET scan was read as increased uptake in the right prostate and a left external iliac node. The patient, having been initially informed of a positive lymph node metastasis, sought a second opinion,resulting in a CT urogram that revealed physiologic ureteral uptake. We were thus able to avoid lymph node radiation and morbidity to the surrounding bowel, already chronically inflamed with ulcerative colitis. This study demonstrates the potential for misinterpretation of PSMA uptake in the ureter as lymph node metastases. We discuss how peri-uretic activity can hinder accurate visualization of pelvic lymph node metastases. This study highlights the need for careful image interpretation of PSMA uptake patterns in order to avoid diagnostic errors and unnecessary radiation to at-risk organs in prostate cancer management.

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Section: Discussionmentioning

confidence: 99%

Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning

Ching,

Bourne,

Kearney

et al. 2024

Cureus

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“…Post-therapy follow-up was conducted regularly, focusing on the assessment of bowel and urinary function and their impact on health-related quality of life. The evaluation included the frequency of stool passage, presence of tenesmus, rectal discomfort, urinary incontinence, frequency of incontinence episodes, and the overall patient satisfaction with the treatment outcomes (12).…”

Section: Methodsmentioning

confidence: 99%

Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation

Saif Ur Rehman,

Shafaq Maqsood,

Aneela Deevan

2024

JHRR

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Background: Pelvic radiotherapy is a primary treatment modality for organ-confined prostate cancer and early-stage endometrial cancer. While effective in improving survival rates and reducing recurrence, it is associated with a range of side effects that can impact patient quality of life. Objective: The study aimed to assess the incidence, management, and resolution of acute and chronic side effects of pelvic radiotherapy in prostate and endometrial cancer patients, focusing on bowel and bladder functions. Methods: This single-center, observational study included 50 patients diagnosed with prostate or endometrial cancer who underwent pelvic radiotherapy with a dose of 66-70 Gy using a four-field technique on a linear accelerator. Patients were assessed for bladder and bowel dysfunction, with follow-up at 6, 12, and 18 months post-treatment. Statistical analysis involved univariate weighted distribution of response frequencies and paired t-tests for ordinal scale scores, using SPSS version 25 for data analysis. Results: Of the participants, 22% experienced dysuria, 64% reported bladder outlet obstruction, and 20% had constipation. Acute bowel symptoms like diarrhea occurred in 32%, and chronic proctitis developed in 22% of patients. Urinary symptoms appeared by the third week and generally resolved within weeks; however, bowel symptoms persisted longer but returned to baseline by 18 months post-treatment. Approximately 70% of patients reported good tolerance to radiotherapy. Conclusion: Pelvic radiotherapy is effective in treating prostate and endometrial cancers but requires management of transient side effects to improve patient outcomes. Advanced radiotherapy techniques such as IMRT and 3D CRT have shown potential in reducing these side effects, emphasizing the need for continuous technological advancements and patient-centered care in radiotherapy.

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“…Following diagnosis, staging, and surgical evaluation, multiple factors must be considered to optimize patient selection for primary treatment of localized RCC with SABR. Patient history must be evaluated for factors that would potentially increase the toxicity risk of abdominal SABR, such as prior abdominal radiotherapy, inflammatory bowel disease [42], connective tissue disorders [43], or concurrent administration of certain systemic therapies [44]. Due to the unique management implications of disorders such as Von Hippel-Landau (VHL) disease, patients should be considered for genetic testing if presenting with multiple renal masses, age ≤ 46 years at diagnosis, or with a family history of RCC [20,45].…”

Section: Patient Evaluation Prior To Sabrmentioning

confidence: 99%

The Judicious Use of Stereotactic Ablative Radiotherapy in the Primary Management of Localized Renal Cell Carcinoma

Barbour

Kirste

Grosu

et al. 2023

Cancers

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Localized renal cell carcinoma is primarily managed surgically, but this disease commonly presents in highly comorbid patients who are poor operative candidates. Less invasive techniques, such as cryoablation and radiofrequency ablation, are effective, but require percutaneous or laparoscopic access, while generally being limited to cT1a tumors without proximity to the renal pelvis or ureter. Active surveillance is another management option for small renal masses, but many patients desire treatment or are poor candidates for active surveillance. For poor surgical candidates, a growing body of evidence supports stereotactic ablative radiotherapy (SABR) as a safe and effective non-invasive treatment modality. For example, a recent multi-institution individual patient data meta-analysis of 190 patients managed with SABR estimated a 5.5% five-year cumulative incidence of local failure with one patient experiencing grade 4 toxicity, and no other grade ≥3 toxic events. Here, we discuss the recent developments in SABR for the management of localized renal cell carcinoma, highlighting key concepts of appropriate patient selection, treatment design, treatment delivery, and response assessment.

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Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series

Cited by 3 publications

References 19 publications

Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning

Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning

Radiotherapy Related Bowel and Bladder Toxicity after Prostate Cancer Irradiation

The Judicious Use of Stereotactic Ablative Radiotherapy in the Primary Management of Localized Renal Cell Carcinoma

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