Impact of dose to the bladder trigone on long-term urinary function after high-dose intensity modulated radiation therapy for localized prostate cancer Journal Article


Authors: Ghadjar, P.; Zelefsky, M. J.; Spratt, D. E.; Munck Af Rosenschöld, P.; Oh, J. H.; Hunt, M.; Kollmeier, M.; Happersett, L.; Yorke, E.; Deasy, J. O.; Jackson, A.
Article Title: Impact of dose to the bladder trigone on long-term urinary function after high-dose intensity modulated radiation therapy for localized prostate cancer
Abstract: Purpose To determine the potential association between genitourinary (GU) toxicity and planning dose-volume parameters for GU pelvic structures after high-dose intensity modulated radiation therapy in localized prostate cancer patients. Methods and Materials A total of 268 patients who underwent intensity modulated radiation therapy to a prescribed dose of 86.4 Gy in 48 fractions during June 2004-December 2008 were evaluated with the International Prostate Symptom Score (IPSS) questionnaire. Dose-volume histograms of the whole bladder, bladder wall, urethra, and bladder trigone were analyzed. The primary endpoint for GU toxicity was an IPSS sum increase ≥10 points over baseline. Univariate and multivariate analyses were done by the Kaplan-Meier method and Cox proportional hazard models, respectively. Results Median follow-up was 5 years (range, 3-7.7 years). Thirty-nine patients experienced an IPSS sum increase ≥10 during follow-up; 84% remained event free at 5 years. After univariate analysis, lower baseline IPSS sum (P=.006), the V90 of the trigone (P=.006), and the maximal dose to the trigone (P=.003) were significantly associated with an IPSS sum increase ≥10. After multivariate analysis, lower baseline IPSS sum (P=.009) and increased maximal dose to the trigone (P=.005) remained significantly associated. Seventy-two patients had both a lower baseline IPSS sum and a higher maximal dose to the trigone and were defined as high risk, and 68 patients had both a higher baseline IPSS sum and a lower maximal dose to the trigone and were defined as low risk for development of an IPSS sum increase ≥10. Twenty-one of 72 high-risk patients (29%) and 5 of 68 low-risk patients (7%) experienced an IPSS sum increase ≥10 (P=.001; odds ratio 5.19). Conclusions The application of hot spots to the bladder trigone was significantly associated with relevant changes in IPSS during follow-up. Reduction of radiation dose to the lower bladder and specifically the bladder trigone seems to be associated with a reduction in late GU toxicity. © 2014 Elsevier Inc.
Journal Title: International Journal of Radiation Oncology, Biology, Physics
Volume: 88
Issue: 2
ISSN: 0360-3016
Publisher: Elsevier Inc.  
Date Published: 2014-02-01
Start Page: 339
End Page: 344
Language: English
DOI: 10.1016/j.ijrobp.2013.10.042
PROVIDER: scopus
PUBMED: 24411606
PMCID: PMC4581453
DOI/URL:
Notes: Export Date: 3 February 2014 -- CODEN: IOBPD -- 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