A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints

Ahmed, Awad A.; Egleston, Brian; Alcantara, Pino; Li, Linna; Pollack, Alan; Horwitz, Eric M.

doi:10.1016/J.IJROBP.2013.03.020

Title: A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints

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Abstract

Background: There are no well-established normal tissue sparing dose–volume histogram (DVH) criteria that limit the risk of urinary toxicity from prostate radiation therapy (RT). The aim of this study was to determine which criteria predict late toxicity among various DVH parameters when contouring the entire solid bladder and its contents versus the bladder wall. The area under the histogram curve (AUHC) was also analyzed. Methods and Materials: From 1993 to 2000, 503 men with prostate cancer received 3-dimensional conformal RT (median follow-up time, 71 months). The whole bladder and the bladder wall were contoured in all patients. The primary endpoint was grade ≥2 genitourinary (GU) toxicity occurring ≥3 months after completion of RT. Cox regressions of time to grade ≥2 toxicity were estimated separately for the entire bladder and bladder wall. Concordance probability estimates (CPE) assessed model discriminative ability. Before training the models, an external random test group of 100 men was set aside for testing. Separate analyses were performed based on the mean age (≤ 68 vs >68 years). Results: Age, pretreatment urinary symptoms, mean dose (entire bladder and bladder wall), and AUHC (entire bladder and bladder wall) were significant (P<.05) in multivariable analysis. Overall, bladder wall CPE valuesmore »« less

Authors:

Ahmed, Awad A. ^[1]; Egleston, Brian ^[2]; Alcantara, Pino ^[3]; Li, Linna ^[4]; Pollack, Alan ^[5]; Horwitz, Eric M. ^[6]

Temple University School of Medicine, Philadelphia, Pennsylvania (United States)
Department of Biostatistics, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)
Department of Radiation Oncology, Hospital Universitario Clínico San Carlos, Madrid (Spain)
Department of Radiation Oncology, Bryn Mawr Hospital, Bryn Mawr, Pennsylvania (United States)
Department of Radiation Oncology, University of Miami Miller School of Medicine, Miami, Florida (United States)
Department of Radiation Oncology, Fox Chase Cancer Center, Philadelphia, Pennsylvania (United States)

Publication Date:: Mon Jul 15 00:00:00 EDT 2013

OSTI Identifier:: 22224531

Resource Type:: Journal Article

Journal Name:: International Journal of Radiation Oncology, Biology and Physics

Additional Journal Information:: Journal Volume: 86; Journal Issue: 4; Other Information: Copyright (c) 2013 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016

Country of Publication:: United States

Language:: English

Subject:: 62 RADIOLOGY AND NUCLEAR MEDICINE; BLADDER; HEALTH HAZARDS; NEOPLASMS; PROSTATE; RADIATION DOSES; RADIOTHERAPY; TOXICITY

Citation Formats


                    Ahmed, Awad A., Egleston, Brian, Alcantara, Pino, Li, Linna, Pollack, Alan, Horwitz, Eric M., and Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu. A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints.  United States: N. p., 2013. 
        Web.  doi:10.1016/J.IJROBP.2013.03.020.

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                    Ahmed, Awad A., Egleston, Brian, Alcantara, Pino, Li, Linna, Pollack, Alan, Horwitz, Eric M., & Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu. A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints.  United States.  https://doi.org/10.1016/J.IJROBP.2013.03.020

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                    Ahmed, Awad A., Egleston, Brian, Alcantara, Pino, Li, Linna, Pollack, Alan, Horwitz, Eric M., and Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu. 2013.  
        "A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints".  United States.  https://doi.org/10.1016/J.IJROBP.2013.03.020.

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@article{osti_22224531,

  title        = {A Novel Method for Predicting Late Genitourinary Toxicity After Prostate Radiation Therapy and the Need for Age-Based Risk-Adapted Dose Constraints},

  author       = {Ahmed, Awad A. and Egleston, Brian and Alcantara, Pino and Li, Linna and Pollack, Alan and Horwitz, Eric M. and Buyyounouski, Mark K., E-mail: mark.buyyounouski@fccc.edu},

  abstractNote = {Background: There are no well-established normal tissue sparing dose–volume histogram (DVH) criteria that limit the risk of urinary toxicity from prostate radiation therapy (RT). The aim of this study was to determine which criteria predict late toxicity among various DVH parameters when contouring the entire solid bladder and its contents versus the bladder wall. The area under the histogram curve (AUHC) was also analyzed. Methods and Materials: From 1993 to 2000, 503 men with prostate cancer received 3-dimensional conformal RT (median follow-up time, 71 months). The whole bladder and the bladder wall were contoured in all patients. The primary endpoint was grade ≥2 genitourinary (GU) toxicity occurring ≥3 months after completion of RT. Cox regressions of time to grade ≥2 toxicity were estimated separately for the entire bladder and bladder wall. Concordance probability estimates (CPE) assessed model discriminative ability. Before training the models, an external random test group of 100 men was set aside for testing. Separate analyses were performed based on the mean age (≤ 68 vs >68 years). Results: Age, pretreatment urinary symptoms, mean dose (entire bladder and bladder wall), and AUHC (entire bladder and bladder wall) were significant (P<.05) in multivariable analysis. Overall, bladder wall CPE values were higher than solid bladder values. The AUHC for bladder wall provided the greatest discrimination for late bladder toxicity when compared with alternative DVH points, with CPE values of 0.68 for age ≤68 years and 0.81 for age >68 years. Conclusion: The AUHC method based on bladder wall volumes was superior for predicting late GU toxicity. Age >68 years was associated with late grade ≥2 GU toxicity, which suggests that risk-adapted dose constraints based on age should be explored.},

  doi          = {10.1016/J.IJROBP.2013.03.020},

  url          = {https://www.osti.gov/biblio/22224531},
  journal      = {International Journal of Radiation Oncology, Biology and Physics},

  issn         = {0360-3016},

  number       = 4,

  volume       = 86,

  place        = {United States},

  year         = {Mon Jul 15 00:00:00 EDT 2013},

  month        = {Mon Jul 15 00:00:00 EDT 2013}

}

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