Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome

Riccardo Valdagni, Michael W. Kattan, Tiziana Rancati, Changhong Yu, Vittorio Vavassori, Giovanni Fellin, Elena Cagna, Pietro Gabriele, Flora Anna Mauro, Micaela Baccolini, Carla Bianchi, Loris Menegotti, Angelo F. Monti, Michele Stasi, Maria Olga Giganti, Claudio Fiorino

Research output: Contribution to journalArticle

Abstract

Purpose: Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. Methods and Materials: This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). Results: Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. Conclusions: We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.

Original languageEnglish
Pages (from-to)1957-1966
Number of pages10
JournalInternational Journal of Radiation Oncology Biology Physics
Volume82
Issue number5
DOIs
Publication statusPublished - Apr 1 2012

Keywords

  • Late rectal toxicity
  • Nomograms
  • Predictive models
  • Prostate cancer
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

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  • Cite this

    Valdagni, R., Kattan, M. W., Rancati, T., Yu, C., Vavassori, V., Fellin, G., Cagna, E., Gabriele, P., Mauro, F. A., Baccolini, M., Bianchi, C., Menegotti, L., Monti, A. F., Stasi, M., Giganti, M. O., & Fiorino, C. (2012). Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome. International Journal of Radiation Oncology Biology Physics, 82(5), 1957-1966. https://doi.org/10.1016/j.ijrobp.2011.03.028