%0 Journal Article
%T Late urinary toxicity after extreme or moderate hypofractionated prostate radiotherapy in patients with prior transurethral resection of prostate (TURP).
%A Singh M
%A Maitre P
%A Krishnan A
%A Adsul K
%A Ms S
%A Chauhan H
%A Bishnu PN
%A Phurailatpam R
%A Singh P
%A Kamble D
%A Bakshi G
%A Pal M
%A Arora A
%A Misra A
%A Prakash G
%A Murthy V
%J Int J Radiat Oncol Biol Phys
%V 0
%N 0
%D 2024 Jun 20
%M 38908410
%F 8.013
%R 10.1016/j.ijrobp.2024.06.003
%X <B>OBJECTIVE: </B>To study the late urinary toxicity in patients with prostate cancer with prior transurethral resection of prostate (TURP) and treated with hypofractionated prostate radiotherapy.<BR><B>METHODS: </B>Patients diagnosed with prostate cancer, with a prior TURP, and treated with moderate or extreme hypofractionated intensity modulated radiotherapy (MHRT or SBRT), were included in this study. Severity and duration of urinary symptoms observed during serial follow up after at least three months from radiotherapy were graded per CTCAE v5.0 using information from prospectively maintained institutional database. Impact of hypofractionation and other potential contributory factors on cumulative grade 2+ late urinary toxicity was analysed with univariable and multivariable binary logistic regression.<BR><B>RESULTS: </B>Total 203 eligible patients were included (MHRT=114, 64-68Gy/25#; SBRT=89, 35-37.5Gy/5#). Median time from TURP to radiotherapy was 10 months (IQR 7-16), similar for MHRT and SBRT. Overall, mean cavity volume was 1.17cc (IQR 0.5-1.35), while in MHRT and SBRT groups was 1.03 cc (IQR 0.4-1.15) and 1.27 cc (IQR 0.5-1.4), respectively. At a median follow up of 37 months, cumulative grade 3 and grade 2 late urinary toxicity was 8.4% (n=17) and 23.2% (n=47) respectively. Grade 3 symptoms were observed at median 29 months (IQR 19-62) after radiotherapy completion, lasting for a median duration of 8 months (IQR 2-14). Hematuria (6.4%) and urinary obstruction (3.4%) were the chief grade 3 symptoms. Multivariable analysis for age, diabetes, pelvic radiotherapy, fraction size, prostate volume, TURP to radiotherapy duration, and TURP cavity volume showed no significant association with late grade 2+ urinary toxicity.<BR><B>CONCLUSIONS: </B>In this large cohort of patients with prior TURP and treated with hypofractionated prostate radiotherapy, incidence of severe late urinary adverse effects was <10%, mainly hematuria or urinary obstruction. Most of these were temporary, and no significant contributory factors were identified for late urinary morbidity after TURP and radiotherapy.