Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer

Huang, Eugene; Pollack, Alan; Levy, Lawrence B.; Starkschall, George; Dong, Lei; Rosen, Isaac I.; Kuban, Deborah A.

doi:10.1016/s0360-3016(02)03245-5

Cited by 100 publications

(116 citation statements)

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“…This supports the evidence of a dose-volume relationship predictive of rectal toxicity (24,29) because 125 I brachytherapy also produces a highly conformal dose distribution with a low rectal dose. However, inexact seed placement or movement of seeds closer to the rectal wall over time (30) can produce higher rectal doses than initially predicted and the potential for late GI toxicity in some patients.…”

Section: Discussionsupporting

confidence: 76%

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Eade

Horwitz

Ruth

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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Purpose-To compare the toxicity and biochemical outcomes of intensity-modulated radiation therapy (IMRT) and 125 I transperineal permanent prostate seed implant ( 125 I) for patients with lowrisk prostate cancer.Methods and Materials-Between 1998 and 2004, a total of 374 low-risk patients (prostatespecific antigen < 10 ng/ml, T1c-T2b, Gleason score of 6 or less, and no neoadjuvant hormones) were treated at Fox Chase Cancer Center (216 IMRT and 158 125 I patients). Median follow-up was 43 months for IMRT and 48 months for 125 I. The IMRT prescription dose ranged from 74-78 Gy, and 125 I prescription was 145 Gy. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was recorded by using a modified Radiation Therapy Oncology Group scale. Freedom from biochemical failure was defined by using the Phoenix definition (prostate-specific antigen nadir + 2.0 ng/ml).Results-Patients treated by using IMRT were more likely to be older and have a higher baseline American Urological Association symptom index score, history of previous transurethral resection of the prostate, and larger prostate volumes. On multivariate analysis, IMRT was an independent predictor of lower acute and late Grade 2 or higher GU toxicity and late Grade 2 or higher GI toxicity. Three-year actuarial estimates of late Grade 2 or higher toxicity were 2.4% for GI and 3.5% for GU by using IMRT compared with 7.7% for GI and 19.2% for GU for 125 I, respectively. Four-year actuarial estimates of freedom from biochemical failure were 99.5% for IMRT and 93.5% for 125 I (p = 0.09).Conclusions-The IMRT and 125 I produce similar outcomes, although IMRT appears to have less acute and late toxicity.

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Section: Discussionsupporting

confidence: 76%

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Eade

Horwitz

Ruth

et al. 2008

International Journal of Radiation Oncology*Biology*Physics

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“…Therefore, it is possible to safely deliver doses in the range of 75-80 Gy, provided that the dose constraints for rectum and bladder are not exceeded. 3,4,7,9,16 In view of these data, the incidence of late rectal toxicity in our patients seems comparable. We have not observed any new cases of rectal toxicity beyond 5 years from the end of radiation therapy.…”

Section: Discussionsupporting

confidence: 73%

“…This is in agreement with other researchers, who reported plateau on the toxicity risk curve starting between 2 and 5 years after treatment. [7][8][9] Toxicity profile showed quite high rate of rectal bleeding among rectal symptoms-68 and 90% in our patients with grade 2 and 3 toxicity, respectively. Zelefsky et al 7 from the Memorial Sloan-Kettering Cancer Center published the long-term data on late toxicity in patients treated with doses ranging from 66 to 81 Gy.…”

Section: Discussionmentioning

confidence: 55%

“…The median time to development of late rectal toxicity is 12-30 months. [7][8][9][10] Prevalence rates of rectal symptoms have been reported with peak values ranging from 12 to 48 months. 6,11,12 Therefore, we primarily focused on the time course of late rectal toxicity in patients treated with the three-dimensional conformal radiation therapy (3D-CRT) for localized prostate cancer.…”

Section: Introductionmentioning

confidence: 99%

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Time course of late rectal toxicity after radiation therapy for prostate cancer

Odrážka

Doležel

Vaňásek³

et al. 2009

Prostate Cancer Prostatic Dis

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Rectum and bladder are the crucial organs at risk for curative radiation therapy of localized prostate cancer. We analyzed the incidence, profile and time course of late rectal radiation toxicity. A total of 320 patients with T1-3 prostate cancer were treated with three-dimensional conformal radiation therapy (3D-CRT). The prescription dose was 70 Gy for T1 and T2 patients (n ¼ 230) and 74 Gy for patients with locally advanced T3 tumors (n ¼ 90). Late rectal toxicity was graded according to the Fox Chase modification of the Radiation Therapy Oncology Group (RTOG) and Late Effects Normal Tissue Task Force (LENT) criteria. The median follow-up time was 6.2 years (range 0.2-10.7 years). At 5 years, the risk for the development of grade 2 and 3 rectal toxicities was 15.6 and 7.0%, respectively. All new cases of grade 2 and 3 rectal toxicities were observed within 5 years after treatment. Prevalence of grade 2 and 3 rectal symptoms showed fluctuation with maximum at 1.5 years and the minor peak at 4.5 years. Toxicity profile changed significantly over time. The proportion of rectal bleeding within grade 2 and 3 toxicity decreased from 85% at 1.5 years to 46% at 4.5 years. Conversely, the proportion of fecal incontinence among grade 2 and 3 rectal symptoms gradually increased (0% at 1.5 years vs 27% at 4.5 years). Late rectal radiation toxicity represents a dynamic process. Rectal bleeding decreases and fecal incontinence increases over time.

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“…The normal tissue planning limits for the bladder and rectum were set based on prior studies (23,24). The plan was deemed acceptable under the following conditions.…”

Section: Imrt Plan Evaluation and Acceptancementioning

confidence: 99%

Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial

Pollack

Hanlon

Horwitz

et al. 2006

International Journal of Radiation Oncology*Biology*Physics

235

130

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Purpose-The α/β ratio for prostate cancer is postulated to be between 1 and 3, giving rise to the hypothesis that there may be a therapeutic advantage to hypofractionation. The dosimetry and acute toxicity are described in the first 100 men enrolled in a randomized trial.Patients and Methods-The trial compares 76 Gy in 38 fractions (Arm I) to 70.2 Gy in 26 fractions (Arm II) using intensity modulated radiotherapy. The planning target volume (PTV) margins in Arms I and II were 5 mm and 3 mm posteriorly and 8 mm and 7 mm in all other dimensions. The PTV D95% was at least the prescription dose.Results-The mean PTV doses for Arms I and II were 81.1 and 73.8 Gy. There were no differences in overall maximum acute gastrointestinal (GI) or genitourinary (GU) toxicity acutely. However, there was a slight but significant increase in Arm II GI toxicity during Weeks 2, 3, and 4. In multivariate analyses, only the combined rectal DVH parameter of V65 Gy/V50 Gy was significant for GI toxicity and the bladder volume for GU toxicity.Conclusion-Hypofractionation at 2.7 Gy per fraction to 70.2 Gy was well tolerated acutely using the planning conditions described.

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Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer

Cited by 100 publications

References 0 publications

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

A Comparison of Acute and Chronic Toxicity for Men With Low-Risk Prostate Cancer Treated With Intensity-Modulated Radiation Therapy or 125I Permanent Implant

Time course of late rectal toxicity after radiation therapy for prostate cancer

Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial

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