Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose–volume effects

Sini, C.; Chiorda, B. Noris; Gabriele, P.; Sanguineti, Giuseppe; Morlino, S.; Badenchini, F.; Cante, Domenico; Carillo, V.; Gaetano, M.; Giandini, T.; Landoni, V.; Maggio, A.; Perna, L.; Petrucci, Edoardo; Sacco, V.; Valdagni, Riccardo; Rancati, T.; Fiorino, Claudio; Cozzarini, C.

doi:10.1016/j.radonc.2017.07.005

Cited by 27 publications

(23 citation statements)

References 25 publications

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“…On the other hand, V 15 as the primary dose-volume evaluation methods in this study was from conformal radiotherapy era, whether it is suitable for IMRT needs further clinical veri cation. Recent research shows that the moderate to high dose (V 20-40 ) trends toward being signi cantly associated with acute toxity of small bowel in IMRT [35][36].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

Liu

Gong

Yang

et al. 2020

Preprint

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Background: The goal of this study was to assess small bowel motion and explore the feasibility of using peritoneal space (PS) to replace bowel loops (BL) via the dose constraint method to spare the small bowel during intensity-modulated radiotherapy (IMRT) for rectal cancer. Methods: A total of 24 patients with rectal cancer who underwent adjuvant or neoadjuvant radiotherapy were selected. Weekly repeat CT scans from pre-treatment to the fourth week of treatment were acquired and defined as Plan, 1W, 2W, 3W, and 4W. The 4 weekly CT scans were co-registered to the Plan CT, BL and PS contours were delineated in all of the scans, an IMRT plan was designed on Plan CT using PS constraint method, and then copied to the 4 weekly CT scans. The dose-volume, normal tissue complication probability (NTCP) of the small bowel and their variations during treatment were evaluated. Results: Overall, 109 sets of CT scans from 24 patients were acquired, and 109 plans were designed and copied. The BL and PS volumes were 250.3 cc and 1339.3 cc. The V15 of BL and PS based plan of pre-treatment were 182.6 cc and 919.0 cc, the shift% of them were 28.9% and 11.3% during treatment (p=0.000), which was less in the prone position than in the supine position (25.2% vs 32.1%, p =0.000; 9.9% vs 14.9%, p=0.000). The NTCPC and NTCPA based plan of pre-treatment were 2.0% and 59.2%, the shift% during treatment were 46.1% and 14.0% respectively. Majority of BL’s Dmax and V15 were meet the safety standard during treatment using PS dose limit method except 3 times (3/109) of V15 and 5 times of Dmax (5/109).Conclusions: This study indicated that small bowel motion may lead to uncertainties in its dose volume and NTCP evaluation during IMRT for rectal cancer. The BL movements were significantly greater than PS, and the prone position was significantly less than the supine position. It is feasibility of using PS to replace BL to spare the small bowel, V15<830 cc is the dose constraint standard.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

Liu

Gong

Yang

et al. 2020

Preprint

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“…The IHU-WPRT TOX (Intestinal Hematologic Urinary Toxicity from Whole-Pelvis Radiotherapy) is a registered multi-Institutional cohort study ( ClinicalTrials.gov identifier #NCT02803086) aimed at developing predictive models of toxicity after WPRT for PCa ( 14 – 16 ). Before the activation of the IHU-WPRT TOX trial in February 2014, a Review Board approved pilot study had been performed at the Coordinating Institute (San Raffaele Scientific Institute, Milan, Italy) ( 14 , 15 ).…”

Section: Methodsmentioning

confidence: 99%

“…Before the activation of the IHU-WPRT TOX trial in February 2014, a Review Board approved pilot study had been performed at the Coordinating Institute (San Raffaele Scientific Institute, Milan, Italy) (14,15). The IHU-WPRT TOX was approved by the Institutional Review Board of each of the participating Institutes and is still enrolling patients (16). Prophylactic WPRT, always at the discretion of the referring radiation oncologist, is usually advised for patients with seminal vesicle invasion, Gleason score ≥ 7, pre-surgical PSA >10 ng/mL and/or histologically positive lymph-nodes at prostatectomy, or in the case of PSA ≥ 0.50 ng/mL in the salvage setting.…”

Section: The Ihu-wprt Tox Studymentioning

confidence: 99%

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Predictors of 2-Year Incidence of Patient-Reported Urinary Incontinence After Post-prostatectomy Radiotherapy: Evidence of Dose and Fractionation Effects

et al. 2020

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Bresolin et al. Two-Year Incontinence After Post-prostatectomy Radiotherapy were entered into a backward stepwise multi-variable logistic regression analysis. Lastly, the goodness of fit and model calibration were evaluated and internally validated. Results: Patients without symptoms at baseline experienced (a), (b), and/or (c) within 2 years in 41/130 (32%), 40/192 (21%), and 41/129 (32%) of the cases, respectively. EQD2 for α/β = 0.8Gy was the best dose metric associated with PRUI. Multi-variable analysis identified baseline incontinence levels as the strongest predictor for all endpoints (p < 0.006). Both FREQUENCY and OBJECTIVE were significantly influenced also by EQD2(α/β = 0.8Gy). The goodness of fit was excellent, as was the calibration; internal calibration confirmed apparent performance. Conclusion: Baseline mild urinary incontinence symptoms strongly modulate the 2-year risk of PRUI. In addition, FREQUENCY is characterized by a marked dose-effect relationship also influencing the trend of OBJECTIVE, with results more reliable than AMOUNT as an objective index. A strong impact of fractionation on severe PRUI after post-prostatectomy radiotherapy also emerged.

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“…Bowel: For rectal cancer patients, preoperatively treated with 3D-CRT, the absolute bowel volume receiving !15 Gy (V 15Gy ) has consistently been found to correlate with acute GI toxicity [7][8][9][10][11]. Studies of rectal [12], anal [13][14][15][16][17], prostate [18][19][20] and gynaecological [21][22][23] cancer patients treated with IMRT or arc therapy have found correlations between acute GI toxicity and dose levels from approximately 25-45 Gy, delivered in 25-28 fractions. For late GI toxicity in rectal cancer, the data is very limited.…”

Section: Literature Search: Oar Dose Levels For Lcrtmentioning

confidence: 99%

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

Appelt

Kerkhof

Nyvang

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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a b s t r a c tBackground and purpose: Organ preservation strategies are increasingly being explored for early rectal cancer. This requires revision of target volumes according to disease stage, as well as new guidelines for treatment planning. We conducted an international, multicentre dose planning study to develop robust planning objectives for modern radiotherapy of a novel mesorectal-only target volume, as implemented in the STAR-TReC trial (NCT02945566). Materials and methods: The published literature was used to establish relevant dose levels for organ at risk (OAR) plan optimisation. Ten representative patients with early rectal cancer were identified. Treatment scans had mesorectal target volumes as well as bowel cavity, bladder and femoral heads outlined, and were circulated amongst the three participating institutions. Each institution produced plans for short course (SCRT, 5 Â 5 Gy) and long course (LCRT, 25 Â 2 Gy) treatment, using volumetric modulated arc therapy on different dose planning systems. Optimisation objectives for OARs were established by determining dose metric objectives achievable for !90% of plans. Results: Sixty plans, all fulfilling target coverage criteria, were produced. The planning results and literature review suggested optimisation objectives for SCRT: V 10Gy < 180 cm 3 , V 18Gy < 110 cm 3 , V 23Gy < 85 cm 3 for bowel cavity; V 21Gy < 15% and V 25Gy < 5% for bladder; and V 12.5Gy < 11% for femoral heads. Corresponding objectives for LCRT: V 20Gy < 180 cm 3 , V 30Gy < 130 cm 3 , V 45Gy < 90 cm 3 for bowel cavity; V 35Gy < 22% and V 50Gy < 7% for bladder; and V 25Gy < 15% for femoral heads. Constraints were validated across all three institutions. Conclusion: We utilized a multicentre planning study approach to develop robust planning objectives for mesorectal radiotherapy for early rectal cancer.

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Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose–volume effects

Cited by 27 publications

References 25 publications

Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

Evaluation of Small Bowel Motion and Feasibility of using the Peritoneal Space to Replace Bowel Loops for Dose Constraints during Intensity-Modulated Radiotherapy for Rectal Cancer

Predictors of 2-Year Incidence of Patient-Reported Urinary Incontinence After Post-prostatectomy Radiotherapy: Evidence of Dose and Fractionation Effects

Robust dose planning objectives for mesorectal radiotherapy of early stage rectal cancer – A multicentre dose planning study

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