Acute and late urinary toxicity following radiation in men with an intact prostate gland or after a radical prostatectomy: A secondary analysis of RTOG 94-08 and 96-01

作者：Mak Raymond H; Hunt Daniel; Efstathiou Jason A; Heney Niall M; Jones Christopher U; Lukka Himu R; Bahary Jean Paul; Patel Malti; Balogh Alexander; Nabid Abdenour; Leibenhaut Mark H; Hamstra Daniel A; Roof Kevin S; Lee Robert Jeffrey; Gore Elizabeth M; Sandler Howard M; Shipley William U

来源：Urologic Oncology-Seminars and Original Investigations, 2016, 34(10): 430.e1-430.e7.

DOI：10.1016/j.urolonc.2016.04.015

• Primary prostate cancer radiation therapy
• Postprostatectomy radiation
• Urinary toxicity

Introduction: To estimate the contribution of the prostate gland and prostatic urethral inflammation to urinary symptoms after radiation therapy for prostate cancer, we performed a secondary analysis of urinary toxicity after primary radiation to an intact prostate vs. postprostatectomy radiation to the prostatic fossa in protocols RTOG 94-08 and 96-01, respectively.
Materials and methods: Patients randomized to the radiation-alone arms (without hormone therapy) of the 2 trials were evaluated, including 104 men receiving primary prostate radiation to 68.4Gy on RTOG 94-08 and 371 men receiving 64.8Gy to the prostatic fossa on RTOG 96-01. Acute and late urinary toxicity were scored prospectively by RTOG scales. Chi-square test/logistic regression and cumulative incidence approach/Fine-Gray regression model were used for analyses of acute and late toxicity, respectively.
Results: Grade >= 2 acute urinary toxicity was significantly higher after primary prostatic radiation compared with postprostatectomy radiation (30.8% vs. 14.0%; P < 0.001), but acute grade >= 3 toxicity did not differ (3.8% vs. 2.7%; P = 0.54). After adjusting for age, primary radiation resulted in significantly higher grade >= 2 acute urinary toxicity (odds ratio = 3.72; 95% CI: 1.65-8.37; P = 0.02). With median follow-up of 7.1 years, late urinary toxicity was not significantly different with primary vs. postprostatectomy radiation (5-year grade >= 2: 16.7% vs. 18.3%; P = 0.65; grade >= 3: 6.0% vs. 3.3%; P = 0.24).
Conclusions: Primary radiation to an intact prostate resulted in higher grade=2 acute urinary toxicity than radiation to the prostatic fossa, with no difference in late urinary toxicity. Thus, a proportion of acute urinary toxicity in men with an intact prostate may be attributable to inflammation of the prostatic gland or urethra.

• 出版日期2016-10