title: Hip-related toxicity after prostate radiotherapy: Treatment related or coincidental?
abstract: To evaluate the incidence and predictors of hip toxicity postradiotherapy for localized prostate cancer.
  
  
  
  4067 prostate cancer patients were treated with external beam radiotherapy (EBRT; n=2569; 63%) or brachytherapy with or without supplemental EBRT (n=1508; 27%). 43% (n=1738) were treated with neo-adjuvant and concurrent ADT and 57% (n=2329) with radiotherapy alone. Hip toxicity was defined as moderate or severe pain upon ambulation with or without the need for hip-revision surgery. Median follow-up was 7years (range, 3-21years).
  
  
  
  One hundred twenty-one (2.7%) patients developed moderate-to-severe hip pain after radiotherapy affecting ambulation. Of these, 73 (60%) required hip replacement secondary to persistent hip pain. Among patients with baseline degenerative joint disease (DJD) changes on scans, 10-year incidence of hip-related toxicity was 11% versus 3% for those without such changes (P<.001). The only variables on multivariate analysis associated with hip-related toxicity post-radiotherapy were baseline DJD on imaging (P<.0001) and prolonged ADT for salvage therapy (P<.0001).
  
  
  
  Prostate EBRT or brachytherapy is associated with low incidence of long-term hip-related toxicity. The only variables identified associated with hip toxicity posttherapy was the presence of baseline DJD and prolonged salvage ADT posttreatment for patients developing recurrence.
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA. Electronic address: zelefskm@mskcc.org.
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Zelefsky
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Marisa A
authors.initials: MA
authors.lastname: Kollmeier
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Elan
authors.initials: E
authors.lastname: Gorshein
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Xin
authors.initials: X
authors.lastname: Pei
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Marina
authors.initials: M
authors.lastname: Torres
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Sean
authors.initials: S
authors.lastname: McBride
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Laura
authors.initials: L
authors.lastname: Happersett
authors.affiliation: Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Gil'ad N
authors.initials: GN
authors.lastname: Cohen
authors.affiliation: Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, USA.
authors.forename: Yoshiya
authors.initials: Y
authors.lastname: Yamada
mesh_terms: D000368:Aged; D001918:Brachytherapy / Q000009:adverse effects / Q000379:methods; D003131:Combined Modality Therapy; D006621:Hip Joint / Q000528:radiation effects*; D006801:Humans; D007592:Joint Diseases / Q000209:etiology*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D016879:Salvage Therapy
keywords: Brachytherapy; External beam radiotherapy; Hip replacement; Prostate cancer; Toxicity