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Urethra-Sparing Prostate Cancer Stereotactic Body Radiation Therapy: Sexual Function and Radiation Dose to the Penile Bulb, the Crura, and the Internal Pudendal Arteries From a Randomized Phase 2 Trial.
Achard, Vérane; Zilli, Thomas; Lamanna, Giorgio; Jorcano, Sandra; Bral, Samuel; Rubio, Carmen; Oliveira, Angelo; Bottero, Marta; Bruynzeel, Anna M E; Ibrahimov, Roman; Minn, Heikki; Symon, Zvi; Constantin, Guillaume; Miralbell, Raymond.
Afiliación
  • Achard V; Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland.
  • Zilli T; Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Oncology Institute of Southern Switzerland (IOSI), Bellinzona, Switzerland; Faculty of Medicine, Università della Svizzera Italiana, Lugano, Switze
  • Lamanna G; Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, HFR Fribourg, Villars-sur-Glâne, Switzerland.
  • Jorcano S; Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain.
  • Bral S; Radiation Oncology, Onze-Lieve-Vrouwziekenhuis, Aalst, Belgium.
  • Rubio C; Radiation Oncology, Hospital Universitario Sanchinarro, Madrid, Spain.
  • Oliveira A; Radiation Oncology, Portuguese Institut of Oncology, Porto, Portugal.
  • Bottero M; Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy.
  • Bruynzeel AME; Radiation Oncology, Amsterdam UMC, Location Vrije Universteit, Amsterdam, The Netherlands.
  • Ibrahimov R; Radiation Oncology, Neolife Medical Center, Istanbul, Turkey.
  • Minn H; Radiation Oncology, University Hospital Turku, Turku, Finland.
  • Symon Z; Radiation Oncology, Sheba Medical Center, Ramat Gan, Israel; Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel.
  • Constantin G; Methodology and Biostatistics, Centre Georges-François-Leclerc, Dijon, France.
  • Miralbell R; Radiation Oncology, Geneva University Hospital, Geneva, Switzerland; Faculty of Medicine, University of Geneva, Geneva, Switzerland; Radiation Oncology, Teknon Oncologic Institute, Barcelona, Spain.
Int J Radiat Oncol Biol Phys ; 119(4): 1137-1146, 2024 Jul 15.
Article en En | MEDLINE | ID: mdl-38160915
ABSTRACT

PURPOSE:

Erectile dysfunction (ED) is a common side effect after prostate cancer stereotactic body radiation therapy (SBRT). We aimed to assess the correlation between the dose to the penile bulb (PB), internal pudendal arteries (IPA), and crura with the development of ED after ultrahypofractionation as part of a phase 2 clinical trial of urethra-sparing prostate SBRT. METHODS AND MATERIALS Among the 170 patients with localized prostate cancer from 9 centers included in the trial, 90 men with Common Terminology Criteria for Adverse Events version 4.03 grade 0 to 1 ED (ED-) at baseline treated with 36.25 Gy in 5 fractions were selected for the present analysis. Doses delivered to the PB, crura, and IPA were analyzed and correlated with grade 2 to 3 ED (ED+) development. The effect on quality of life, assessed by the European Organisation for Research and Treatment of Cancer (EORTC QLQ-PR25) questionnaire, was reported.

RESULTS:

After a median follow-up of 6.5 years, 43% (n = 39) of the patients developed ED+, and 57% (n = 51) remained ED-. The dose delivered to the crura was significantly higher in ED+ patients than in ED- patients (7.7 vs 3.6 Gy [P = .014] for the Dmean and 18.5 vs 7.2 Gy [P = .015] for the D2%, respectively). No statistically significant difference between ED+ and ED- patients was observed for the dose delivered to the PB and IPA. The median ED+-free survival was worse in patients receiving a crura Dmean ≥ 4.7 versus < 4.7 Gy (51.5% vs 71.7%, P = .005) and a crura D2% > 12 versus ≤ 12 Gy (54.9% vs 68.9%, P = .015). No ED+-free survival differences were observed for doses delivered to the PB and IPA. Decline in EORTC QLQ-PR25 sexual functioning was significantly more pronounced in patients with higher doses to the crura.

CONCLUSIONS:

By keeping a Dmean and D2% to crura below 4.7 and 12 Gy, respectively, the risk of developing ED+ after prostate SBRT may be significantly reduced.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pene / Arterias / Neoplasias de la Próstata / Calidad de Vida / Uretra / Radiocirugia / Tratamientos Conservadores del Órgano / Disfunción Eréctil Límite: Aged / Aged80 / Humans / Male / Middle aged Idioma: En Revista: Int J Radiat Oncol Biol Phys Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Pene / Arterias / Neoplasias de la Próstata / Calidad de Vida / Uretra / Radiocirugia / Tratamientos Conservadores del Órgano / Disfunción Eréctil Límite: Aged / Aged80 / Humans / Male / Middle aged Idioma: En Revista: Int J Radiat Oncol Biol Phys Año: 2024 Tipo del documento: Article País de afiliación: Suiza Pais de publicación: Estados Unidos