Universität zu Köln

Matta, Rano, Chapple, Christopher R., Fisch, Margit, Heidenreich, Axel, Herschorn, Sender, Kodama, Ronald T., Koontz, Bridget F., Murphy, Declan G., Nguyen, Paul L. and Nam, Robert K. (2019). Pelvic Complications After Prostate Cancer Radiation Therapy and Their Management: An International Collaborative Narrative Review. Eur. Urol., 75 (3). S. 464 - 477. AMSTERDAM: ELSEVIER SCIENCE BV. ISSN 1873-7560

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Abstract

Context: Radiotherapy used for treating localized prostate cancer is effective at prolonging cancer-specific and overall survival. Still, acute and late pelvic toxicities are a concern, with gastrointestinal (GI) and genitourinary (GU) sequelae being most common as well as other pelvic complications. Objective: To present a critical review of the literature regarding the incidence and risk factors of pelvic toxicity following primary radiotherapy for prostate cancer and to provide a narrative review regarding its management. Evidence acquisition: A collaborative narrative review of the literature from 2010 to present was conducted. Evidence synthesis: Regardless of the modality used, the incidence of acute high-grade pelvic toxicity is low following conventionally fractionated external beam radiotherapy (EBRT). After moderate hypofractionation, the crude cumulative incidences for late grade 3 or higher (G3+) GI and GU complications are as high as 6% and 7%, respectively. After extreme hypofractionation, the 5-yr incidences of G2+ GU and GI toxicities are 39% and 0-4%, respectively. Following brachytherapy monotherapy, crude rates of late G3 + GU toxicity range from 6% to 8%, while late GI toxicity is rare. With combination therapy (EBRT and brachytherapy), the cumulative incidence of late GU toxicity is high, between 18% and 31%; however, the prevalence is lower at 4-14%. Whole pelvic radiotherapy remains a controversial treatment option as there is increased G3+ GI toxicity compared with prostate-only treatment, with no overall survival benefit. Proton beam therapy appears to have similar toxicity to photon therapies currently in use. With respect to specific complications, urinary obstruction and urethral stricture are the most common severe urinary toxicities. Rectal and urinary bleeding can be recurrent long-term toxicities. The risk of hip fracture is also increased following prostate radiotherapy. The literature is mixed on the risk of in-field secondary pelvic malignancies following prostate radiotherapy. Urinary and GI fistulas are rare complications. Management of these toxicities may require invasive treatment and reconstructive surgery for refractory and severe symptoms. Conclusions: There has been progress in the delivery of radiotherapy, enabling the administration of higher doses with minimal tradeoff in terms of slightly increased or equal toxicity. There is a need to focus future improvements in radiotherapy on sparing critical structures to reduce GU and GI morbidities. While complications such as fistulae, bone toxicity, and secondary malignancy are rare, there is a need for higher-quality studies assessing these outcomes and their management. Patient summary: In this report, we review the literature regarding pelvic complications following modern primary prostate cancer radiotherapy and their management. Modern radiotherapy technologies have enabled the administration of higher doses with minimal increases in toxicity. Overall, high-grade long-term toxicity following prostate radiotherapy is uncommon. Management of late high-grade pelvic toxicities can be challenging, with patients often requiring invasive therapies for refractory cases. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Item Type:	Journal Article
Creators:	Creators Email ORCID ORCID Put Code Matta, Rano UNSPECIFIED UNSPECIFIED UNSPECIFIED Chapple, Christopher R. UNSPECIFIED UNSPECIFIED UNSPECIFIED Fisch, Margit UNSPECIFIED UNSPECIFIED UNSPECIFIED Heidenreich, Axel UNSPECIFIED UNSPECIFIED UNSPECIFIED Herschorn, Sender UNSPECIFIED UNSPECIFIED UNSPECIFIED Kodama, Ronald T. UNSPECIFIED UNSPECIFIED UNSPECIFIED Koontz, Bridget F. UNSPECIFIED UNSPECIFIED UNSPECIFIED Murphy, Declan G. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nguyen, Paul L. UNSPECIFIED UNSPECIFIED UNSPECIFIED Nam, Robert K. UNSPECIFIED UNSPECIFIED UNSPECIFIED
URN:	urn:nbn:de:hbz:38-155999
DOI:	10.1016/j.eururo.2018.12.003
Journal or Publication Title:	Eur. Urol.
Volume:	75
Number:	3
Page Range:	S. 464 - 477
Date:	2019
Publisher:	ELSEVIER SCIENCE BV
Place of Publication:	AMSTERDAM
ISSN:	1873-7560
Language:	English
Faculty:	Unspecified
Divisions:	Unspecified
Subjects:	no entry
Uncontrolled Keywords:	Keywords Language DOSE-RATE BRACHYTHERAPY; INTENSITY-MODULATED RADIOTHERAPY; EXTERNAL-BEAM RADIOTHERAPY; QUALITY-OF-LIFE; CONVENTIONALLY FRACTIONATED RADIOTHERAPY; 3-DIMENSIONAL CONFORMAL RADIOTHERAPY; HYPERBARIC-OXYGEN THERAPY; ARGON PLASMA COAGULATION; LONG-TERM; RANDOMIZED-TRIAL Multiple languages Urology & Nephrology Multiple languages
Refereed:	Yes
URI:	http://kups.ub.uni-koeln.de/id/eprint/15599