Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection Journal Article
| Authors: | Sandhu, A. S.; Zelefsky, M. J.; Lee, H. J.; Lombardi, D.; Fuks, Z.; Leibel, S. A. |
| Article Title: | Long-term urinary toxicity after 3-dimensional conformal radiotherapy for prostate cancer in patients with prior history of transurethral resection |
| Abstract: | Purpose: To report on the long-term urinary morbidity among prostate cancer patients with a prior history of a transurethral resection of the prostate (TURP) treated with high-dose 3-dimensional conformal radiotherapy (3D-CRT). Methods and Materials: Between 1988 and 1997, 1100 patients with clinically localized prostate cancer were treated with 3D-CRT. Of these, 120 patients (8%) were identified as having had a prior TURP and are the subjects of this analysis. The median age was 71 years (range: 49-83 years). The clinical stages of the patients were T1c: 33 (28%); T2a: 38 (32%); T2b: 15 (13%); and T3: 34 (27%). Neoadjuvant androgen ablation therapy was given to 39 (33%). The median radiation dose prescribed to the planning target volume was 75.6 Gy (range: 64.8-81 Gy). The median elapsed time from TURP to initiation of 3D-CRT was 69 months (range: 4-360 months). The median follow- up time was 51 months (range: 18-109 months). Results: Five patients of the 120 with a prior history of TURP (4%) developed a urethral stricture after 3D-CRT which was corrected with dilatation. The 5-year actuarial likelihood of ≥ Grade 2 late urinary toxicities was 9%. No Grade 4 urinary toxicities were observed in this group of patients. Among 110 patients who were completely continent of urine prior to 3D-CRT, 10 (9%) developed stress incontinence requiring 1 pad daily for protection or experienced occasional leakage (not requiring pad protection). The 5-year incidence of ≥ Grade 1 stress incontinence was 18% in patients who developed acute ≥ Grade 2 GU symptoms during the course of 3D-CRT compared to 7% for patients who experienced Grade 1 or no acute urinary symptoms (p = 0.05). The radiation dose (≥ 75.6 Gy vs. < 75.6 Gy), the number of prior TURP procedures, or the volume of resected tissue at the time of TURP had no significant impact on the long-term urinary morbidity outcome. A multivariate analysis demonstrated that the presence of Grade 2 acute urinary symptoms was the only predictor of ≥ Grade 1 stress incontinence after 3D-CRT in this group of patients. Conclusions: Despite prior TURP, the incidence of ≥ Grade 3 urinary toxicities is low. Nevertheless, especially among patients with a prior history of TURP who experience Grade 2 acute urinary symptoms during radiation treatment, a higher risk of stress incontinence is observed. (C) 2000 Elsevier Science Inc. |
| Keywords: | adult; aged; aged, 80 and over; major clinical study; androgen; radiation dose; combined modality therapy; cancer staging; follow up; follow-up studies; neoplasm staging; proportional hazards models; radiotherapy dosage; incidence; morbidity; cancer hormone therapy; prostate cancer; prostatic neoplasms; urine incontinence; multivariate analysis; radiotherapy, conformal; toxicity; transurethral resection; computer assisted radiotherapy; middle age; conformal radiotherapy; transurethral resection of prostate; urethra stricture; stress incontinence; urinary incontinence, stress; urinary tract disease; human; male; priority journal; article |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 48 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2000-10-01 |
| Start Page: | 643 |
| End Page: | 647 |
| Language: | English |
| DOI: | 10.1016/s0360-3016(00)00714-8 |
| PUBMED: | 11020559 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Export Date: 18 November 2015 -- Source: Scopus |
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