Late rectal and bladder toxicity following radiation therapy for prostate cancer: Predictive factors and treatment results

Abstract

Aim

This study aimed at investigating factors associated to late rectal and bladder toxicity following radiation therapy and the effectiveness of Hyperbaric Oxygen Therapy (HBOT) when toxicity is grade ≥2.

Background

Radiation is frequently used for prostate cancer, but a 5–20% incidence of late radiation proctitis and cystitis exists. Some clinical and dosimetric factors have been defined without a full agreement. For patients diagnosed of late chronic proctitis and/or cystitis grade ≥2 treatment is not well defined. Hyperbaric Oxygen Therapy (HBOT) has been used, but its effectiveness is not well known.

Materials and methods

257 patients were treated with radiation therapy for prostate cancer. Clinical, pharmacological and dosimetric parameters were collected. Patients having a grade ≥2 toxicity were treated with HBOT. Results of the intervention were measured by monitoring toxicity by Common Toxicity Criteria v3 (CTCv3).

Results

Late rectal toxicity was related to the volume irradiated, i.e. V50[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]53.64 (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.013); V60[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]38.59% (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.005); V65[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]31.09% (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.002) and V70[[ce:hsp sp="0.25"/]]>[[ce:hsp sp="0.25"/]]22.81% (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.012). We could not correlate the volume for bladder. A total of 24 (9.3%) patients experienced a grade ≥2. Only the use of dicumarinic treatment was significant for late rectal toxicity (p[[ce:hsp sp="0.25"/]]=[[ce:hsp sp="0.25"/]]0.014). A total of 14 patients needed HBOT. Final percentage of patients with a persistent toxicity grade ≥2 was 4.5%.

Conclusion

Rectal volume irradiated and dicumarinic treatment were associated to late rectal/bladder toxicity. When toxicity grade ≥2 is diagnosed, HBOT significantly ameliorate symptoms.