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Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer.

Gurka MK, Chen LN, Bhagat A, Moures R, Kim JS, Yung T, Lei S, Collins BT, Krishnan P, Suy S, Dritschilo A, Lynch JH, Collins SP - Radiat Oncol (2015)

Bottom Line: There were no grade 4 or 5 events.The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%.On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Louisville, Louisville, USA. marie.gurka@gmail.com.

ABSTRACT

Background: Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient's quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution.

Methods: Two hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35-36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26.

Results: The median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.

Conclusions: SBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors associated with BPH, such as larger prostate volume, alpha antagonist usage, and prior history of procedures for BPH are at increased risk for the development of hematuria.

No MeSH data available.


Related in: MedlinePlus

Treatment plan. (a) Axial T2-weighted MR image demonstrating central simple prostatectomy defect (arrow). (b) Treatment planning axial CT images demonstrating the prostate (red line). Isodose lines shown as follows: 115% of the prescription dose, pink line; 100% of the prescription dose, blue line: 75% of the prescription dose, orange line; and 50% of the prescription dose, green line.
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Fig1: Treatment plan. (a) Axial T2-weighted MR image demonstrating central simple prostatectomy defect (arrow). (b) Treatment planning axial CT images demonstrating the prostate (red line). Isodose lines shown as follows: 115% of the prescription dose, pink line; 100% of the prescription dose, blue line: 75% of the prescription dose, orange line; and 50% of the prescription dose, green line.

Mentions: SBRT treatment planning and delivery were conducted as previously described (Figure 1) [18,19]. Four gold markers were placed into the prostate 5–7 days prior to simulation. Patients were simulated with an empty bladder. Fused computed tomography (CT) and magnetic resonance (MR) images were used for treatment planning. The clinical target volume (CTV) included the prostate and the proximal seminal vesicles. Intrafraction image-guidance was employed to minimize the required PTV treatment margins [20]. The PTV equaled the CTV expanded 3 mm posteriorly and 5 mm in all other dimensions. The prescription dose was 35–36.25 Gy to the PTV delivered in five fractions of 7–7.25 Gy corresponding to a tumor EQD2 of approximately 85–90 Gy assuming an alpha/ beta ratio of 1.5. The prescription isodose line was limited to ≥ 75%, which limited the maximum prostatic urethra dose to 133% of the prescription dose. The bladder was contoured and evaluated with dose-volume histogram analysis during treatment planning using Multiplan (Accuray Inc., Sunnyvale, CA) inverse treatment planning. The empty bladder volume receiving 37 Gy was limited to < 10 cc in all patients. The bladder dose-volume histogram (DVH) goals were < 40% bladder volume receiving 50% of the prescribed dose and < 10% receiving 100% of the prescribed dose. To minimize the risk of local recurrence, the dose to the prostatic urethra was not constrained [21].Figure 1


Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer.

Gurka MK, Chen LN, Bhagat A, Moures R, Kim JS, Yung T, Lei S, Collins BT, Krishnan P, Suy S, Dritschilo A, Lynch JH, Collins SP - Radiat Oncol (2015)

Treatment plan. (a) Axial T2-weighted MR image demonstrating central simple prostatectomy defect (arrow). (b) Treatment planning axial CT images demonstrating the prostate (red line). Isodose lines shown as follows: 115% of the prescription dose, pink line; 100% of the prescription dose, blue line: 75% of the prescription dose, orange line; and 50% of the prescription dose, green line.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4358866&req=5

Fig1: Treatment plan. (a) Axial T2-weighted MR image demonstrating central simple prostatectomy defect (arrow). (b) Treatment planning axial CT images demonstrating the prostate (red line). Isodose lines shown as follows: 115% of the prescription dose, pink line; 100% of the prescription dose, blue line: 75% of the prescription dose, orange line; and 50% of the prescription dose, green line.
Mentions: SBRT treatment planning and delivery were conducted as previously described (Figure 1) [18,19]. Four gold markers were placed into the prostate 5–7 days prior to simulation. Patients were simulated with an empty bladder. Fused computed tomography (CT) and magnetic resonance (MR) images were used for treatment planning. The clinical target volume (CTV) included the prostate and the proximal seminal vesicles. Intrafraction image-guidance was employed to minimize the required PTV treatment margins [20]. The PTV equaled the CTV expanded 3 mm posteriorly and 5 mm in all other dimensions. The prescription dose was 35–36.25 Gy to the PTV delivered in five fractions of 7–7.25 Gy corresponding to a tumor EQD2 of approximately 85–90 Gy assuming an alpha/ beta ratio of 1.5. The prescription isodose line was limited to ≥ 75%, which limited the maximum prostatic urethra dose to 133% of the prescription dose. The bladder was contoured and evaluated with dose-volume histogram analysis during treatment planning using Multiplan (Accuray Inc., Sunnyvale, CA) inverse treatment planning. The empty bladder volume receiving 37 Gy was limited to < 10 cc in all patients. The bladder dose-volume histogram (DVH) goals were < 40% bladder volume receiving 50% of the prescribed dose and < 10% receiving 100% of the prescribed dose. To minimize the risk of local recurrence, the dose to the prostatic urethra was not constrained [21].Figure 1

Bottom Line: There were no grade 4 or 5 events.The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%.On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Louisville, Louisville, USA. marie.gurka@gmail.com.

ABSTRACT

Background: Hematuria following prostate radiotherapy is a known toxicity that may adversely affect a patient's quality of life. Given the higher dose of radiation per fraction using stereotactic body radiation therapy (SBRT) there is concern that post-SBRT hematuria would be more common than with alternative radiation therapy approaches. Herein, we describe the incidence and severity of hematuria following stereotactic body radiation therapy (SBRT) for prostate cancer at our institution.

Methods: Two hundred and eight consecutive patients with prostate cancer treated with SBRT monotherapy with at least three years of follow-up were included in this retrospective analysis. Treatment was delivered using the CyberKnife® (Accuray) to doses of 35-36.25 Gy in 5 fractions. Toxicities were scored using the CTCAE v.4. Hematuria was counted at the highest grade it occurred in the acute and late setting for each patient. Cystoscopy findings were retrospectively reviewed. Univariate and multivariate analyses were performed. Hematuria-associated bother was assessed via the Expanded Prostate Index Composite (EPIC)-26.

Results: The median age was 69 years with a median prostate volume of 39 cc. With a median follow-up of 48 months, 38 patients (18.3%) experienced at least one episode of hematuria. Median time to hematuria was 13.5 months. In the late period, there were three grade 3 events and five grade 2 events. There were no grade 4 or 5 events. The 3-year actuarial incidence of late hematuria ≥ grade 2 was 2.4%. On univariate analysis, prostate volume (p = 0.022) and history of prior procedure(s) for benign prostatic hypertrophy (BPH) (p = 0.002) were significantly associated with hematuria. On multivariate analysis, history of prior procedure(s) for BPH (p < 0.0001) and α1A antagonist use (p = 0.008) were significantly associated with the development of hematuria.

Conclusions: SBRT for prostate cancer was well tolerated with hematuria rates comparable to other radiation modalities. Patients factors associated with BPH, such as larger prostate volume, alpha antagonist usage, and prior history of procedures for BPH are at increased risk for the development of hematuria.

No MeSH data available.


Related in: MedlinePlus