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Association between acute histopathological changes of rectal walls and late radiation proctitis following radiotherapy for prostate cancer+

Assoziation zwischen akuten histopathologischen Veränderungen der Rektumwände und einer späten radiogenen Proktitis nach Strahlentherapie des Prostatakarzinoms

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A Letter to the Editor to this article was published on 09 December 2020

Abstract

Purpose

The impact of acute histopathological changes (HC) of the rectum on development of late clinical proctitis (LCP) after external radiotherapy (RT) for prostate cancer is poorly explored and was the primary end point of this prospective study.

Methods

In 70 patients, 15 HC of early rectal biopsies after RT were identified, whereby RT was conventional 2D RT in 41 cases and conformational 3D RT in 29. Associations of HC in anterior and posterior rectal walls (ARW, PRW) with LCP, acute endoscopic (AEP) and acute clinical proctitis (ACP) were statistically evaluated considering as explicative variables the patient general characteristics and the HC.

Results

The mean patients’ follow-up was 123.5 months (24–209). The median prostatic dose was 72 Gy (2 Gy/fraction). For the 41 and 29 patients the ARW and PRW doses were 64 and 49 Gy vs. 63 and 50 Gy, respectively. The incidence of LCP ≥ grade 2 at 10 years was 12.9%. The univariate (p = 0.02) and Kaplan–Meyer methods (p = 0.007) showed that the gland (or crypts) loss in the ARW was significantly associated with LCP. AEP and ACP occurred in 14.3 and 55.7% of cases. At multivariate level AEP significantly correlated with hemorrhoids (p = 0.014) and neutrophilia in ARW (p = 0.042).

Conclusions

Early after RT, substantial gland loss in ARW is predictive of LCP. To reduce this complication with conventional fractionation, we suggest keeping the mean dose to ARW ≤48–52 Gy.

Zusammenfassung

Zielsetzung

Der Einfluss akuter histopathologischer Veränderungen (HV) des Rektums auf die Entwicklung einer späten klinischen Proktitis (SKP) nach perkutaner Strahlentherapie (RT) des Prostatakarzinoms ist kaum untersucht und war primärer Endpunkt dieser prospektiven Studie.

Methoden

Bei 70 Patienten wurden 15 HV in frühen Biopsien des Rektums nach RT identifiziert, wobei 41 Patienten mit einer konventionellen 2‑D- und 29 Patienten mit einer 3‑D-konformalen Technik bestrahlt wurden. Die Assoziationen von HV in den anterioren und posterioren Rektumwänden (ARW, PRW) mit SKP, akuter endoskopischer (AEP) und akuter klinischer Proktitis (AKP) wurden statistisch evaluiert, wobei die allgemeinen Eigenschaften der Patienten und die HV als erklärende Variablen herangezogen wurden.

Ergebnisse

Das durchschnittliche Follow-up betrug 123,5 Monate (24–209 Monate). Die mediane Prostatagesamtdosis lag bei 72 Gy (2 Gy/Fraktion). Für die 41 bzw. 29 Patienten betrugen die ARW- und PRW-Dosis 64 und 49 Gy bzw. 63 und 50 Gy. Die Inzidenzrate von SKP ≥ Grad 2 nach 10 Jahren war 12,9 %. Die univariate Analyse (p = 0,02) und der Kaplan-Meier-Test (p = 0,007) zeigten, dass ein Verlust von Drüsen (oder Krypten) im Bereich der ARW signifikant mit der SKP korrelierte. AEP und AKP ereigneten sich in 14,3 bzw. 55,7 % der Fälle. In der multivariaten Analyse korrelierten AEP statistisch signifikant mit Hämorrhoiden (p = 0,014) und Neutrophilie in ARW (p = 0,042).

Schlussfolgerungen

Früh nach der RT ist ein erheblicher Verlust an Drüsen im Bereich der ARW prädiktiv für eine SKP. Um diese Komplikation bei konventioneller Fraktionierung zu vermeiden, empfehlen wir, im Bereich der ARW die mittlere Dosis im Bereich der ARW ≤48–52 Gy zu halten.

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Authors and Affiliations

  1. Department of Radiation Oncology, “Mater Salutis” Hospital, Legnago, Italy

    Franco Campostrini MD

  2. Department of Pathology, “Mater Salutis” Hospital, Via Gianella 1, 37045, Legnago, Italy

    Andrea Remo MD, Laura Astati BS & Caterina Zanella MD

  3. Veneto Tumour Registry, Azienda Zero, Padova, Italy

    Manuel Zorzi MD

  4. Epidemiological Department, Azienda Zero, Padova, Italy

    Giulia Capodaglio ScD

  5. Radiotherapy Department, Istituto Clinico S. Anna, Brescia, Italy

    Alberto Buffoli MD, Gaia Moretti M Ph & Barbara Della Monica M Ph

  6. Unit of Epidemiology and Medical Statistics, University of Verona, Verona, Italy

    Giuseppe Verlato PhD

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  1. Franco Campostrini MD
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  2. Andrea Remo MD
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Correspondence to Franco Campostrini MD or Andrea Remo MD.

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Conflict of interest

F. Campostrini, A. Remo, L. Astati, M. Zorzi, G. Capodaglio, A. Buffoli, G. Moretti, B. Della Monica, C. Zanella and G. Verlato declare that they have no competing interests.

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Campostrini, F., Remo, A., Astati, L. et al. Association between acute histopathological changes of rectal walls and late radiation proctitis following radiotherapy for prostate cancer+. Strahlenther Onkol 196, 617–627 (2020). https://doi.org/10.1007/s00066-020-01590-3

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