Rectal and Urethro-Vesical Subregions for Toxicity Prediction After Prostate Cancer Radiation Therapy: Validation of Voxel-Based Models in an Independent Population.

Published on Dec 1, 2020in International Journal of Radiation Oncology Biology Physics5.859
· DOI :10.1016/J.IJROBP.2020.07.019
Eugenia Mylona4
Estimated H-index: 4
(French Institute of Health and Medical Research),
Martin A. Ebert26
Estimated H-index: 26
(UWA: University of Western Australia)
+ 6 AuthorsRenaud de Crevoisier28
Estimated H-index: 28
(French Institute of Health and Medical Research)
Abstract Purpose /Objectives: Recent voxel-based studies have shown that the dose to specific rectal and urethro-vesical subregions is predictive of toxicities, following prostate cancer IMRT. The objective of this study was to validate the discriminatory power of these subregions with respect to the whole organs, in a large independent population. Material/Methods The validation cohort consisted of 450 patients, from the XXX(BLIND) trial, treated with 3D-CRT at 66-74 Gy. Previous voxel-based analyses identified an infero-anterior rectal subregion as predictive of rectal bleeding and five subregions in the urethra and the posterior and superior part of the bladder as predictive of urinary incontinence, dysuria, retention and hematuria. In the validation cohort, these subregions were segmented in each patient’s anatomy. DVHs of the whole organs and the six subregions were compared bin-wise between patients with and without toxicities. The discriminatory power of DVHs for grade≥2 toxicity endpoints was assessed using the area under the ROC curve (AUC). Results Subregion DVHs were significantly different between patients with and without toxicities for late rectal bleeding (V44-V74), acute urinary incontinence (V68-V72), late dysuria (V56-V68) and late retention (V14-V64). The dose to the rectal subregion and the whole rectum were equally predictive of rectal bleeding (V68;AUC=0.61). The doses to three out of the five urethro-vesical subregions were found to be more predictive than the dose to the whole bladder: in the urethra for acute incontinence (V71;AUC=0.69 versus V71;AUC=0.66), in the posterior part of the bladder for late dysuria (V65;AUC=0.66 vs V68;AUC=0.59) and late retention (V39;AUC=0.74 vs no significant AUC). Conclusion Three subregions located in the urethra and the bladder were successfully validated as more predictive of urinary toxicity than the whole bladder, for urinary incontinence, retention and dysuria. Sparing in particular the posterior part of the bladder in treatment planning may reduce the risk of late urinary retention.
📖 Papers frequently viewed together
161 Citations
13 Authors (Reem Ujaimi, ..., Kathy Han)
3 Citations
232 Citations
#1Eugenia Mylona (French Institute of Health and Medical Research)H-Index: 4
#2Alessandro Cicchetti (UNIPV: University of Pavia)H-Index: 7
Last. Renaud de Crevoisier (French Institute of Health and Medical Research)H-Index: 28
view all 11 authors...
Abstract Purpose To perform bladder dose-surface map (DSM) analysis for (1) identifying symptom-related sub-surfaces (Ssurf) and evaluating their prediction capability of urinary toxicity, (2) comparing DSM with dose-volume map (DVM) (method effect), and (3) assessing the reproducibility of DSM (cohort effect). Methods and materials Urinary toxicities were prospectively analyzed for 254 prostate cancer patients treated with IMRT/IGRT at 78/80 Gy. DSMs were generated by unfolding bladder surfaces...
5 CitationsSource
#1Eugenia Mylona (French Institute of Health and Medical Research)H-Index: 4
#2Oscar Acosta (French Institute of Health and Medical Research)H-Index: 21
Last. Renaud de Crevoisier (French Institute of Health and Medical Research)H-Index: 28
view all 12 authors...
Purpose To apply a voxel-based analysis to identify urethrovesical symptom-related subregions (SRSs) associated with acute and late urinary toxicity in prostate cancer radiation therapy. Methods and Materials Two hundred seventy-two patients with prostate cancer treated with intensity-modulated radiation therapy/image-guided radiation therapy were analyzed prospectively. Each patient's computed tomography imaging was spatially normalized to a common coordinate system via nonrigid registration. T...
14 CitationsSource
#1Frederik Fuchs (TUM: Technische Universität München)H-Index: 1
#2Gregor Habl (TUM: Technische Universität München)H-Index: 21
Last. Kerstin A. Kessel (TUM: Technische Universität München)H-Index: 20
view all 6 authors...
PURPOSE: The aim of this study was to identify volume changes and dose variations of rectum and bladder during radiation therapy in prostate cancer (PC) patients. MATERIALS AND METHODS: We analyzed 20 patients with PC treated with helical tomotherapy. Daily image guidance was performed. We re-contoured the entire bladder and rectum including its contents as well as the organ walls on megavoltage computed tomography once a week. Dose variations were analyzed by means of Dmedian, Dmean, Dmax, V10 ...
5 CitationsSource
#1Renaud de Crevoisier (French Institute of Health and Medical Research)H-Index: 28
#2Mohamed Amine Bayar (Université Paris-Saclay)H-Index: 9
Last. Jean Léon Lagrange (Paris 12 Val de Marne University)H-Index: 1
view all 16 authors...
Purpose The optimal frequency of prostate cancer image guided radiation therapy (IGRT) has not yet been clearly identified. This study sought to compare the safety and efficacy of daily versus weekly IGRT. Materials and Methods This phase 3 randomized trial recruited patients with N0 localized prostate cancer. The total IGRT doses in the prostate ranged from 70 Gy to 80 Gy, sparing the lymph nodes. Patients were randomly assigned (1:1) to 2 prostate IGRT frequency groups: daily and weekly (ie, o...
46 CitationsSource
1 CitationsSource
#1Oscar Acosta (University of Rennes)H-Index: 21
#2Eugenia Mylona (University of Rennes)H-Index: 1
Last. Renaud de Crevoisier (University of Rennes)H-Index: 28
view all 9 authors...
Background and purpose Segmentation of intra-prostatic urethra for dose assessment from planning CT may help explaining urinary toxicity in prostate cancer radiotherapy. This work sought to: i) propose an automatic method for urethra segmentation in CT, ii) compare it with previously proposed surrogate models and iii) quantify the dose received by the urethra in patients treated with IMRT. Materials and methods A weighted multi-atlas-based urethra segmentation method was devised from a training ...
12 CitationsSource
#1Alan McWilliamH-Index: 12
#2J. KennedyH-Index: 5
Last. Marcel van HerkH-Index: 75
view all 6 authors...
Advances in radiotherapy (RT) have allowed an increased proportion of lung cancer patients to be treated curatively. High doses delivered to critical thoracic organs can result in excess mortality with tolerance doses poorly defined. This work presents a novel method of identifying anatomical dose-sensitive regions within the thorax. A high-resolution, normal-tissue dosimetric analysis was performed to identify regions in the heart that correlate with poorer survival. A total of 1101 patients tr...
61 CitationsSource
#1Maria JolnerovskiH-Index: 1
#2Julia SalleronH-Index: 35
Last. Ciprian ChiraH-Index: 3
view all 9 authors...
To report grade ≥2 overall late rectal and urinary toxicities in patients (pts) with prostate cancer treated by intensity-modulated radiotherapy (IMRT) at 3 dose-levels. Identify predictors of radiation toxicity and report biochemical progression free survival (bPFS). A total of 277 pts were treated with 70Gy (10.8%), 74Gy (63.9%) and 80 Gy (25.3%) using IMRT without pelvic irradiation were analyzed. Short or long-course androgen deprivation therapy (ADT) was allowed in 46.1% of pts. The toxicit...
9 CitationsSource
#1Charles CattonH-Index: 71
#2Himu LukkaH-Index: 30
Last. Mark LevineH-Index: 134
view all 21 authors...
PurposeMen with localized prostate cancer often are treated with external radiotherapy (RT) over 8 to 9 weeks. Hypofractionated RT is given over a shorter time with larger doses per treatment than standard RT. We hypothesized that hypofractionation versus conventional fractionation is similar in efficacy without increased toxicity.Patients and MethodsWe conducted a multicenter randomized noninferiority trial in intermediate-risk prostate cancer (T1 to 2a, Gleason score ≤ 6, and prostate-specific...
253 CitationsSource
#1Giuseppe Palma (National Research Council)H-Index: 14
#2Serena MontiH-Index: 14
Last. Laura Cella (National Research Council)H-Index: 25
view all 11 authors...
Purpose To apply a voxel-based (VB) approach aimed at exploring local dose differences associated with late radiation-induced lung damage (RILD). Methods and Materials An interinstitutional database of 98 patients who were Hodgkin lymphoma (HL) survivors treated with postchemotherapy supradiaphragmatic radiation therapy was analyzed in the study. Eighteen patients experienced late RILD, classified according to the Radiation Therapy Oncology Group scoring system. Each patient's computed tomograph...
25 CitationsSource
Cited By1
#1Martin A. Ebert (SCGH: Sir Charles Gairdner Hospital)H-Index: 26
#2Sarah L. Gulliford (UCLH: University College London Hospitals NHS Foundation Trust)H-Index: 23
Last. Claudio Fiorino (UniSR: Vita-Salute San Raffaele University)H-Index: 54
view all 10 authors...
For decades, dose-volume information for segmented anatomy has provided the essential data for correlating radiotherapy dosimetry with treatment-induced complications. Dose-volume information has formed the basis for modelling those associations via normal tissue complication (NTCP) models and for driving treatment planning. Limitations to this approach have been identified. Many studies have emerged demonstrating that the incorporation of information describing the spatial nature of the dose di...
#1C. Veiga (UCL: University College London)H-Index: 11
#2Pei Lim (UCLH: University College Hospital)
Last. Jennifer Gains (UCLH: University College Hospital)
view all 9 authors...
Reducing radiation-induced side effects is one of the most important challenges in paediatric cancer treatment. Recently, there has been growing interest in using spatial normalisation to enable voxel-based analysis of radiation-induced toxicities in a variety of patient groups. The need to consider three-dimensional distribution of doses, rather than dose-volume histograms, is desirable but not yet explored in paediatric populations. In this paper, we investigate the feasibility of atlas constr...
#1Daniëlle C. Voshart (UMCG: University Medical Center Groningen)H-Index: 2
#2Julia Wiedemann (UMCG: University Medical Center Groningen)H-Index: 1
Last. Lara Barazzuol (UMCG: University Medical Center Groningen)H-Index: 12
view all 4 authors...
Normal tissue side effects remain a major concern in radiotherapy. The improved precision of radiation dose delivery of recent technological developments in radiotherapy has the potential to reduce the radiation dose to organ regions that contribute the most to the development of side effects. This review discusses the contribution of regional variation in radiation responses in several organs. In the brain, various regions were found to contribute to radiation-induced neurocognitive dysfunction...
1 CitationsSource