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Intensity-modulated radiation therapy for prostate cancer after rectal surgery: a single hospital long-term safety analysis

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Abstract

Background

Radiotherapy is a treatment option for prostate cancer patients after rectal surgery; however, the toxicity profile of radiotherapy for such patients has not been elucidated. This study aimed to evaluate the long-term toxicities and efficacy of intensity-modulated radiotherapy (IMRT) in patients with prostate cancer who had undergone rectal surgery.

Methods

We retrospectively analyzed patients with prostate cancer after rectal surgery, who were definitively treated with IMRT between January 2000 and December 2019 at our institution. The planned total dose was 70–78 Gy in 2-Gy fraction, and the dose to the rectal anastomosis was limited to 70 Gy. The acute and late toxicities and survival outcomes were evaluated.

Results

Twenty patients were included in the analysis. The median age was 71 years, with a median follow-up of 86 months. The median time from surgery to IMRT was 93.5 months. The median prostate-specific antigen value was 13.17 ng/ml. The median total dose was 74 Gy, and the median maximum dose to rectal anastomosis was 66.97 Gy. The 8-year biochemical recurrence-free and overall survival rates were 70.2% and 90.0%, respectively. The incidence rates of grade 2 acute genitourinary and gastrointestinal toxicities were 14.3% and 0%, respectively. No grade ≥ 3 acute or late toxicities were observed when the rectal anastomosis dose was limited to 70 Gy.

Conclusions

This retrospective analysis suggested that IMRT for patients with prostate cancer after rectal surgery may be safe and effective with rectal dose constraint of Dmax < 70 Gy if more than 5 years have passed after surgery.

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Acknowledgements

The authors express their sincere appreciation to all the staff members of the Department of Radiation Oncology and Image-Applied Therapy, Kyoto University Hospital.

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Authors and Affiliations

  1. Department of Radiation Oncology and Image-Applied Therapy, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Shuang Zhang, Kiyonao Nakamura, Rihito Aizawa & Takashi Mizowaki

  2. Department of Urology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan

    Shusuke Akamatsu

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  1. Shuang Zhang
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  2. Kiyonao Nakamura
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  3. Rihito Aizawa
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  4. Shusuke Akamatsu
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  5. Takashi Mizowaki
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Correspondence to Takashi Mizowaki.

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Zhang, S., Nakamura, K., Aizawa, R. et al. Intensity-modulated radiation therapy for prostate cancer after rectal surgery: a single hospital long-term safety analysis. Int J Clin Oncol 27, 977–982 (2022). https://doi.org/10.1007/s10147-022-02124-w

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  • DOI: https://doi.org/10.1007/s10147-022-02124-w

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