Impact of changing rectal dose volume parameters over time on late rectal and urinary toxicity after high-dose intensity-modulated radiotherapy for prostate cancer: A 10-years single centre experience

Fonteyne, Valérie; Sadeghi, Simin; Ost, Piet; Vanpachtenbeke, Frank; Vuye, Philippe; Lumen, Nicolaas; Meerleer, Gert De

doi:10.3109/0284186x.2014.974826

Cited by 10 publications

(10 citation statements)

References 27 publications

(2 reference statements)

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“…Incidence of late grade 3 GI toxicity was low, which is in agreement with similar IMRT studies ( Table 5 ). Fonteyne et al 26 reported a 1% late grade 3 GI toxicity with median of 5 years of follow-up for 232 patients who were treated with IMRT postoperatively, which is comparable with our finding of 2%. However, many IMRT series with lower patient numbers report 0% late grade 3 GI toxicity.…”

Section: Discussionsupporting

confidence: 92%

“…2011 17 136 136 60 56% In-house toxicity score G2: 15% G3: 0% G2: 13% G3: < 1% G2: 28% G3: 3% G2: 31% G3: 3% Stricture: 6% G3: 1% Fonteyne et al. 2015 (combined 16 and 17) 26 232 232 60 NR In-house toxicity score NR G2: 11% G3: 1% NR G2: 26% G3: 6% G2: 2% Current Study 313 313 55 59% CTCAE v4.0 G2: 33% G3: < 1% G2: 16% G3: 2% G2: 25% G3: 0% G2: 37% G3: 10% G3: 5% bPFS, biochemical progression-free survival; CTCAE, Common Terminology Criteria for Adverse Events; FU, follow up; G, grade; GI, gastrointestinal; GU, genitourinary; IMRT, intensity modulated radiation therapy; NR, not reported; RTOG, Radiation Technology Oncology Group. a Rates include both patients were treated with IMRT and those who were not.…”

Section: Discussionmentioning

confidence: 99%

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Outcomes and toxicity of 313 prostate cancer patients receiving helical tomotherapy after radical prostatectomy

Jensen

Yuh

Wong

et al. 2017

Advances in Radiation Oncology

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PurposeThere are limited long-term data on patients treated with image guided intensity modulated radiation therapy (IG-IMRT) for prostate cancer recurrence or high-risk disease features after radical prostatectomy. We report single-institution results for patients treated with IG-IMRT and identify variables associated with outcome.Methods and materialsThis is a retrospective chart review consisting of 313 consecutive patients who were treated with adjuvant or salvage IG-IMRT from 2004 to 2013. Cox proportional hazards analysis was used to identify factors related to survival and toxicity. Toxicity was graded using the Common Terminology Criteria for Adverse Events Version 4.0.ResultsThe median follow-up was 55 months (range, 6-131 months). The median pre-radiation therapy (RT) prostate-specific antigen (PSA) was 0.3 ng/mL (range, <0.01-55.4). The vast majority of patients (87%) received elective pelvic nodal irradiation (median dose: 45 Gy). Androgen deprivation therapy (ADT) was given to 39% of patients for a median of 9 months. Five-year biochemical progression-free survival and distant metastasis-free survival were 59% (95% confidence interval, 53%-66%) and 89% (95% confidence interval, 85%-93%), respectively. On multivariate analysis, higher pre-RT PSA (>0.2 ng/mL), biopsy Gleason score (≥7 [4+3]), and duration of ADT (>6 months) were significantly associated (P < .05) with biochemical progression-free survival. Actuarial late grade 3 genitourinary and gastrointestinal toxicities at 5 years were 10% and 2%, respectively.ConclusionOur results suggest that lower pre-RT PSA level and longer duration of ADT are associated with improved biochemical control. The incidence of late grade 3 gastrointestinal toxicity was low, but late grade 3 genitourinary toxicity was higher than anticipated.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Outcomes and toxicity of 313 prostate cancer patients receiving helical tomotherapy after radical prostatectomy

Jensen

Yuh

Wong

et al. 2017

Advances in Radiation Oncology

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“…The development of ever more elaborate normal-tissue complication probability (NTCP) models is driven by the concern that a poor characterization of the dose-response relationship may unnecessarily limit the effectiveness of the treatment; a simplistic NTCP model could imply conservative dose-volume constraints to the organs-at-risk (OAR), or cause avoidable suffering through a suboptimal distribution of the dose to OAR for a given tumor dose (e.g., Ref. [18]). Reliable NTCP models can also be used to optimize the treatment strategy [19,20].…”

Section: Introductionmentioning

confidence: 99%

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

et al. 2019

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The aim of this work was to determine how the spatial pattern of dose in the ano-rectal wall is related to late gastro-intestinal toxicity for prostate cancer patients treated with mainly IMRT. Patients and methods: Patients from the DUE-01 multicentre study with patient-reported (prospective) follow-up and available dosimetric data were included. Conventionally fractionated patients received 74-80 Gy and hypofractionated patients received 65-75.2 Gy. A large majority of the patients were treated with intensity-modulated radiotherapy (IMRT). Dose-surface maps (DSMs) for the anal canal and rectum as a single structure, and for the anal canal and the rectum separately, were co-registered rigidly in two dimensions and, for the patients with and without toxicity, respectively, the mean value of the dose in each pixel was calculated. A pixel-wise t-test was used to highlight the anatomical areas where there was a significant difference between the 'mean dose maps' of each group. Univariate models were also fitted to a range of spatial parameters. The endpoints considered were a mean grade !1 late fecal incontinence and a maximum grade !2 late rectal bleeding. Results: Twenty-six out of 213 patients had fecal incontinence, while 21/225 patients had rectal bleeding. Incontinence was associated with a higher dose in the caudal region of the anal canal; the most relevant spatial parameter was the lateral extent of the low and medium isodoses (5-49 Gy in EQD2). Bleeding was associated with high isodoses reaching the posterior rectal wall. The spatial dose parameters with the highest AUC value (.69) were the lateral extent of the 60-70 Gy isodoses. Conclusions: To avoid fecal incontinence it is important to limit the portion of the anal canal irradiated. Our analysis confirms that rectal bleeding is a function of similar spatial dose parameters for patients treated with IMRT, compared to previous studies on patients treated with three-dimensional conformal radiotherapy.

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“…The pathophysiology behind such RT-induced injuries is, however, not extensively understood [14]. Typically, the risk of RT-induced GI morbidity is described by dose/volume parameters of the rectum [7,15– 17]. Novel but less recognized approaches involve for example addressing dose surface/wall distributions of the rectum [18–20], and studying pathophysiological properties.…”

Section: Introductionmentioning

confidence: 99%

An image-based method to quantify biomechanical properties of the rectum in radiotherapy of prostate cancer

et al. 2015

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Gastrointestinal morbidity after radiotherapy (RT) for prostate cancer may be related to the biomechanical properties of the rectum. In this study we present a magnetic resonance imaging (MRI)-based method to quantitate the thickness and elasticity of the rectal wall in prostate cancer patients treated with RT. Material and methods. Four patients previously treated with RT for prostate cancer underwent an MRI session with stepwise rectal bag deflation (from a maximum tolerable volume to 0 ml, in 50 ml steps), with a probe inserted inside the bag to monitor the internal rectal pressure. MRIs were acquired using Dixon sequences (4 mm axial slice thickness) at each deflation step. Rectal walls were defined from the recto-sigmoid junction to 3 cm above the anal canal as the space between the inner and outer wall surfaces. The wall thickness was determined and biomechanical properties (strain and stress) were calculated from the pressure measurements and the MRI-segmented rectal walls. results. The integral rectal pressure varied for the maximum tolerable volume (range 150-250 ml) across patients and ranged from 1.3 to 4.0 kPa (SD  1.2 kPa). Wall thickness was found to vary between patients and also across different rectum segments, with a mean (SD) thickness for the different segments at the 50 ml distension volume of 1.8-4.0 (0.6) mm. Stress showed larger variation than strain, with mean (SD) values for the different segments ranging between 1.5 and 7.0 (1.5) kPa. conclusion. We have developed a method to quantify biomechanical properties of the rectal wall. The resulting rectal wall thickness, strain and stress differed between patients, as well as across different rectal wall sections. These findings could provide guidance in future predictive outcome modelling in order to better understand the rectal dose-volume response relationship.

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Impact of changing rectal dose volume parameters over time on late rectal and urinary toxicity after high-dose intensity-modulated radiotherapy for prostate cancer: A 10-years single centre experience

Cited by 10 publications

References 27 publications

Outcomes and toxicity of 313 prostate cancer patients receiving helical tomotherapy after radical prostatectomy

Outcomes and toxicity of 313 prostate cancer patients receiving helical tomotherapy after radical prostatectomy

Patterns in ano-rectal dose maps and the risk of late toxicity after prostate IMRT

An image-based method to quantify biomechanical properties of the rectum in radiotherapy of prostate cancer

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