Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit, oncologic outcomes and incidence of gastrointestinal and urinary toxicities

Flores-Balcázar, Christian Haydeé; Urías-Arce, DM; Bourlon, María Teresa; Gabilondo-Navarro, Fernando; Pérez-Álvarez, Sandra Ileana; Ramos-Prudencio, Rubí; Rodríguez-Covarrubias, Francisco

doi:10.1016/j.rpor.2020.04.018

Cited by 3 publications

(7 citation statements)

References 23 publications

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“…observed reduced toxicity rates in patients receiving IMRT ( 24 ), although this effect was not observed in our cohort or in the study by Flores-Balcazar et al. ( 27 ).…”

Section: Discussioncontrasting

confidence: 74%

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis

Buwenge,

Macchia,

Cavallini

et al. 2023

Front. Oncol.

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BackgroundThe objective of this study was to assess the impact of age and other patient and treatment characteristics on toxicity in prostate cancer patients receiving adjuvant radiotherapy (RT).Materials and methodsThis observational study (ICAROS-1) evaluated both acute (RTOG) and late (RTOG/EORTC) toxicity. Patient- (age; Charlson’s comorbidity index) and treatment-related characteristics (nodal irradiation; previous TURP; use, type, and duration of ADT, RT fractionation and technique, image-guidance systems, EQD2 delivered to the prostate bed and pelvic nodes) were recorded and analyzed.ResultsA total of 381 patients were enrolled. The median EQD2 to the prostate bed (α/β=1.5) was 71.4 Gy. The majority of patients (75.4%) were treated with intensity-modulated radiation therapy (IMRT) or volumetric-modulated arc therapy (VMAT). Acute G3 gastrointestinal (GI) and genitourinary (GU) toxicity rates were 0.5% and 1.3%, respectively. No patients experienced >G3 acute toxicity. The multivariable analysis of acute toxicity (binomial logistic regression) showed a statistically significant association between older age (> 65) and decreased odds of G≥2 GI acute toxicity (OR: 0.569; 95%CI: 0.329-0.973; p: 0.040) and decreased odds of G≥2 GU acute toxicity (OR: 0.956; 95%CI: 0.918-0.996; p: 0.031). The 5-year late toxicity-free survival rates for G≥3 GI and GU toxicity were 98.1% and 94.5%, respectively. The only significant correlation found (Cox’s regression model) was a reduced risk of late GI toxicity in patients undergoing hypofractionation (HR: 0.38; 95% CI: 0.18-0.78; p: 0.008).ConclusionsThe unexpected results of this analysis could be explained by a “response shift bias” concerning the protective effect of older age and by treatment in later periods (using IMRT/VMAT) concerning the favorable effect of hypofractionation. However, overall, the study suggests that age should not be a reason to avoid adjuvant RT and that the latter is well-tolerated even with moderately hypofractionated regimens.

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“…observed reduced toxicity rates in patients receiving IMRT ( 24 ), although this effect was not observed in our cohort or in the study by Flores-Balcazar et al. ( 27 ).…”

Section: Discussioncontrasting

confidence: 74%

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis

Buwenge,

Macchia,

Cavallini

et al. 2023

Front. Oncol.

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Section: Discussionmentioning

confidence: 99%

“…A recent experience demonstrated no toxicity improvement between 3D conformal radiotherapy and intensity modulated RT, questioning how clinicians can improve the safety of the postoperative treatment. 17 Gacci et al 14 reported their experience with chondroitin sulfate (CS) and hyaluronic acid (HA) bladder instillation in patients treated with definitive or aRT. They observed that after RT about one-third of patients suffered from cystitis or urinary retention, and HA instillation might significantly improve urinary symptoms.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated Postoperative Radiotherapy in Prostate Cancer with Ialuril Soft Gels®: Toxicity and Efficacy Analysis on a Retrospective Series of 305 Patients

Nicosia¹,

Vitale²,

Cuccia³

et al. 2022

CMAR

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Aim To evaluate the impact of Ialuril soft Gels ® (HA) in reducing acute genito-urinary (GU) toxicity in patients treated with adjuvant or salvage radiotherapy for a prostate cancer relapse. Material and Methods The data of 305 patients were retrospectively collected. One hundred and five patients underwent adjuvant radiotherapy (aRT), while 200 a salvage treatment (sRT). GU toxicity was evaluated according to CTCAE v5.0. Every patient received RT combined with HA. Results Grade 1–2 GU toxicity during RT was represented by: urgency (36%), dysuria (23%), increased urinary frequency (12.1%), and urinary retention (11.8%). Nevertheless, the majority of symptoms were present at the baseline. Grade 3 severe toxicity was represented by 10 (3.2%) cases of incontinence and 3 (1%) cases of urgency. The incidence of any-grade RT-related GU toxicity was significantly higher in the aRT group than the salvage group (esRT + sRT) (83.8% versus 64.5%). When comparing the incidence of any-grade RT-related GU toxicity in the aRT, esRT, and sRT groups we observed a significant correlation favoring sRT, over esRT, and aRT. Conclusion Postoperative hypofractionated radiotherapy is safe and not correlated with increase of unexpected toxicity when administered with oral hyaluronic acid. A prospective study is necessary to confirm these results.

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“…Recently, 2 large-scale RCTs (RTOG 9601 and GETUG-AFU 16) showed that adding ADT to SRT had a positive effect on OS and/or biochemical progression-free survival (bPFS) and MFS. 16 , 17 This is reflected in the ASTRO/American Urological Association guidelines, a previous version of which were published in 2013. Those guidelines were revised in 2018, and a new statement that ADT should be offered to candidates for SRT was added.…”

Section: Discussionmentioning

confidence: 99%

“…Our results for this study's entire cohort, including 41.9% bNED, 100% OS, 96.5% LRC, and 94.9% MFS at 5 yr, were comparable to those of previous studies, which found 38%-67%, 97%-100%, 86%-96%, and 81%-98% at 5 yr, respectively (Appendix E). 5,8,[12][13][14][15][16] The relatively better PSA control of the IMRT group (Fig 1A, P = .202) should be considered partly as an effect of the more frequent use of ADT in the IMRT group (use of ADT: 3D-CRT, 3.3%; IMRT, 19.6%; P = .011), which was administered according to recent evidence. 17,18 However, bNED rates in most recent SRT trials are approximately 70-80% at 5 yr, [17][18][19][20][21][22] which are higher than reported here.…”

Section: Clinical Outcomesmentioning

confidence: 99%

Comparison Between Dose-Escalated Intensity Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy for Salvage Radiation Therapy After Prostatectomy

Shimoyachi¹,

Yoshioka²,

Sasamura³

et al. 2021

Advances in Radiation Oncology

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Transitioning from conformal radiotherapy to intensity-modulated radiotherapy after radical prostatectomy: Clinical benefit, oncologic outcomes and incidence of gastrointestinal and urinary toxicities

Cited by 3 publications

References 23 publications

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis

Unraveling the safety of adjuvant radiotherapy in prostate cancer: impact of older age and hypofractionated regimens on acute and late toxicity - a multicenter comprehensive analysis

Hypofractionated Postoperative Radiotherapy in Prostate Cancer with Ialuril Soft Gels®: Toxicity and Efficacy Analysis on a Retrospective Series of 305 Patients

Comparison Between Dose-Escalated Intensity Modulated Radiation Therapy and 3-Dimensional Conformal Radiation Therapy for Salvage Radiation Therapy After Prostatectomy

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