Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT

Riccardo Valdagni, Tiziana Rancati, Claudio Fiorino, Gianni Fellin, Alessandro Magli, Michela Baccolini, Carla Bianchi, Emanuela Cagna, Carlo Greco, Flora A. Mauro, Angelo F. Monti, Fernando Munoz, Michele Stasi, Paola Franzone, Vittorio Vavassori

Research output: Contribution to journalArticle

52 Citations (Scopus)

Abstract

Purpose: To predict acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) and Subjective Objective Signs Management and Analysis/Late Effect of Normal Tissue (SOMA/LENT) toxicities of the lower gastrointestinal (LGI) syndrome in patients with prostate cancer undergoing three-dimensional conformal radiotherapy using a tool (nomogram) that takes into account clinical and dosimetric variables that proved to be significant in the Italian Association for Radiation Oncology (AIRO) Group on Prostate Cancer (AIROPROS) 0102 trial. Methods and Materials: Acute rectal toxicity was scored in 1,132 patients by using both the RTOG/EORTC scoring system and a 10-item self-assessed questionnaire. Correlation between clinical variables/dose-volume histogram constraints and rectal toxicity was investigated by means of multivariate logistic analyses. Multivariate logistic analyses results were used to create nomograms predicting the symptoms of acute LGI syndrome. Results: Mean rectal dose was a strong predictor of Grade 2-3 RTOG/EORTC acute LGI toxicity (p = 0.0004; odds ratio (OR) = 1.035), together with hemorrhoids (p = 0.02; OR = 1.51), use of anticoagulants/antiaggregants (p = 0.02; OR = 0.63), and androgen deprivation (AD) (p = 0.04; OR = 0.65). Diabetes (p = 0.34; OR = 1.28) and pelvic node irradiation (p = 0.11; OR = 1.56) were significant variables to adjust toxicity prediction. Bleeding was related to hemorrhoids (p = 0.02; OR = 173), AD (p = 0.17; OR = 0.67), and mean rectal dose (p = 0.009; OR = 1.024). Stool frequency was related to seminal vesicle irradiation (p = 0.07; OR = 6.46), AD administered for more than 3 months (p = 0.002; OR = 0.32), and the percent volume of rectum receiving more than 60 Gy (V60Gy) V60 (p = 0.02; OR = 1.02). Severe fecal incontinence depended on seminal vesicle irradiation (p = 0.14; OR = 4.5) and V70 (p = 0.033; OR = 1.029). Conclusions: To the best of our knowledge, this work presents the first set of nomograms available in the literature specific to symptoms of LGI syndrome and provides clinicians with a tailored probability of the specific outcome. Validation of the tool is in progress.

Original languageEnglish
Pages (from-to)1065-1073
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume71
Issue number4
DOIs
Publication statusPublished - Jul 15 2008

Fingerprint

nomographs
Nomograms
toxicity
Prostatic Neoplasms
deprivation
cancer
Odds Ratio
radiation therapy
logistics
dosage
irradiation
Radiation Oncology
anticoagulants
rectum
bleeding
scoring
predictions
Androgens
histograms
Hemorrhoids

Keywords

  • Acute LGI toxicity
  • Conformal radiotherapy
  • Nomograms
  • Prostate radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT. / Valdagni, Riccardo; Rancati, Tiziana; Fiorino, Claudio; Fellin, Gianni; Magli, Alessandro; Baccolini, Michela; Bianchi, Carla; Cagna, Emanuela; Greco, Carlo; Mauro, Flora A.; Monti, Angelo F.; Munoz, Fernando; Stasi, Michele; Franzone, Paola; Vavassori, Vittorio.

In: International Journal of Radiation Oncology Biology Physics, Vol. 71, No. 4, 15.07.2008, p. 1065-1073.

Research output: Contribution to journalArticle

Valdagni, R, Rancati, T, Fiorino, C, Fellin, G, Magli, A, Baccolini, M, Bianchi, C, Cagna, E, Greco, C, Mauro, FA, Monti, AF, Munoz, F, Stasi, M, Franzone, P & Vavassori, V 2008, 'Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT', International Journal of Radiation Oncology Biology Physics, vol. 71, no. 4, pp. 1065-1073. https://doi.org/10.1016/j.ijrobp.2007.11.037
Valdagni, Riccardo ; Rancati, Tiziana ; Fiorino, Claudio ; Fellin, Gianni ; Magli, Alessandro ; Baccolini, Michela ; Bianchi, Carla ; Cagna, Emanuela ; Greco, Carlo ; Mauro, Flora A. ; Monti, Angelo F. ; Munoz, Fernando ; Stasi, Michele ; Franzone, Paola ; Vavassori, Vittorio. / Development of a Set of Nomograms to Predict Acute Lower Gastrointestinal Toxicity for Prostate Cancer 3D-CRT. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 71, No. 4. pp. 1065-1073.
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AU - Valdagni, Riccardo

AU - Rancati, Tiziana

AU - Fiorino, Claudio

AU - Fellin, Gianni

AU - Magli, Alessandro

AU - Baccolini, Michela

AU - Bianchi, Carla

AU - Cagna, Emanuela

AU - Greco, Carlo

AU - Mauro, Flora A.

AU - Monti, Angelo F.

AU - Munoz, Fernando

AU - Stasi, Michele

AU - Franzone, Paola

AU - Vavassori, Vittorio

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N2 - Purpose: To predict acute Radiation Therapy Oncology Group (RTOG)/European Organization for Research and Treatment of Cancer (EORTC) and Subjective Objective Signs Management and Analysis/Late Effect of Normal Tissue (SOMA/LENT) toxicities of the lower gastrointestinal (LGI) syndrome in patients with prostate cancer undergoing three-dimensional conformal radiotherapy using a tool (nomogram) that takes into account clinical and dosimetric variables that proved to be significant in the Italian Association for Radiation Oncology (AIRO) Group on Prostate Cancer (AIROPROS) 0102 trial. Methods and Materials: Acute rectal toxicity was scored in 1,132 patients by using both the RTOG/EORTC scoring system and a 10-item self-assessed questionnaire. Correlation between clinical variables/dose-volume histogram constraints and rectal toxicity was investigated by means of multivariate logistic analyses. Multivariate logistic analyses results were used to create nomograms predicting the symptoms of acute LGI syndrome. Results: Mean rectal dose was a strong predictor of Grade 2-3 RTOG/EORTC acute LGI toxicity (p = 0.0004; odds ratio (OR) = 1.035), together with hemorrhoids (p = 0.02; OR = 1.51), use of anticoagulants/antiaggregants (p = 0.02; OR = 0.63), and androgen deprivation (AD) (p = 0.04; OR = 0.65). Diabetes (p = 0.34; OR = 1.28) and pelvic node irradiation (p = 0.11; OR = 1.56) were significant variables to adjust toxicity prediction. Bleeding was related to hemorrhoids (p = 0.02; OR = 173), AD (p = 0.17; OR = 0.67), and mean rectal dose (p = 0.009; OR = 1.024). Stool frequency was related to seminal vesicle irradiation (p = 0.07; OR = 6.46), AD administered for more than 3 months (p = 0.002; OR = 0.32), and the percent volume of rectum receiving more than 60 Gy (V60Gy) V60 (p = 0.02; OR = 1.02). Severe fecal incontinence depended on seminal vesicle irradiation (p = 0.14; OR = 4.5) and V70 (p = 0.033; OR = 1.029). Conclusions: To the best of our knowledge, this work presents the first set of nomograms available in the literature specific to symptoms of LGI syndrome and provides clinicians with a tailored probability of the specific outcome. Validation of the tool is in progress.

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