26
|
Cozzarini C, Magli A, Cante D, Andreoli L, Pastorino A, Faiella A, Fodor A, Deantoni C, Zerbetto F, Tonetto F, Noris Chiorda B, Piva C, Olivetta E, Avuzzi B, Gandaglia G, Fossati N, Fiorino C, Sanguineti G, Valdagni R, Briganti A, Montorsi F, Di Muzio N. PO-1354 Time Dependence of PSADT prognostic threshold in men treated with post-prostatectomy salvage RT. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07805-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
|
27
|
Cozzarini C, Sanguineti G, Vavassori V, Munoz F, Avuzzi B, Garibaldi E, Cante D, Waskiewicz J, Magli A, Faiella A, Villa E, Ferella L, Gatti M, Noris Chiorda B, Piva C, Ferrari P, Rancati T, Badenchini F, Girelli G, Moretti E, Valdagni R, Bresolin A, Di Muzio N, Fiorino C. PD-0767 Predictors of urinary incontinence 2 years after RT with different intents for prostate cancer. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07046-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
28
|
Cozzarini C, Magli A, Cante D, Noris Chiorda B, Munoz F, Faiella A, Olivetta E, Marco Andrea S, Piva C, Avuzzi B, Ferella L, Pastorino A, Fodor A, Deantoni C, Fossati N, Gandaglia G, Sanguineti G, Valdagni R, Fiorino C, Briganti A, Montorsi F, Di Muzio N. PH-0660 Independent role of dose-escalation and prophylactic WPRT in salvage RT after radical prostatectomy. Radiother Oncol 2021. [DOI: 10.1016/s0167-8140(21)07392-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
29
|
Munoz F, Sanguineti G, Bresolin A, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Garibaldi E, Faiella A, Villa E, Magli A, Noris Chiorda B, Gatti M, Rancati T, Valdagni R, Di Muzio NG, Fiorino C, Cozzarini C. Predictors of Patient-Reported Incontinence at Adjuvant/Salvage Radiotherapy after Prostatectomy: Impact of Time between Surgery and Radiotherapy. Cancers (Basel) 2021; 13:cancers13133243. [PMID: 34209562 PMCID: PMC8269132 DOI: 10.3390/cancers13133243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 06/16/2021] [Accepted: 06/24/2021] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Baseline urinary incontinence (UI) strongly modulates UI recovery after adjuvant/salvage radiotherapy (ART/SRT), inducing clinicians to postpone it "as much as possible", maximizing UI recovery but possibly reducing efficacy. This series aims to analyze the trend of UI recovery and its predictors at radiotherapy start. METHODS A population of 408 patients treated with ART/SRT enrolled in a cohort study (ClinicalTrials.gov #NCT02803086) aimed at developing predictive models of radiation-induced toxicities. Self-reported UI and personality traits, evaluated by means of the International Consultation on Incontinence Questionnaire-Urinary Incontinence Short Form (ICIQ-SF) and Eysenck Personality Questionnaire - Revised (EPQ-R) questionnaires, were assessed at ART/SRT start. Several endpoints based on baseline ICIQ-SF were investigated: frequency and amount of urine loss (ICIQ3 and ICIQ4, respectively), "objective" UI (ICIQ3 + 4), "subjective" UI (ICIQ5), and "TOTAL" UI (ICIQ3 +4 + 5). The relationship between each endpoint and time from prostatectomy to radiotherapy (TTRT) was investigated. The association between clinical and personality variables and each endpoint was tested by uni- and multivariable logistic regression. RESULTS TTRT was the strongest predictor for all endpoints (p-values ≤ 0.001); all scores improved between 4 and 8 months after prostatectomy, without any additional long-term recovery. Neuroticism independently predicted subjective UI, TOTAL UI, and daily frequency. CONCLUSIONS Early UI recovery mostly depends on TTRT with no further improvement after 8 months from prostatectomy. Higher levels of neuroticism may overestimate UI.
Collapse
|
30
|
Franco NR, Massi MC, Ieva F, Manzoni A, Paganoni AM, Zunino P, Veldeman L, Ost P, Fonteyne V, Talbot CJ, Rattay T, Webb A, Johnson K, Lambrecht M, Haustermans K, De Meerleer G, de Ruysscher D, Vanneste B, Van Limbergen E, Choudhury A, Elliott RM, Sperk E, Veldwijk MR, Herskind C, Avuzzi B, Noris Chiorda B, Valdagni R, Azria D, Farcy-Jacquet MP, Brengues M, Rosenstein BS, Stock RG, Vega A, Aguado-Barrera ME, Sosa-Fajardo P, Dunning AM, Fachal L, Kerns SL, Payne D, Chang-Claude J, Seibold P, West CML, Rancati T. Development of a method for generating SNP interaction-aware polygenic risk scores for radiotherapy toxicity. Radiother Oncol 2021; 159:241-248. [PMID: 33838170 PMCID: PMC8754257 DOI: 10.1016/j.radonc.2021.03.024] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/19/2021] [Accepted: 03/17/2021] [Indexed: 12/03/2022]
Abstract
AIM To identify the effect of single nucleotide polymorphism (SNP) interactions on the risk of toxicity following radiotherapy (RT) for prostate cancer (PCa) and propose a new method for polygenic risk score incorporating SNP-SNP interactions (PRSi). MATERIALS AND METHODS Analysis included the REQUITE PCa cohort that received external beam RT and was followed for 2 years. Late toxicity endpoints were: rectal bleeding, urinary frequency, haematuria, nocturia, decreased urinary stream. Among 43 literature-identified SNPs, the 30% most strongly associated with each toxicity were tested. SNP-SNP combinations (named SNP-allele sets) seen in ≥10% of the cohort were condensed into risk (RS) and protection (PS) scores, respectively indicating increased or decreased toxicity risk. Performance of RS and PS was evaluated by logistic regression. RS and PS were then combined into a single PRSi evaluated by area under the receiver operating characteristic curve (AUC). RESULTS Among 1,387 analysed patients, toxicity rates were 11.7% (rectal bleeding), 4.0% (urinary frequency), 5.5% (haematuria), 7.8% (nocturia) and 17.1% (decreased urinary stream). RS and PS combined 8 to 15 different SNP-allele sets, depending on the toxicity endpoint. Distributions of PRSi differed significantly in patients with/without toxicity with AUCs ranging from 0.61 to 0.78. PRSi was better than the classical summed PRS, particularly for the urinary frequency, haematuria and decreased urinary stream endpoints. CONCLUSIONS Our method incorporates SNP-SNP interactions when calculating PRS for radiotherapy toxicity. Our approach is better than classical summation in discriminating patients with toxicity and should enable incorporating genetic information to improve normal tissue complication probability models.
Collapse
|
31
|
Cozzarini C, Magli A, Cante D, Noris Chiorda B, Munoz F, Faiella A, Olivetta E, Signor M, Piva C, Avuzzi B, Ferella L, Pastorino A, Fodor A, Deantoni C, Nicola F, Gandaglia G, Sanguineti G, Valdagni R, Fiorino C, Briganti A, Montorsi F, Di Muzio N. Independent role of dose-escalation and prophylactic lymph-nodal irradiation in salvage radiotherapy after prostatectomy. A retrospective, multi-institute analysis on 725 men treated with high-dose radiotherapy and eight years follow-up. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)01555-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
|
32
|
Bresolin A, Faiella A, Garibaldi E, Munoz F, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Villa E, Magli A, Noris Chiorda B, Gatti M, Ferella L, Maggio A, Landoni V, Aimonetto S, Sini C, Rancati T, Sanguineti G, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. Acute patient-reported intestinal toxicity in whole pelvis IMRT for prostate cancer: Bowel dose-volume effect quantification in a multicentric cohort study. Radiother Oncol 2021; 158:74-82. [PMID: 33639190 DOI: 10.1016/j.radonc.2021.02.026] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 02/16/2021] [Accepted: 02/17/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To assess bowel dose-volume relationships for acute patient-reported intestinal symptoms of patients treated with whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. MATERIALS AND METHODS Complete data of 415 patients enrolled in a multi institute, prospective trial (#NCT02803086) treated with radical (31%), adjuvant (33%) and salvage (36%) intent at a median dose to pelvic nodes/lymph-nodal area of 53 Gy were available. The most severe changes between baseline and radiotherapy mid-point/end toxicity assessed by Inflammatory Bowel Disease Questionnaire (only Bowel Domain) were considered (ΔIBDQ). The 25th percentile values of these score variations were set as endpoints. DVHs of bowel loops for patients with/without toxicity were compared for each endpoint, having excluded patients with baseline scores <5 (rate ranging between 2% and 7% according to the endpoint): the resulting best dosimetric predictors were combined with selected clinical parameters through multivariate logistic regression (MVA) to derive predictive models. RESULTS ΔIBDQ ranged between 0.2-1.5 points considering separately each IBDQ symptom. Only four symptoms (IBDQ1 = frequency, IBDQ5 = diarrhea, IBDQ17 = gas passage, IBDQ24 = urgency) showed a median worsening ≥ 1; DVH predicted the risk of worse symptoms for IBDQ5, IBDQ24 and overall Bowel Domain. At multivariable analysis DVHs (best cut-off: V46Gy ≥80 cc) and baseline scores (Odd-Ratio:0.35-0.65) were independently associated to the three end-points. The resulting models were reliable (H&L test: 0.453-0.956), well calibrated (calibration plot: slope = 0.922-1.069, R2 = 0.725-0.875) and moderately discriminative (Area Under the Curve:0.628-0.669). A bootstrap-based validation confirmed their robustness. CONCLUSION Constraining the bowel loops (V46 < 80 cc) may reduce the risk of several moderate intestinal symptoms, with a much greater impact for patients with lower IBDQ baseline scores.
Collapse
|
33
|
Avuzzi B, Tittarelli A, Andreani S, Noris Chiorda B, Seregni E, Villa S, Tana S, Valdagni R, Salvioni R, Biasoni D, Catanzaro M, Stagni S, Nicolai N. Radiotherapy after testis-sparing surgery for seminoma in monorchid patients: safety and efficacy. TUMORI JOURNAL 2021; 108:165-171. [PMID: 33588700 DOI: 10.1177/0300891621992428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
PURPOSE To evaluate local control and longitudinal endocrine data in monorchid patients treated with testicular-sparing surgery and adjuvant radiotherapy (RT) for seminomatous germ-cell tumors. METHODS We searched our database established in 2009 for patients with seminoma who received testis irradiation following partial orchiectomy up to 2018. Eleven patients were identified. All had associated germ cell neoplasia in situ (GCNIS) in surrounding parenchyma. Analysis focused on local control and testosterone levels preservation after RT. We considered age, baseline (pre-RT) testosterone and luteinizing hormone (LH) levels, residual testicular volume, tumor size, and testosterone and LH levels trend over time in order to identify any association with endocrine impairment leading to hormonal replacement need. RESULTS After a median follow-up of 21 months, no local or distant relapses were observed and hormonal function was maintained in 54.5% of patients (6/11). No significant interactions were observed for the investigated covariates. Notably, we observed an association between higher baseline testosterone levels and a decreased risk of exogenous androgen replacement (hazard ratio [HR] 0.409, 95% confidence interval [CI] 0.161-1.039, p = 0.060), whereas tumor size was associated with an increased risk of exogenous androgen replacement (HR 1.847, 95% CI 0.940-3.627, p = 0.075). CONCLUSIONS Radiotherapy after testicular sparing surgery is effective in preventing local disease relapse in presence of GCNIS in the medium term. This strategy allows a preservation of adequate endocrine function in about half of patients. More patients and longer follow-up are needed to confirm these findings.
Collapse
|
34
|
Alvisi MF, Dordoni P, Rancati T, Avuzzi B, Nicolai N, Badenchini F, De Luca L, Magnani T, Marenghi C, Menichetti J, Silvia V, Fabiana Z, Roberto S, Riccardo V, Lara B. Supporting Patients With Untreated Prostate Cancer on Active Surveillance: What Causes an Increase in Anxiety During the First 10 Months? Front Psychol 2020; 11:576459. [PMID: 33363494 PMCID: PMC7753742 DOI: 10.3389/fpsyg.2020.576459] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/28/2020] [Indexed: 11/13/2022] Open
Abstract
Background The psychological burden possibly deriving from not immediately undergoing radical treatment for prostate cancer (PCa) could be a potential disadvantage of active surveillance (AS), especially in the eve of some relevant clinical exams [i.e., re-biopsy, prostate-specific antigen (PSA) test, and medical examination]. Even if it is known from the literature that the majority of PCa men in AS do not report heightened anxiety, there is a minority of patients who show clinically significant levels of anxiety after diagnosis. The present study aimed to investigate if demographic, clinical, and psychological variables at the entrance in AS (T0) were associated with the risk of developing clinically significant PCa-related anxiety 2 months before the first re-biopsy (T1) and to offer psychological support to improve quality of life (QoL). Materials and Methods A total of 236 patients participated in the PCa Research International: AS (PRIAS) protocol and in PRIAS-QoL study. Demographic/clinical features, health-related QoL domains, coping with cancer, PCa-related anxiety [Memorial Anxiety Scale for PCa (MAX-PC)], personality traits, and decision-making-related factors were assessed at T0. MAX-PC was also administered at T1. PCa-related anxiety at T1 was considered to be of clinical significance if the MAX-PC score was ≥1.5. Multivariable logistic regression coupled to bootstrap was used to detect factors associated with high levels of anxiety. Results The median age was 64.4 years. Fifty-six patients (24%) reported MAX-PC total score above the cutoff. Three factors were associated with a high level of PCa anxiety at T1: anxious preoccupation [odds ratio (OR) = 4.36], extraversion (OR = 1.9), and prostate-related symptoms (median OR = 0.46). Physical well-being was associated with a low PCa anxiety subscale (median OR = 0.15); neuroticism and functional well-being were associated with PSA anxiety (median OR = 7.05 and 0.73, respectively). Neuroticism and helplessness/hopelessness were associated with fear of progression (median OR = 18.1 and 5.8, respectively). Conclusion Only a partial portion of the sample experienced significant levels of anxiety after 10 months. Psychological assessment should be routinely conducted to detect risk factors (i.e., anxious preoccupation, extraversion) for increased anxiety, offering tailored psychological interventions aimed at promoting interpersonal awareness and emotional well-being.
Collapse
|
35
|
Bresolin A, Garibaldi E, Faiella A, Cante D, Vavassori V, Waskiewicz J, Girelli G, Avuzzi B, Villa E, Magli A, Chiorda B, Munoz F, Sanguineti G, Gabriele P, Gatti M, Rancati T, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. PH-0366: Predictors of incontinence 2yr after post-prostatectomy RT: evidence of dose & fractionation effects. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00390-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
Munoz F, Sanguineti G, Gabriele P, Bresolin A, Cante D, Vavassori V, Waskiewicz J, Girelli G, Avuzzi B, Faiella A, Garibaldi E, Villa E, Magli A, Chiorda B, Gatti M, Rancati T, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. PD-0059: Patient-reported baseline incontinence at post-prostatectomy RT: its dependence on time from surgery. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00085-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
37
|
Garibaldi E, Bresolin A, Cante D, Sanguineti G, Munoz F, Vavassori V, Waskiewicz J, Girelli G, Avuzzi B, Faiella A, Villa E, Magli A, Chiorda B, Gabriele P, Gatti M, Rancati T, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. PD-0668: Longitudinal analysis of patient-reported urinary incontinence 2yr after post-prostatectomy RT. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)00690-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
38
|
Marvaso G, Gugliandolo S, Comi S, Pepa M, Russo S, Vischioni B, Valvo F, Giandini T, Avuzzi B, Valdagni R, Ciardo D, Jereczek-Fossa B, Cattani F, Orecchia R. PO-1748: Carbon-ion boost followed by photon IMRT for PCa: dosimetric and geometric evaluations, AIRCIG. Radiother Oncol 2020. [DOI: 10.1016/s0167-8140(21)01766-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
39
|
Massi MC, Gasperoni F, Ieva F, Paganoni AM, Zunino P, Manzoni A, Franco NR, Veldeman L, Ost P, Fonteyne V, Talbot CJ, Rattay T, Webb A, Symonds PR, Johnson K, Lambrecht M, Haustermans K, De Meerleer G, de Ruysscher D, Vanneste B, Van Limbergen E, Choudhury A, Elliott RM, Sperk E, Herskind C, Veldwijk MR, Avuzzi B, Giandini T, Valdagni R, Cicchetti A, Azria D, Jacquet MPF, Rosenstein BS, Stock RG, Collado K, Vega A, Aguado-Barrera ME, Calvo P, Dunning AM, Fachal L, Kerns SL, Payne D, Chang-Claude J, Seibold P, West CML, Rancati T. A Deep Learning Approach Validates Genetic Risk Factors for Late Toxicity After Prostate Cancer Radiotherapy in a REQUITE Multi-National Cohort. Front Oncol 2020; 10:541281. [PMID: 33178576 PMCID: PMC7593843 DOI: 10.3389/fonc.2020.541281] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2020] [Accepted: 09/02/2020] [Indexed: 12/23/2022] Open
Abstract
Background: REQUITE (validating pREdictive models and biomarkers of radiotherapy toxicity to reduce side effects and improve QUalITy of lifE in cancer survivors) is an international prospective cohort study. The purpose of this project was to analyse a cohort of patients recruited into REQUITE using a deep learning algorithm to identify patient-specific features associated with the development of toxicity, and test the approach by attempting to validate previously published genetic risk factors. Methods: The study involved REQUITE prostate cancer patients treated with external beam radiotherapy who had complete 2-year follow-up. We used five separate late toxicity endpoints: ≥grade 1 late rectal bleeding, ≥grade 2 urinary frequency, ≥grade 1 haematuria, ≥ grade 2 nocturia, ≥ grade 1 decreased urinary stream. Forty-three single nucleotide polymorphisms (SNPs) already reported in the literature to be associated with the toxicity endpoints were included in the analysis. No SNP had been studied before in the REQUITE cohort. Deep Sparse AutoEncoders (DSAE) were trained to recognize features (SNPs) identifying patients with no toxicity and tested on a different independent mixed population including patients without and with toxicity. Results: One thousand, four hundred and one patients were included, and toxicity rates were: rectal bleeding 11.7%, urinary frequency 4%, haematuria 5.5%, nocturia 7.8%, decreased urinary stream 17.1%. Twenty-four of the 43 SNPs that were associated with the toxicity endpoints were validated as identifying patients with toxicity. Twenty of the 24 SNPs were associated with the same toxicity endpoint as reported in the literature: 9 SNPs for urinary symptoms and 11 SNPs for overall toxicity. The other 4 SNPs were associated with a different endpoint. Conclusion: Deep learning algorithms can validate SNPs associated with toxicity after radiotherapy for prostate cancer. The method should be studied further to identify polygenic SNP risk signatures for radiotherapy toxicity. The signatures could then be included in integrated normal tissue complication probability models and tested for their ability to personalize radiotherapy treatment planning.
Collapse
|
40
|
Nicolai N, Nazzani S, Catanzaro M, Tesone A, Macchi A, Torelli T, Stagni S, Celso F, Agostini E, Cloecchia M, Avuzzi B, Lanocita R, Necchi A, Raggi D, Giannatempo P, Farè E, Salvioni R, Biasoni D. Retroperitoneal lymph-node dissection (RPLND) as upfront management in stage II germ-cell tumours: evaluation of safety and efficacy of open and laparoscopic procedures. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)35543-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
|
41
|
Bresolin A, Garibaldi E, Faiella A, Cante D, Vavassori V, Waskiewicz JM, Girelli G, Avuzzi B, Villa E, Magli A, Noris Chiorda B, Munoz F, Sanguineti G, Gabriele P, Gatti M, Rancati T, Valdagni R, Di Muzio N, Fiorino C, Cozzarini C. Predictors of 2-Year Incidence of Patient-Reported Urinary Incontinence After Post-prostatectomy Radiotherapy: Evidence of Dose and Fractionation Effects. Front Oncol 2020; 10:1207. [PMID: 32850354 PMCID: PMC7396712 DOI: 10.3389/fonc.2020.01207] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2020] [Accepted: 06/15/2020] [Indexed: 11/13/2022] Open
Abstract
Objective: To investigate predictors of patient-reported urinary incontinence (PRUI) in the first 2 years after post-prostatectomy radiotherapy (PORT) with particular emphasis on possible dose-effect relationships. Patients and Methods: Two-hundred-thirteen patients, whose clinical and dosimetric data were prospectively collected within a registered multi-institutional cohort study, underwent PORT with adjuvant (n = 106) or salvage (n = 107) intent with conventional (n = 123, prescribed dose to the prostatic bed: 66.6–79.8Gy in 1.8–2.0Gy/fr) or moderately hypo- (n = 90, 65.8–76.8Gy in 2.1–2.7Gy/fr) fractionation during the period 2011–2017. PRUI was evaluated through the ICIQ-SF questionnaire filled in at baseline and every 6 months thereafter. The analysis focused on three ICIQ-based clinically relevant endpoints: (a) very frequent leakage (FREQUENCY, ICIQ3 score >3), (b) moderate to severe amount of urine loss (AMOUNT, ICIQ4>2) (c) objective severe symptoms (OBJECTIVE, ICIQ3+4>5). Predictors of the incidence within 2 years for the three endpoints were investigated focusing only on patients without endpoint symptoms at baseline. A uni-variable logistic regression analysis was performed in order to determine the best dose metrics describing PRUI risk in terms of 2-Gy equivalent dose (EQD2) calculated with different α/β values reported in the literature (0.8, 3, 5Gy), and to identify the most significant clinical variables. Variables showing p < 0.20 at uni-variable analysis were entered into a backward stepwise multi-variable logistic regression analysis. Lastly, the goodness of fit and model calibration were evaluated and internally validated. Results: Patients without symptoms at baseline experienced (a), (b), and/or (c) within 2 years in 41/130 (32%), 40/192 (21%), and 41/129 (32%) of the cases, respectively. EQD2 for α/β = 0.8Gy was the best dose metric associated with PRUI. Multi-variable analysis identified baseline incontinence levels as the strongest predictor for all endpoints (p < 0.006). Both FREQUENCY and OBJECTIVE were significantly influenced also by EQD2(α/β = 0.8Gy). The goodness of fit was excellent, as was the calibration; internal calibration confirmed apparent performance. Conclusion: Baseline mild urinary incontinence symptoms strongly modulate the 2-year risk of PRUI. In addition, FREQUENCY is characterized by a marked dose-effect relationship also influencing the trend of OBJECTIVE, with results more reliable than AMOUNT as an objective index. A strong impact of fractionation on severe PRUI after post-prostatectomy radiotherapy also emerged.
Collapse
|
42
|
Badenchini F, Marenghi C, Avuzzi B, Bellardita L, Casale A, Catanzaro M, Claps M, Colecchia M, De Luca L, Di Florio T, Donegani S, Dordoni P, Macchi A, Messina A, Morlino S, Noris Chiorda B, Stagni S, Tesone A, Torelli T, Villa S, Zollo F, Magnani T, Rancati T, Valdagni R, Nicolai N. A predictive model to personalize follow up schedules for patients in active surveillance. EUR UROL SUPPL 2020. [DOI: 10.1016/s2666-1683(20)33880-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
|
43
|
Scalco E, Belfatto A, Mastropietro A, Rancati T, Avuzzi B, Messina A, Valdagni R, Rizzo G. T2w‐MRI signal normalization affects radiomics features reproducibility. Med Phys 2020; 47:1680-1691. [DOI: 10.1002/mp.14038] [Citation(s) in RCA: 50] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 01/13/2020] [Accepted: 01/14/2020] [Indexed: 01/01/2023] Open
|
44
|
Rancati T, Bedini N, De Cecco L, Avuzzi B, Morlino S, Noris Chiorda B, Dispinzieri M, Villa S, Di Florio T, Badenchini F, Palorini F, Giandini T, Cicchetti A, Mancinelli E, Serafini M, De Vecchi A, Orlandi E, Valdagni R. OC-0616 Introducing information on gut microbiota into toxicity modeling: preliminary results from a trial. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31036-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
45
|
Munoz F, Cante D, Garibaldi E, Peruzzo A, Petrucci E, Delmastro E, Sanguineti G, Faiella A, Avuzzi B, Chiorda BN, Giandini T, Vavassori V, Villa E, Girelli G, Farina B, Waskiewicz J, Magli A, Moretti E, Valdagni R, Bianconi C, Badenchini F, Di Muzio N, Rancati T, Fiorino C, Cozzarini C. PO-0850 Comparison of self-reported acute urinary incontinence in pts treated with adjuvant or salvage IMRT. Radiother Oncol 2019. [DOI: 10.1016/s0167-8140(19)31270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
|
46
|
Valvo F, Ciurlia E, Avuzzi B, Doci R, Ducreux M, Roelofsen F, Roth A, Trama A, Wittekind C, Bosset JF. Cancer of the anal region. Crit Rev Oncol Hematol 2019; 135:115-127. [DOI: 10.1016/j.critrevonc.2018.12.007] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 12/06/2018] [Accepted: 12/19/2018] [Indexed: 11/25/2022] Open
|
47
|
Palorini F, Cicchetti A, Rancati T, Cozzarini C, Avuzzi B, Botti A, Cante D, Borca VC, Esposti CD, Garibaldi E, Girelli G, Iotti C, Maggio A, Munoz F, Palombarini M, Pierelli A, Pignoli E, Vavassori V, Valdagni R, Fiorino C. 47. Dependence from dose and fractionation of late severe urinary toxicities after radical radiotherapy for prostate cancer. Phys Med 2018. [DOI: 10.1016/j.ejmp.2018.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
|
48
|
Torrente S, Andreani S, Badenchini F, Rancati T, Marenghi C, Avuzzi B, Morlino S, Bedini N, Villa S, Noris Chiorda B, Palorini F, Andreoli L, Di Florio T, Catanzaro M, Stagni S, Biasoni D, Torelli T, Tesone A, Nicolai N, Valdagni R. Clinical Results for an Active Surveillance Cohort with Localized Prostate Cancer Receiving RT after Exiting Active Surveillance. Int J Radiat Oncol Biol Phys 2018. [DOI: 10.1016/j.ijrobp.2018.07.282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
|
49
|
Cicchetti A, Avuzzi B, Palorini F, Ballarini F, Stucchi C, Fellin G, Gabriele P, Vavassori V, Esposti CD, Cozzarini C, Fiorino C, Rancati T, Valdagni R. Predicting Late Fecal Incontinence Risk After Radiation Therapy for Prostate Cancer: New Insights From External Independent Validation. Int J Radiat Oncol Biol Phys 2018; 102:127-136. [PMID: 29970313 DOI: 10.1016/j.ijrobp.2018.05.013] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Revised: 03/30/2018] [Accepted: 05/02/2018] [Indexed: 12/24/2022]
Abstract
PURPOSE This study aimed to validate a previously published predictive model for late fecal incontinence (FI) in a contemporary population of prostate cancer patients treated with radical radiation therapy. METHODS AND MATERIALS The validation included patients treated with intensity-modulated radiation therapy (IMRT) (2010-2014). Prescribed dose range was 65-80 Gy, including conventional and moderate hypo-fractionated treatments. Rectal toxicity was scored using LENT/SOMA, a minimum 2-year follow up was considered. We chose to validate the model published by Rancati et al for predicting chronic FI, developed on a 3-dimensional conformal radiation therapy (3DCRT) population. It considered a longitudinal endpoint defined as the average toxicity grade during the follow up. This continuous endpoint was dichotomized using a cut-off value of mean FI grade >1. The model included mean rectal dose (Dmean), previous diseases of the colon (COLO) and previous abdominal surgery (SURG). Doses were corrected to 2 Gy/fraction using the linear-quadratic model and applying alpha/beta ratio = 4.8 Gy. RESULTS 228 patients constituted the validation population. A mean FI grade >1 was scored in 25 patients (11%). Logistic regression confirmed risk factors reported in the literature, with similar odds ratios (ORs) for Dmean (1.04 ± 0.03 vs 1.06 ± 0.04) and SURG (1.9 ± 1.7 vs 1.6 ± 1.45); COLO was not confirmed. Consequently, the predictive models including Dmean/Dmean + SURG were evaluated using calibration plots. Both showed a clear discriminative trend, but the absolute observed toxicity rates were underestimated (ie, absolute predicted rates were always lower than corresponding absolute observed rates). This result was consistent with an unexpected effect of hypofractionation (OR = 2.20, conventional = 8.1% vs hypofractionated = 17.4%) beyond the standard correction using linear-quadratic model. Nevertheless, the FI rate in the conventionally treated group was almost double the rate observed in the previously studied cohort (4.3% vs 8.1%). CONCLUSIONS The study confirms previously published results indicating that abdominal surgery and rectal mean dose are risk factors for late FI. Calibration plots highlight a possible role of hypofractionation beyond linear-quadratic correction.
Collapse
|
50
|
Carrara M, Massari E, Cicchetti A, Giandini T, Avuzzi B, Palorini F, Stucchi C, Fellin G, Gabriele P, Vavassori V, Degli Esposti C, Cozzarini C, Pignoli E, Fiorino C, Rancati T, Valdagni R. Development of a Ready-to-Use Graphical Tool Based on Artificial Neural Network Classification: Application for the Prediction of Late Fecal Incontinence After Prostate Cancer Radiation Therapy. Int J Radiat Oncol Biol Phys 2018; 102:1533-1542. [PMID: 30092335 DOI: 10.1016/j.ijrobp.2018.07.2014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 06/19/2018] [Accepted: 07/26/2018] [Indexed: 12/13/2022]
Abstract
PURPOSE This study was designed to apply artificial neural network (ANN) classification methods for the prediction of late fecal incontinence (LFI) after high-dose prostate cancer radiation therapy and to develop a ready-to-use graphical tool. MATERIALS AND METHODS In this study, 598 men recruited in 2 national multicenter trials were analyzed. Information was recorded on comorbidity, previous abdominal surgery, use of drugs, and dose distribution. Fecal incontinence was prospectively evaluated through self-reported questionnaires. To develop the ANN, the study population was randomly split into training (n = 300), validation (n = 149), and test (n = 149) sets. Mean grade of longitudinal LFI (ie, expressed as the average incontinence grade over the first 3 years after radiation therapy) ≥1 was considered the endpoint. A suitable subset of variables able to better predict LFI was selected by simulating 100,000 ANN configurations. The search for the definitive ANN was then performed by varying the number of inputs and hidden neurons from 4 to 5 and from 1 to 9, respectively. A final classification model was established as the average of the best 5 among 500 ANNs with the same architecture. An ANN-based graphical method to compute LFI prediction was developed to include one continuous and n dichotomous variables. RESULTS An ANN architecture was selected, with 5 input variables (mean dose, previous abdominal surgery, use of anticoagulants, use of antihypertensive drugs, and use of neoadjuvant and adjuvant hormone therapy) and 4 hidden neurons. The developed classification model correctly identified patients with LFI with 80.8% sensitivity and 63.7% ± 1.0% specificity and an area under the curve of 0.78. The developed graphical tool may efficiently classify patients in low, intermediate, and high LFI risk classes. CONCLUSIONS An ANN-based model was developed to predict LFI. The model was translated in a ready-to-use graphical tool for LFI risk classification, with direct interpretation of the role of the predictors.
Collapse
|