Radiotherapy & Oncology
Volume 93, Issue 2 , Pages 197-202 , November 2009

Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: Results of a large multicenter observational study

  • Gianni Fellin

      Affiliations

    • Radiotherapy and Medical Physics, Ospedale Santa Chiara, Trento, Italy
    • ,
  • Claudio Fiorino

      Affiliations

    • Medical Physics, Ospedale San Raffaele, Milano, Italy
    • Corresponding Author InformationCorresponding author. Address: Medical Physics Department, San Raffaele Institute, Via Olgettina 60, 20132 Milano, Italy.
    • ,
  • Tiziana Rancati

      Affiliations

    • Prostate program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy
    • ,
  • Vittorio Vavassori

      Affiliations

    • Radiotherapy and Medical Physics, Ospedale di Circolo, Varese, Italy
    • ,
  • Micaela Baccolini

      Affiliations

    • Department of Radiotherapy and Medical Physics, Ospedale Villa Maria Cecilia, Lugo, Italy
    • ,
  • Carla Bianchi

      Affiliations

    • Radiotherapy and Medical Physics, Ospedale di Circolo, Varese, Italy
    • ,
  • Emanuela Cagna

      Affiliations

    • Department of Radiotherapy and Medical Physics, Ospedale “S. Anna”, Como, Italy
    • ,
  • Pietro Gabriele

      Affiliations

    • Department of Radiotherapy and Medical Physics, Institute for Cancer Research and Treatment, Candiolo, Italy
    • ,
  • Floranna Mauro

      Affiliations

    • Department of Radiotherapy and Medical Physics, Ospedale Villa Maria Cecilia, Lugo, Italy
    • ,
  • Loris Menegotti

      Affiliations

    • Radiotherapy and Medical Physics, Ospedale Santa Chiara, Trento, Italy
    • ,
  • Angelo Filippo Monti

      Affiliations

    • Department of Radiotherapy and Medical Physics, Ospedale “S. Anna”, Como, Italy
    • ,
  • Michele Stasi

      Affiliations

    • Department of Radiotherapy and Medical Physics, Institute for Cancer Research and Treatment, Candiolo, Italy
    • ,
  • Riccardo Valdagni

      Affiliations

    • Prostate program, Scientific Directorate, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy

Received 9 February 2009 ,Revised 9 September 2009 ,Accepted 12 September 2009.

References 

  1. Boersma LJ, van den Brink M, Allison M, et al. Estimation of the incidence of late bladder and rectum complications after high-dose (70–78Gy) conformal radiotherapy for prostate cancer, using dose–volume histograms. Int J Radiat Oncol Biol Phys. 1998;41:83–92
  2. Skwarchuk MW, Jackson A, Zelefsky MJ, et al. Late rectal toxicity after conformal radiotherapy of prostate cancer (I): multivariate analysis and dose response. Int J Radiat Oncol Biol Phys. 2000;47:103–113
  3. Storey MR, Pollack A, Zagars G, et al. Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys. 2000;48:635–642
  4. Fiorino C, Cozzarini C, Vavassori V, et al. Relationships between DVHs and late rectal bleeding after radiotherapy for prostate cancer: analysis of a large group of patients pooled from three institutions. Radiother Oncol. 2002;64:1–12
  5. Huang EH, Pollack A, Levy L, et al. Late rectal toxicity: dose–volume effects of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2002;54:1009–1019
  6. Cozzarini C, Fiorino C, Ceresoli GL, et al. Significant correlation between rectal DVH and late rectal bleeding in patients treated after radical prostatectomy with conformal or conventional radiotherapy (66.6–70.2Gy). Int J Radiat Oncol Biol Phys. 2003;55:688–694
  7. Fiorino C, Sanguineti G, Cozzarini C, et al. Rectal dose–volume constraints in high-dose conformal radiotherapy for localized prostate cancer. J Radiat Oncol Biol Phys. 2003;57:953–962
  8. Zapatero A, Garcia-Vicente F, Modolell I, et al. Impact of mean rectal dose on late rectal bleeding after conformal radiotherapy for prostate cancer: dose–volume effect. Int J Radiat Oncol Biol Phys. 2004;59:1343–1351
  9. Rancati T, Fiorino C, Gagliardi G, et al. Fitting late rectal bleeding data using different NTCP models: results from an Italian multi-centric study (AIROPROS0101). Radiother Oncol. 2004;73:21–32
  10. Vargas C, Martinez A, Kestin LL, et al. Dose–volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. Int J Radiat Oncol Biol Phys. 2005;62:1297–1308
  11. Peeters STH, Lebesque JV, Heemsbergen WD, et al. Localized volume effects for late rectal and anal toxicity after radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2006;64:1151–1161
  12. Peeters STH, Hoogeman M, Heemsbergen WD, et al. Rectal bleeding, fecal incontinence and high stool frequency after conformal radiotherapy for prostate cancer: normal tissue complication probability modeling. Int J Radiat Oncol Biol Phys. 2006;66:11–19
  13. Söhn M, Yan D, Liang J, Meldolesi E, Vargas C, Alber M. Incidence of late rectal bleeding in high-dose conformal radiotherapy of prostate cancer using equivalent uniform dose-based and dose–volume-based normal tissue complication probability models. Int J Radiat Oncol Biol Phys. 2007;26:1066–1073
  14. Van der Laan HP, van der Bergh A, Schilstra C, et al. Grading-system-dependent volume effects of late radiation induced rectal toxicity after curative radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:1138–1145
  15. Denham JW, O’Brien PC, Dunstan R, et al. Is there more than one late radiation proctitis syndrome?. Radiother Oncol. 1999;51:43–53
  16. Vavassori V, Fiorino C, Rancati T, et al. Predictors for rectal and intestinal acute toxicities during prostate cancer high-dose 3D-CRT: results of a prospective multicenter study. Int J Radiat Oncol Biol Phys. 2007;66:1401–1410
  17. Fiorino C, Fellin G, Rancati T, et al. Clinical and dosimetric predictors of late rectal syndrome after 3DCRT for localized prostate cancer: preliminary results of a multicenter prospective study. Int J Radiat Oncol Biol Phys. 2008;70:1130–1137
  18. Foppiano F, Fiorino C, Frezza G, et al. The impact of contouring uncertainty on rectal 3D dose–volume data: results of a dummy run in a multicenter trial (AIROPROS01-02). Int J Radiat Oncol Biol Phys. 2003;57:573–579
  19. Heemsbergen WD, Peeters STH, Koper PCM, et al. Acute and late gastrointestinal toxicity after radiotherapy in prostate cancer patients: consequential late damage. Int J Radiat Oncol Biol Phys. 2006;66:3–10
  20. Zelefsky M, Levin E, Hunt M, et al. Incidence of late rectal and urinary toxicities after three-dimensional conformal radiotherapy and intensity-modulated radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2008;70:1124–1129
  21. Tucker SL, Dong L, Bosch WR, et al. Fit of a generalized Lyman normal tissue complication probability (NTCP) model to grade ⩾2 late rectal toxicity data from patients treated on protocol RTOG 94-06. Int J Radiat Oncol Biol Phys. 2007;69:S8–S9
  22. Rancati T, Fiorino C, Valvassori V, et al. Late rectal bleeding after conformal radiotherapy for prostate cancer: NTCP modeling. Radiother Oncol. 2008;88:S332–S333
  23. Cesaretti JA, Stock RG, Atencio DP, et al. A genetically determined dose–volume histogram predicts for rectal bleeding among patients treated with prostate brachytherapy. Int J Radiat Oncol Biol Phys. 2007;68:1410–1416
  24. Valdagni R, Rancati T, Ghilotti M, et al. To bleed or not to bleed. A prediction based on individual gene profiling combined with dose–volume histogram shapes in prostate cancer patients undergoing three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys. 2009;74:1431–1440
  25. Heemsbergen WD, Hoogeman MS, Hart GA, et al. Gastrointestinal toxicity and its relation to dose distributions in the anorectal region of prostate cancer patients treated with radiotherapy. Int J Radiat Oncol Biol Phys. 2005;61:1011–1018
  26. Vordemark D, Schwab M, Ness-Duurdoumas R, et al. Association of anorectal dose–volume histograms and impaired fecal continence after 3D conformal radiotherapy for carcinoma of the prostate. Radiother Oncol. 2003;69:209–214
  27. al Abany M, Helgason AR, Agren Cronqvist AK, et al. Dose to the anal-sphincter region and risk of fecal leakage. Acta Oncol. 2004;43:117–118
  28. Smit WG, Helle Pa, van Putten WL, et al. Late radiation damage in prostate cancer patients treated by high dose external radiotherapy in relation to rectal dose. Int J Radiat Oncol Biol Phys. 1990;18:23–29
  29. Valdagni R, Rancati T, Fiorino C, et al. Development of a set of nomograms to predict acute lower gastrointestinal toxicity for prostate cancer 3D-CRT. Int J Radiat Oncol Biol Phys. 2008;71:1065–1173
  30. Liu M, Pickles T, Agranovich A, et al. Impact of neoadjuvant androgen ablation and other factors on late toxicity after external beam radiotherapy. Int J Radiat Oncol Biol Phys. 2004;58:59–67
  31. Peeters STH, Hoogeman MS, Heemsbergen WD, et al. Volume and hormonal effects for acute side effects of rectum and bladder during conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys. 2005;63:1142–1152
  32. Herold DM, Hanlon AL, Hanks GE. Diabetes mellitus: a predictor for late radiation morbidity. Int J Radiat Oncol Biol Phys. 1999;43:475–479
  33. Denham JW, Hauer-Jensen M. The radiotherapeutic injury – a complex “wound”. Radiother Oncol. 2002;63:129–145
  34. Valdagni R, Rancati T, Fiorino C. Predictive models of toxicity in prostate cancer external radiotherapy: clinical issues. Cancer. 2009;115:3141–3149

PII: S0167-8140(09)00538-6

doi: 10.1016/j.radonc.2009.09.004

Radiotherapy & Oncology
Volume 93, Issue 2 , Pages 197-202 , November 2009

Article Tools

* Image Usage & Resolution