Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

Paleny, Roman; Bremer, Michael; Walacides, Daniel; Mainwaring, Silke; Weber, Kristina; Henkenberens, Christoph

doi:10.1007/s00066-018-1365-4

Cited by 6 publications

(6 citation statements)

References 29 publications

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“…The largest effect has been found on gastrointestinal toxicity, with significantly higher grade two or higher rates for higher doses [3]. A correlation of gastrointestinal toxicity with rectal dose-volume parameters is well known [16]. However, quality of life from the patients' perspective have not been evaluated in these trials.…”

Section: Discussionmentioning

confidence: 99%

Quality of life more than 10 years after radiotherapy for localized prostate cancer—impact of time after treatment and prescription dose

et al. 2020

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Purpose Analysis of quality of life changes after radiotherapy with focus on the impact of time after treatment and prescription dose. Methods Consecutive patients were treated with doses from 70.2/1.8 Gy (n = 206) to 72/1.8–2.0 Gy (n = 176) in a single centre and surveyed using the Expanded Prostate Cancer Index Composite questionnaire. Results Urinary and bowel bother scores decreased 1 / 3 / 6 points and 7 / 7 / 9 points on average 1 / 5 / 10 years after RT in comparison to baseline scores. The rate of urinary (need of pads in 8% vs. 15% before vs. 10 years after RT; p = 0.01) and bowel (uncontrolled leakage of stool in 5% vs. 12% before vs. 10 years after RT; p < 0.01) incontinence, as well as rectal bleeding (4% vs. 8% before vs. 10 years after RT; p = 0.05) increased. Sexual function scores decreased (erections sufficient for intercourse in 36% vs. 12% before vs. 10 years after RT; p < 0.01). A higher dose had a statistically significant impact on urinary bother and stool incontinence, but also tended to decrease urinary continence. Age and comorbidities did not have an influence on score changes, but on baseline urinary function/bother and baseline sexual function. Conclusion Apart from an increasing rate of erectile dysfunction, urinary and bowel incontinence rates increased with increasing follow-up period. A higher dose was found to be associated with increased urinary problems and larger stool incontinence rates. Age and comorbidities were found to be relevant for baseline scores, but not for score changes.

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Section: Discussionmentioning

confidence: 99%

Quality of life more than 10 years after radiotherapy for localized prostate cancer—impact of time after treatment and prescription dose

et al. 2020

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“…All patients received neoadjuvant radiochemotherapy treatment including 50.4 Gy overall dose fractured into 28 sessions of 1.8 Gy and chemotherapy including 5-FU for an overall period of 38 days. 10,11 The tumor response was surveilled 8 weeks post-RCT with proctoscopy, CT of the pelvis, endorectal ultrasound and clinical examination. Thereafter, tumor resection was performed in 191 patients.…”

Section: Treatment Protocolmentioning

confidence: 99%

Regulatory T cells and cytotoxic T cells close to the epithelial–stromal interface are associated with a favorable prognosis

et al. 2020

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Cytotoxic T cells and regulatory T cells play a crucial role in the outcome of cancer patients. Besides the density of these cells, it was shown recently that the spatial distribution is equally important. Here, we specifically analyzed the spatial distribution of these T cell subtypes at the epithelial-stromal interface in a rectal cancer cohort and its relevance for prognosis. We studied a cohort of 191 patients with advanced rectal cancer treated by radiochemotherapy (RCT). Tissue microarrays were immunohistochemical double-stained by FoxP3+ and CD+. Cell densities were analyzed in the stromal and epithelial compartment. Additionally, an image analysis software calculated the distances of lymphocytes to the epithelial-stromal interface (ESI). CD8+ and FoxP3+ cell counts decreased clearly after RCT with the decrease of FoxP3+ being more pronounced than of CD8+ cells. In the invasive front, short distances of the ESI to CD8+ and to FoxP3+ cells were associated with improved overall survival. Cell counts in the stromal compartment had no influence on prognosis. No correlation between stromal and epithelial lymphocyte densities was observed. The distance of epithelial-stromal interface to CD8+ and FoxP3+ cells was more accurate in predicting prognosis in the stromal compartment of rectal cancer patients than mere cell counts and could thereby be means of better stratifying patients for therapy. This observation will have to be validated in future prospective studies with regard to other tumor entities and its implications for the responsiveness of tumors to new therapeutic modalities.

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“…The results published by Mirjolet et al(44) were along the same lines: the absolute volume of the rectum between 25 Gy and 50 Gy correlates significantly with acute toxicity rate, while their relative counterpart does not. These findings were contradicted by the results published by Paleny et al(45) that reaffirm the correctness of the dosimetric evaluation for the prediction of proctitis referring to the relative and not to the absolute rectal volumes, except for V50Gyccm, which is the only absolute dose volume parameter statistically associated with acute proctitis.Thor et al (46) suggest that of stool incontinence and rectal bleeding(48).Martínez-Arribas et al (49) reported a greater risk of proctitis with a mean rectal dose >45 Gy. Sanguineti et al (50) proposed the following relative dose-volume constraints in order doses ≥50 Gy.…”

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confidence: 75%

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

Ferini¹,

Pergolizzi

2021

In Vivo

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This comprehensive synopsis summarizes the most relevant information obtained from a systematic analysis of studies of the last decade on radiation proctitis, one of the most feared radioinduced side effects among prostate cancer patients treated with curative external beam radiotherapy. The present review provides a useful support to radiation oncologists for limiting the onset or improving the treatment of radiation proctitis. This work shows that the past decade was a harbinger of significant new evidence in technological advances and technical tricks to avoid radiation proctitis, in addition to dosimetric perspectives and goals, understanding of pathogenesis, diagnostic work-up and treatment. We believe that a well-rounded knowledge of such an issue is fundamental for its appropriate management.

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Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

Abstract: Absolute DV parameters in ccm are not required for RT in PCa patients.

Cited by 6 publications

References 29 publications

Quality of life more than 10 years after radiotherapy for localized prostate cancer—impact of time after treatment and prescription dose

Quality of life more than 10 years after radiotherapy for localized prostate cancer—impact of time after treatment and prescription dose

Regulatory T cells and cytotoxic T cells close to the epithelial–stromal interface are associated with a favorable prognosis

A Ten-year-long Update on Radiation Proctitis Among Prostate Cancer Patients Treated With Curative External Beam Radiotherapy

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