title: Late rectal and bladder toxicity following radiation therapy for prostate cancer: Predictive factors and treatment results.
abstract: OBJECTIVE
  This study aimed at investigating factors associated to late rectal and bladder toxicity following radiation therapy and the effectiveness of Hyperbaric Oxygen Therapy (HBOT) when toxicity is grade ≥2.
  
  
  BACKGROUND
  Radiation is frequently used for prostate cancer, but a 5-20% incidence of late radiation proctitis and cystitis exists. Some clinical and dosimetric factors have been defined without a full agreement. For patients diagnosed of late chronic proctitis and/or cystitis grade ≥2 treatment is not well defined. Hyperbaric Oxygen Therapy (HBOT) has been used, but its effectiveness is not well known.
  
  
  METHODS
  257 patients were treated with radiation therapy for prostate cancer. Clinical, pharmacological and dosimetric parameters were collected. Patients having a grade ≥2 toxicity were treated with HBOT. Results of the intervention were measured by monitoring toxicity by Common Toxicity Criteria v3 (CTCv3).
  
  
  RESULTS
  Late rectal toxicity was related to the volume irradiated, i.e. V50 > 53.64 (p = 0.013); V60 > 38.59% (p = 0.005); V65 > 31.09% (p = 0.002) and V70 > 22.81% (p = 0.012). We could not correlate the volume for bladder. A total of 24 (9.3%) patients experienced a grade ≥2. Only the use of dicumarinic treatment was significant for late rectal toxicity (p = 0.014). A total of 14 patients needed HBOT. Final percentage of patients with a persistent toxicity grade ≥2 was 4.5%.
  
  
  CONCLUSIONS
  Rectal volume irradiated and dicumarinic treatment were associated to late rectal/bladder toxicity. When toxicity grade ≥2 is diagnosed, HBOT significantly ameliorate symptoms.
authors.affiliation: Catalan Institute of Oncology. Hospital Universitari "Josep Trueta" Girona, Spain ; Institut de Recerca Biomèdica de Girona, IDIBGi, Spain.
authors.forename: Rafael
authors.initials: R
authors.lastname: Fuentes-Raspall
authors.affiliation: Unit of Hyperbaric Medicine, Hospital de Palamós, Girona, Spain.
authors.forename: José Maria
authors.initials: JM
authors.lastname: Inoriza
authors.affiliation: Catalan Institute of Oncology. Hospital Universitari "Josep Trueta" Girona, Spain ; Institut de Recerca Biomèdica de Girona, IDIBGi, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Rosello-Serrano
authors.affiliation: Catalan Institute of Oncology. Hospital Universitari "Josep Trueta" Girona, Spain ; Institut de Recerca Biomèdica de Girona, IDIBGi, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Auñón-Sanz
authors.affiliation: Unit of Hyperbaric Medicine, Hospital de Palamós, Girona, Spain.
authors.forename: Pilar
authors.initials: P
authors.lastname: Garcia-Martin
authors.affiliation: Unit of Hyperbaric Medicine, Hospital de Palamós, Girona, Spain.
authors.forename: Gemma
authors.initials: G
authors.lastname: Oliu-Isern
keywords: Bladder toxicity; Hyperbaric oxygen; Predictive factors; Radiotherapy; Rectal toxicity; Treatment