Volumetric image-guided highly conformal radiotherapy of the prostate bed: Toxicity analysis

Ingrosso, Gianluca; Carosi, Alessandra; Cristino, Daniela di; Ponti, Elisabetta; Lancia, Andrea; Murgia, Alessandra; Bruni, Claudia; Morelli, Pasquale; Pietrasanta, Franca; Santoni, Riccardo

doi:10.1016/j.rpor.2016.10.006

Cited by 6 publications

(4 citation statements)

References 33 publications

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“…Moreover, failure after SRT occurs in 82% of patients with a pre-SRT value ≥ 1.5 ng/ml [ 5 – 8 ]. Thus, local burden of disease negatively affects prognosis of these patients, and therapeutic ratio of conventional SRT may be further worsened by a rate of late grade ≥ 2 GI and GU adverse events reported in the literature, ranging between 3.4 and 18% [ 9 – 11 ]. In this setting, dose-escalated treatment may achieve better disease control [ 12 ].…”

Section: Purpose/objectivementioning

confidence: 99%

Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis

et al. 2022

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Purpose To assess outcomes between salvage radiation therapy (SRT) with curative intent and stereotactic radiotherapy for macroscopic prostate recurrence (SSRT) after radical prostatectomy (RP). In order to compare these two different options, we compared their outcomes with a propensity score-based matched analysis. Methods Data from 185 patients in seven Italian centres treated for macroscopic prostate bed recurrence after RP were retrospectively collected. To make a comparison between the two treatment groups, propensity matching was applied to create comparable cohorts. Results After matching, 90 patients in the SRT and SSRT groups were selected (45 in each arm). Kaplan–Meier analysis did not show any significant differences in terms of BRFS and PFS between matched populations ( p = 0.08 and p = 0.8, respectively). Multivariate models show that treatment was not associated with BRFS, neither in the whole or matched cohort, with HR of 2.15 (95%CI 0.63–7.25, p = 0.21) and 2.65 (95%CI 0.59–11.97, p = 0.21), respectively. In the matched cohort, lower rate of toxicity was confirmed for patients undergoing SSRT, with acute GI and GU adverse events reported in 4.4 versus 44.4% ( p < 0.001) and 28.9 versus 46.7% ( p = 0.08) of patients, and late GI and GU adverse events reported in 0 versus 13.3% ( p = 0.04) and 6.7 versus 22.2% ( p = 0.03) of patients, respectively. Conclusion Considering the favourable therapeutic ratio of this approach and the lower number of fractions needed, SSRT should be considered as an attractive alternative to conventional SRT in this setting. Supplementary Information The online version contains supplementary material available at 10.1007/s11547-022-01465-w.

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Section: Purpose/objectivementioning

confidence: 99%

Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis

et al. 2022

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“…Recently, Palumbo et al [20] reported that statins were an independent factor associated with the reduction of acute GI toxicity in 195 patients treated with IMRT for localized PCa. The protective effect of ADT on the intestinal tissue, which has been demonstrated in animal models [21] as well as in clinical studies [22][23][24], could depend on the reduction of radiation-induced cytokines and pro-inflammatory molecules (i.e., IL-6, NFkB, TGFβ) [21] within the irradiated rectal wall in patients under androgen deprivation. We identified anticoagulants and antiaggregants as clinical variables associated with acute GU toxicity, but we have to consider that anticoagulant therapy itself is a risk factor for urinary complaints and hematuria.…”

Section: Discussionmentioning

confidence: 99%

“…In a French retrospective study [25], these agents significantly affected late GU toxicity in 965 patients treated with EBRT for localized PCa. Even though the relationship between radiation-induced toxicity and anticoagulants is not clear, some reports showed that their use could be associated not only with GU but also with rectal toxicity [22,24,26] in patients undergoing radiotherapy for localized PCa. About oncologic outcomes, in our analysis clinical prognostic factors (D' Amico risk class and ISUP grade) are important tools in detecting the risk of disease progression in localized PCa patients.…”

Section: Discussionmentioning

confidence: 99%

Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis

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Ingrosso

Bini

et al. 2022

Rep Pract Oncol Radiother.

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“…Rectal bleeding as a side-effect after prostate cancer radiation therapy, PCRT, is frequently reported and the extent has been shown to be related to absorbed dose to the rectum [ 1 , 2 ]. However, most data are from primary PCRT while there is limited information on the risk of rectal bleeding in the postoperative setting, delivered by salvage radiation therapy, ST [ 3 , 4 ]. Since ST is a rescue after radical prostatectomy in prostate cancer and the only curative treatment option when there is a PSA-relapse after surgery, knowledge of curability and side-effects seem crucial.…”

Section: Introductionmentioning

confidence: 99%

Salvage radiation therapy in prostate cancer: relationship between rectal dose and long-term, self-reported rectal bleeding

et al. 2020

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Purpose To quantify the relationship between the rectal dose distribution and the prevalence of self-reported rectal bleeding among men treated with salvage radiotherapy (ST) delivered by three-dimensional conformal radiotherapy (3DCRT) for prostate cancer. To use this relationship to estimate the risk of rectal bleeding for a contemporary cohort of patients treated with volumetric modulated arc therapy (VMAT) ST. Methods and patients Rectal bleeding of any grade was reported by 56 (22%) of 255 men in a PROM-survey at a median follow-up of 6.7 years after 3DCRT ST. Treatment plan data were extracted and dose–response relationships for the rectal volumes receiving at least 35 Gy (V35Gy) or 63 Gy (V63Gy) were calculated with logistic regression. These relationships were used to estimate the risk of rectal bleeding for a cohort of 253 patients treated with VMAT ST. Results In the dose–response analysis of patients in the 3DCRT ST cohort, both rectal V35Gy and V63Gy were statistically significant parameters in univariable analysis (p = 0.005 and 0.003, respectively). For the dose–response models using either rectal V35Gy or V63Gy, the average calculated risk of rectal bleeding was 14% among men treated with VMAT ST compared to a reported prevalence of 22% for men treated with 3DCRT ST. Conclusions We identified dose–response relationships between the rectal dose distribution and the risk of self-reported rectal bleeding of any grade in a long-term perspective for men treated with 3DCRT ST. Furthermore, VMAT ST may have the potential to decrease the prevalence of late rectal bleeding.

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Volumetric image-guided highly conformal radiotherapy of the prostate bed: Toxicity analysis

Abstract: a b s t r a c tAim: To evaluate toxicity of high conformal image-guided radiotherapy of the prostate bed.Background: Radiotherapy of the prostate bed has a pivotal role in the post-operative and

Cited by 6 publications

References 33 publications

Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis

Stereotactic or conventional radiotherapy for macroscopic prostate bed recurrence: a propensity score analysis

Tomotherapy-based moderate hypofractionation for localized prostate cancer: a mono-institutional analysis

Salvage radiation therapy in prostate cancer: relationship between rectal dose and long-term, self-reported rectal bleeding

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