Adverse effects of androgen deprivation therapy on persistent genitourinary complications after carbon ion radiotherapy for prostate cancer.
OBJECTIVE
To determine the risk factors for persistent late genitourinary (GU) morbidity after carbon ion radiotherapy (C-ion RT) for prostate cancer.


METHODS
Between April 2000 and November 2003, a Phase II study of 175 prostate cancer patients was performed to assess C-ion RT with a dose fractionation (66 Gray equivalent in 20 fractions) established from previous Phase I-II studies. The effects of the clinical and dosimetric parameters on the occurrence of persistent GU toxicity in 172 patients who survived for >18 months after C-ion RT were examined retrospectively. C-ion RT alone was performed for 33 low-risk patients, and 139 high-risk patients received C-ion RT combined with androgen deprivation therapy (ADT).


RESULTS
Grade 1 and 2 persistent GU toxicities developed in 36 (21%) and 3 (2%) patients, respectively. The use of long-course ADT (>or=24 months) and acute GU toxicity were associated with the occurrence of persistent toxicity by multivariate analysis (p = 0.016 and p = 0.048, respectively), but short-course ADT (<24 months) had no effect on the development of toxicity (p = 0.35). The 5-year actuarial complication rate of 80 patients undergoing long-course ADT was 31.1%; the corresponding rate for the 92 patients who received no ADT or short-course ADT was 22.2%.


CONCLUSIONS
Adverse effects with long-course ADT on persistent GU morbidity were observed in this study. Additional investigation is needed to identify suitable ADT administration according to risk groups, but long-course ADT should not be adopted for non-high-risk prostate cancer patients to reduce the GU toxicity rate with C-ion RT.
Ishikawa
Hitoshi
H
Research Center for Charged Particle Therapy, National Institute of Radiological Sciences, Chiba, Japan.
Tsuji
Hiroshi
H
Kamada
Tadashi
T
Hirasawa
Naoki
N
Yanagi
Takeshi
T
Mizoe
Jun-Estu
JE
Akakura
Koichiro
K
Suzuki
Hiroyoshi
H
Shimazaki
Jun
J
Nakano
Takashi
T
Tsujii
Hirohiko
H
D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000726:Androgen Antagonists / Q000009:adverse effects* / Q000627:therapeutic use; D002250:Carbon Radioisotopes / Q000009:adverse effects / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D019583:Dose Fractionation, Radiation; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009919:Orchiectomy; D011471:Prostatic Neoplasms / Q000188:drug therapy* / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000453:epidemiology*; D012189:Retrospective Studies; D012307:Risk Factors; D014521:Urethra / Q000033:anatomy & histology / Q000528:radiation effects; D014555:Urination Disorders / Q000453:epidemiology* / Q000209:etiology; D014566:Urogenital System / Q000528:radiation effects
D000726:Androgen Antagonists; D002250:Carbon Radioisotopes