Radiation treatment of men with prostate cancer and inflammatory bowel disease

A analysis of date from a tumor registry in Texas challenges the historic notion that men suffering from inflammatory bowel disease (IBD) ought not to have radiation therapy for treatment of prostate cancer.

Gestaut and Swanson presented their findings at the recent ASCO Genitourinary Cancers Symposium (abstract no. 15; “Inflammatory bowel disease in patients with prostate cancer treated with radiation”). They searched a tumor registry and found 18 patients who suffered from IBD (either Crohn’s disease or ulcerative colitis) and were treated with radiation between 2000 and 2010.

  • 12 were treated with external beam radiation therapy – either IMRT or 3D-CRT.
  • 6 were treated with low-dose-rate brachytherapy.
  • 22 percent were in remission for IBD before treatment.
  • 56 percent were taking a 5-aminosalicylic acid (5-ASA) type of medication.
  • 17 percent were taking prednisone.
  • 6 percent were taking infliximab (Remicade).
  • 6 patients (40 percent) had grade 1 diarrhea at baseline.
  • 2 had had an ostomy.

After a median follow-up of 9.5 years:

  • 4 patients (22 percent) had grade 1 diarrhea, none of higher grade.
  • 3 patients (17 percent) had grade 2 proctitis, none of higher grade.
    • All three of these patients had 3D-CRT, rather than IMRT

The authors conclude:

Our findings suggest that IBD patients experience minimal toxicity with IMRT-based radiation therapy.

While a study of 18 patients is far too small to draw any projectable conclusions, it does raise the interesting hypothesis that patients with IBD should not automatically be ruled out as candidates for primary radiation treatment. It might be prudent, however, to use a rectal spacer when giving radiation therapy to such patients.

The full poster presented by Gestaut and Swanson is also available on line.

Editorial note: This commentary was written for The “New” Prostate Cancer InfoLink by Allen Edel.

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