Toxicity of radiotherapy following radical prostatectomy: a national population-based study evaluating the impact of timing and modality
BAUS ePoster online library. Sujenthiran A.
Jun 26, 2018; 211345
Mr. Arunan Sujenthiran
Mr. Arunan Sujenthiran
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Introduction: Evidence exists supporting the role of radiotherapy (RT) after radical prostatectomy (RP) in high-risk prostate cancer. However, concerns remain about treatment-related toxicity and costs. Aim: To evaluate the impact of timing and modality of post-prostatectomy RT on severe genitourinary (GU) and gastrointestinal (GI) toxicity.

Methods: We performed a population-based study of all men treated with post-prostatectomy RT in England (2010-2013). A validated coding system captured severe toxicity following RT. A competing-risks regression analysis was used to estimate adjusted hazard ratios (HR) comparing toxicity between the following groups: (i) RT < 6 months after RP vs RT > 6 months after RP. (ii) 3D-conformal radiotherapy (3D-CRT) vs Intensity-modulated radiotherapy (IMRT).

Results: Men who started RT > 6 months after RP were less likely to experience GU toxicity than those who started RT within 6 months (HR: 0.72, 95% CI: 0.59-0.89; p<0.01). There was no difference in GI toxicity between IMRT and 3D-CRT groups (3D-CRT: 5.8 events/100 person years; IMRT: 5.5 events/100 person years; HR: 0.85, 95% CI: 0.63-1.13; p=0.26). GU toxicity was lower but not statistically significant following IMRT (3D-CRT: 5.4 events/100 person-years; IMRT: 3.8 events/100 person-years; HR: 0.76, 95% CI: 0.55-1.03; p=0.08).

Conclusion: Starting RT at least 6 months post-RP reduced GU toxicity. The use of post-prostatectomy IMRT compared to 3D-CRT is not associated with a statistically significant reduction in rates of severe GU and GI toxicity. We would recommend waiting at least 6 months after surgery before starting RT and caution transitioning to IMRT in the post-prostatectomy setting
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