Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT

Journal Article · Tue Jul 15 04:00:00 EDT 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2007.11.037· OSTI ID:21124352

Valdagni, Riccardo ^[1]; Rancati, Tiziana ^[1]; Fiorino, Claudio ^[2]; Fellin, Gianni ^[3]; Magli, Alessandro ^[4]; Baccolini, Michela ^[5]; Bianchi, Carla ^[6]; Cagna, Emanuela ^[7]; Greco, Carlo ^[8]; Mauro, Flora A ^[9]; Monti, Angelo F ^[10]; Munoz, Fernando ^[11]; Stasi, Michele ^[12]; Franzone, Paola ^[13]; Vavassori, Vittorio ^[4]

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1. Prostate Programme, Fondazione IRCCS, Istituto Nazionale dei Tumori, Milano (Italy)
2. Department of Medical Physics, Ospedale San Raffaele, Milano (Italy)
3. Department of Radiotherapy, Ospedale Santa Chiara, Trento (Italy)
4. Department of Radiotherapy, Ospedale di Circolo, Varese (Italy)
5. Department of Medical Physics, Ospedale Villa Maria Cecilia, Lugo (Italy)
6. Department of Medical Physics, Ospedale di Circolo, Varese (Italy)
7. Department of Radiotherapy, Ospedale Sant' Anna, Como (Italy)
8. Division of Radiation Oncology, University of Magna Graecia, Catanzaro (Italy)
9. Department of Radiotherapy, Ospedale Villa Maria Cecilia, Lugo (Italy)
10. Department of Medical Physics, Ospedale Sant' Anna, Como (Italy)
11. Department of Radiotherapy, Istituto per la Ricerca e la Cura del Cancro, Candiolo (Italy)
12. Department of Medical Physics, Istituto per la Ricerca e la Cura del Cancro, Candiolo (Italy)
13. Department of Radiotherapy, Ospedale SS. Antonio e Biagio, Alessandria (Italy)

Purpose: To predict acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) and Subjective Objective Signs Management and Analysis/Late Effect of Normal Tissue (SOMA/LENT) toxicities of the lower gastrointestinal (LGI) syndrome in patients with prostate cancer undergoing three-dimensional conformal radiotherapy using a tool (nomogram) that takes into account clinical and dosimetric variables that proved to be significant in the Italian Association for Radiation Oncology (AIRO) Group on Prostate Cancer (AIROPROS) 0102 trial. Methods and Materials: Acute rectal toxicity was scored in 1,132 patients by using both the RTOG/EORTC scoring system and a 10-item self-assessed questionnaire. Correlation between clinical variables/dose-volume histogram constraints and rectal toxicity was investigated by means of multivariate logistic analyses. Multivariate logistic analyses results were used to create nomograms predicting the symptoms of acute LGI syndrome. Results: Mean rectal dose was a strong predictor of Grade 2-3 RTOG/EORTC acute LGI toxicity (p 0.0004; odds ratio (OR) = 1.035), together with hemorrhoids (p = 0.02; OR 1.51), use of anticoagulants/antiaggregants (p = 0.02; OR = 0.63), and androgen deprivation (AD) (p = 0.04; OR = 0.65). Diabetes (p = 0.34; OR 1.28) and pelvic node irradiation (p = 0.11; OR = 1.56) were significant variables to adjust toxicity prediction. Bleeding was related to hemorrhoids (p = 0.02; OR = 173), AD (p = 0.17; OR = 0.67), and mean rectal dose (p 0.009; OR = 1.024). Stool frequency was related to seminal vesicle irradiation (p = 0.07; OR = 6.46), AD administered for more than 3 months (p = 0.002; OR = 0.32), and the percent volume of rectum receiving more than 60 Gy (V60Gy) V60 (p = 0.02; OR = 1.02). Severe fecal incontinence depended on seminal vesicle irradiation (p = 0.14; OR = 4.5) and V70 (p = 0.033; OR 1.029). Conclusions: To the best of our knowledge, this work presents the first set of nomograms available in the literature specific to symptoms of LGI syndrome and provides clinicians with a tailored probability of the specific outcome. Validation of the tool is in progress.

• OSTI ID: 21124352
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 4 Vol. 71; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ANDROGENS
ANTICOAGULANTS
IRRADIATION
MULTIVARIATE ANALYSIS
NEOPLASMS
NOMOGRAMS
PATIENTS
PROSTATE
RADIATION DOSES
RADIOTHERAPY
RECTUM
SYMPTOMS
TOXICITY