Shuang Zhang1, Kiyonao Nakamura1, Rihito Aizawa1, Shusuke Akamatsu2, Takashi Mizowaki3. 1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. 2. Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. 3. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan. mizo@kuhp.kyoto-u.ac.jp.
Abstract
BACKGROUND: Radiotherapy is a treatment option for prostate cancer patients after rectal surgery; however, the toxicity profile of radiotherapy for such patients has not been elucidated. This study aimed to evaluate the long-term toxicities and efficacy of intensity-modulated radiotherapy (IMRT) in patients with prostate cancer who had undergone rectal surgery. METHODS: We retrospectively analyzed patients with prostate cancer after rectal surgery, who were definitively treated with IMRT between January 2000 and December 2019 at our institution. The planned total dose was 70-78 Gy in 2-Gy fraction, and the dose to the rectal anastomosis was limited to 70 Gy. The acute and late toxicities and survival outcomes were evaluated. RESULTS: Twenty patients were included in the analysis. The median age was 71 years, with a median follow-up of 86 months. The median time from surgery to IMRT was 93.5 months. The median prostate-specific antigen value was 13.17 ng/ml. The median total dose was 74 Gy, and the median maximum dose to rectal anastomosis was 66.97 Gy. The 8-year biochemical recurrence-free and overall survival rates were 70.2% and 90.0%, respectively. The incidence rates of grade 2 acute genitourinary and gastrointestinal toxicities were 14.3% and 0%, respectively. No grade ≥ 3 acute or late toxicities were observed when the rectal anastomosis dose was limited to 70 Gy. CONCLUSIONS: This retrospective analysis suggested that IMRT for patients with prostate cancer after rectal surgery may be safe and effective with rectal dose constraint of Dmax < 70 Gy if more than 5 years have passed after surgery.
BACKGROUND: Radiotherapy is a treatment option for prostate cancer patients after rectal surgery; however, the toxicity profile of radiotherapy for such patients has not been elucidated. This study aimed to evaluate the long-term toxicities and efficacy of intensity-modulated radiotherapy (IMRT) in patients with prostate cancer who had undergone rectal surgery. METHODS: We retrospectively analyzed patients with prostate cancer after rectal surgery, who were definitively treated with IMRT between January 2000 and December 2019 at our institution. The planned total dose was 70-78 Gy in 2-Gy fraction, and the dose to the rectal anastomosis was limited to 70 Gy. The acute and late toxicities and survival outcomes were evaluated. RESULTS: Twenty patients were included in the analysis. The median age was 71 years, with a median follow-up of 86 months. The median time from surgery to IMRT was 93.5 months. The median prostate-specific antigen value was 13.17 ng/ml. The median total dose was 74 Gy, and the median maximum dose to rectal anastomosis was 66.97 Gy. The 8-year biochemical recurrence-free and overall survival rates were 70.2% and 90.0%, respectively. The incidence rates of grade 2 acute genitourinary and gastrointestinal toxicities were 14.3% and 0%, respectively. No grade ≥ 3 acute or late toxicities were observed when the rectal anastomosis dose was limited to 70 Gy. CONCLUSIONS: This retrospective analysis suggested that IMRT for patients with prostate cancer after rectal surgery may be safe and effective with rectal dose constraint of Dmax < 70 Gy if more than 5 years have passed after surgery.
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