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Urol Oncol. 2016 Oct;34(10):430.e1-7. doi: 10.1016/j.urolonc.2016.04.015. Epub 2016 Jul 2.

Acute and late urinary toxicity following radiation in men with an intact prostate gland or after a radical prostatectomy: A secondary analysis of RTOG 94-08 and 96-01.

Author information

1
Harvard Radiation Oncology Program, Dana Farber/Brigham and Women׳s/Cancer Center, Boston, MA.
2
NRG Oncology Statistics and Data Management Center, Philadelphia, PA.
3
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
4
Department of Urology, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
5
Sutter Cancer Research Consortium, Roseville, CA.
6
Division of Radiation Oncology, Juravinski Cancer Centre, Hamilton Health Sciences, Hamilton, Ontario, Canada.
7
Department of Radiation Oncology, CHUM-Hospital Notre-Dame, Montreal, Québec, Canada.
8
Division of Radiation Oncology, Tom Baker Cancer Centre, Calgary, Alberta, Canada.
9
Department of Nuclear Medicine and Radiobiology, Centre Hospitalier Universitaire de Sherbrooke-Fleurimont, Sherbrooke, Québec, Canada.
10
Department of Radiation Oncology, University of Michigan Health System-Cancer Center, Ann Arbor, MI.
11
Southeast Cancer Control Consortium, Inc., CCOP, Winston-Salem, NC.
12
Intermountain Medical Center, Murray, UT.
13
Department of Radiation Oncology, Froedtert and the Medical College of Wisconsin, Milwaukee, WI.
14
Department of Radiation Oncology, Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, CA.
15
Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Electronic address: wshipley@partners.org.

Abstract

INTRODUCTION:

To estimate the contribution of the prostate gland and prostatic urethral inflammation to urinary symptoms after radiation therapy for prostate cancer, we performed a secondary analysis of urinary toxicity after primary radiation to an intact prostate vs. postprostatectomy radiation to the prostatic fossa in protocols RTOG 94-08 and 96-01, respectively.

MATERIALS AND METHODS:

Patients randomized to the radiation-alone arms (without hormone therapy) of the 2 trials were evaluated, including 104 men receiving primary prostate radiation to 68.4Gy on RTOG 94-08 and 371 men receiving 64.8Gy to the prostatic fossa on RTOG 96-01. Acute and late urinary toxicity were scored prospectively by RTOG scales. Chi-square test/logistic regression and cumulative incidence approach/Fine-Gray regression model were used for analyses of acute and late toxicity, respectively.

RESULTS:

Grade≥2 acute urinary toxicity was significantly higher after primary prostatic radiation compared with postprostatectomy radiation (30.8% vs. 14.0%; P<0.001), but acute grade≥3 toxicity did not differ (3.8% vs. 2.7%; P = 0.54). After adjusting for age, primary radiation resulted in significantly higher grade≥2 acute urinary toxicity (odds ratio = 3.72; 95% CI: 1.65-8.37; P = 0.02). With median follow-up of 7.1 years, late urinary toxicity was not significantly different with primary vs. postprostatectomy radiation (5-year grade≥2: 16.7% vs. 18.3%; P = 0.65; grade≥3: 6.0% vs. 3.3%; P = 0.24).

CONCLUSIONS:

Primary radiation to an intact prostate resulted in higher grade≥2 acute urinary toxicity than radiation to the prostatic fossa, with no difference in late urinary toxicity. Thus, a proportion of acute urinary toxicity in men with an intact prostate may be attributable to inflammation of the prostatic gland or urethra.

KEYWORDS:

Postprostatectomy radiation; Primary prostate cancer radiation therapy; Urinary toxicity

PMID:
27381895
PMCID:
PMC5035191
DOI:
10.1016/j.urolonc.2016.04.015
[Indexed for MEDLINE]
Free PMC Article

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