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Clinical Predictors of Acute Urinary Symptoms Following Radiotherapy for Prostate Cancer

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A provisional study conducted by Italian researchers revealed that utilizing a modeling program in conjunction with IPSS and dosage measure can foretell the seriousness of acute urinary symptoms in patients with early prostate cancer who have received radiotherapy.

Quantitative models predicting the risk of acute (and late) genito-urinary (GU) toxicity in patients treated with high dose radiotherapy for prostate cancer are lacking. This work represents one of the first attempts to provide radiation oncologists with quantitative tools to reliably predict the risk of moderate-severe acute GU effects based on both clinical and dosimetric individual parameters," said Dr. Cesare Cozzarini of the San Raffaele Scientific Institute, Dept. of Radiation Oncology in Milan, Italy.

Cozzarini presented the study’s findings at the 5th European Multidisciplinary Meeting on Urological Cancers (EMUC) held in Marseille. A potential group study (DUE-01) which started in April 2010, Cozzarini and colleagues sought to develop predictive models of genito-urinary (GU) toxicity and erectilse dysfuction following high dose radiotherapy (RT) for prostate cancer.

Patients treated with standard (1.8-2Gy/fr, CONV) or moderate hypo-fractionation (2.5-2.7Gy/fr HYPO) were included.

In their ad-interim analysis, the researchers also planned to find a correlation between pollakiuria (POLL), dysuria (DYS) and nicturia (NICT) as measured by IPSS at RT end and clinical/dosimetric risk factors.

IPSS questionnaire at the beginning and at the end of RT were prospectively collected by the researchers and planning data were gathered and analyzed with a dedicated program (Vodca, MSS GmbH, Zurich), including absolute (cc/cm2) and % bladder dose-volume/surface (DVH/DSH) guidelines referred to both the entire treatment and to the weekly delivered dose (DVHw/DSHw).

For this study, pertinent clinical factors were also prospectively gathered including T stage, concomitant morbidities and drugs, use of hormonal therapy (HT), previous surgery, smoking, age, body mass index (BMI), and prostate volume. In IPSS, each article ranges from 0 to 5 with increasing score which points to increasing toxicity severity: for every question, a score≥4 at the end of the therapy was regarded as the end point.rt prostate cancer

During the time of the analysis (January 2013), 339 patients had been enrolled by nine institutes. Clinical data of 212/339 patients were available (93 CONV and 119 HYPO). Of 172/212 patients both baseline and end-RT IPSS were gathered.

For 179/212 patients. DVH/DSH was also available. Questions POLL, DYS and NICT (respectively 2, 3 and 7) demonstrated the higher increase of the fraction of patients with scores ≥4 between basal and end questionnaire; consequently, the analysis focused on these symptoms.

The number of patients with scores≥4 increased from 8 to 30 for POLL, from 5 to 20 for DYS and from 12 to 34 for NICT. At MVA (overall p<0.0001), the main independent predictors of acute POLL were: Smoking (OR:2.74, p=0.04) and S8.5w (OR:1.01, p=0.10); AUC=0.66. The model was also verified following the omission of patients with baseline IPSS-POLL ≥4 (AUC=0.69).

"This study (DUE01) is aimed at prospectively collecting an enormous number of patient-reported information concerning GU toxicity (and erectile dysfunction as well) before, during and at the end of radiotherapy and for a period of five years after its completion. The study therefore has a high probability of helping to develop highly reliable models for the prediction of acute and late GU toxicity and erectile dysfunction and their impact on quality of life,” said Cozzarini.

"As a consequence, the final results of this investigation should have a significant impact on the evolution of radiotherapy of prostate cancer in the next five to 10 years leading to a significant reduction of GU toxicity and sexual dysfunction deriving from a more refined "tailoring" of the radiation therapy," he concluded.

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