An endorectal balloon reduces patient-reported GI toxicity in postop radiotherapy of prostate cancer


An endorectal balloon reduces patient-reported GI toxicity in postop radiotherapy of prostate cancer

Holscher, T.; Rentsch, A.; Zastrow, S.; Wirth, M.; Ahmad, A.; Krause, M.; Troost, E.

Purpose or Objective
In dose-escalated radiotherapy (RT) of prostate cancer late rectal toxicity is one of the dose limiting factors. In primary RT, an endorectal balloon (RB) has been shown to reduce the dose to parts of rectum and anus, stabilize prostate position and may therefore be a means to improve therapeutic ratio. In postoperative radiotherapy the effect of RB is less well-known, in general a dose of <70 Gy is applied and therefore no clinical outcome data regarding the benefit of a RB is available.
The aim of this retrospective study was to assess the patient-reported late rectal toxicity (GItox) 3, 12, and 24 months after RT in postoperative prostate cancer patients receiving a daily RB, compared to an earlier cohort, which was treated without RB.
Material and Methods
We identified all patients who received postoperative radiotherapy (66 Gy in 33 fractions) after radical prostatectomy, had no nodal or distant metastases and at least one follow-up visit. In those treated between 2008 and 2013, no RB was applied whereas between 2014 and 2016, a RB was routinely applied. All patients were followed with the same set of questionnaires and outpatient visits. Results where compared and analysed by Chi²-Test (SPSS 23.0).
Results
In total, 433 patients were retrieved, of whom 194 were treated with and 239 patients without RB. The patients were well balanced according initial NCCN risk and other confounding factors. The maximum patient reported GItox in the first 2 years after RT was low: 75,5%, 20,8%, 3,7 %, 0 % reported no, grade 1 (G1), G2 and G3 GItox, respectively. The prevalence of rate of G1+ GItox was 16,5%, 15,1% and 18,0% at 3, 12, and 24 months, respectively. No GItox within 2 years occurred in 71,1% patients without RB versus 80,9% with RB. G1+ GItox was reported in 28,5% without RB and in 19,1% with RB. G2 GITox was reported by 13 (5,4%) patients without and by 3 (1,5%) with RB. These results are statistically significant at p<0,025.
Conclusion
This retrospective data show a significant and clinically relevant reduction of GItox after postoperative RT for prostate cancer using an endorectal balloon. A prospective randomized trial is currently being prepared.

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Permalink: https://www.hzdr.de/publications/Publ-27969
Publ.-Id: 27969