Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer
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RESEARCH
Open Access
Hematuria following stereotactic body radiation therapy (SBRT) for clinically localized prostate cancer Marie K Gurka1†, Leonard N Chen2†, Aditi Bhagat2, Rudy Moures2, Joy S Kim2, Thomas Yung2, Siyuan Lei2, Brian T Collins2, Pranay Krishnan4, Simeng Suy2, Anatoly Dritschilo2, John H Lynch3 and Sean P Collins2*
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.
Background Radiation-induced hematuria is common after prostate cancer treatment due to the close proximity of the bladder and urethra to the prostate [1]. However, the incidence of clinically significant (≥ grade 2) late gross hematuria after conventionally fractionated external beam radiation therapy is generally < 5%. Hematuria commonly occurs * Correspondence: [email protected] † Equal contributors 2 Department of Radiation Medicine, Georgetown University Hospital, 3800 Reservoir Road, N.W, Washington D.C 20007, US
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