Skip to main content

Advertisement

SpringerLink
Log in

Dosimetric predictors of diarrhea during radiotherapy for prostate cancer

Dosimetrische Prädiktoren einer Diarrhö bei Bestrahlung von Prostatakarzinomen

  • Original Article
  • Published:
Strahlentherapie und Onkologie Aims and scope Submit manuscript

Purpose:

To investigate dosimetric predictors of diarrhea during radiotherapy (RT) for prostate cancer.

Patients and Methods:

All patients who underwent external-beam radiotherapy as part of treatment for localized prostate cancer at the University of Texas Medical Branch, Galveston, TX, USA, from May 2002 to November 2006 were extracted from the own database. From the cumulative dose-volume histogram (DVH), the absolute volumes (V-value) of intestinal cavity (IC) receiving 15, 30, and 45 Gy were extracted for each patient. Acute gastrointestinal toxicity was prospectively scored at each weekly treatment visit according to CTC (Common Toxicity Criteria) v2.0. The endpoint was the development of peak grade ≥ 2 diarrhea during RT. Various patient, tumor, and treatment characteristics were evaluated using logistic regression.

Results:

149 patients were included in the analysis, 112 (75.2%) treated with whole-pelvis intensity-modulated radiotherapy (WP-IMRT) and 37 (24.8%) with prostate-only RT, including or not including, the seminal vesicles (PORT ± SV). 45 patients (30.2%) developed peak grade ≥ 2 diarrhea during treatment. At univariate analysis, IC-V15 and IC-V30, but not IC-V45, were correlated to the endpoint; at multivariate analysis, only IC-V15 (p = 0.047) along with peak acute proctitis (p = 0.041) was independently correlated with the endpoint.

Conclusion:

These data provide a novel and prostate treatment-specific “upper limit” DVH for IC.

Ziel:

Untersuchung der dosimetrischen Prädiktoren einer Diarrhö bei der Strahlentherapie (RT) von Prostatakarzinomen.

Patienten und Methodik:

Alle Patienten, die sich von Mai 2002 bis November 2006 am UTMB (University of Texas Medical Branch), Galveston, TX, USA, im Rahmen der Behandlung lokalisierter Prostatakarzinome einer externen Strahlentherapie unterzogen, wurden aus der eigenen Datenbank extrahiert. Aus dem kumulativen Dosis-Volumen-Histogramm (DVH) wurden für jeden Patienten die absoluten Volumina (V-Wert) der Eingeweidehöhle (IC [„intestinal cavity“]), die 15, 30 und 45 Gy erhalten hatten, extrahiert. Die akute gastrointestinale Toxizität wurde prospektiv bei jeder wöchentlichen Therapiesitzung gemäß den CTC (Common Toxicity Criteria) v2.0 erfasst. Endpunkt war die Entwicklung einer Diarrhö Grad ≥ 2 während der RT. Verschiedene Patienten-, Tumor- und Behandlungscharakteristika wurden mit Hilfe der logistischen Regression bewertet.

Ergebnisse:

149 Patienten wurden in die Analyse eingeschlossen, wovon 112 (75,2%) eine intensitätsmodulierte Bestrahlung des gesamten Beckens (B-IMRT) und 37 (24,8%) eine alleinige Prostata-RT unter Ein- oder Ausschluss der Samenbläschen (PORT ± SV) erhielten. 45 Patienten (30,2%) entwickelten während der Behandlung eine Diarrhö Grad ≥ 2. Bei der univariaten Analyse korrelierten IC-V15 und IC-V30, nicht dagegen IC-V45 mit dem Endpunkt; bei der multivariaten Analyse fand sich nur für IC-V15 (p = 0,047) mit hochgradiger akuter Proktitis (p = 0,041) eine unabhängige Korrelation mit dem Endpunkt.

Schlussfolgerung:

Diese Daten stellen ein neues und für die Behandlung der Prostata spezifisches „Obergrenzen“-DVH für IC zur Verfügung.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Cavey ML, Bayouth JE, Colman M, et al. IMRT to escalate the dose to the prostate while treating the pelvic nodes. Strahlenther Onkol 2005;181:431–41.

    Article  PubMed  Google Scholar 

  2. Combs SE, Konkel S, Thilmann C, et al. Local high-dose radiotherapy and sparing of normal tissue using intensity-modulated radiotherapy (IMRT) for mucosal melanoma of the nasal cavity and paranasal sinuses. Strahlenther Onkol 2007;183:63–8.

    Article  PubMed  Google Scholar 

  3. Diaz A, Roach M3rd, Marquez C, et al. Indications for and the significance of seminal vesicle irradiation during 3D conformal radiotherapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 1994;30:323–9.

    PubMed  CAS  Google Scholar 

  4. Emami B, Lyman J, Brown A, et al. Tolerance of normal tissue to therapeutic irradiation. Int J Radiat Oncol Biol Phys 1991;21:109–22.

    PubMed  CAS  Google Scholar 

  5. Fiorino C, Vavassori V, Sanguineti G, et al. Rectum contouring variability in patients treated for prostate cancer: impact on rectum dose-volume histograms and normal tissue complication probability. Radiother Oncol 2002;63:249–55.

    Article  PubMed  Google Scholar 

  6. Hong TS, Tome WA, Jaradat H, et al. Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy. Acta Oncol 2006;45:717–27.

    Article  PubMed  Google Scholar 

  7. Leichman CG, Fleming TR, Muggia FM, et al. Phase II study of fluorouracil and its modulation in advanced colorectal cancer: a Southwest Oncology Group study. J Clin Oncol 1995;13:1303–11.

    PubMed  CAS  Google Scholar 

  8. McKenzie A, van Herk M, Mijnheer B. Margins for geometric uncertainty around organs at risk in radiotherapy. Radiother Oncol 2002;62:299–307.

    Article  PubMed  Google Scholar 

  9. Milano MT, Constine LS, Okunieff P. Normal tissue tolerance dose metrics for radiation therapy of major organs. Semin Radiat Oncol 2007;17:131–40.

    Article  PubMed  Google Scholar 

  10. Muren LP, Karlsdottir A, Kvinnsland Y, et al. Testing the new ICRU 62 “Planning Organ at Risk Volume” concept for the rectum. Radiother Oncol 2005;75:293–302.

    Article  PubMed  Google Scholar 

  11. Nairz O, Merz F, Deutschmann H, et al. A strategy for the use of image-guided radiotherapy (IGRT) on linear accelerators and its impact on treatment margins for prostate cancer patients. Strahlenther Onkol 2008;184:663–7.

    Article  PubMed  Google Scholar 

  12. Nevinny-Stickel M, Poljanc K, Forthuber BC, et al. Optimized conformal paraaortic lymph node irradiation is not associated with enhanced renal toxicity. Strahlenther Onkol 2007;183:385–91.

    Article  PubMed  Google Scholar 

  13. Roach M3rd, Marquez C, Yuo HS, et al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 1994;28:33–7.

    PubMed  Google Scholar 

  14. Robertson JM, Lockman D, Yan D, et al. The dose-volume relationship of small bowel irradiation and acute grade 3 diarrhea during chemoradiotherapy for rectal cancer. Int J Radiat Oncol Biol Phys 2008;70:413–8.

    PubMed  CAS  Google Scholar 

  15. Roeske JC, Bonta D, Mell LK, et al. A dosimetric analysis of acute gastro-intestinal toxicity in women receiving intensity-modulated whole-pelvic radiation therapy. Radiother Oncol 2003;69:201–7.

    Article  PubMed  Google Scholar 

  16. Sanguineti G, Cavey ML, Endres EJ, et al. Is IMRT needed to spare the rectum when pelvic lymph nodes are part of the initial treatment volume for prostate cancer? Int J Radiat Oncol Biol Phys 2006;64:151–60.

    PubMed  Google Scholar 

  17. Sanguineti G, Culp L, Pena J, et al. Acute small bowel and colon toxicity after pelvic IMRT for prostate cancer. Eur J Cancer Suppl 2003;1: S268.

    Article  Google Scholar 

  18. Sanguineti G, Endres EJ, Parker BC, et al. Acute toxicity of whole-pelvis IMRT in 87 patients with localized prostate cancer. Acta Oncol 2008;47: 301–10.

    Article  PubMed  Google Scholar 

  19. Sanguineti G, Little M, Endres EJ, et al. Comparison of three strategies to delineate the bowel for whole pelvis IMRT of prostate cancer. Radiother Oncol 2008;88:95–101.

    Article  PubMed  Google Scholar 

  20. Tho LM, Glegg M, Paterson J, et al. Acute small bowel toxicity and pre-operative chemoradiotherapy for rectal cancer: investigating dose-volume relationships and role for inverse planning. Int J Radiat Oncol Biol Phys 2006;66:505–13.

    PubMed  Google Scholar 

  21. Van Duijvendijk P, Slors F, Taat CW, et al. A prospective evaluation of anorectal function after total mesorectal excision in patients with a rectal carcinoma. Surgery 2003;133:56–65.

    Article  PubMed  Google Scholar 

  22. Vargas C, Yan D, Kestin LL, et al. Phase II dose escalation study of image-guided adaptive radiotherapy for prostate cancer: use of dose-volume constraints to achieve rectal isotoxicity. Int J Radiat Oncol Biol Phys 2005;63:141–9.

    PubMed  Google Scholar 

  23. Voordeckers M, Everaert H, Tournel K, et al. Longitudinal assessment of parotid function in patients receiving tomotherapy for head-and-neck cancer. Strahlenther Onkol 2008;184:400–5.

    Article  PubMed  Google Scholar 

  24. Zelefsky MJ, Fuks Z, Hunt M, et al. High-dose intensity modulated radiation therapy for prostate cancer: early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys 2002;53:1111–6.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Radiation Oncology, University of Texas Medical Branch, Galveston, TX, USA

    Giuseppe Sanguineti MD

  2. Physics, University of Texas Medical Branch, Galveston, TX, USA

    Eugene J. Endres & Brent C. Parker

  3. Biostatistics Unit, University of Genoa, Genoa, Italy

    Maria Pia Sormani

  4. Dept. of Radiation Oncology and Molecular Radiation Sciences, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, 401 N. Broadway, Suite 1440, Baltimore, MD, 21231-2410, USA

    Giuseppe Sanguineti MD

Authors
  1. Giuseppe Sanguineti MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Eugene J. Endres
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maria Pia Sormani
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Brent C. Parker
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Giuseppe Sanguineti MD.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sanguineti, G., Endres, E.J., Sormani, M.P. et al. Dosimetric predictors of diarrhea during radiotherapy for prostate cancer. Strahlenther Onkol 185, 390–396 (2009). https://doi.org/10.1007/s00066-009-1953-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00066-009-1953-4

Key Words:

Schlüsselwörter:

Search

Navigation