Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer
Purpose: Implications of radiation dose exposure to the urethra on urinary morbidity after prostate radiotherapy are poorly understood, especially by long-term patient-reported outcomes (PRO). Therefore, our primary objective was to investigate associations of urethral dose and long-term patient-rep...
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Elsevier
2025-03-01
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| Series: | Clinical and Translational Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405630825000084 |
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| author | Lars Haack David Krug Justus Domschikowski Olaf Wittenstein Severin Rodler Philipp Nuhn Christof van der Horst Claudia Schmalz Christian Schulz Oliver Blanck Frank-André Siebert Alexander Fabian |
| author_facet | Lars Haack David Krug Justus Domschikowski Olaf Wittenstein Severin Rodler Philipp Nuhn Christof van der Horst Claudia Schmalz Christian Schulz Oliver Blanck Frank-André Siebert Alexander Fabian |
| author_sort | Lars Haack |
| collection | DOAJ |
| description | Purpose: Implications of radiation dose exposure to the urethra on urinary morbidity after prostate radiotherapy are poorly understood, especially by long-term patient-reported outcomes (PRO). Therefore, our primary objective was to investigate associations of urethral dose and long-term patient-reported urinary morbidity after external beam radiotherapy and high-dose rate brachytherapy boost for prostate cancer. Materials and methods: We conducted a pre-registered (https://doi.org/10.17605/OSF.IO/A6DC3) cross-sectional study at a tertiary academic center including a consecutive sample of patients being at least two years after treatment. Primary outcome measurements included urinary domains of the EPIC-26 questionnaire. Their associations with predefined urethral dose levels were assessed by univariable analyses (Pearson’s correlation) and by predefined multivariable analyses (multiple regression). Sample size calculation was based on a predefined multivariable model. A p-value < 0.05 was considered statistically significant. Results: Among 277 screened patients, 113 patients were alive, eligible, consented, and provided PRO. The median time passed since radiotherapy was 4 years. Per univariable analysis, a higher near maximum point dose of the urethra (DU0.1cc) was associated with worse urinary incontinence (r = -0.32; CI = −0.48 − -0.13; p < 0.001) and worse overall urinary function (r = -0.21; CI = −0.38 − -0.03; p = 0.02) of the respective EPIC-26 domains. Per predefined multivariable analysis, DU0.1cc and urinary incontinence remained significantly associated (B = −0.005; CI = −0.008 − -0.002; p = 0.003). These associations were only present, when very high DU0.1 cc above 137 Gy were kept in the analysis. Conclusions: Very high urethral near point doses appear to be associated with worse long-term patient-reported urinary morbidity after radiotherapy for prostate cancer. Urethral dose should be considered in practice and future trials to potentially minimize long-term urinary morbidity. Trial registration: The study protocol was pre-registered prior to patient accrual on the Open Science Framework (https://doi.org/10.17605/OSF.IO/A6DC3). |
| format | Article |
| id | doaj-art-27e7e0d98ede47ce992582605e191d56 |
| institution | Kabale University |
| issn | 2405-6308 |
| language | English |
| publishDate | 2025-03-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Clinical and Translational Radiation Oncology |
| spelling | doaj-art-27e7e0d98ede47ce992582605e191d562025-01-30T05:14:31ZengElsevierClinical and Translational Radiation Oncology2405-63082025-03-0151100918Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancerLars Haack0David Krug1Justus Domschikowski2Olaf Wittenstein3Severin Rodler4Philipp Nuhn5Christof van der Horst6Claudia Schmalz7Christian Schulz8Oliver Blanck9Frank-André Siebert10Alexander Fabian11Department of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany; Department of Radiotherapy and Radiation Oncology, University Medical Center Hamburg-Eppendorf, Hamburg, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Urology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Urology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyURODOCK Urology Group Practice, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, GermanyDepartment of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Germany; Corresponding author at: Department of Radiation Oncology, University Hospital Schleswig-Holstein Campus Kiel, Kiel, Arnold-Heller-Str.3, 24105, Germany.Purpose: Implications of radiation dose exposure to the urethra on urinary morbidity after prostate radiotherapy are poorly understood, especially by long-term patient-reported outcomes (PRO). Therefore, our primary objective was to investigate associations of urethral dose and long-term patient-reported urinary morbidity after external beam radiotherapy and high-dose rate brachytherapy boost for prostate cancer. Materials and methods: We conducted a pre-registered (https://doi.org/10.17605/OSF.IO/A6DC3) cross-sectional study at a tertiary academic center including a consecutive sample of patients being at least two years after treatment. Primary outcome measurements included urinary domains of the EPIC-26 questionnaire. Their associations with predefined urethral dose levels were assessed by univariable analyses (Pearson’s correlation) and by predefined multivariable analyses (multiple regression). Sample size calculation was based on a predefined multivariable model. A p-value < 0.05 was considered statistically significant. Results: Among 277 screened patients, 113 patients were alive, eligible, consented, and provided PRO. The median time passed since radiotherapy was 4 years. Per univariable analysis, a higher near maximum point dose of the urethra (DU0.1cc) was associated with worse urinary incontinence (r = -0.32; CI = −0.48 − -0.13; p < 0.001) and worse overall urinary function (r = -0.21; CI = −0.38 − -0.03; p = 0.02) of the respective EPIC-26 domains. Per predefined multivariable analysis, DU0.1cc and urinary incontinence remained significantly associated (B = −0.005; CI = −0.008 − -0.002; p = 0.003). These associations were only present, when very high DU0.1 cc above 137 Gy were kept in the analysis. Conclusions: Very high urethral near point doses appear to be associated with worse long-term patient-reported urinary morbidity after radiotherapy for prostate cancer. Urethral dose should be considered in practice and future trials to potentially minimize long-term urinary morbidity. Trial registration: The study protocol was pre-registered prior to patient accrual on the Open Science Framework (https://doi.org/10.17605/OSF.IO/A6DC3).http://www.sciencedirect.com/science/article/pii/S2405630825000084Prostate cancerRadiotherapyBrachytherapyUrethraRadiation dose response relationshipPatient-reported outcome |
| spellingShingle | Lars Haack David Krug Justus Domschikowski Olaf Wittenstein Severin Rodler Philipp Nuhn Christof van der Horst Claudia Schmalz Christian Schulz Oliver Blanck Frank-André Siebert Alexander Fabian Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer Clinical and Translational Radiation Oncology Prostate cancer Radiotherapy Brachytherapy Urethra Radiation dose response relationship Patient-reported outcome |
| title | Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer |
| title_full | Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer |
| title_fullStr | Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer |
| title_full_unstemmed | Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer |
| title_short | Associations of dose to the urethra and long-term patient-reported outcomes after radiotherapy with EBRT and HDR brachytherapy boost for prostate cancer |
| title_sort | associations of dose to the urethra and long term patient reported outcomes after radiotherapy with ebrt and hdr brachytherapy boost for prostate cancer |
| topic | Prostate cancer Radiotherapy Brachytherapy Urethra Radiation dose response relationship Patient-reported outcome |
| url | http://www.sciencedirect.com/science/article/pii/S2405630825000084 |
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