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Schaake W, van der Schaaf A, van Dijk LV, Bongaerts AHH, van den Bergh ACM, Langendijk JA. Normal tissue complication probability (NTCP) models for late rectal bleeding, stool frequency and fecal incontinence after radiotherapy in prostate cancer patients. Radiother Oncol 2016; 119:381-7. [PMID: 27157889 DOI: 10.1016/j.radonc.2016.04.005] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Revised: 02/28/2016] [Accepted: 04/03/2016] [Indexed: 01/09/2023]
Abstract
BACKGROUND AND PURPOSE Curative radiotherapy for prostate cancer may lead to anorectal side effects, including rectal bleeding, fecal incontinence, increased stool frequency and rectal pain. The main objective of this study was to develop multivariable NTCP models for these side effects. MATERIAL AND METHODS The study sample was composed of 262 patients with localized or locally advanced prostate cancer (stage T1-3). Anorectal toxicity was prospectively assessed using a standardized follow-up program. Different anatomical subregions within and around the anorectum were delineated. A LASSO logistic regression analysis was used to analyze dose volume effects on toxicity. RESULTS In the univariable analysis, rectal bleeding, increase in stool frequency and fecal incontinence were significantly associated with a large number of dosimetric parameters. The collinearity between these predictors was high (VIF>5). In the multivariable model, rectal bleeding was associated with the anorectum (V70) and anticoagulant use, fecal incontinence was associated with the external sphincter (V15) and the iliococcygeal muscle (V55). Finally, increase in stool frequency was associated with the iliococcygeal muscle (V45) and the levator ani (V40). No significant associations were found for rectal pain. CONCLUSIONS Different anorectal side effects are associated with different anatomical substructures within and around the anorectum. The dosimetric variables associated with these side effects can be used to optimize radiotherapy treatment planning aiming at prevention of specific side effects and to estimate the benefit of new radiation technologies.
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Affiliation(s)
- Wouter Schaake
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands; Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, Groningen, The Netherlands.
| | - Arjen van der Schaaf
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Lisanne V van Dijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alfons H H Bongaerts
- Department of Radiology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Alfons C M van den Bergh
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
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Palorini F, Cozzarini C, Gianolini S, Botti A, Carillo V, Iotti C, Rancati T, Valdagni R, Fiorino C. First application of a pixel-wise analysis on bladder dose-surface maps in prostate cancer radiotherapy. Radiother Oncol 2016; 119:123-8. [PMID: 26993415 DOI: 10.1016/j.radonc.2016.02.025] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Revised: 02/08/2016] [Accepted: 02/17/2016] [Indexed: 01/26/2023]
Abstract
PURPOSE To develop a method for investigating local dose effects on the bladder after prostate cancer radiotherapy based on dose-surface maps (DSMs). BACKGROUND AND PURPOSE DSMs of patients included in a prospective study (DUE01) were generated by virtually cutting bladder contours at the points intersecting the sagittal plane passing through its center-of-mass: maps were laterally normalized and aligned at the posterior inferior point. The average DSMs of patients with/without toxicity, the DSMs of differences and t statistic were used to select regions better discriminating patients with toxicity. A total of 72 patients with no/mild urinary symptoms before radiotherapy and who were treated with moderate hypo-fractionation (2.5-2.65Gy/fr, 70-74Gy) were considered, and the endpoint was an International Prostate Symptoms Score (IPSS)⩾15 at the end of therapy (IPSSend⩾15, n=25/72). RESULTS The DSMs of patients with/without toxicity were significantly different (p<0.05). The percentage of bladder circumference receiving >50-70Gy at 5-7mm from the base was associated with an IPSSend⩾15 (odds ratios: 1.03-1.07). Different patterns were recognized for specific symptoms. With frequency/urgency, a quasi-threshold effect on the absolute posterior dose at 5-12mm from the base (2Gy equivalent doses=80-82Gy, α/β=3-5Gy) was observed. CONCLUSIONS Local-dose effects for acute symptoms were detected in a group of patients treated within a moderately hypo-fractionated protocol. The results for frequency/urgency were consistent with a threshold effect on the trigone.
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Fellin G, Rancati T, Fiorino C, Vavassori V, Antognoni P, Baccolini M, Bianchi C, Cagna E, Borca VC, Girelli G, Iacopino B, Maliverni G, Mauro FA, Menegotti L, Monti AF, Romani F, Stasi M, Valdagni R. Long term rectal function after high-dose prostatecancer radiotherapy: results from a prospective cohort study. Radiother Oncol 2013; 110:272-7. [PMID: 24332020 DOI: 10.1016/j.radonc.2013.09.028] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Revised: 07/05/2013] [Accepted: 09/07/2013] [Indexed: 12/15/2022]
Abstract
PURPOSE To prospectively evaluate long-term late rectal bleeding (lrb) and faecal incontinence (linc) after high-dose radiotherapy (RT) for prostate cancer in the AIROPROS 0102 population, and to assess clinical/dosimetric risk factors. MATERIALS AND METHODS Questionnaires of 515 patients with G0 baseline incontinence and bleeding scores (follow-up ≥6 years) were analysed. Correlations between lrb/linc and many clinical and dosimetric parameters were investigated by univariate and multivariate logistic analyses. The correlation between lrb/linc and symptoms during the first 3 years after RT was also investigated. RESULTS Of 515 patients lrb G1, G2 and G3 was found in 32 (6.1%), 2 (0.4%) and 3 (0.6%) patients while linc G1, G2 and G3 was detected in 50 (9.7%), 3 (0.6%) and 3 (0.6%), respectively. The prevalence of G2-G3 lrb events was significantly reduced compared to the first 3-years (1% vs 2.7%, p=0.016) ≥G1 lrb was significantly associated with V75 Gy (OR=1.07). In multivariate analysis, ≥G1 linc was associated with V40 Gy (OR=1.015), use of antihypertensive medication (OR=0.38), abdominal surgery before RT (OR=4.7), haemorrhoids (OR=2.6), and G2-G3 acute faecal incontinence (OR=4.4), a nomogram to predict the risk of long-term ≥G1 linc was proposed. Importantly, the prevalence of ≥G1 linc was significantly correlated with the mean incontinence score during the first 3 years after RT (OR=16.3). CONCLUSIONS Long-term (median: 7 years) rectal symptoms are prevalently mild and strongly correlated with moderate/severe events occurring in the first 3 years after RT. Linc was associated with several risk factors.
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Affiliation(s)
- Gianni Fellin
- Department of Radiotherapy, Ospedale Santa Chiara, Trento, Italy
| | - Tiziana Rancati
- Prostate Cancer Program, Ospedale San Raffaele, Milan, Italy.
| | | | | | - Paolo Antognoni
- Department of Radiotherapy, Ospedale di Circolo, Varese, Italy
| | - Michela Baccolini
- Department of Medical Physics, Ospedale Villa Maria Cecilia, Lugo di Romagna, Italy
| | - Carla Bianchi
- Department of Medical Physics, Ospedale di Circolo, Varese, Italy
| | - Emanuela Cagna
- Department of Radiotherapy, Ospedale Sant'Anna, Como, Italy
| | | | | | - Bruno Iacopino
- Department of Radiotherapy, Policlinico Sant'Orsola Malpighi, Bologna, Italy
| | | | - Flora A Mauro
- Department of Radiotherapy, Ospedale Villa Maria Cecilia, Lugo di Romagna, Italy
| | - Loris Menegotti
- Department of Medical Physics, Ospedale Santa Chiara, Trento, Italy
| | - Angelo F Monti
- Department of Medical Physics, Ospedale Sant'Anna, Como, Italy
| | - Fabrizio Romani
- Department of Medical Physics, Policlinico Sant'Orsola Malpighi Bologna, Italy
| | | | - Riccardo Valdagni
- Prostate Cancer Program, Ospedale San Raffaele, Milan, Italy; Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy
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