Purpose: Assessing the predictors of late rectal toxicity after high-dose conformal radiotherapy for prostate cancer. Methods: One thousand one hundred thirty-two patients entered a prospective observational multicentric study; late rectal toxicity was evaluated by a self-reported questionnaire. Results concerning bleeding and faecal incontinence of 718/1132 patients with a complete follow-up at 36 months were analysed. The correlation between a number of clinical-dosimetric parameters and moderate/severe toxicity was investigated by univariate and multivariate logistic analyses. Results: Fifty-two (7.2%) and 57/718 (7.9%) patients were scored as moderate/severe bleeders and faecal incontinents, respectively; 19/57 incontinent patients showed persistent incontinence at 36 months. Bleeding was mainly correlated with V75 Gy while severe bleeding was mainly correlated with the previous abdominal/pelvic surgery; a different rectal dose-volume relationship in the two groups of patients (with/without surgery) was found. Moderate/severe acute toxicity was weakly correlated to late bleeding. The best predictor of faecal incontinence was acute toxicity (OR = 4 and 7 for chronic and actuarial incontinence, respectively). Conclusion: The application of rectal dose-volume constraints limited the incidence of rectal bleeding. The risk of bleeding may be further reduced by limiting V75 Gy < 5% and, in the case of patients previously submitted to abdominal/pelvic surgery, V70 Gy < 15-20%. Faecal incontinence seems to be mainly a consequential effect after acute toxicity.
Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer : results of a large multicenter observational study / G. Fellin, C. Fiorino, T. Rancati, V. Vavassori, M. Baccolini, C. Bianchi, E. Cagna, P. Gabriele, F. Mauro, L. Menegotti, A. Monti, M. Stasi, R. Valdagni. - In: RADIOTHERAPY AND ONCOLOGY. - ISSN 0167-8140. - 93:2(2009 Nov), pp. 197-202.
|Titolo:||Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer : results of a large multicenter observational study|
|Parole Chiave:||Dose-volume effects; Prostate Radiotherapy; Rectal toxicity; Oncology; Radiology, Nuclear Medicine and Imaging; Hematology|
|Settore Scientifico Disciplinare:||Settore MED/36 - Diagnostica per Immagini e Radioterapia|
|Data di pubblicazione:||nov-2009|
|Digital Object Identifier (DOI):||http://dx.doi.org/10.1016/j.radonc.2009.09.004|
|Appare nelle tipologie:||01 - Articolo su periodico|