Clinical Factors Predicting Late Severe Urinary Toxicity After Postoperative Radiotherapy for Prostate Carcinoma: A Single-Institute Analysis of 742 Patients

Journal Article · Sun Jan 01 04:00:00 EST 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2010.09.027· OSTI ID:22055933

Cozzarini, Cesare ^[1]; Fiorino, Claudio ^[2]; Da Pozzo, Luigi Filippo ^[3]; Alongi, Filippo; Berardi, Genoveffa; Bolognesi, Angelo ^[1]; Briganti, Alberto ^[3]; Broggi, Sara ^[2]; Deli, Aniko ^[1]; Guazzoni, Giorgio ^[3]; Perna, Lucia ^[2]; Pasetti, Marcella; Salvadori, Giovannella ^[1]; Montorsi, Francesco; Rigatti, Patrizio ^[3]; Di Muzio, Nadia ^[1]

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1. Department of Radiotherapy, San Raffaele Scientific Institute, Milan (Italy)
2. Department of Medical Physics, San Raffaele Scientific Institute, Milan (Italy)
3. Department of Urology, San Raffaele Scientific Institute, Milan (Italy)

Purpose: To investigate the clinical factors independently predictive of long-term severe urinary sequelae after postprostatectomy radiotherapy. Patients and Methods: Between 1993 and 2005, 742 consecutive patients underwent postoperative radiotherapy with either adjuvant (n = 556; median radiation dose, 70.2 Gy) or salvage (n = 186; median radiation dose, 72 Gy) intent. Results: After a median follow-up of 99 months, the 8-year risk of Grade 2 or greater and Grade 3 late urinary toxicity was almost identical (23.9% vs. 23.7% and 12% vs. 10%) in the adjuvant and salvage cohorts, respectively. On univariate analysis, acute toxicity was significantly predictive of late Grade 2 or greater sequelae in both subgroups (p <.0001 in both cases), and hypertension (p = .02) and whole-pelvis radiotherapy (p = .02) correlated significantly in the adjuvant cohort only. The variables predictive of late Grade 3 sequelae were acute Grade 2 or greater toxicity in both groups and whole-pelvis radiotherapy (8-year risk of Grade 3 events, 21% vs. 11%, p = .007), hypertension (8-year risk, 18% vs. 10%, p = .005), age {<=} 62 years at RT (8-year risk, 16% vs. 11%, p = .04) in the adjuvant subset, and radiation dose >72 Gy (8-year risk, 19% vs. 6%, p = .007) and age >71 years (8-year risk, 16% vs. 6%, p = .006) in the salvage subgroup. Multivariate analysis confirmed the independent predictive role of all the covariates indicated as statistically significant on univariate analysis. Conclusions: The risk of late Grade 2 or greater and Grade 3 urinary toxicity was almost identical, regardless of the RT intent. In the salvage cohort, older age and greater radiation doses resulted in a worse toxicity profile, and younger, hypertensive patients experienced a greater rate of severe late sequelae in the adjuvant setting. The causes of this latter correlation and apparently different etiopathogenesis of chronic damage in the two subgroups were unclear and deserve additional investigation.

• OSTI ID: 22055933
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 1 Vol. 82; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
DAMAGE
HAZARDS
HYPERTENSION
MULTIVARIATE ANALYSIS
PATIENTS
PELVIS
PROSTATE
RADIATION DOSES
RADIOTHERAPY
TOXICITY