Prostate cancer radiotherapy: increased biochemical control and late toxicity in men with medication allergies
Menée auprès de 587 patients atteints d'un cancer de la prostate non métastatique traité par radiothérapie entre 1989 et 2006, cette étude évalue, en fonction des antécédents d'allergies médicamenteuses, le taux d'absence d'échec biochimique à 10 ans et la toxicité génito-urinaire ou gastro-intestinale
Background : Given similarities in the mediators of medication allergy (MA) and tissue response to radiotherapy, we assessed whether outcomes following prostate radiotherapy differ in patients with MAs. Methods : 587 men with known MA history and non-metastatic prostate cancer underwent radiotherapy from 1989-2006. Clinicopathologic and treatment variables were analyzed for association with freedom from biochemical failure (FFBF) and late treatment-related, physician-defined Radiation Therapy Oncology Group gastrointestinal (GI) and genitourinary (GU) toxicity. Covariates identified on univariate analysis (UVA) for toxicity and disease control were examined on multivariable analysis (MVA). All statistical tests were two-sided and a P < .05 was considered statistically significant. Results : 155 of 587 men (26.4%) had one or more MAs, most commonly to penicillin (n = 71), sulfa (n = 35) and aspirin/NSAIDs (n = 28). On UVA, men with MA had superior 10-y FFBF (71.5% vs. 63.5%, P = .02) and higher incidence of late GI grade 2 + (G2+; 20.6% vs. 13.2%, P = .04) and grade 3 + (G3+; 7.5% vs. 3.9%, P = .08), as well as late GU G2 + (42.5% vs. 33.2%, P = .04) and G3 + (7.5% vs. 3.0%, P = .02) toxicity than men without MA. On MVA, MA history remained a statistically significant predictor of FFBF (HR = 0.64 [95% CI = 0.43 to 0.93]; P = .02), late G2+ GI (HR = 1.76 [95% CI = 1.06 to 2.90]; P = .03) and G3+ GU (HR = 2.69 [95% CI = 1.16 to 6.27]; P = .02) toxicity after controlling for corresponding covariates in each model. Conclusions : Men with MA had improved FFBF and increased treatment-related toxicity following radiotherapy for prostate cancer. MA history could be a relevant consideration in the management of men with localized prostate cancer.
JNCI Cancer Spectrum 2020