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Impact of bladder volume on acute genitourinary toxicity in intensity modulated radiotherapy for localized and locally advanced prostate cancer

Einfluss des Harnblasenvolumens auf uro-genitale akut-Nebenwirkungen unter hochdosierter intensitätsmodulierter Strahlentherapie (IMRT) bei lokal begrenztem und fortgeschrittenem Prostatakarzinom

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Abstract

Background and purpose

To evaluate the effect of changes in bladder volume during high-dose intensity-modulated-radiotherapy (IMRT) of prostate cancer on acute genitourinary (GU) toxicity and prospectively evaluate a simple biofeedback technique for reproducible bladder filling with the aim of reducing acute GU toxicity.

Methods

One hundred ninety-three patients were trained via a biofeedback mechanism to maintain a partially filled bladder with a reproducible volume of 200–300 cc at planning CT and subsequently at each fraction of radiotherapy. We prospectively analyzed whether and to what extent the patients’ ability to maintain a certain bladder filling influenced the degree of acute GU toxicity and whether cut-off values could be differentiated.

Results

We demonstrated that the ability to reach a reproducible bladder volume above a threshold volume of 180 cc and maintain that volume via biofeedback throughout treatment predicts for a decrease in acute GU toxicity during curative high-dose IMRT of the prostate. Patients who were not able to reach a partial bladder filling to that cut-off value and were not able to maintain a partially filled bladder throughout treatment had a significantly higher risk of developing ≥grade 2 GU acute toxicity.

Conclusion

Our results support the hypothesis that a biofeedback training for the patient is an easy-to-apply, useful, and cost-effective tool for reducing acute GU toxicity in high-dose IMRT of the prostate. Patients who are not able to reach and maintain a certain bladder volume during planning and treatment—two independent risk factors—might need special consideration.

Zusammenfassung

Hintergrund und Ziel

Auswertung des Einflusses des Harnblasenvolumens während hochdosierter intensitätsmodulierter Strahlentherapie (IMRT) bei Prostatakarzinom auf die akute urogenitale Toxizität sowie prospektive Auswertung eines einfachen Biofeedback-Mechanismus zur reproduzierbaren Harnblasenfüllung mit dem Ziel, akute urogenitale Nebenwirkungen zu reduzieren.

Methoden

Insgesamt 193 Patienten wurde mit Hilfe eines einfachen Biofeedback-Mechanismus beigebracht, während der Planungs-CT und jeder folgenden Fraktion ein Harnblasenvolumen von 200–300 ml zu reproduzieren. Es erfolgte eine prospektive Auswertung inwiefern sich die Fähigkeit, ein bestimmtes Harnblasenvolumen zu erreichen und zu halten, auf die Rate an akuten urogenitalen Nebenwirkungen auswirkt und ob Grenzwerte definiert werden können.

Ergebnisse

Wir konnten zeigen, dass während einer hochdosierten IMRT der Prostata die Fähigkeit ein Harnblasenvolumen von mindestens 180 ml zu erreichen und zu jeder Fraktion der Therapie reproduzieren zu können, prädiktiv für eine Reduktion von akuten urogenitalen Nebenwirkungen ist. Patienten, die keine partielle Harnblasenfüllung erreichen und reproduzieren konnten, zeigten eine signifikant erhöhte Rate urogenitaler Nebenwirkungen ≥ Grad 2.

Schlussfolgerung

Unsere Ergebnisse zeigen, dass akute urogenitale Nebenwirkungen während einer hochdosierten IMRT der Prostata kostengünstig mit einem einfachen Biofeedback-Mechanismus reduziert werden können. Patienten, die es nicht schaffen, ein bestimmtes Blasenvolumen zu erreichen und zu halten, benötigen möglicherweise intensivere Betreuung.

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Authors and Affiliations

  1. Department for Radiation Oncology, Charité—University Medicine Berlin, Campus Virchow-Clinic, Augustenburger Platz 1, 13353, Berlin, Germany

    Arne Grün MD, David Kaul PhD, Carmen Stromberger MD &  Volker Budach

  2. Department for Radiation Oncology, Helios Klinikum Berlin-Buch, Schwanebecker Chaussee 50, 13125, Berlin, Germany

    Michael Kawgan-Kagan MD

  3. Department for Radiation Oncology, Ernst-von-Bergmann Klinikum, Charlottenstraße 72, 14467, Potsdam, Germany

    Harun Badakhshi PhD

  4. Department for Radiation Oncology, Charité—University Medicine Berlin, Campus Benjamin Franklin, Hindenburgdamm 30, 12203, Berlin, Germany

    Dirk Böhmer PhD

Authors
  1. Arne Grün MD
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  2. Michael Kawgan-Kagan MD
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Correspondence to Arne Grün MD.

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A. Grün, M. Kawgan-Kagan, D. Kaul, H. Badakhshi, C. Stromberger, V. Budach, and D. Böhmer declare that they have no competing interests.

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Grün, A., Kawgan-Kagan, M., Kaul, D. et al. Impact of bladder volume on acute genitourinary toxicity in intensity modulated radiotherapy for localized and locally advanced prostate cancer. Strahlenther Onkol 195, 517–525 (2019). https://doi.org/10.1007/s00066-018-1398-8

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  • DOI: https://doi.org/10.1007/s00066-018-1398-8

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