Hematologic Toxicity of Conformal Radiotherapy and Intensity Modulated Radiotherapy in Prostate and Bladder Cancer Patients

Background: The purpose of this study was to compare hematologic adverse effects and hematologic toxicity(HT) of pelvic irradiation in patients treated with conformal radiotherapy (CRT) and intensity modulated radiotherapy(IMRT) for radical treatment of prostate and bladder cancer. Methods: A group of 115 patients with prostate or bladdercancer treated with definitive radical radiotherapy was evaluated retrospectively. Blood test were taken before andafter treatment comprising of following indices: white blood cells (WBC) hemoglobin (HGB), red blood cell (RBC),lymphocyte (LC), neutrophil (NC) and platelet (PLT) count. Patients were divided into several subgroups and the datawas evaluated statistically using absolute and relative values. Results: There was a statistically significant differencein WBC (p=0.007), NC (p=0.031) and PLT (p=0.026) count decrease (absolute values) after treatment, between twotreatment methods (CRT and IMRT), all in favor of IMRT. The relationship still proves to be significant regardingWBC (p=0,02) and (NC) (p=0,049) after presenting the data as relative percentage loss of starting value. Howeverusing Common Terminology Criteria for Adverse Effects (CTCAE), PLT count toxicity was more common in IMRTgroup (p=0.045). Conclusion: IMRT in comparison to CRT in bladder and prostate cancer patients is associated with alesser absolute and relative decrease of hematologic indices. The hematologic effect of radiation was observed mainlyregarding LC. Patients treated with IMRT suffered from significantly lesser decrease in relative and absolute valuesof WBC and NC. The mean of absolute PLT decrease count was lower in IMRT group; however, toxicity according toCTCAE was slightly more prevalent in IMRT group.     

盆腔体外联合腔内放射治疗宫颈癌72例的临床疗效分析

目的探讨盆腔体外联合腔内放射治疗宫颈癌的疗效、不良反应及预后影响因素。方法对72例初治Ⅰ～Ⅳ期宫颈癌患者,应用6-MVX线全盆前后对穿照射,4 000～5 000 cGy,体外放疗3～4次/周,每次180～200 cGy;宫腔内放疗3 000～4 000 cGy,阴道腔内放疗3 000～4 500 cGy1,～2次/周,每次300～700 cGy,宫腔与阴道腔内治疗交替进行。结果盆腔体外联合腔内放射治疗宫颈癌的近期有效率是98.6%,5年总生存率为54.1%,其中Ⅱ期患者5年生存率为75.0%,Ⅲ期患者5年生存率为41.4%,影响宫颈癌近期疗效的主要因素是肿瘤大小。肿瘤病理类型、大小、临床分期及近期疗效是影响宫颈癌预后的因素。常见的不良反应为放射性直肠炎、放射性膀胱炎及骨髓抑制。结论盆腔体外联合腔内放射治疗宫颈癌,能提高肿瘤局部控制率,但不能有效控制肿瘤全身转移。     

A Nationwide Persistent Underutilization of Adjuvant Radiotherapy in North American Prostate Cancer Patients

ObjectiveTo examine the utilization of adjuvant radiotherapy (aRT) in contemporary prostate cancer patients with adverse pathological features at radical prostatectomy (RP).MethodsWe identified 189,240 patients with adverse features at RP (positive margin, stage ≥pT3a, and/or pN1 disease), from 2004 to 2015, within the National Cancer Database, and validated our findings within Surveillance, Epidemiology, and End Results (SEER) program. We examined the utilization of patients with aRT with adverse features at RP and patients with very aggressive disease (at least 2 of the following: ≥pT3b, pathological Gleason 8-10, and pN1). Regression analysis examined the relationship of various predictors of utilization adjusting to confounders. Pseudo R² analysis examined the magnitude of influence that each variable had on the decision to use aRT.ResultsWithin the National Cancer Database cohort, only 11.7% of our patients received aRT. In patients with very aggressive disease, aRT utilization rate was 28.9%. Within the SEER cohort, 16.3% of patients with any adverse features at time of RP received aRT. In patients with very aggressive disease, only 30% of patients received aRT. Further, year of diagnosis, Gleason grade, pathologic stage, and positive surgical margin were the variables that had the greatest influence on the decision to use aRT, and that positive surgical margin, type of institution at which care was received, and lymph node involvement were the most influential variables in patients with very aggressive disease.ConclusionsThe current standard of care in the United States represents a significant underutilization of aRT in eligible patients with prostate cancer. Urgent efforts are necessary to address this quality-of-care concern.     

Trial Participation is Not Associated with Better Biochemical Recurrence-free Survival in a Large Cohort of External Beam Radiotherapy-Treated Intermediate- and High-Risk Prostate Cancer Patients

AimsThere is a widespread belief that outcomes of cancer patients treated within clinical trials might not be representative of the outcomes obtained within standard clinical settings. We sought to investigate the effect of trial participation on biochemical recurrence (BCR) in localised, D'Amico intermediate- and high-risk prostate cancer patients treated with external beam radiotherapy (EBRT).Materials and methodsWe relied on a study population treated with EBRT between January 2001 and January 2021 at a single tertiary care centre, stratified according to trial enrolment. Separate Kaplan–Meier and multivariable Cox regression models tested BCR-free survival at 60 months within intermediate- and high-risk EBRT patients, after adjustment for covariables. Additionally, the analyses were refitted after inverse probability treatment weighting was performed separately for both risk subgroups.ResultsOf 932 eligible patients, 635 (68%) and 297 (32%) had intermediate- and high-risk prostate cancer, respectively. Overall, 53% of patients were trial participants. BCR rates were 11 versus 5% (P = 0.27) and 12 versus 14% (P = 0.08) in trial participants versus non-participants for intermediate- and high-risk subgroups, respectively. Differences in patient and clinical characteristics were recorded. Trial participation status failed to reach predictor status in multivariable Cox regression models for BCR in both intermediate-risk (hazard ratio 1.34; 95% confidence interval 0.71–2.49; P = 0.4) and high-risk patients (hazard ratio 1.03; 95% confidence interval 0.45–2.34; P = 0.9). Virtually the same results were recorded in inverse probability treatment weighting cohorts.ConclusionsRelying on a large cohort of EBRT-treated intermediate- and high-risk patients, no BCR differences were recorded between trial participants and non-participants after accounting for confounders.