Multi-variable models of large International Prostate Symptom Score worsening at the end of therapy in prostate cancer radiotherapy

Federica Palorini, Tiziana Rancati, Cesare Cozzarini, Ilaria Improta, Viviana Carillo, Barbara Avuzzi, Valeria Casanova Borca, Andrea Botti, Claudio Degli Esposti, Pierfrancesco Franco, Elisabetta Garibaldi, Giuseppe Girelli, Cinzia Iotti, Angelo Maggio, Marcella Palombarini, Alessio Pierelli, Emanuele Pignoli, Vittorio Vavassori, Riccardo Valdagni, Claudio Fiorino

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Abstract

Purpose/objective Prospectively assessing clinical/dosimetry factors affecting the acute worsening of urinary functionality after radiotherapy for prostate cancer. Material/methods DUE01 population was considered, including patients treated with conventional or moderate hypo-fractionation (2.2-2.7 Gy/fr). Relevant clinical factors were collected, urinary symptoms were self-reported through the International Prostate Symptom Score (IPSS) before and at the end of radiotherapy; while absolute weekly dose-surface histograms (DSHw) were chosen as dosimetry descriptors. An IPSS increase of at least 10 and 15 points (ΔIPSS ≥ 10 and ΔIPSS ≥ 15) were chosen as endpoints. Patients with baseline IPSS > 20 were excluded. Relevant factors were chosen through a bootstrap-based in silico methodology. Results Complete information was available for 380 patients: 77/380 (20%) and 28/380 (7%) with ΔIPSS ≥ 10 and ΔIPSS ≥ 15, respectively. Neoadjuvant hormone was protective (OR = 0.49 and 0.69). DSHw at 8.5 Gy/week and 12 Gy/week were risk factors, with additional risk for patients who use cardiovascular drugs and anti-hypercholesterolemia drugs. In the hypo-fractionated subgroup (n = 209) the role of cardiovascular drugs (OR = 2.16) for ΔIPSS ≥ 10 and anti-hypercholesterolemia drugs (OR = 2.80) for ΔIPSS ≥ 15, together with DSHw (10 Gy/week and 12.5 Gy/week, respectively), was confirmed. Conclusion Current study shows a dose-surface/volume effect for acute large worsening of urinary functionality; several clinical variables largely impact the risk and especially all the factors related with vascular diseases.

Original languageEnglish
Pages (from-to)92-98
Number of pages7
JournalRadiotherapy and Oncology
Volume118
Issue number1
DOIs
Publication statusPublished - Jan 1 2016

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Keywords

  • Dose-volume effects
  • Prostate cancer
  • Radiotherapy
  • Urinary toxicity

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

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