Late gastrointestinal toxicities following radiation therapy for prostate cancer

Abstract

Background: Radiation therapy is commonly used to treat localized prostate cancer; however, representative data regarding treatment-related toxicities compared with conservative management are sparse.

Objective: To evaluate gastrointestinal (GI) toxicities in men treated with either primary radiation or conservative management for T1-T2 prostate cancer.

Design, setting, and participants: We performed a population-based cohort study, using Medicare claims data linked to the Surveillance Epidemiology and End Results data. Competing risk models were used to evaluate the risks.

Measurements: GI toxicities requiring interventional procedures occurring at least 6 mo after cancer diagnosis.

Results and limitations: Among 41,737 patients in this study, 28,088 patients received radiation therapy. The most common GI toxicity was GI bleeding or ulceration. GI toxicity rates were 9.3 per 1000 person-years after three-dimensional conformal radiotherapy, 8.9 per 1000 person-years after intensity-modulated radiotherapy, 5.3 per 1000 person-years after brachytherapy alone, 20.1 per 1000 person-years after proton therapy, and 2.1 per 1000 person-years for conservative management patients. Radiation therapy is the most significant factor associated with an increased risk of GI toxicities (hazard ratio [HR]: 4.74; 95% confidence interval [CI], 3.97-5.66). Even after 5 yr, the radiation group continued to experience significantly higher rates of new GI toxicities than the conservative management group (HR: 3.01; 95% CI, 2.06-4.39). Because our cohort of patients were between 66 and 85 yr of age, these results may not be applicable to younger patients.

Conclusions: Patients treated with radiation therapy are more likely to have procedural interventions for GI toxicities than patients with conservative management, and the elevated risk persists beyond 5 yr.

Fig. 1

Cumulative incidence estimates of any gastrointestinal (GI) toxicity by treatment group. Competing risk was computed by using cumulative incidence adjusting for death from any cause prior to any GI toxicity.

Fig. 2

Cumulative incidence estimates of any gastrointestinal (GI) toxicity by radiation modality. Competing risk was computed by using cumulative incidence adjusting for death from any cause prior to any GI toxicity. 3D CRT = three-dimensional conformal radiotherapy; Brachy = brachytherapy; IMRT = intensity-modulated radiotherapy; Proton = proton beam therapy.

Fig. 3

(a) Cumulative incidence estimates of any gastrointestinal (GI) toxicity by year of cancer diagnosis for proton-treated patients. Competing risk was computed by using cumulative incidence adjusting for death from any causes prior to any GI toxicity. (b) Cumulative incidence estimates of any GI toxicity by year of cancer diagnosis for patients treated with intensity-modulated radiotherapy. Competing risk was computed by using cumulative incidence adjusting for death from any causes before any GI toxicity.

Fig. 3

(a) Cumulative incidence estimates of any gastrointestinal (GI) toxicity by year of cancer diagnosis for proton-treated patients. Competing risk was computed by using cumulative incidence adjusting for death from any causes prior to any GI toxicity. (b) Cumulative incidence estimates of any GI toxicity by year of cancer diagnosis for patients treated with intensity-modulated radiotherapy. Competing risk was computed by using cumulative incidence adjusting for death from any causes before any GI toxicity.