Stereotactic Body Radiation Therapy for the Treatment of Localized Prostate Cancer in Men with Underlying Inflammatory Bowel Disease

Overview

Journal Radiat Oncol

Publisher Biomed Central

Specialties Oncology
Radiology

Date 2021 Jul 10

PMID 34243797

Citations 3

Authors

Jonathan W Lischalk

Seth Blacksburg

Christopher Mendez

Michael Repka

Astrid Sanchez

Todd Carpenter

Matthew Witten

Jules E Garbus

Andrew Evans

Sean P Collins

Aaron Katz

Jonathan Haas

Affiliations

Soon will be listed here.

Abstract

Background: Historically, IBD has been thought to increase the underlying risk of radiation related toxicity in the treatment of prostate cancer. In the modern era, contemporary radiation planning and delivery may mitigate radiation-related toxicity in this theoretically high-risk cohort. This is the first manuscript to report clinical outcomes for men diagnosed with prostate cancer and underlying IBD curatively treated with stereotactic body radiation therapy (SBRT).

Methods: A large institutional database of patients (n = 4245) treated with SBRT for adenocarcinoma of the prostate was interrogated to identify patients who were diagnosed with underlying IBD prior to treatment. All patients were treated with SBRT over five treatment fractions using a robotic radiosurgical platform and fiducial tracking. Baseline IBD characteristics including IBD subtype, pre-SBRT IBD medications, and EPIC bowel questionnaires were reviewed for the IBD cohort. Acute and late toxicity was evaluated using the CTCAE version 5.0.

Results: A total of 31 patients were identified who had underlying IBD prior to SBRT for the curative treatment of prostate cancer. The majority (n = 18) were diagnosed with ulcerative colitis and were being treated with local steroid suppositories for IBD. No biochemical relapses were observed in the IBD cohort with early follow up. High-grade acute and late toxicities were rare (n = 1, grade 3 proctitis) with a median time to any GI toxicity of 22 months. Hemorrhoidal flare was the most common low-grade toxicity observed (n = 3).

Conclusion: To date, this is one of the largest groups of patients with IBD treated safely and effectively with radiation for prostate cancer and the only review of patients treated with SBRT. Caution is warranted when delivering therapeutic radiation to patients with IBD, however modern radiation techniques appear to have mitigated the risk of GI side effects.

Citing Articles

Distinguishing Physiological Ureter Uptake From an Involved Lymph Node in Staging Prostate-Specific Membrane Antigen (PSMA) Scans: Implications for Radiation Planning.

Ching L, Bourne M, Kearney T, Choudhury K, Zwart A, Danner M Cureus. 2024; 16(6):e63105.

PMID: 39055460 PMC: 11271162. DOI: 10.7759/cureus.63105.

Safety of Radiation Therapy in Patients With Prostate Cancer and Inflammatory Bowel Disease: A Systematic Review.

Trotta M, Patel K, Singh S, Verma V, Ryckman J Pract Radiat Oncol. 2023; 13(5):454-465.

PMID: 37100389 PMC: 10527639. DOI: 10.1016/j.prro.2023.04.006.

Rationale for Utilization of Hydrogel Rectal Spacers in Dose Escalated SBRT for the Treatment of Unfavorable Risk Prostate Cancer.

Repka M, Creswell M, Lischalk J, Carrasquilla M, Forsthoefel M, Lee J Front Oncol. 2022; 12:860848.

PMID: 35433457 PMC: 9008358. DOI: 10.3389/fonc.2022.860848.

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