Late Gastrointestinal Toxicities Following Radiation Therapy for Prostate Cancer

The Cancer Institute of New Jersey, New Brunswick, NJ 08903, USA.
European Urology (Impact Factor: 13.94). 06/2011; 60(5):908-16. DOI: 10.1016/j.eururo.2011.05.052
Source: PubMed


Radiation therapy is commonly used to treat localized prostate cancer; however, representative data regarding treatment-related toxicities compared with conservative management are sparse.
To evaluate gastrointestinal (GI) toxicities in men treated with either primary radiation or conservative management for T1-T2 prostate cancer.
We performed a population-based cohort study, using Medicare claims data linked to the Surveillance Epidemiology and End Results data. Competing risk models were used to evaluate the risks.
GI toxicities requiring interventional procedures occurring at least 6 mo after cancer diagnosis.
Among 41,737 patients in this study, 28,088 patients received radiation therapy. The most common GI toxicity was GI bleeding or ulceration. GI toxicity rates were 9.3 per 1000 person-years after three-dimensional conformal radiotherapy, 8.9 per 1000 person-years after intensity-modulated radiotherapy, 5.3 per 1000 person-years after brachytherapy alone, 20.1 per 1000 person-years after proton therapy, and 2.1 per 1000 person-years for conservative management patients. Radiation therapy is the most significant factor associated with an increased risk of GI toxicities (hazard ratio [HR]: 4.74; 95% confidence interval [CI], 3.97-5.66). Even after 5 yr, the radiation group continued to experience significantly higher rates of new GI toxicities than the conservative management group (HR: 3.01; 95% CI, 2.06-4.39). Because our cohort of patients were between 66 and 85 yr of age, these results may not be applicable to younger patients.
Patients treated with radiation therapy are more likely to have procedural interventions for GI toxicities than patients with conservative management, and the elevated risk persists beyond 5 yr.

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    • "Two other recent studies , however , have suggested that PBT is associated with increased bowel toxicity compared with IMRT ( Kim et al , 2011 ; Sheets et al , 2012 ) . These studies rely on billing codes that may not capture the patient ' s own experience and large databases that contain few PBT patients and also lack data on treatment dose , margins , and other important relevant clinical factors . "
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    • "In summary, Kim et al. [3] teach us about the low rates of severe GI toxicity seen with RT. Their data show evidence of an RT learning curve and suggest that further improvements will occur once newer modalities are mastered. "
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