IBD, Crohn's/UC relative contraindication to IMRT for Prostate CA?

[medgator]

Any data long-term outcomes data in surgically-inoperable patients where this has been done? I've found some brachy studies on the matter that suggest it's OK. Apparently the urologists don't like cryo in this situation either.

Per NCCN, active inflammatory disease of the rectum/bowel is a contraindication, while "inactive ulcerative colitis" is a "relative" contraindication.

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[napoleondynamite]

I was trained to not offer RT if they had been hospitalized with an episode anytime in the preceding 12 months. So that's always been my rule of thumb - otherwise, if it's inactive disease, I have offered it and have treated probably 7-10 or so patients with either prostate or rectal and never seen a problem.

That's a made up rule..but so is a lot of the "data" surrounding the relative contraindication IMO. So you just have to do what makes sense..if a patient has another option, I would push them in that direction. But if they are not a surgical candidate or they are highly motivated to avoid surgery and understand the theoretical risk, I have no problem offering RT in that situation.

As an aside, I once had my back against the wall and treated an anal cancer patient who was both HIV positive and had active UC. She had a tough time hematologically from the chemo, but nothing out of the ordinary GI-wise (with about 12 months f/u).

 

[autobahn]

Good time for your question...there was just a study recently published in PRO last month out of Fox Chase on this exact topic. PMID: 25424586

http://www.ncbi.nlm.nih.gov/pubmed/25424586

Findings were similar to previous post: acceptable toxicity with quiescent disease (>1yr since last flare)...median RT dose was 74 or 76Gy. They give dose constraints in the paper.