Worsening of 2-year patient-reported intestinal functionality after radiotherapy for prostate cancer including pelvic node irradiation.

Autor: Sanguineti G; Radiotherapy, IRCCS Istituto Nazionale dei Tumori 'Regina Elena', Roma, Italy., Pavarini M; Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy., Munoz F; Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy., Magli A; Radiotherapy, Azienda Ospedaliero Universitaria S. Maria della Misericordia, Udine, Italy., Cante D; Radiotherapy, ASL TO4 Ospedale di Ivrea, Ivrea, Italy., Garibaldi E; Radiotherapy, Ospedale Regionale Parini-AUSL Valle d'Aosta, Aosta, Italy., Gebbia A; Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy., Noris Chiorda B; Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Girelli G; Radiotherapy, Ospedale degli Infermi, Biella, Italy., Villa E; Radiotherapy, Cliniche Gavazzeni-Humanitas, Bergamo, Italy., Faiella A; Radiotherapy, IRCCS Istituto Nazionale dei Tumori 'Regina Elena', Roma, Italy., Magdalena Waskiewicz J; Radiotherapy, Comprensorio Sanitario di Bolzano, Bolzano, Italy., Avuzzi B; Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Pastorino A; Radiotherapy, A.O.SS. Antonio e Biagio, Alessandria, Italy., Moretti E; Medical Physics, Azienda sanitaria universitaria Friuli Centrale, Udine, Italy., Rago L; Radiotherapy, Centro di Riferimento Oncologico della Basilicata (IRCCS-CROB), Rionero in Vulture, Italy., Statuto T; Laboratory of Clinical Research and Advanced Diagnostics, Centro di Riferimento Oncologico della Basilicata (IRCCS - CROB), Rionero in Vulture, Italy., Gatti M; Radiotherapy, Istituto di Candiolo - Fondazione del Piemonte per l'Oncologia IRCCS, Candiolo, Italy., Rancati T; Unit of Data Science, Department of Epidemiology and Data Science, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Valdagni R; Radiotherapy, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy., Luigi Vavassori V; Radiotherapy, Cliniche Gavazzeni-Humanitas, Bergamo, Italy., Gisella Di Muzio N; Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy; Medicine and Surgery, Vita-Salute San Raffaele University, Milano, Italy., Fiorino C; Medical Physics, IRCCS San Raffaele Scientific Institute, Milano, Italy., Cozzarini C; Radiotherapy, IRCCS San Raffaele Scientific Institute, Milano, Italy. Electronic address: cozzarini.cesare@hsr.it.
Jazyk: angličtina
Zdroj: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology [Radiother Oncol] 2024 Mar; Vol. 192, pp. 110088. Date of Electronic Publication: 2024 Jan 08.
DOI: 10.1016/j.radonc.2024.110088
Abstrakt: Background and Purpose: To quantify patient-reported 2-year intestinal toxicity (IT) from pelvic nodal irradiation (PNI) for prostate cancer. The association between baseline/acute symptoms and 2-year worsening was investigated.
Materials and Methods: Patient-reported IT was prospectively assessed through the Inflammatory Bowel Disease Questionnaire (IBDQ), filled in at baseline, radiotherapy mid-point and end, at 3 and 6 months and every 6 months until 5 years. Two-year deterioration of IBDQ scores relative to the Bowel Domain was investigated for 400 patients with no severe baseline symptoms and with questionnaires available at baseline, 2 years, RT mid-point and/or end and at least three follow-ups between 3 and 18 months. The significance of the 2-year differences from baseline was tested. The association between baseline values and Δ Acute (the worst decline between baseline and RT mid-point/end) was investigated.
Results: In the IBDQ lower scores indicate worse symptoms. A significant (p < 0.0001) 2-year mean worsening, mostly in the range of -0.2/-0.4 points on a 1-7 scale, emerged excepting one question (IBDQ29, "nausea/feeling sick"). This decline was independent of treatment intent while baseline values were associated with 2-year absolute scores. The Δ Acute largely modulated 2-year worsening: patients with Δ Acute greater than the first quartile (Q1) and Δ Acute less or equal than Q1 showed no/minimal and highly significant (p < 0.0001) deterioration, respectively. Rectal incontinence, urgency, frequency and abdominal pain showed the largest mean changes (-0.5/-1): risk of severe worsening (deemed to be of clinical significance if ≤ 2) was 3-5 fold higher in the Δ Acute  ≤ Q1 vs Δ Acute  > Q1 group (p < 0.0001).
Conclusion: A modest but significant deterioration of two-year patient-reported intestinal symptoms from PNI compared to baseline was found. Patients experiencing more severe acute symptoms are at higher risk of symptom persistence at 2 years, with a much larger prevalence of clinically significant symptoms.
Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
(Copyright © 2024 Elsevier B.V. All rights reserved.)
Databáze: MEDLINE
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