Ces Urol 2010, 14(3):156-163 | DOI: 10.48095/cccu2010028

Late urinary toxicity after 3D-CRT and IMRT for prostate cancer

Karel Odrážka^1,2,3, Martin Doležel^1,3, Jaroslav Vaňásek¹, Miloslava Vaculíková⁴, Milan Zouhar⁵, Jana Šefrová⁵, Petr Paluska⁵, Milan Vošmik⁵, Tereza Kohlová⁶, Iveta Kolářová¹, Miloš Broďák⁷, Pavel Navrátil⁷, Petr Prošvic⁸, Petr Hoffmann⁹, Abdulbaset Hafuda⁸

¹ Oddělení klinické a radiační onkologie, Multiscan s.r.o., Pardubická krajská nemocnice a.s., Pardubice

² 1. a 3. lékařská fakulta UK, Praha

³ Katedra radiační onkologie IPVZ, Praha

⁴ Oddělení klinické onkologie, Oblastní nemocnice Náchod

⁵ Klinika onkologie a radioterapie FN, Hradec Králové

⁶ Oddělení nukleární medicíny FN, Hradec Králové

⁷ Urologická klinika FN, Hradec Králové

⁸ Urologické oddělení, Oblastní nemocnice Náchod

⁹ Radiologická klinika FN, Hradec Králové

Aim:
The purpose of this research was to retrospectively compare late urinary toxicity of the three-dimensional conformal radiation therapy (3D-CRT) 74 Gy and intensity-modulated radiation therapy (IMRT) 78 Gy for localized prostate cancer.
Material a method:
A total of 203 patients with Tl-3 prostate cancer were treated with 3D-CRT (n = 91) and IMRT (n = 112). The median follow-up time was 5.2 years and 3.0 years, respectively. The prescription dose was 74 Gy for 3D-CRT and 78 Gy for IMRT. Late urinary toxicity was graded according to the Fox Chase modification of the Radiation Therapy Oncology Group and Late Effects Normal Tissue Task Force criteria.

Results:
There was no difference between 3D-CRT and IMRT regarding the three-year risk for the development of late urinary toxicity Grade > 2 (14% vs. 11%, p = 0.18). On multivariate analysis, two signifiant toxicity predictors were identified - previous trans-urethral resection of prostate/open transvesical prostatectomy for benign prostatic hyperplasia TURP/TVPE (relative risk 3.85) and acute urinary toxicity Grade 2 or higher (relative risk 2.35). In the total patient population, there were 22 patients with late urinary toxicity Grade 3. At last follow-up visit, 9 of them (41%) reported no or only minimal symptoms.

Conclusion:
Tolerance of 3D-CRT and IMRT was similar despite the use of high radiation dose 78 Gy with IMRT. Previous TURP/TVPE increased the risk of urinary toxicity.

Keywords: prostate cancer, radiation therapy, urinary toxicity, 3D-CRT, IMRT

Received: March 3, 2010; Accepted: March 8, 2010; Published: June 1, 2010