TREATMENT RELATED SEQUELAE FOLLOWING EXTERNAL-BEAM RADIATION FOR PROSTATE-CANCER - A REVIEW WITH AN UPDATE IN PATIENTS WITH STAGES T1 AND T2 TUMOR

The primary goal of radical radiation therapy in men with localized pr ostate carcinoma is cure and a secondary but important goal is to achi eve cure without treatment related sequelae, such as loss of continenc e, rectal injury, loss of potency and the need for castration. A liter ature review of 2,611 men undergoing irradiation for all stages of loc alized prostatic carcinoma documented a 0.2% incidence of treatment re lated mortality, 1.9% severe complications, 0.9% incontinence and 33 t o 60% maintenance of full potency 5 or more years after treatment. A s eparate analysis was made of 331 patients with only early tumors (stag es T1 and T2) treated with conventional external beam radiation therap y to doses of 63 to 74 Gy. from 2 individual centers (Massachusetts Ge neral Hospital and M. D. Anderson Hospital) and 1 multi-institutional group (Radiation Therapy Oncology Group). Median followup was 6.1 year s; however, in 2 series followup ranged to 14 years. This analysis rev ealed frequencies of treatment associated sequelae of 0% for mortality , 0% severe complications, 0.4% urinary incontinence, 5.4% genitourina ry strictures (1.2% persisting), 5.1% hematuria (0.9% persisting) and 5.4% rectal bleeding (0.6% persisting). This composite analysis of men undergoing irradiation for stages T1 and T2 tumors with conventional fractionation and doses indicates that acute morbidity is minor and us ually transient, severe injury is rare, most late gastrointestinal and genitourinary symptoms of radiation injury are neither permanent nor debilitating, and few symptoms of radiation injury develop beyond 5 ye ars from treatment. These data, combined with the low progression rate s (using prostate specific antigen criteria) following irradiation of men with early tumors, further substantiate the primary role of radica l radiotherapy in the treatment of surgical risk adversive patients.