Abstract Aim To investigate late gastrointestinal toxicity in a large pooled population of prostate cancer patients treated with radical radiotherapy. Normal tissue complication probability models were developed for late stool frequency and late rectal pain. Methods and materials Population included 1336 patients, 3-year minimum follow-up, treated with 66–80 Gy. Toxicity was scored with LENT-SOMA-scale. Two toxicity endpoints were considered: grade ⩾2 rectal pain and mean grade (average score during follow-up) in stool frequency >1. DVHs of anorectum were reduced to equivalent uniform dose (EUD). The best-value of the volume parameter n was determined through numerical optimization. Association between EUD/clinical factors and the endpoints was investigated by logistic analyses. Likelihood, Brier-score and calibration were used to evaluate models. External calibration was also carried out. Results 4% of patients (45/1122) reported mean stool frequency grade >1; grade ⩾2 rectal pain was present in the TROG 03.04 RADAR population only (21/677, 3.1%): for this endpoint, the analysis was limited to this population. Analysis of DVHs highlighted the importance of mid-range doses (30–50 Gy) for both endpoints. EUDs calculated with n = 1 (OR = 1.04) and n = 0.35 (OR = 1.06) were the most suitable dosimetric descriptors for stool frequency and rectal pain respectively. The final models included EUD and cardiovascular diseases (OR = 1.78) for stool frequency and EUD and presence of acute gastrointestinal toxicity (OR = 4.2) for rectal pain. Conclusion Best predictors of stool frequency and rectal pain are consistent with findings previously reported for late faecal incontinence, indicating an important role in optimization of mid-range dose region to minimize these symptoms highly impacting the quality-of-life of long surviving patients.
Background and purpose: Curative radiotherapy for prostate cancer may lead to anorectal side effects, including rectal bleeding, fecal incontinence, increased stool frequency and rectal pain. The main objective of this study was to develop multivariable NTCP models for these side effects. Material and methods: The study sample was composed of 262 patients with localized or locally advanced prostate cancer (stage T1-3). Anorectal toxicity was prospectively assessed using a standardized follow-up ...
Abstract This comprehensive review addresses most organs at risk involved in planning optimization for prostate cancer. It can be considered an update of a previous educational review that was published in 2009 (Fiorino et al., 2009). The literature was reviewed based on PubMed and MEDLINE database searches (from January 2009 up to September 2015), including papers in press; for each section/subsection, key title words were used and possibly combined with other more general key-words (such as ra...
Last. Joseph O. Deasy(MSK: Memorial Sloan Kettering Cancer Center)H-Index: 63
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ABSTRACTBackground. Gastrointestinal (GI) morbidity after radiotherapy (RT) for prostate cancer is typically addressed by studying specific single symptoms. The aim of this study was to explore the interplay between domains of patient- reported outcomes (PROs) on GI morbidity, and to what extent these are explained by RT dose to the GI tract.Material and methods. The study included men from two Scandinavian studies (N = 211/277) who had undergone primary external beam radiotherapy (EBRT) for loc...
Purpose To use a high-quality multicenter trial dataset to determine dose-volume effects for gastrointestinal (GI) toxicity following radiation therapy for prostate carcinoma. Influential dose-volume histogram regions were to be determined as functions of dose, anatomical location, toxicity, and clinical endpoint. Methods and Materials Planning datasets for 754 participants in the TROG 03.04 RADAR trial were available, with Late Effects of Normal Tissues (LENT) Subjective, Objective, Management,...
Last. Wim P.M. Hopman(Radboud University Nijmegen)H-Index: 25
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Purpose Pelvic radiotherapy may lead to changes of anorectal function resulting in incontinence-related complaints. The aim of this study was to systematically review objective findings of late anorectal physiology and mucosal appearance after irradiation for prostate cancer.
#2Tiziana Rancati(UniSR: Vita-Salute San Raffaele University)H-Index: 27
Last. Riccardo Valdagni(UniSR: Vita-Salute San Raffaele University)H-Index: 51
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Abstract Purpose To prospectively evaluate long-term late rectal bleeding (lrb) and faecal incontinence (linc) after high-dose radiotherapy (RT) for prostate cancer in the AIROPROS 0102 population, and to assess clinical/dosimetric risk factors. Materials and methods Questionnaires of 515 patients with G0 baseline incontinence and bleeding scores (follow-up ⩾6years) were analysed. Correlations between lrb/linc and many clinical and dosimetric parameters were investigated by univariate and multiv...
Last. Wim P.M. Hopman(Radboud University Nijmegen)H-Index: 25
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Purpose Anorectal dysfunction is common after pelvic radiotherapy. This study aims to explore the relationship of subjective and objective anorectal function with quality of life (QoL) and their relative impact in patients irradiated for prostate cancer.
Introduction: The Trans-Tasman Radiation Oncology Group 03.04 'Randomised Androgen Deprivation and Radiotherapy' multicentre prostate cancer trial examined the optimal duration of androgen deprivation in combination with dose-escalated radiotherapy. Rigorous quality assurance (QA) processes were undertaken to ensure the validity and reliability of the radiation therapy treatment plan data. Method: QA processes included a planning benchmarking exercise and a periodic audit of target and normal ti...
#1Amit Bahl(University Hospitals Bristol NHS Foundation Trust)H-Index: 24
#2Amarnath Challapalli(University Hospitals Bristol NHS Foundation Trust)H-Index: 14
Last. Heather Payne(UCL: University College London)H-Index: 11
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AIM To understand the awareness and use of rectal spacers for prostate cancer patients undergoing radical radiotherapy in the UK. METHODS An expert-devised online questionnaire was completed by members of the British Uro-oncology Group (BUG). RESULTS Sixty-three specialists completed the survey (50% of BUG members at that point in time). Only 37% had used rectal spacers, mostly for private patients or those with pre-existing bowel conditions. However, many (68%) would like to use these devices i...
Abstract Purpose Changes in fraction size of external beam radiotherapy (EBRT) exert non-linear impacts on subsequent toxicity. Commonly described by the linear-quadratic model, fraction size sensitivity of normal tissues is expressed by the α/β ratio. Here we study individual α/β ratios for different late rectal side effects after prostate EBRT. Methods and Materials The XXXXXXX trial (XX-REGISTRATION-NUMBER-XX) randomised men with non-metastatic prostate cancer 1:1:1 to 74Gy/37 fractions (Fr),...
Last. Paolo Zunino(Polytechnic University of Milan)H-Index: 28
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Abstract Background Radiation-induced organ dysfunction are frequently described by Normal Tissue Complication Probability models. The approximations of this radiobiological approach do not allow to consider the important role played by the microvasculature not only in the dose–response of the blood vessels but also of the organs where it is located. To this purpose, we presented a computational model that describes the fluid dynamics of microcirculation when the parameters of the network and th...
#1Isabelle R. Miousse(University of Arkansas for Medical Sciences)H-Index: 23
#2Laura E. Ewing(University of Arkansas for Medical Sciences)H-Index: 8
Last. Igor Koturbash(University of Arkansas for Medical Sciences)H-Index: 36
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Methionine is an essential amino acid needed for a variety of processes in living organisms. Ionizing radiation (IR) depletes tissue methionine concentrations and leads to the loss of DNA methylati...
Purpose This study aimed to validate a previously published predictive model for late fecal incontinence (FI) in a contemporary population of prostate cancer patients treated with radical radiation therapy. Methods and Materials The validation included patients treated with intensity-modulated radiation therapy (IMRT) (2010-2014). Prescribed dose range was 65-80 Gy, including conventional and moderate hypo-fractionated treatments. Rectal toxicity was scored using LENT/SOMA, a minimum 2-year foll...
Last. Ben J.M. Heijmen(EUR: Erasmus University Rotterdam)H-Index: 64
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Purpose/objective: Assess to what extent the use of automated treatment planning would have reduced organ-at-risk dose delivery observed in the randomized HYPRO trial for prostate cancer, and estimate related toxicity reductions. Investigate to what extent improved plan quality for hypofractionation scheme as achieved with automated planning can potentially reduce observed enhanced toxicity for the investigated hypofractionation scheme to levels observed for conventional fractionation scheme. Ma...
#1Minakshi Prasad(UVAS: University of Veterinary and Animal Sciences)H-Index: 9
#2Upendra P. Lambe(UVAS: University of Veterinary and Animal Sciences)H-Index: 3
Last. G Prasad(H.I., S.I.: University of Agriculture, Faisalabad)H-Index: 4
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Abstract In recent years nanotechnology has revolutionized the healthcare strategies and envisioned to have a tremendous impact to offer better health facilities. In this context, medical nanotechnology involves design, fabrication, regulation, and application of therapeutic drugs and devices having a size in nano-range (1–100 nm). Owing to the revolutionary implications in drug delivery and gene therapy, nanotherapeutics has gained increasing research interest in the current medical sector of t...
Abstract Traditionally rectal symptoms following pelvic/prostate radiotherapy are correlated to the dosimetry of the anorectum or a substructure of this. It has been suggested that the perirectal fat space (PRS) surrounding the rectum may also be relevant. This study considers the delineation and dosimetry of the PRS related to both rectal bleeding and control-related toxicity. Initially, a case–control cohort of 100 patients from the RADAR study were chosen based on presence/absence of rectal c...