Late genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: A systematic review
BAUS ePoster online library. David R. 11/10/20; 304205; P10-11
Dr. Rowan David
Dr. Rowan David
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Late genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: A systematic review

David R1,2,3,4, Kahokehr A1,2,5, Lee J2,3, Watson D2, O'Callaghan M2,3,4
1Lyell Mcewin Hospital, Elizabeth Vale, Australia, 2Flinders University, Bedford Park, Australia, 3Department of Urology, Flinders Medical Center, Bedford Park, Australia, 4South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, Australia, 5University of Adelaide, Discipline of Medicine, Freemasons Foundation Centre for Mens Health, Australia

Introduction:
The aim of this systematic review is to assess the incidence of late genitourinary toxicity following curative intent intensity modulated radiotherapy (IMRT) in patients with localised prostate cancer, as recorded by institutions and reported in Patient Reported Outcome Measures.

Methods:
We conducted a systematic literature search of MEDLINE, EMBASE and Cochrane from January 2008 to January 2019 following PRISMA guidelines. Published prospective studies measuring post-IMRT genitourinary adverse events in localised prostate cancer with a 60-month endpoint were included. The Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scoring systems were included. Two reviewers independently assessed risk of bias. The study is registered in PROSPERO: CRD42019133320.

Results:
Of 4720 identified studies, five met our inclusion criteria with a total of 4671 patients. We identified 1001 RTOG Grade ≥2 complications with a cumulative incidence of 19% (95% CI 6-32, random effects model) at 60-months of follow-up. There were 153 CTCAE Grade ≥2 complications (33%), Haematuria 69 (4%, 95% CI 0.7-7.5%), Urinary incontinence 194 (10%, 95% CI 8.9-12.6 %), Urinary retention 10 (24%). One study reported time to event analyses, one reported predictive factors and no studies reported economic analysis. There was considerable heterogeneity amongst the studies, but this varied with outcome (I2 95 %-0%).

Conclusion:
Late genitourinary toxicity as defined as 60-month following IMRT is common. Urologists are likely to face a growing burden of care from these difficult to cure complications. This data may lead to better patient counselling.
Late genitourinary toxicity following curative intent intensity-modulated radiotherapy for prostate cancer: A systematic review

David R1,2,3,4, Kahokehr A1,2,5, Lee J2,3, Watson D2, O'Callaghan M2,3,4
1Lyell Mcewin Hospital, Elizabeth Vale, Australia, 2Flinders University, Bedford Park, Australia, 3Department of Urology, Flinders Medical Center, Bedford Park, Australia, 4South Australian Prostate Cancer Clinical Outcomes Collaborative, Adelaide, Australia, 5University of Adelaide, Discipline of Medicine, Freemasons Foundation Centre for Mens Health, Australia

Introduction:
The aim of this systematic review is to assess the incidence of late genitourinary toxicity following curative intent intensity modulated radiotherapy (IMRT) in patients with localised prostate cancer, as recorded by institutions and reported in Patient Reported Outcome Measures.

Methods:
We conducted a systematic literature search of MEDLINE, EMBASE and Cochrane from January 2008 to January 2019 following PRISMA guidelines. Published prospective studies measuring post-IMRT genitourinary adverse events in localised prostate cancer with a 60-month endpoint were included. The Radiation Therapy Oncology Group (RTOG) and National Cancer Institute Common Terminology Criteria for Adverse Events (CTCAE) scoring systems were included. Two reviewers independently assessed risk of bias. The study is registered in PROSPERO: CRD42019133320.

Results:
Of 4720 identified studies, five met our inclusion criteria with a total of 4671 patients. We identified 1001 RTOG Grade ≥2 complications with a cumulative incidence of 19% (95% CI 6-32, random effects model) at 60-months of follow-up. There were 153 CTCAE Grade ≥2 complications (33%), Haematuria 69 (4%, 95% CI 0.7-7.5%), Urinary incontinence 194 (10%, 95% CI 8.9-12.6 %), Urinary retention 10 (24%). One study reported time to event analyses, one reported predictive factors and no studies reported economic analysis. There was considerable heterogeneity amongst the studies, but this varied with outcome (I2 95 %-0%).

Conclusion:
Late genitourinary toxicity as defined as 60-month following IMRT is common. Urologists are likely to face a growing burden of care from these difficult to cure complications. This data may lead to better patient counselling.
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