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Defining an “ideal” continuous dose-volume constraint curve using literature recommended individual dose-volume thresholds for reducing rectal toxicity from external beam prostate radiation therapy

  • Original Research
  • Published:
Journal of Radiation Oncology

Abstract

Objective

We postulated that a contiguous rectal dose-volume threshold curve obtained via a best mathematical fit of the toughest literature recommended dose-volume thresholds could be deemed as “safe” related to the risk of rectal toxicity. The practicality of restricting rectal doses to such ideal volume thresholds in clinical practice was tested by comparing data collected from a pool of prostate patients treated with external beam radiation therapy (EBRT) in our institution.

Methods

Available rectal dose-volume constraint recommendation in prostate EBRT was collected. At each dose level, the toughest recommended volume limit was identified and an ideal dose-volume threshold curve was generated using a best mathematical fit. Rectal dose-volume data on 105 prostate patients treated to 75.6 Gy dose with intensity modulated radiation therapy (IMRT) in our institution were retrospectively reviewed.

Results

The “ideal” rectal dose-volume threshold curve is defined by V 75 ≤ 7%, V 70 ≤ 11%, V 65 ≤ 15%, V 60 ≤ 20%, V 50 ≤ 30%, V 40 ≤ 43%, and V 30 ≤ 60%. At doses larger or equal to 65 Gy, our patient averaged dose-volume histograms (DVHs) for all groups converged with the ideal curve. At intermediate and low doses (less than 60 Gy), higher volumes of rectum were irradiated than described by the hypothetical curve, with pelvic group receiving more rectal dose than prostate only group respectively. Rectal mean dose correlated strongly with V 40 values (R 2 = 0.84).

Conclusion

Our “ideal” rectal dose-volume curve generated from literature dose-volume thresholds in the most stringent manner is realistic and achievable at high doses (≥60 Gy) and not realistic at intermediate and low doses (≤50 Gy). Standardizing rectal definition and dose-volume metrics will make published analyses and dose-volume constraint recommendations easier to follow.

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Authors and Affiliations

  1. Department of Radiation Oncology, Montefiore Medical Center and the Albert Einstein College of Medicine, 111 East 210th Street, Bronx, NY, 10467, USA

    Ravindra Yaparpalvi, Madhur K. Garg, Nitin Ohri, William R. Bodner, Wolfgang A. Tomé, Chandan Guha & Shalom Kalnicki

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  1. Ravindra Yaparpalvi
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  2. Madhur K. Garg
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Correspondence to Ravindra Yaparpalvi.

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Funding

The work was supported by the Department of Radiation Oncology, Montefiore Medical Center and the Albert Einstein College of Medicine in Bronx, New York, USA.

Conflict of interest

Author Ravindra Yaparpalvi declares that he has no conflict of interest.

Author Madhur K Garg declares that he has no conflict of interest.

Author Nitin Ohri declares that he has no conflict of interest.

Author William R Bodner declares that he has no conflict of interest.

Author Wolfgang A Tome declares that he has no conflict of interest.

Author Chandan Guha declares that he has no conflict of interest.

Author Shalom Kalnicki declares that he has no conflict of interest.

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This article does not contain any studies with human participants or animals performed by any of the authors.

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Yaparpalvi, R., Garg, M.K., Ohri, N. et al. Defining an “ideal” continuous dose-volume constraint curve using literature recommended individual dose-volume thresholds for reducing rectal toxicity from external beam prostate radiation therapy. J Radiat Oncol 6, 405–411 (2017). https://doi.org/10.1007/s13566-017-0323-6

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  • DOI: https://doi.org/10.1007/s13566-017-0323-6

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