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Ndjembidouma BCM, James LG, Meye PO, Loembamouandza SY, Belembaogo E, Ben-Bolie GH. Assessment of rectal toxicities after radiation therapy for localized prostate cancer: experience of the Akanda Cancer Institute in Gabon. Rep Pract Oncol Radiother 2023; 28:636-645. [PMID: 38179290 PMCID: PMC10764052 DOI: 10.5603/rpor.97507] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 10/18/2023] [Indexed: 01/06/2024] Open
Abstract
Background The purpose was to evaluate the incidence of acute and late rectal toxicities and their correlation with the clinical and dosimetric parameters of patients who underwent curative radiotherapy for localized prostate cancer at the Akanda Cancer Institute, Gabon. Materials and methods Between 2013 and 2021, a cohort of 46 patients with clinically localized stage cT1c-T4 prostate cancer was treated with three-dimensional conformal radiation therapy (3D-CRT) at the national cancer institute with doses ranging from 66 to 80 Gy. Post-radiation gastrointestinal (GI) toxicities were classified and graded according to the Common Terminology Criteria for Adverse Events CTCAE v4.0. Results In our study, 17.4% (8/46) developed acute GI. Grades 1 and 3 acute GI complications were seen in 13.0% (6/46) and 4.3% (2/46), respectively. No patient developed acute grade 2 or grade higher than 3 complications. Late GI side effects were limited. The median time to the development of late GI Grade ≥ 1 toxicities was 12 months (range: 9-19 months). 10.9% (5/46) had experience late GI. Among them, grade 1 and 2 were seen in 6.5% (3/46), and 4.3% (2/46), respectively. There was no grade 3 or higher complications. Statistically, we did not find any correlation between the presence of rectal toxicity and clinical factors or the presence of comorbidity. On the dosimetric level, the Mann-Whitney statistical test found a correlation between the presence of late GI toxicity and rectal volume irradiated at the prescribed dose (p = 0.02). Conclusion Despite the high radiation doses involved, our results showed an acceptable complication rate.
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Affiliation(s)
- Beaud Conrad Mabika Ndjembidouma
- Departement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
| | | | - Phillippe Ondo Meye
- General Directorate for Radiation Protection and Nuclear Safety, Ministery of Energy and Hydraulic Resources, Libreville Gabon
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
| | | | - Ernest Belembaogo
- Departement of Medical Physics and Radiotherapy, Akanda Cancer Institute, Libreville, Gabon
| | - Germain Hubert Ben-Bolie
- Laboratory of Atomic, Molecular and Nuclear Physics, Department of Physics, Faculty of Science, University of Yaounde I, Yaounde, Cameroun
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Boladeras A, Ferrer F, Navarro V, De Blas R, Cunillera O, Mateo D, Gutierrez C, Martinez E, Villà S, Pera J, Ferrer M, Guedea F. Association between EBRT dose volume histograms and quality of life in prostate cancer patients. Rep Pract Oncol Radiother 2018; 23:360-368. [PMID: 30127676 DOI: 10.1016/j.rpor.2018.07.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 07/22/2018] [Indexed: 01/06/2023] Open
Abstract
Aim To evaluate the association between dose-volume histogram (DVH) values in organs at risk (OAR) and patient-reported HRQoL outcomes. Background Data on the association between DVHs and health-related quality of life (HRQoL) in prostate cancer (PCa) patients are limited. Materials and methods Five-year follow-up study of 154 patients with organ-confined (stage T1/T2) PCa treated with EBRT between January 2003 and November 2005. HRQoL was evaluated with the Expanded Prostate Cancer Index (EPIC). DVH for OARs (penile bulb, rectum and bladder) were created for all patients for whom data were available (119/154; 77%). The functional data analysis (FDA) statistical method was used. HRQoL data was collected prospectively and data analysis was performed retrospectively. Results Worsening of urinary incontinence and obstructive symptoms correlated with higher DVH dose distributions at 24 months. Increased rectal bleeding at months 24 and 60 correlated with higher DVH dose distributions in the 40-70 Gy range. Patients with deterioration in rectal incontinence presented a higher DVH distribution range than patients without rectal incontinence. Penile bulb DVH values and erectile dysfunction were not significantly associated. Conclusions DVH parameters and post-radiotherapy HRQoL appear to be closely correlated, underscoring the importance of assessing DVH values prior to initiating EBRT to determine the risk of developing HRQoL related adverse effects. Advanced treatment modalities may be appropriate in high risk cases to minimize treatment-related toxicity and to improve treatment outcomes and HRQoL. Future studies are needed to better elucidate the association between pre-treatment DVH parameters in organs at risk and subsequent HRQoL.
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Affiliation(s)
- Anna Boladeras
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | - Ferran Ferrer
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | - Valentin Navarro
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | - Rodolfo De Blas
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | - Oriol Cunillera
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - David Mateo
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | | | - Evelyn Martinez
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | | | - Joan Pera
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
| | - Montse Ferrer
- Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, Spain.,CIBER en Epidemiología y Salud Pública, CIBERESP, Spain
| | - Ferran Guedea
- Institut Català d'Oncologia (ICO), L'Hospitalet, Barcelona, Spain
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Ren W, Sun C, Lu N, Xu Y, Han F, Liu YP, Dai J. Dosimetric comparison of intensity-modulated radiotherapy and volumetric-modulated arc radiotherapy in patients with prostate cancer: a meta-analysis. J Appl Clin Med Phys 2016; 17:254-262. [PMID: 27929498 PMCID: PMC5690508 DOI: 10.1120/jacmp.v17i6.6464] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Revised: 08/13/2016] [Accepted: 08/10/2016] [Indexed: 11/23/2022] Open
Abstract
Intensity-modulated radiotherapy (IMRT) and volumetric-modulated arc therapy (VMAT) are two main radiotherapy techniques. The aim of this study is to explore which is the preferred technique in prostate treatment through the related publica-tions and meta-analysis. Two authors independently identified all relevant articles available regarding eligibility criteria on PubMed, Embase, and Cochrane Library databases until December 2015. Publication bias was evaluated with funnel plot, and statistical analyses were performed with Stata software. P < 0.05 was thought statistically significant. Ten studies comprised a total of 110 patients; in total 110 IMRT plans and 110 VMAT plans that were included in this study. V40, V60, and V70 of rectum were significantly decreased in VMAT than in IMRT. However, V50 of rectum and V40, V50, V60, V70 of bladder had no statistical differences between IMRI and VMAT plans. Compared with IMRT, the treatment time and MUs of VMAT were significantly lower. VMAT protects rectum better than IMRT and improves the delivery efficiency. VMAT may be the preferred modality for treating prostate cancer.
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Affiliation(s)
- Wenting Ren
- Cancer Hospital, National Cancer Center, Chinese Academy of Medical Sciences and Peking Union Medical College.
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Suivi après radiothérapie des cancers de prostate : évaluation et prise en charge de la toxicité et de la récidive. Cancer Radiother 2015; 19:582-9. [DOI: 10.1016/j.canrad.2015.05.016] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2015] [Accepted: 05/20/2015] [Indexed: 12/17/2022]
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Cancers de prostate : quelles techniques de radiothérapie pour quelles tumeurs ? Enjeux éthiques et méthodologiques. Cancer Radiother 2014; 18:369-78. [DOI: 10.1016/j.canrad.2014.07.154] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2014] [Revised: 07/21/2014] [Accepted: 07/24/2014] [Indexed: 11/22/2022]
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Munbodh R, Jackson A. Quantifying cell migration distance as a contributing factor to the development of rectal toxicity after prostate radiotherapy. Med Phys 2014; 41:021724. [PMID: 24506615 DOI: 10.1118/1.4852955] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Spatial information is usually neglected in mathematical models of radiation-induced toxicity. In the presence of inhomogeneous dose distributions produced by intensity modulated radiation therapy (IMRT) and volumetric arc therapy, this may be a limitation. We present a model to quantify the spatial characteristics of the dose distribution on the rectum through the quantification of the distribution of distances between dose points on the surface of the rectum in three-dimensions. The method allows us to evaluate the hypothesis that distances between lower and higher dose regions on the rectum influence radiation damage repair due to the migration of normal cells into damaged areas, and consequently, the development of radiation-induced toxicity in patients treated with radiation for prostate cancer. METHODS We present a method to compute distances between dose points on the surface of the rectum in three dimensions (3D) and to generate distance maps representing the distances between specific dose regions on the rectum. We introduce the concept of the distance dose surface histogram (DDSH), which is computed from the distance maps. The DDSH is a 2D histogram of rectum area on a grid defined by pairwise combinations of dose and distance. Each bin in the DDSH quantifies the area of the rectum exposed to a given dose and at a given distance from other another dose region on the rectum. By summing across the columns and rows of the DDSH, the authors can generate the dose surface histogram (DSH) and distance surface histogram (DiSH) for a particular dose region. The DiSH is a marginal histogram showing the distribution of distances for the dose points in a specific dose region from another region. We computed the DDSH, DiSH, and DSH for 33 patients treated with IMRT for prostate cancer, nine of whom developed late Grade 2 or higher late rectal toxicity. RESULTS We show how even though the total area of the rectum exposed to a given dose may be the same for different patients, the distribution of distances for points receiving that dose can be different depending on the shape and contiguity of the region(s) containing those dose points. We also show that area of the rectum in the region receiving more than 75 Gy and at a distance of 16 to 22 mm from the 50 Gy isodose line was significantly correlated to the development of toxicity (p = 0.004, two sided t-test). This suggests that examining the distance distribution of points in specific dose regions could provide valuable additional information in predicting the risk of a patient developing radiation-induced rectal toxicity. CONCLUSIONS We present a new method to quantify the spatial distribution of points in a given region relative to other regions on the rectum. The method provides a means to evaluate the hypothesis that distances between lower and higher dose regions on the rectum influence radiation damage repair due to the migration of normal cells into damaged areas, and may be a contributing factor to the development of radiation-induced toxicity in patients treated with radiation for prostate cancer.
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Affiliation(s)
- Reshma Munbodh
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, Pennsylvania 19104
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York 10065
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Carillo V, Cozzarini C, Chietera A, Perna L, Gianolini S, Maggio A, Botti A, Rancati T, Valdagni R, Fiorino C. Correlation between surrogates of bladder dosimetry and dose-volume histograms of the bladder wall defined on MRI in prostate cancer radiotherapy. Radiother Oncol 2012. [PMID: 23182056 DOI: 10.1016/j.radonc.2012.10.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The correlation between bladder dose-wall-histogram (DWH) and dose-volume-histogram (DVH), dose-surface-histogram (DSH), and DVH-5/10 was investigated in a group of 28 patients; bladder walls were drawn on T2-MRI. DVH showed the poorest correlation with DWH; DSH or DVH-5/10 should be preferred in planning; absolute DVH may be used for radical patients, although less robust.
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Kintzinger C, Demoor-Goldschmidt C, Abderrahmani R, Paris F, Supiot S. Toxicité rectale de la radiothérapie : signes cliniques, physiopathologie et prise en charge. Cancer Radiother 2012; 16:372-6. [DOI: 10.1016/j.canrad.2012.05.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 05/28/2012] [Indexed: 12/29/2022]
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Leroy T, Gabelle Flandin I, Habold D, Hannoun-Lévi JM. [The impact of radiation therapy on sexual function]. Cancer Radiother 2012; 16:377-85. [PMID: 22921960 DOI: 10.1016/j.canrad.2012.05.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2012] [Accepted: 05/20/2012] [Indexed: 10/28/2022]
Abstract
The aim of this study was to evaluate the impact of radiation therapy on sexual life. The analysis was based on a Pubmed literature review. The keywords used for this research were "sexual, radiation, oncology, and cancer". After a brief reminder on the anatomy and physiology, we explained the main complications of radiation oncology and their impact on sexual life. Preventive measures and therapeutic possibilities were discussed. Radiation therapy entails local, systematic and psychological after-effects. For women, vaginal stenosis and dyspareunia represent the most frequent side effects. For men, radiation therapy leads to erectile disorders for 25 to 75% of the patients. These complications have an echo often mattering on the patient quality of life of and on their sexual life post-treatment reconstruction. The knowledge of the indications and the various techniques of irradiation allow reducing its potential sexual morbidity. The information and the education of patients are essential, although often neglected. In conclusion, radiation therapy impacts in variable degrees on the sexual life of the patients. Currently, there are not enough preventive and therapeutic means. Patient information and the early screening of the sexual complications are at stake in the support of patients in the reconstruction of their sexual life.
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Affiliation(s)
- T Leroy
- Département universitaire de radiothérapie, centre Oscar-Lambret, Lille, France.
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Auberdiac P, Chargari C, Négrier F, Boutinaud C, Zioueche A, Cartier L, Leduc B, Dumas JP, Colombeau P, de Laroche G, Magné N. Imagerie par résonance magnétique et délinéation de la prostate en radiothérapie : expérience monocentrique et revue de la littérature. Prog Urol 2012; 22:159-65. [DOI: 10.1016/j.purol.2011.09.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2011] [Revised: 09/20/2011] [Accepted: 09/20/2011] [Indexed: 10/15/2022]
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Supiot S, Rio E, Clément-Colmou K, Bouchot O, Rigaud J. Suivi après la radiothérapie des cancers de la prostate : bases scientifiques, rapport coût–bénéfice. Cancer Radiother 2011; 15:540-5. [DOI: 10.1016/j.canrad.2011.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2011] [Accepted: 05/23/2011] [Indexed: 01/21/2023]
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