MP14-14 MANAGEMENT OF RADIATION THERAPY ONCOLOGY GROUP (RTOG) GRADE 4 UROLOGIC COMPLICATIONS OF RADIOTHERAPY FOR PROSTATE CANCER

Abstract

You have accessJournal of UrologyProstate Cancer: Localized: Radiation Therapy1 Apr 2016MP14-14 MANAGEMENT OF RADIATION THERAPY ONCOLOGY GROUP (RTOG) GRADE 4 UROLOGIC COMPLICATIONS OF RADIOTHERAPY FOR PROSTATE CANCER Erik N. Mayer, BS Jonathan D. Tward, MD, PhD Sara Lenherr, MD, MS James M. Hotaling, MD William O. Brant, andMD Jeremy B. MyersMD Erik N. MayerErik N. Mayer More articles by this author , Jonathan D. TwardJonathan D. Tward More articles by this author , Sara LenherrSara Lenherr More articles by this author , James M. HotalingJames M. Hotaling More articles by this author , William O. BrantWilliam O. Brant More articles by this author , and Jeremy B. MyersJeremy B. Myers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.2517AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Grade 4 RTOG complications after radiotherapy (XRT) for prostate cancer (CaP) are purportedly rare; however, the literature is limited by short follow up and lack of surgical management outcomes. We hypothesized that grade 4 complications require complex surgical management with high morbidity. METHODS A retrospective/prospective review identified men with RTOG grade 4 urinary complications after XRT for CaP referred in a 5-year period to a tertiary care center. We excluded patients with progression to grade 4 complications after treatment for incontinence or erectile dysfunction. XRT was classified as dual therapy (radical prostatectomy (RRP) followed by external beam radiotherapy (EBRT), or various combinations of XRT) or monotherapy (single modality XRT). Complications were classified as outlet (urethral stricture, bladder neck contracture, prostate necrosis, and recto-urethral fistula) or bladder (contraction, necrosis, fistula, ureteral stricture, hemorrhage). RESULTS We identified 67 men with a median age of 74 years. 42 (63%) had dual therapy, consisting of RRP + EBRT (18), high dose rate brachytherapy (HDR) + EBRT (18), low dose rate brachytherapy (LDR) + EBRT (4), and other dual XRT (2). 25 (37%) patients had monotherapy consisting of EBRT (4), HDR (9), LDR (10), or proton beam (2). Complications were isolated to the bladder in 4 (6%), the outlet in 46 (67%), and both in 17 (25%). The majority of outlet problems were identified as urethral obstruction (n=48, 72%). Complications were managed conservatively in 17 (25%) cases (no intervention besides intermittent catheterization or local treatment), with indwelling catheters in 14 (21%), by urinary diversion (UD) in 21 (31%) (conduit or catheterizable pouch), and with reconstruction in 17 (25%). Reconstruction consisted of ureteral (4), recto-urethral fistula repair (2), and posterior urethroplasty (11). Success was achieved in 15/17 (88%) cases. Two failures were treated by UD and suprapubic tube. Hyperbaric oxygen (HBO2) was used in 25 (37%), gracilis flap in 14 (21%), and increased to 65% for both in the reconstructive group. CONCLUSIONS RTOG grade 4 complications were most common in those patients that underwent dual therapy, but there was significant morbidity regardless of treatment modality. Reconstruction is successful in highly selected patients. Outcomes are improved with HBO2 and gracilis flaps. Grade 4 complications necessitated UD in one out of three patients. Further series with longer follow up are necessary to define and predict the outcomes in these patients. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e149 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Erik N. Mayer More articles by this author Jonathan D. Tward More articles by this author Sara Lenherr More articles by this author James M. Hotaling More articles by this author William O. Brant More articles by this author Jeremy B. Myers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...