Is It Time to Tailor the Prediction of Radio-Induced Toxicity in Prostate Cancer Patients? Building the First Set of Nomograms for Late Rectal Syndrome

Journal Article · Sun Apr 01 04:00:00 EDT 2012 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/J.IJROBP.2011.03.028· OSTI ID:22056258

Valdagni, Riccardo ^[1]; Kattan, Michael W ^[2]; Rancati, Tiziana ^[1]; Changhong, Yu ^[2]; Vavassori, Vittorio ^[3]; Fellin, Giovanni ^[4]; Cagna, Elena ^[5]; Gabriele, Pietro ^[6]; Mauro, Flora Anna; Baccolini, Micaela ^[7]; Bianchi, Carla ^[3]; Menegotti, Loris ^[4]; Monti, Angelo F ^[5]; Stasi, Michele ^[6]; Giganti, Maria Olga ^[1]; others, and

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1. Prostate Program, Scientific Directorate, Fondazione IRCCS-Istituto Nazionale Tumori, Milan (Italy)
2. Department of Quantitative Health Sciences, Cleveland Clinic Lerner College of Medicine of Case Western Reserve University, Cleveland, OH (United States)
3. Radiotherapy and Medical Physics, Ospedale di Circolo, Varese (Italy)
4. Radiotherapy and Medical Physics, Ospedale Santa Chiara, Trento (Italy)
5. Department of Radiotherapy and Medical Physics, Ospedale Sant'Anna, Como (Italy)
6. Department of Radiotherapy and Medical Physics, Institute for Cancer Research and Treatment, Candiolo (Italy)
7. Department of Radiotherapy and Medical Physics, Ospedale Villa Maria Cecilia, Lugo (Italy)

Purpose: Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. Methods and Materials: This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). Results: Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. Conclusions: We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.

• OSTI ID: 22056258
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 82; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
ADULTS
DISEASE INCIDENCE
EVALUATION
FORECASTING
MEN
NEOPLASMS
NOMOGRAMS
PATIENTS
PROBABILITY
PROSTATE
RADIATION DOSES
RADIOLOGICAL PERSONNEL
RADIOTHERAPY
RECTUM
REGRESSION ANALYSIS
STANDARD OF LIVING
SURGERY
TOXICITY