Comparison of genitourinary and gastrointestinal toxicity among four radiotherapy modalities for prostate cancer: Conventional radiotherapy, intensity-modulated radiotherapy, and permanent iodine-125 implantation with or without external beam radiotherapy

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• 作者：Shinya Sutani^a ; Toshio Ohashi^a ; ^b ; ^{ohashi@rad.med.keio.ac.jp" class="auth_mail" title="E-mail the corresponding author} ; Masanori Sakayori^a ; Tomoya Kaneda^a ; Shoji Yamashita^b ; Tetsuo Momma^c ; Takashi Hanada^a ; Yutaka Shiraishi^a ; Junichi Fukada^a ; Mototsugu Oya^d ; Naoyuki Shigematsu^a
• 关键词：Prostate cancer ; Radiotherapy ; Brachytherapy ; IMRT ; Toxicity
• 刊名：Radiotherapy and Oncology
• 出版年：2015
• 出版时间：November 2015
• 年：2015
• 卷：117
• 期：2
• 页码：270-276
• 全文大小：889 K

文摘

To compare late genitourinary (GU) and gastrointestinal (GI) toxicity following different prostate cancer treatment modalities.

Materials and methods

This study included 1084 consecutive prostate cancer patients treated with conventional radiotherapy, intensity-modulated radiotherapy (IMRT), permanent iodine-125 implantation (PI) alone, and PI combined with external beam radiotherapy (PI + EBRT). The effects of treatment- and patient-related factors on late grade ⩾ 2 (G2+) GU/GI toxicity risk were assessed.

Results

The median follow-up was 43 months (range, 12–97 months). Compared to the PI + EBRT, there was significantly less G2+ GU toxicity in the conventional radiotherapy (hazard ratio [HR] = 0.39; 95% CI, 0.20–0.77) and the IMRT (HR = 0.45, 95% CI, 0.27–0.73). Compared to the PI + EBRT, there was significantly more G2+ GI toxicity in the IMRT (HR = 2.38; 95% CI, 1.16–4.87). In PI-related groups, prostate equivalent dose in 2 Gy fractions was a significant predictor of G2+ GU toxicity (p = 0.001), and the rectal volume receiving more than 100% of the prescribed dose was a significant predictor of G2+ GI toxicity (p = 0.001).

Conclusion

The differences in the late G2+ GU/GI risk cannot be explained by the differences in treatment modalities themselves, but by the total radiation dose to the GU/GI tract, which had a causal role in the development of late G2+ GU/GI toxicity across all treatment modality groups.