Features of Radiation Reactions in Patients with Prostate Cancer with Metabolic Syndrome on the Background of Thermoradiotherapy

Background: Prostate cancer (PC) is one of the most common malignancies in men. According to statistics of the Russian Federation for 2023, prostate cancer ranks first among malignant neoplasms in men (19.1%) and third (8.3%) in the structure of mortality from malignant tumors in the male population. One of the main treatment methods for prostate cancer is external beam radiation therapy; when radiotherapy is combined with local hyperthermia, the term thermoradiotherapy is used. A steady increase in the prevalence of metabolic syndrome (MS) has been observed among patients with prostate cancer. Given the complex hormonal and metabolic changes associated with MS, this condition is considered a potential risk factor for an unfavorable treatment outcome.

Purpose: To evaluate the impact of metabolic syndrome in patients with prostate malignancy on the frequency and severity of adverse events during thermoradiotherapy.

Material and methods: This non-randomized comparative study included 60 patients with prostate cancer (adenocarcinoma) T3–T4N0M0 who underwent external beam radiation therapy using volumetric modulated arc therapy (VMAT). Irradiation involved the prostate gland, seminal vesicles, and pelvic lymph nodes to a total focal dose of 80/80/50 Gy delivered five times per week (28 fractions) using an Elekta Versa HD linear accelerator (United Kingdom) with a 6 MeV photon beam. Radiomodification was performed using local hyperthermia on a Celsius TCS device (Germany) according to the following protocol: twice weekly, 8–10 procedures in total, 2 hours before radiation therapy, with a heating duration of 40–60 minutes at a temperature of 40–42 °C. The study group consisted of 30 patients with metabolic syndrome diagnosed prior to treatment according to the IDF 2009 criteria, while the control group included 30 patients without a history of metabolic syndrome.

Results and discussion: Patients with prostate cancer and metabolic syndrome demonstrated more pronounced radiation-induced reactions compared to the control group, including radioepitheliitis of the skin in the irradiation area and nocturia. Metabolic disturbances contribute to impaired lymphatic and microcirculatory function as well as delayed skin repair processes, while abdominal obesity increases intra-abdominal pressure, leading to more frequent nocturnal urination.

Conclusion: Prostate cancer patients with metabolic syndrome receiving thermoradiotherapy require increased clinical attention due to a higher risk of developing severe radiation reactions. Further research in this field is necessary to optimize treatment strategies and improve therapeutic outcomes in this patient population.

prostate cancer, radiation therapy, local hyperthermia, thermoradotherapy, metabolic syndrome, radiation reactions