Late fecal incontinence after high-dose radiotherapy for prostate cancer: Better prediction using longitudinal definitions

Claudio Fiorino, Tiziana Rancati, Gianni Fellin, Vittorio Vavassori, Emanuela Cagna, Valeria Casanova Borca, Giuseppe Girelli, Loris Menegotti, Angelo Filippo Monti, Francesca Tortoreto, Stefania Delle Canne, Riccardo Valdagni

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: To model late fecal incontinence after high-dose prostate cancer radiotherapy (RT) in patients accrued in the AIROPROS (prostate working group of the Italian Association of Radiation Oncology) 0102 trial using different endpoint definitions. Methods and Materials: The self-reported questionnaires (before RT, 1 month after RT, and every 6 months for ≤3 years after RT) of 586 patients were available. The peak incontinence (P-INC) and two longitudinal definitions (chronic incontinence [C-INC], defined as the persistence of Grade 1 or greater incontinence after any Grade 2-3 event; and mean incontinence score [M-INC], defined as the average score during the 3-year period after RT) were considered. The correlation between the clinical/dosimetric parameters (including rectal dose-volume histograms) and P-INC (Grade 2 or greater), C-INC, and M-INC of ≥1 were investigated using multivariate logistic analyses. Receiver operating characteristic curves and the area under the curve were used to assess the predictive value of the different multivariate models. Results: Of the 586 patients, 36 with a Grade 1 or greater incontinence score before RT were not included in the present analysis. Of the 550 included patients, 197 (35.8%) had at least one control with a Grade 1 or greater incontinence score (M-INC >0). Of these 197 patients, 37 (6.7%), 22 (4.0%), and 17 (3.1%) were scored as having P-INC, M-INC ≥1, and C-INC, respectively. On multivariate analysis, Grade 2 or greater acute incontinence was the only predictor of P-INC (odds ratio [OR], 5.9; p =.0009). Grade 3 acute incontinence was predictive of C-INC (OR, 9.4; p =.02), and percentage of the rectal volume receiving >40 Gy of ≥80% was predictive of a M-INC of ≥1 (OR, 3.8; p =.008) and of C-INC (OR, 3.6; p =.03). Previous bowel disease, previous abdominal/pelvic surgery, and the use of antihypertensive (protective factor) correlated highly with both C-INC and M-INC ≥1. The predictive values of the models for C-INC (area under the curve, 0.83) and M-INC ≥1 (area under the curve, 0.73) were greater than the ones for P-INC (area under the curve, 0.62) and more reliable (p =.0001-.0003 against p =.02). Nomograms for the two longitudinal definitions were derived. Conclusions: The longitudinal definitions of fecal incontinence (C-INC and M-INC ≥1) were helpful in accounting for both the persistence and the severity of the incontinence. A significant fraction of peak events was consequential to acute incontinence, and a longer duration of symptoms mainly depended on the rectal dose bath (percentage of rectal volume receiving >40 Gy), and pretreatment clinical factors.

Original languageEnglish
Pages (from-to)38-45
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume83
Issue number1
DOIs
Publication statusPublished - May 1 2012

Keywords

  • Dose-volume effects
  • Incontinence
  • Prostate radiotherapy
  • Rectal toxicity

ASJC Scopus subject areas

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

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