Acute genitourinary toxicity of pencil beam scanning proton therapy for localized prostate cancer: utility of the transition zone index and average urinary flow rate in predicting acute urinary retention

Author:

Takaoka Taiki12ORCID,Yanagi Takeshi1,Tanaka Atsushi3,Kiriyama Yuka4,Tanaka Yoshihiro5,Kondo Takuhito2,Takano Seiya2,Takahashi Shinsei1,Shibamoto Yuta1,Tomita Natsuo2,Hiwatashi Akio2

Affiliation:

1. Department of Radiation Oncology, Narita Memorial Proton Center , Toyohashi , Japan

2. Department of Radiology, Nagoya City University Graduate School of Medical Sciences , Nagoya , Japan

3. Department of Urology, Narita Memorial Hospital , Toyohashi , Japan

4. Department of Diagnostic Pathology, Narita Memorial Hospital , Toyohashi , Japan

5. Department of Radiology, Narita Memorial Hospital , Toyohashi , Japan

Abstract

Abstract Background The purpose of this study was to evaluate the incidence of acute genitourinary toxicities in patients undergoing pencil beam scanning proton therapy for prostate cancer and investigate predictive factors associated with acute urinary retention. Methods A total of 227 patients treated between 2018 and 2021 were divided into the normo-fractionated proton therapy group (n = 107) and the moderately hypo-fractionated proton therapy group (n = 120), with prescribed doses of 76–78 Gy relative biological effectiveness in 38–39 fractions and 60–63 Gy relative biological effectiveness in 20–21 fractions, respectively. Uroflowmetry parameters and the transition zone index were prospectively evaluated. Results Forty-five patients (42%) in the normo-fractionated proton therapy and 33 (28%) in the moderately hypo-fractionated proton therapy developed acute grade 2 genitourinary toxicities (P = 0.02). The most common acute genitourinary toxicity was acute urinary retention. Thirty-nine patients (36%) treated with normo-fractionated proton therapy and 27 (23%) treated with moderately hypo-fractionated proton therapy developed grade 2 acute urinary retention (P = 0.02). No patients developed grade ≥ 3 toxicity. Univariate analysis showed the transition zone index, prostate volume, international prostate symptom score, voided volume, maximum flow rate and average flow rate were associated with grade 2 acute urinary retention. Multivariate analysis in both groups revealed the transition zone index (P = 0.025 and 0.029) and average flow rate (P = 0.039 and 0.044) were predictors of grade 2 acute urinary retention. Conclusions The incidence of acute genitourinary toxicities was lower in the moderately hypo-fractionated proton therapy compared with the normo-fractionated proton therapy. Lower pretreatment average flow rate and a higher transition zone index were useful predictors of grade 2 acute urinary retention.

Publisher

Oxford University Press (OUP)

Subject

Cancer Research,Radiology, Nuclear Medicine and imaging,Oncology,General Medicine

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