Patterns and predictors of amelioration of genitourinary toxicity after high-dose intensity-modulated radiation therapy for localized prostate cancer: Implications for defining postradiotherapy urinary toxicity Journal Article


Authors: Ghadjar, P.; Jackson, A.; Spratt, D. E.; Oh, J. H.; Munck Af Rosenschold, P.; Kollmeier, M.; Yorke, E.; Hunt, M.; Deasy, J. O.; Zelefsky, M. J.
Article Title: Patterns and predictors of amelioration of genitourinary toxicity after high-dose intensity-modulated radiation therapy for localized prostate cancer: Implications for defining postradiotherapy urinary toxicity
Abstract: Background Treatment-related toxicity and quality of life (QoL) considerations are important when counseling patients with localized prostate cancer (PCa). Objective To determine the incidence and longitudinal pattern of late genitourinary (GU) toxicity and QoL after high-dose, intensity-modulated radiotherapy (IMRT). Design, setting, and participants A total of 268 patients with localized PCa were treated between June 2004 and December 2008 at a tertiary referral center. Median follow-up was 5 yr (range: 3-7.7 yr). Intervention Patients underwent IMRT to a total dose of 86.4 Gy; 50% of patients underwent neoadjuvant and concurrent androgen-deprivation therapy. Outcome measurements and statistical analysis Patients were evaluated with the prospectively obtained International Prostate Symptom Score (IPSS) questionnaire. GU toxicity was also scored using the Common Terminology Criteria for Adverse Events (CTCAE) v.4.0; toxicity events were defined as increase over baseline. Differences in increases in IPSS sums and QoL index between baseline IPSS sum and QoL index groups were analyzed using the Kruskal-Wallis and Mann-Whitney tests. Univariate and multivariate Cox regression models were applied. Results and limitations The overall median IPSS sum increase during follow-up was 3 and was less pronounced among patients with severe baseline symptoms compared with those with mild baseline symptoms (median increase: 0 vs 4; p < 0.0001). Overall QoL index was unchanged after IMRT but appeared to improve in patients with dissatisfied baseline QoL compared with satisfied baseline QoL (p < 0.0001). Fifty-five (20%) and 2 (1%) patients developed grade 2 and 3 late GU toxicities, respectively; however, in 28 of 57 patients (49%), toxicity resolved during follow-up. Even though the IPSS data were prospectively obtained, most patients were not treated within a prospective protocol. Conclusions Late GU toxicity after high-dose IMRT was mild; severe, late GU toxicity was rare. Changes in IPSS sum and QoL index were dependent on the baseline GU function, which might be useful for future patient counseling. © 2013 European Association of Urology.
Keywords: radiotherapy; prostatic neoplasms; toxicity; urogenital abnormalities
Journal Title: European Urology
Volume: 64
Issue: 6
ISSN: 0302-2838
Publisher: Elsevier Science, Inc.  
Date Published: 2013-12-01
Start Page: 931
End Page: 938
Language: English
DOI: 10.1016/j.eururo.2013.02.001
PROVIDER: scopus
PUBMED: 23522772
PMCID: PMC4786022
DOI/URL:
Notes: --- - Cited By (since 1996):1 - "Export Date: 2 December 2013" - "CODEN: EUURA" - "Source: Scopus"
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MSK Authors
  1. Michael J Zelefsky
    615 Zelefsky
  2. Marisa A Kollmeier
    144 Kollmeier
  3. Andrew Jackson
    167 Jackson
  4. Ellen D Yorke
    314 Yorke
  5. Jung Hun Oh
    111 Oh
  6. Joseph Owen Deasy
    277 Deasy
  7. Margie A Hunt
    228 Hunt
  8. Daniel Eidelberg Spratt
    83 Spratt