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Management of Radiation Therapy Oncology Group grade 4 urinary adverse events after radiotherapy for prostate cancer
- Source :
- BJU international. 119(5)
- Publication Year :
- 2016
-
Abstract
- Objective To describe the management of Radiation Therapy Oncology Group (RTOG) grade 4 urinary adverse events (UAEs) after radiotherapy (RT) for prostate cancer (PCa). Methods We conducted a single-centre retrospective review, over a 6-year period (2010–2015), to identify men with RTOG grade 4 UAEs after RT for PCa. RT was classified as combined therapy (radical prostatectomy [RP] followed by external beam radiotherapy [EBRT], EBRT + low-dose-rate [LDR] brachytherapy, EBRT + high-dose-rate [HDR] brachytherapy or other combinations of RT) or monotherapy RT. UAEs were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, or recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteric stricture or haemorrhage) UAEs. Results We identified 73 men with a mean age of 73 years. Of these, 44 (60%) received combined therapy, consisting of RP + EBRT (n = 19), HDR brachytherapy + EBRT (n = 19), LDR brachytherapy + EBRT (n = 5), and other combined RT (n = 1). Twenty-nine (40%) patients had monotherapy consisting of EBRT (n = 4), HDR brachytherapy (n = 11), LDR brachytherapy (n = 12), or proton beam therapy (n = 2). UAEs were isolated to the bladder in six men (8%), the outlet in 52 men (71%), and to both in 15 men (21%). UAE management included: conservative in 21 (29%), indwelling catheters in 12 (16%), reconstructive in 19 (26%), and urinary diversion (UD) in 23 men (32%). Reconstruction included: ureteric (n = 4), recto-urethral fistula repair (n = 2), and posterior urethroplasty (n =13), of which 14/16 surgeries (88%) with follow-up >90 days were successful. Conclusions Although the incidence of RTOG grade 4 UAEs after PCa radiation treatment is not well defined, their associated morbidity is significant, and approximately one third of patients with these high-grade complications require UD. Conversely, only about a quarter of patients can be managed with conservative strategies or local surgeries. Reconstruction is successful in selected patients.
- Subjects :
- Oncology
Male
Urologic Diseases
medicine.medical_specialty
Urethral stricture
Urology
medicine.medical_treatment
Brachytherapy
030232 urology & nephrology
03 medical and health sciences
Prostate cancer
0302 clinical medicine
Internal medicine
medicine
Humans
External beam radiotherapy
Aged
Retrospective Studies
Aged, 80 and over
Radiotherapy
business.industry
Prostatectomy
Urinary diversion
Prostatic Neoplasms
Middle Aged
medicine.disease
Radiation therapy
030220 oncology & carcinogenesis
Urologic disease
business
Algorithms
Subjects
Details
- ISSN :
- 1464410X
- Volume :
- 119
- Issue :
- 5
- Database :
- OpenAIRE
- Journal :
- BJU international
- Accession number :
- edsair.doi.dedup.....0f3c615211373110532a36ad6e2cc825