Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series

Jesus E Juarez; Tahmineh Romero; Constantine A Mantz; Abigail Pepin; Nima Aghdam; Simeng Suy; Michael L Steinberg; Rebecca G Levin-Epstein; Nicholas G Nickols; Irving D Kaplan; Robert M Meier; Huong T Pham; Patrick W Linson; Robert L Hong; Mark K Buyyounouski; Hilary P Bagshaw; Donald B Fuller; Alan J Katz; Andrew Loblaw; Sean P Collins; Amar U Kishan

doi:10.1016/j.adro.2021.100759

Toxicity After Stereotactic Body Radiation Therapy for Prostate Cancer in Patients With Inflammatory Bowel Disease: A Multi-institutional Matched Case-Control Series

Adv Radiat Oncol. 2021 Aug 28;6(6):100759. doi: 10.1016/j.adro.2021.100759. eCollection 2021 Nov-Dec.

Authors

Jesus E Juarez¹, Tahmineh Romero², Constantine A Mantz³, Abigail Pepin^{4

5}, Nima Aghdam⁴, Simeng Suy⁴, Michael L Steinberg¹, Rebecca G Levin-Epstein¹, Nicholas G Nickols^{1

6}, Irving D Kaplan⁷, Robert M Meier⁸, Huong T Pham⁹, Patrick W Linson¹⁰, Robert L Hong¹¹, Mark K Buyyounouski¹², Hilary P Bagshaw¹², Donald B Fuller¹³, Alan J Katz¹⁴, Andrew Loblaw¹⁵, Sean P Collins⁴, Amar U Kishan^{1

16}

Affiliations

¹ Department of Radiation Oncology, UCLA Medical Center, Los Angeles, California.
² Department of Medicine Statistics Core, David Geffen School of Medicine at UCLA, Los Angeles, California.
³ 21st Century Oncology, Inc, Fort Meyers, Florida.
⁴ Department of Radiation Medicine, Georgetown University Hospital, Washington, DC.
⁵ Department of Radiation Oncology, George Washington School of Medicine and Health Sciences, Washington, DC.
⁶ Department of Radiation Oncology, West Los Angeles Veterans Health Administration, Los Angeles, California.
⁷ Department of Radiation Oncology, Beth Israel Deaconess, Boston, Massachusetts.
⁸ Swedish Radiosurgery Center, Seattle, Washington.
⁹ Section of Radiation Oncology, Virginia Mason Medical Center, Seattle, Washington.
¹⁰ Department of Radiation Oncology, Scripps MD Anderson Cancer Center, San Diego, California.
¹¹ Department of Radiation Oncology, Virginia Hospital Center, Arlington, Virginia.
¹² Department of Radiation Oncology, Stanford University, Stanford, California.
¹³ Division of Genesis Health care Partners Inc, CyberKnife Centers of San Diego Inc, San Diego, California.
¹⁴ Flushing Radiation Oncology Services, New York.
¹⁵ Department of Radiation Oncology, Odette Cancer Center, Sunnybrook Health Sciences Center, Toronto, Ontario, Canada.
¹⁶ Department of Urology, University of California, Los Angeles, California.

Abstract

Purpose: To evaluate the safety of stereotactic body radiation therapy (SBRT) for prostate cancer in men with inflammatory bowel disease (IBD).

Methods and materials: We queried a consortium database for patients with IBD receiving SBRT for prostate cancer between 2006 and 2012. Identified patients were matched with patients without a history of IBD in a 3:1 fashion based on dose, fractionation, use of androgen deprivation therapy, and age distribution. Logistic regression was used to evaluate the association between having IBD and experiencing acute and late gastrointestinal (GI) and genitourinary (GU) toxicities as scored on the Common Terminology Criteria for Adverse Events scale. Time to late toxicity was evaluated using proportional hazard Cox models. Our study was limited by absence of data on prostate size, baseline International Prostate Symptom Score, and rectal dose-volume histogram parameters.

Results: Thirty-nine patients with flare-free IBD at time of treatment (median follow-up 83.9 months) and 117 matched controls (median follow-up 88.7 months) were identified. A diagnosis of IBD was associated with increased odds of developing any late grade GI toxicity (odds ratio [OR] 6.11, P <.001) and GU toxicity (odds ratio 6.14, P < .001), but not odds of developing late grade ≥2 GI (P = .08) or GU toxicity (P = .069). Acute GI and GU toxicity, both overall and for grade ≥2 toxicities, were more frequent in men with IBD (P < .05). Time to late GI and GU toxicity of any grade was significantly shorter in patients with IBD (P < .001). Time to late grade ≥2 GU, but not grade ≥2 GI toxicity, was also shorter in patients with IBD (P = .044 for GU and P = .144 for GI).

Conclusions: Patients with IBD who received SBRT for PCa had a higher likelihood of developing acute GI and GU toxicity, in addition to experiencing lower grade late toxicities that occurred earlier. However, patients with IBD did not have a higher likelihood for late grade ≥2 GI or GU toxicity after SBRT compared with the control cohort. Interpretation of this data are limited by the small sample size. Thus, men with IBD in remission should be properly counseled about these risks when considering SBRT.