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Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer: preliminary results of a multicenter prospective study.

AbstractPURPOSE:
To assess the predictors of late rectal toxicity in a prospectively investigated group of patients treated at 70-80 Gy for prostate cancer (1.8-2 Gy fractions) with three-dimensional conformal radiotherapy.
METHODS AND MATERIALS:
A total of 1,132 patients were entered into the study between 2002 and 2004. Three types of rectal toxicity, evaluated by a self-administered questionnaire, mainly based on the subjective objective management, analytic late effects of normal tissue system, were considered: stool frequency/tenesmus/pain, fecal incontinence, and bleeding. The data from 506 patients with a follow-up of 24 months were analyzed. The correlation between a number of clinical and dosimetric parameters and Grade 2 or greater toxicity was investigated by univariate and multivariate (MVA) logistic analyses.
RESULTS:
Of the 1,132 patients, 21, 15, and 30 developed stool frequency/tenesmus/pain, fecal incontinence, and bleeding, respectively. Stool frequency/tenesmus/pain correlated with previous abdominal/pelvic surgery (MVA, p=0.05, odds ratio [OR], 3.3). With regard to incontinence, MVA showed the volume receiving>or=40 Gy (V40) (p=0.035, OR, 1.037) and surgery (p=0.02, OR, 4.4) to be the strongest predictors. V40 to V70 were highly predictive of bleeding; V70 showed the strongest impact on MVA (p=0.03), together with surgery (p=0.06, OR, 2.5), which was also the main predictor of Grade 3 bleeding (p=0.02, OR, 4.2).
CONCLUSIONS:
The predictive value of the dose-volume histogram was confirmed for bleeding, consistent with previously suggested constraints (V50<55%, V60<40%, V70<25%, and V75<5%). A dose-volume histogram constraint for incontinence can be suggested (V40<65-70%). Previous abdominal/pelvic surgery correlated with all toxicity types; thus, a modified constraint for bleeding (V70<15%) can be suggested for patients with a history of abdominal/pelvis surgery, although further validation on a larger population with longer follow-up is needed.
AuthorsClaudio Fiorino, Gianni Fellin, Tiziana Rancati, Vittorio Vavassori, Carla Bianchi, Valeria Casanova Borca, Giuseppe Girelli, Marco Mapelli, Loris Menegotti, Simona Nava, Riccardo Valdagni
JournalInternational journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 70 Issue 4 Pg. 1130-7 (Mar 15 2008) ISSN: 0360-3016 [Print] United States
PMID17881142 (Publication Type: Journal Article, Multicenter Study)
Topics
  • Abdomen (surgery)
  • Analysis of Variance
  • Constipation (etiology)
  • Defecation
  • Fecal Incontinence (etiology)
  • Gastrointestinal Hemorrhage (etiology)
  • Humans
  • Male
  • Odds Ratio
  • Pelvis (surgery)
  • Postoperative Complications
  • Prospective Studies
  • Prostatic Neoplasms (pathology, radiotherapy)
  • Radiation Injuries (complications)
  • Radiotherapy Dosage
  • Radiotherapy, Conformal (adverse effects)
  • Rectum (radiation effects)
  • Surveys and Questionnaires

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