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Strahlentherapie und Onkologie

, Volume 195, Issue 2, pp 103–112 | Cite as

Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

  • Roman Paleny
  • Michael Bremer
  • Daniel Walacides
  • Silke Mainwaring
  • Kristina Weber
  • Christoph HenkenberensEmail author
Original Article
  • 113 Downloads

Abstract

Purpose

To compare relative and absolute dose–volume parameters (DV) of the rectum and their clinical correlation with acute and late radiation proctitis (RP) after radiotherapy (RT) for prostate cancer (PCa).

Patients and methods

366 patients received RT for PCa. In total, 49.2% received definitive RT, 20.2% received postoperative RT and 30.6% received salvage RT for biochemical recurrence. In 77.9% of patients, RT was delivered to the prostate or prostate bed, and additional whole pelvic RT was performed in 22.1%. 33.9% received 3D-RT, and 66.1% received IMRT. The median follow-up was 59.5 months (18.0–84.0 months). The relative (in %) and absolute (in ccm) rectal doses from 20–75 Gy including the receiver operating characteristics curves (rAUC) from 30–65 Gy (in % and ccm) and several other clinical parameters were analyzed in univariate and multivariate analyses. We performed the statistical analyses separately for the entire cohort (n = 366), patients with (n = 81) and without (n = 285) pelvic RT, comparing RP vs. RP ≥ grade I.

Results

With the exception of the V50Gyccm (p = 0.02) in the univariate analyses for acute RP in the entire patient cohort, no absolute DV parameter (in ccm) was statistically significant associated with either acute or late RP. In the multivariate analyses, 3D-RT (p< 0.008) and rAUCV30–50Gy% (p = 0.006) were significant parameters for acute RP for the entire cohort, and the V50Gy% (p = 0.01) was the significant parameter for patients with pelvic RT. The rAUCV40–50Gy% (p = 0.004) was significant for RT to the prostate/prostate bed. Regarding the statistical analysis for late RP, the rAUCV30–65Gy% (p = 0.001) was significant for the entire cohort, and rAUCV30–50Gy% (p = 0.001) was significant for RT of the prostate/prostate bed. No parameter was significant in patients with pelvic RT.

Conclusion

Absolute DV parameters in ccm are not required for RT in PCa patients.

Keywords

Dose–volume parameter Prostate cancer Radiotherapy Radiation proctitis 

Vergleich von relativen und absoluten rektalen Dosis-Volumen-Parametern und klinische Korrelation mit akuter und später radiogener Proktitis bei Prostatakarzinompatienten

Zusammenfassung

Ziel

Vergleich von absoluter und relativer Dosisvolumenbelastung des Rektums und Korrelation mit akuter und später radiogener Proktitis (RP) nach Radiotherapie (RT) beim Prostatakarzinom (PCa)

Patienten und Methodik

366 PCa-Patienten erhielten eine RT: 49,2 % eine definitive, 20,2 % eine postoperative und 30,9 % eine Salvage-RT. Bei 78,3 % wurde Prostata oder Prostatabett bestrahlt und bei 21,7 % zusätzlich der Beckenlymphabfluss. Die Dosen betrugen 60 Gy bei postoperativer, 66 Gy bei Salvage- und 74–78 Gy bei definitiver RT. Eine 3D-RT erhielten 33,9 %, eine IMRT 66,1 %. Das mediane Follow-up betrug 59.5 Monate (18.0–84.0 Monate). Die relativen (%) und absoluten (ccm) rektalen Dosisvolumina (DV) von 20–75 Gy, sowie die Fläche unter der Kurve (rAUC) von 30–65 Gy (in % und ccm) und weitere klinische Parameter wurden univariat und multivariat untersucht. Die statistische Auswertung hinsichtlich keine RP vs. RP ≥ Grad I wurde für das gesamte Kollektiv (n = 366), für Patienten mit (n = 81) und ohne (n = 285) pelvine RT durchgeführt.

Ergebnisse

Mit Ausnahme der V50Gyccm (p = 0,02) in der univariaten Analyse für die akute RP im Gesamtkollektiv war kein absoluter DV-Parameter in ccm signifikant mit akuter oder später RP assoziiert. In der multivariaten Analyse waren die 3‑D-RT (p < 0,008) und die rAUCVGy30–50% (p = 0,006) im Gesamtkollektiv und die V50Gy% (p = 0,01) bei pelviner RT signifikant mit einer akuten RP assoziiert. Die rAUCVGy40–50% (p = 0,004) war bei der Bestrahlung beschränkt auf Prostata/Prostatabett multivariat signifikant. Hinsichtlich der späten RP war die rAUCVGy30–65% (p = 0,001) für das Gesamtkollektiv und die rAUCVGy30–50% (p = 0.001) für die Bestrahlung von Prostata/Prostatabett signifikant. Kein Parameter war multivariat signifikant für die späte RP bei additiver Beckenbestrahlung.

Schlussfolgerung

Absolute DV-Parameter in ccm zusätzlich zu relativen DV „constraints“ des Rektums werden für die RT beim PCa nicht benötigt.

Schlüsselwörter

Dosis-Volumen-Parameter Prostatakarzinom Strahlentherapie Strahlenproktitis 

Notes

Conflict of interest

R. Paleny, M. Bremer, D. Walacides, S. Mainwaring, K. Weber and C. Henkenberens declare that they have no competing interests.

References

  1. 1.
    Wortel RC, Incrocci L, Pos FJ, van der Heide UA, Lebesque JV, Aluwini S et al (2016) Late side effects after image guided intensity modulated radiation therapy compared to 3D-Conformal radiation therapy for prostate cancer: results from 2 prospective cohorts. Int J Radiat Oncol Biol Phys 95:680–689CrossRefGoogle Scholar
  2. 2.
    Zapatero A, Guerrero A, Maldonado X, Alvarez A, Gonzalez San Segundo C, Cabeza Rodriguez MA (2015) High-dose radiotherapy with short-term or long-term androgen deprivation in localised prostate cancer (DART01/05 GICOR): a randomised, controlled, phase 3 trial. Lancet Oncol 16:320–327CrossRefGoogle Scholar
  3. 3.
    Waldstein C, Dörr W, Pötter R, Widder J, Goldner G (2017) Postoperative radiotherapy for prostate cancer: morbidity of local-only or local-plus-pelvic radiotherapy. Strahlenther Onkol 194(1):23–30.  https://doi.org/10.1007/s00066-017-1215-9 CrossRefGoogle Scholar
  4. 4.
    Wiegel T, Bartkowiak D, Bottke D, Bronner C, Steiner U, Siegmann A et al (2014) Adjuvant radiotherapy versus wait-and-see after radical prostatectomy: 10-year follow-up of the ARO 96-02/UO AP 09/95 trial. Eur Urol 66:243–250CrossRefGoogle Scholar
  5. 5.
    Budäus L, Schiffmann J, Graefen M, Huland H, Tennstedt P, Siegmann A et al (2017) Defining biochemical recurrence after radical prostatectomy and timing of early salvage radiotherapy: informing the debate. Strahlenther Onkol 193:692–699CrossRefGoogle Scholar
  6. 6.
    Lohm G, Neumann K, Budach V, Wiegel T, Hoecht T, Gollrad J (2017) Salvage radiotherapy in prostate cancer patients with biochemical relapse after radical prostatectomy: prolongation of prostate-specific antigen doubling time in patients with subsequent biochemical progression. Strahlenther Onkol 194(4):325–332.  https://doi.org/10.1007/s00066-017-1247-1 CrossRefGoogle Scholar
  7. 7.
    Gulliford SL, Foo K, Morgan RC, Aird EG, Bidmead AM, Critchley H et al (2010) Dose-volume constraints to reduce rectal side effects from prostate radiotherapy: evidence from MRC RT01 Trial ISRCTN 47772397. Int J Radiat Oncol Biol Phys 76:747–754CrossRefGoogle Scholar
  8. 8.
    Marks LB, Yorke ED, Jackson A, Ten Haken RK, Constine LS, Eisbruch A et al (2010) Use of normal tissue complication probability models in the clinic. Int J Radiat Oncol Biol Phys 76:10–19CrossRefGoogle Scholar
  9. 9.
    Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO (2010) Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 76(3 Suppl):123–129CrossRefGoogle Scholar
  10. 10.
    Casares-Magaz O, Muren LP, Moiseenko V, Petersen SE, Pettersson NJ, Høyer M et al (2017) Spatial rectal dose/volume metrics predict patient-reported gastro-intestinal symptoms after radiotherapy for prostate cancer. Acta Oncol 56:1507–1513CrossRefGoogle Scholar
  11. 11.
    Kupelian PA, Reddy CA, Carlson TP, Wiloughby TR (2002) Dose/volume relationship of late rectal bleeding after external beam radiotherapy for localized prostate cancer: absolute or relative rectal volume? Cancer J 8:62–66CrossRefGoogle Scholar
  12. 12.
    D’Amico AV, Whittington R, Malkowicz SB, Schultz D, Blank K, Broderick GA et al (1998) Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 280:969–974CrossRefGoogle Scholar
  13. 13.
    National Cancer Institute (2010) Common terminology criteria for adverse events v4.0. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_8.5x11.pdf. Accessed 22 Dec 2017Google Scholar
  14. 14.
    LENT SOMA scales for all anatomic sites. (1995) Int J Radiat Oncol Biol Phys 31:1049–1092.Google Scholar
  15. 15.
    Fiorino C, Sanguineti G, Cozzarini C, Foppiano F, Piazzolla A, Menegotti L et al (2003) Rectal dose-volume constraints in high-dose radiotherapy of localized prostate cancer. Int J Radiat Oncol Biol Phys 57:953–962CrossRefGoogle Scholar
  16. 16.
    Fiorino C, Fellin G, Rancati T, Vavassori V, Bianchi VC, Borca VC, Girelli G et al (2008) Clinical and dosimetric predictors of late rectal syndrome after 3D-CRT for localized prostate cancer: preliminary results of a multicenter prospective study. Int J Radiat Oncol Biol Phys 70:1130–1137CrossRefGoogle Scholar
  17. 17.
    Fiorino C, Cozzarini C, Vavassori V, Sanguineti G, Bianchi C, Cattaneo GM et al (2002) 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 64:1–12CrossRefGoogle Scholar
  18. 18.
    Someya M, Hori M, Tatoeka K, Nakata K, Takagi M, Saito M et al (2015) Results and DVH analysis of late rectal bleeding in patients treated with 3D-CRT or IMRT for localized prostate cancer. J Radiat Res 56:122–127CrossRefGoogle Scholar
  19. 19.
    Mirjolet C, Walker PM, Gauthier M, Dalban C, Naudy S, Mazoyer F et al (2016) Absolute volume of the rectum and AUC from rectal DVH between 25 and 50 Gy predict acute gastrointestinal toxicity with IG-IMRT in prostate cancer. Radiat Oncol 11:145CrossRefGoogle Scholar
  20. 20.
    Nuyttens JJ, Milito S, Rust PF, Turrisi AT 3rd (2002) Dose-volume relationship for acute side effects during high dose conformal radiotherapy for prostate cancer. Radiother Oncol 64:209–214CrossRefGoogle Scholar
  21. 21.
    Huang EH, Pollak A, Levy L, Starkschall G, Dong L, Rosen I et al (2002) Late rectal toxicity: dose-volume effects of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 54:1314–1321CrossRefGoogle Scholar
  22. 22.
    McDonald AM, Baker CB, Popple RA, Shekar K, Yang ES, Jacob R et al (2014) Different rectal toxicity tolerance with and without simultaneous conventionally-fractionated pelvic lymph node treatment in patients receiving hypofractionated prostate radiotherapy. Radiat Oncol.  https://doi.org/10.1186/1748-717X-9-129 Google Scholar
  23. 23.
    Guckenberger M, Andratschke N, Alheit N, Holy R, Moustakis C, Nestle U et al (2014) Definition of stereotactic body radiotherapy: principles and practice for the treatment of stage I non-small cell lung cancer. Strahlenther Onkol 190:26–33CrossRefGoogle Scholar
  24. 24.
    Kocher M, Wittig A, Piroth MD, Treuer H, Seegenschmiedt H, Ruge M et al (2014) Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO Working Group on Stereotactic Radiotherapy. Strahlenther Onkol 190:521–531CrossRefGoogle Scholar
  25. 25.
    Shu HK, Lee TT, Vigneauly E, Xia P, Pickett B, Phillips TL et al (2001) Toxicity following high-dose three-dimensional conformal and intensity-modulated radiation therapy for clinically localized prostate cancer. Urology 57:102–107CrossRefGoogle Scholar
  26. 26.
    Chan LW, Xia P, Gottschalk AR, Akazawa M, Scala M, Picket B et al (2008) Proposed rectal dose constraints for patients undergoing definitive whole pelvic radiotherapy for clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 72:69–77CrossRefGoogle Scholar
  27. 27.
    Zelefsky MJ, Levin EJ, Hunt M, Yamada Y, Shippy AM, Jackson A et al (2008) 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 70:1124–1129CrossRefGoogle Scholar
  28. 28.
    Wortel RC, Incrocci L, Pos FJ, Lebesque JV, Witte MG, van der Heide UA et al (2015) Acute toxicity after image-guided intensity modulated radiation therapy compared to 3D conformal radiation therapy in prostate cancer patients. Int J Radiat Oncol Biol Phys 91:737–744CrossRefGoogle Scholar
  29. 29.
    Tucker SL, Dong L, Cheung R, Johnson J, Mohan R, Huang EH et al (2004) Comparison of rectal dose-wall histogram versus dose-volume histogram for modeling the incidence of late rectal bleeding after radiotherapy. Int J Radiat Oncol Biol Phys 60:1589–1601CrossRefGoogle Scholar
  30. 30.
    Guckenberger M, Pohl F, Baier K, Meyer J, Koebl O, Flentje M et al (2006) Influence of rectum delineation (rectal volume vs. rectal wall) on IMRT treatment planning of the prostate. Strahlenther Onkol 182:721–726CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Radiotherapy and Special OncologyHannover Medical SchoolHannoverGermany
  2. 2.Institute for BiometryHannover Medical SchoolHannoverGermany

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