Impact of neoadjuvant androgen ablation and other factors on late toxicity after external beam prostate radiotherapy

Mitchell Liu, Tom Pickles, Alexander Agranovich, Eric Berthelet, Graeme Duncan, Mira Keyes, Winkle Kwan, Michael McKenzie, James Morris, Howard Pai, Scott Tyldesley, Jonn Wu
International Journal of Radiation Oncology, Biology, Physics 2004 January 1, 58 (1): 59-67

PURPOSE: To evaluate the late toxicity profile of prostate cancer patients treated with external beam radiotherapy, to investigate the possible risk factors for late toxicity, and to determine whether neoadjuvant androgen ablation (NAA) is a factor.

METHODS AND MATERIALS: The study population consisted of 1192 patients with > or =24 months' follow-up. Late GI and GU toxicities were scored with a modified Radiation Therapy Oncology Group/Subjective, Objective, Management, and Analytic scale. All patients were treated with external beam radiotherapy (52.5 Gy in 20 fractions to 72 Gy in 36 fractions), using either conventional or three-dimensional conformal techniques. Of the 1192 patients, 40% received NAA (median 5 months). Risk factors investigated on multivariate analysis were age, past medical history, use of pelvic fields, dose, fractionation, use and duration of neo- and adjuvant androgen ablation, and acute toxicity (Grade 2 or greater).

RESULTS: The median follow-up for the group was 49 months (range 24-105). The incidence of late Grade 2-3 GI or GU toxicity was 30% at 5 years (GI 12% and GU 20%). The incidence of late Grade 3 GI or GU toxicity was 8% at 5 years (GI 2.7% and GU 5.5%). No Grade 4 toxicity occurred. The risk factors of significance in relation to the development of late Grade 3 GU toxicity were coexisting GU disease (p = 0.02), prior transurethral resection of the prostate or transurethral resection of bladder tumor (p <0.0001), and presence of acute GU toxicity (p = 0.012). For late Grade 3 GI toxicity, short-term (< or =2 months) NAA (p = 0.0002) and coexisting GI disease (p = 0.017) were risk factors.

CONCLUSION: Short-term (< or =2 months) NAA, but not longer durations of NAA, increases the risk of developing Grade 3 GI late toxicity. The possible mechanism of this phenomenon is unclear.

Full Text Links

Find Full Text Links for this Article


You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read

Save your favorite articles in one place with a free QxMD account.


Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"