Rates of Adverse IBD-Related Outcomes for Patients With IBD and Concomitant Prostate Cancer Treated With Radiation Therapy

2019 ◽  
Vol 26 (5) ◽  
pp. 728-733 ◽  
Author(s):  
Linda A Feagins ◽  
Jaehyun Kim ◽  
Anchalia Chandrakumaran ◽  
Cassandra Gandle ◽  
Katrina H Naik ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Inflammatory Bowel Disease ◽  
Radiation Therapy ◽  
Cancer Diagnosis ◽  
Bowel Disease ◽  
Radiation Treatment ◽  
Multiple Logistic Regression Analysis ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Inflammatory Bowel

Abstract Background Patients with inflammatory bowel disease (IBD) may be at higher risk for complications from radiation treatment for prostate cancer. However, available data are limited, and controversy remains regarding the best treatment approach for IBD patients who develop prostate cancer. Methods A retrospective cohort study across 4 Department of Veterans Affairs hospital systems. Patients with established IBD who were diagnosed and treated for prostate cancer between 1996–2015 were included. We assessed for flares of IBD, IBD-related hospitalizations, and IBD-related surgeries within 6, 12, and 24 months of cancer diagnosis and survival at 1, 2, and 5 years. Flares of IBD were those documented as such by the treating physician, and treatment changed accordingly. Results One hundred patients with IBD and prostate cancer were identified. Forty-seven were treated with either treatment with external beam radiation or brachytherapy, and 53 were treated with nonradiation modalities. Comparing cohorts with or without radiation treatment, there were no differences in baseline IBD characteristics, Charlson comorbidity index, or prostate cancer stage. Inflammatory bowel disease flares were 2-fold higher for radiation-treated patients within 6 months (10.6% vs 5.7%) and 6–12 months (4.3% vs 1.9%) after cancer diagnosis. On multiple logistic regression analysis, radiation treatment (adjusted odds ratio, 4.82; 95% confidence interval, 1.15–20.26) was a significant predictor of flares. However, rates of IBD-related hospitalizations or surgeries were not significantly different. Conclusions In this retrospective, multicenter study, 2-fold higher rates of flare were found within the first year after prostate cancer diagnosis for patients treated with radiation, but there were no differences in IBD-related hospitalizations or surgeries. Although patients should be counseled of these risks, avoidance of radiation therapy in IBD patients with prostate cancer is likely not necessary.

Inflammatory bowel disease in patients with prostate cancer treated with radiation.

2016 ◽  
Vol 34 (2_suppl) ◽  
pp. 15-15
Author(s):  
Matthew Maxwell Gestaut ◽  
Gregory P. Swanson
Keyword(s):  
Prostate Cancer ◽  
Inflammatory Bowel Disease ◽  
Radiation Therapy ◽  
Bowel Disease ◽  
External Beam Radiation ◽  
Published Data ◽  
Beam Radiation ◽  
Radiation Stricture ◽  
Post Radiation ◽  
Inflammatory Bowel

15 Background: Inflammatory bowel disease (IBD) has long been considered a risk factor for increased bowel toxicity from radiation therapy (RT); however, minimal evidence exists for patients with prostate cancer (PC) and IBD. Methods: The tumor registry was queried for patients with both IBD and PC from 2000-2010. A chart review was conducted for patients who received RT for PC. All patients carried the diagnosis IBD as defined by either Crohn’s disease or ulcerative colitis. RT specifics and radiation toxicity (acute and late) data were collected. Results: Eighteen patients met the inclusion criteria for PC and IBD diagnoses with radiation therapy treatment. Twelve were treated with external beam radiation therapy (EBRT), and 6 were treated with low dose rate (LDR) brachytherapy. Average length of follow-up was 12 years (median 9.54, range 0.42-19.9). Most patients had well controlled baseline bowel function on medical management. Twenty-two percent were in remission from IBD without any form of treatment; 56% were actively taking 5-ASA; 17% were prescribed prednisone; and 6% were taking Remicade. Sixty percent of patients (9/15) reported grade 0 (G0) diarrhea at baseline prior to radiation therapy. Forty percent (6/15) suffered grade 1 (G1) diarrhea at baseline. No baseline proctitis existed. Two patients reported ostomy prior to radiation. Following radiation treatment, 78% (14/18) of patients experienced G0 diarrhea while 22% (4/18) reported G1 diarrhea. No patients suffered from greater than G1 diarrhea. Sixty-seven percent (12/18), 17% (3/18) and 17% (3/18) of patients experienced G0, G1, and G2 proctitis, respectively. No patients suffered post-radiation stricture formation. All patients with G2 proctitis following RT received 3dCRT. Conclusions: No available published data explores RT for patients with PC and IBD. This retrospective review offers valuable insight into appropriate counseling for a rare patient subset. EBRT was associated with improvement in late G1 diarrhea rates. Grade 2 proctitis was only encountered among 3dCRT patients. No post-radiation stricture or ostomy placements occurred. Our findings suggest that IBD patients experience minimal toxicity with IMRT-based radiation therapy.

Risk of second primary cancers after treatment for locoregional rectal cancer.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. 3578-3578 ◽  
Author(s):  
Chaitali Singh Nangia ◽  
Thomas H. Taylor ◽  
Walter Tsang ◽  
Jason Wong ◽  
Joseph Carmichael ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Rectal Cancer ◽  
Radiation Therapy ◽  
Small Intestine ◽  
Radiation Treatment ◽  
Uterine Cancer ◽  
External Beam Radiation ◽  
Second Primary ◽  
Beam Radiation ◽  
Pelvic Radiation

3578 Background: The risk of second primary colorectal cancers among rectal cancer patients has been described, but little is known about the risk of non-colorectal malignancies that may occur in the field of radiation. We attempted to quantify the risk, using data from the large population-based California Cancer Registry (CCR). Methods: We analyzed the CCR data for surgically-treated locoregional rectal cancer cases, diagnosed during the period 1988–2009. We excluded cases with second primary tumor (SPT) diagnosed within 12 months of initial diagnosis . Radiation treatment used was external beam radiation therapy. Standardized incidence ratios (SIR) with 95% confidence intervals (CI) were calculated to evaluate risk as compared to the underlying population after matching for age, sex, ethnicity, and time. Results: Of the study cohort of 13,418 rectal cancer cases, 1572 cases of SPTs were observed . The SIR was increased for small intestine cancer among cases receiving radiation treatment (4 cases observed vs. 1.01 cases expected; SIR=3.94, 95% CI 1.07-10.10) but not among cases lacking radiation treatment (4 observed vs. 4.45 expected; SIR=0.90, 5% CI 0.24-2.30). Among females treated with radiation, the SIR was increased for uterine cancer (12 observed vs. 5.59 expected; SIR=2.15, 95% CI 1.11 to 3.75) but not among cases lacking radiation therapy (23 observed vs. 26.17 expected; SIR=0.88, 95% CI 0.56-1.32). Among males receiving radiation treatment, the SIR for prostate cancer was decreased (23 observed vs. 69.78 expected; SIR=0.33; 95% CI 0.21 to 0.49) but of borderline significance among males lacking radiation therapy (243 observed vs. 276.97 expected; SIR=0.88, 95% CI 0.77-0.99). No significant differences were observed for cancers of the vagina, cervix, ovary, kidney, bladder, penis, testes, or leukemia based on prior radiation treatment for rectal cancer. Conclusions: Patients receiving pelvic radiation for treatment of rectal cancer have a subsequently higher than expected incidence of small intestine and uterine cancer. The incidence of prostate cancer appears to fall after pelvic radiation. These unexpected findings suggest complex relationships associated with radiation treatment for rectal cancer and SPT risk.

scholarly journals External beam radiation treatment for rectal cancer is associated with a decrease in subsequent prostate cancer diagnosis

Cancer ◽  
2008 ◽  
Vol 112 (4) ◽  
pp. 943-949 ◽  
Author(s):  
Karen E. Hoffman ◽  
Theodore S. Hong ◽  
Anthony L. Zietman ◽  
Anthony H. Russell
Keyword(s):  
Prostate Cancer ◽  
Rectal Cancer ◽  
Cancer Diagnosis ◽  
Radiation Treatment ◽  
External Beam Radiation ◽  
External Beam ◽  
Beam Radiation ◽  
Prostate Cancer Diagnosis

Bladder filling during radiation therapy for prostate cancer treatment: Assessment via bladder ultrasound scanner.

2018 ◽  
Vol 36 (6_suppl) ◽  
pp. 147-147
Author(s):  
Mark Raymond Waddle ◽  
Robin Landy ◽  
Karen Ryan ◽  
Katherine S. Tzou ◽  
William C Stross ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Older Patients ◽  
Radiation Treatment ◽  
Bladder Volume ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Bladder Filling ◽  
Full Bladder ◽  
Ct Simulation

147 Background: Prostate cancer patients treated with external beam radiation therapy are instructed to present daily with a full bladder to decrease small bowel and bladder toxicity and to increase reproducibility of treatment. However, older patients may have difficulty presenting with full bladders and variation of bladder volume with treatment is unknown. The objective of this study was to assess bladder filling at the time of radiation treatment (RT) using a bladder ultrasound in patients undergoing treatment for prostate cancer. Methods: Patients with prostate cancer were prospectively enrolled prior to CT simulation from January to August 2017. Bladder volume was recorded during CT simulation and daily immediately prior to RT. Patients were instructed to drink 8-12 ounces of water 30-60 minutes prior to RT. Three bladder volume measurements were recorded daily and averaged at the time of each treatment. Average bladder volume during treatment and the number of treatments with low bladder volumes ( < 50cc, < 60cc, and < 100cc) were reported using descriptive statistics. Results: A total of 13 patients completed a median of 42 days of RT during the study period, resulting in 550 daily bladder volumes. Ten patients were treated definitively and 3 with salvage radiation after prostatectomy. The median age of patients in the study was 72 years. Older patients were statistically more likely to present with low bladder volumes, with percentage of treatments with a bladder volume less than 50cc, 60cc, and 100cc being 29%, 42%, and 66% compared to only 4%, 7%, and 18% in patients aged < 70 (P < 0.01). The average bladder volume at the time of CT simulation was 176cc ± 57cc and the average volume during treatment was 140cc± 93cc, which was not statistically different (P = 0.28). The bladder volume did not significantly change over the course of treatment. Conclusions: Older patients (age 70+) with prostate cancer were more likely to present for RT with low bladder volumes in this prospective study. Our findings suggest that older patients should receive extra counseling about bladder filling and/or may require less bladder filling at the time of CT simulation to provide more accurate bowel dosimetry measurements.

Do inflammatory bowel disease patients experience more toxicity after radiotherapy for colorectal and anal cancer?

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 570-570 ◽  
Author(s):  
Bianca W. Chang ◽  
Aryavarta M. S. Kumar ◽  
Ravi P. Kiran ◽  
Matthew F. Kalady ◽  
Ian C. Lavery ◽  
...  
Keyword(s):  
Inflammatory Bowel Disease ◽  
Bowel Disease ◽  
Clinical Stage ◽  
Wound Dehiscence ◽  
Skin Toxicity ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Similar Treatment ◽  
Gi Toxicity ◽  
Inflammatory Bowel

570 Background: Despite potential oncologic gains from using radiotherapy in patients with inflammatory bowel disease (IBD), it has historically been contraindicated due to increased acute gastrointestinal (GI) toxicity. Yet recent published literature is mixed with regards to toxicity outcomes in these patients. In this study, we examine GI, genitourinary (GU), and skin toxicity in IBD patients compared to non-IBD patients both treated with external beam radiation therapy (EBRT) for anal or colorectal cancer (CRC). Methods: Anal and CRC patients who received EBRT were included in this single institutional IRB-approved study. 15 IBD patients and 30 non-IBD patients were matched 1:2 based on age (±5 years), treatment year (±1 year), BMI (±10 kg/m2), and clinical stage. No IBD patients had documented active disease at the time of treatment. All patients had a pathologic diagnosis of anal or CRC and received EBRT either neoadjuvantly or adjuvantly. Acute toxicity occurred within 100 days of EBRT. Data was collected via retrospective review of the treatment charts. Results: All patients received radiation doses between 45-52 Gy in 1.8Gy/fx or 2Gy/fx, delivered using AP/PA, IMRT, 3-field, or 4-field plans. There was no difference in the rate of grade 3 (20% vs 7%, p=0.19) or grade 4 (7% vs 0%, p=0.13) lower GI toxicity. There was also no difference in the incidence of GU (47% vs 30%, p=0.37), upper GI (60% vs 33.3%, p=0.08), or skin toxicity (40% vs 64%, p=0.17). Post-operatively, IBD patients had a significantly higher rate of wound dehiscence (35.7% vs 7.1%, p=0.02); however, there was no difference in the rate of bleeding (29% vs 18%, p=0.43), infection (50% vs 32%, p=0.50), or ileus (36% vs 11%, p=0.06). Conclusions: IBD patients with anal or CRC who received EBRT neoadjuvantly or adjuvantly did not experience more acute GI, GU, or skin toxicity than matched non-IBD patients with similar treatment. Post-operatively, IBD patients were more likely to have wound dehiscence, but were not more likely to have bleeding, infection, or ileus.

Skeletal-related events (SREs) and survival among elderly patients with stage IV prostate cancer (PCa) in SEER Medicare data.

2014 ◽  
Vol 32 (31_suppl) ◽  
pp. 249-249
Author(s):  
Ebere Onukwugha ◽  
Young Kwok ◽  
Candice Yong ◽  
Christine Franey ◽  
C. Daniel Mullins ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Radiation Therapy ◽  
Bone Metastasis ◽  
Radiation Treatment ◽  
Stage Iv ◽  
External Beam Radiation ◽  
Beam Radiation ◽  
Palliative Radiation ◽  
All Cause Mortality ◽  
Skeletal Related Events

249 Background: Skeletal-related events occurring among PCa patients with bone metastasis include radiation to the bone (RttB), pathological fracture, spinal cord compression (SCC), and bone surgery (BS). There is no validated algorithm for identifying RttB using claims data. We investigated the prevalence and mortality impact of SREs across alternative claims-based algorithms for identifying RttB. Methods: We analyzed data for stage IV PCa cases identified between 2005 and 2009 in the Surveillance, Epidemiology, and End Results registry linked with Medicare claims. Fracture, SCC, and BS were identified from claims. Focusing on external beam radiation therapy, radiopharmaceutical therapy, intensity modulated radiotherapy and stereotactic radiosurgery, three approaches were created based on data visualization software: 1) radiation claim occurred after a claim with a bone metastasis (BM) code; 2) BM code directly coincided with the period of the radiation treatment episode; 3) either #2 or the duration of the radiation episode was less than or equal to 4 weeks. Regression models for all-cause mortality used these measures. Results: The study sample included 5,380 men with stage IV PCa. The median age of the sample was 77 years. All-cause mortality was 54% during median (mean) follow-up of 579 (656) days. The proportion who had any fracture, SCC, and BS was 23.2%, 6.3%, and 5.8%. Without taking BM code or duration of radiation into consideration, the proportion who received radiation therapy was 35%. Using approaches 1, 2 and 3 we have the following four results: 1) the proportion who received RttB was 22%, 18%, and 24%; 2) the prevalence of any SRE was 39%, 37%, and 41%; 3) among those with an SRE, the proportion receiving RttB was 57%, 50%, and 58%; 4) the adjusted hazard ratio (95% CI) associated with any SRE was 1.22 (1.13–1.33), 1.22 (1.12–1.33), and 1.25 (1.15–1.36). Conclusions: Among older men diagnosed with stage IV prostate cancer, approximately one in five men received palliative radiation and the mortality impact of skeletal-related events was comparable across alternative approaches to identifying palliative radiation.

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