Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy

First quantification of bowel dose–volume effects

Carla Sini, Barbara Noris Chiorda, Pietro Gabriele, Giuseppe Sanguineti, Sara Morlino, Fabio Badenchini, Domenico Cante, Viviana Carillo, Marcella Gaetano, Tommaso Giandini, Valeria Landoni, Angelo Maggio, Lucia Perna, Edoardo Petrucci, Vincenzo Sacco, Riccardo Valdagni, Tiziana Rancati, Claudio Fiorino, Cesare Cozzarini

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background and purpose Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose–volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. Materials and methods Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8 Gy (range 50.4–54.4, 1.7–2 Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose–volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. Results Analyses were focused on the four questions showing a median ΔIBDQ-B > 0. No dose volume/surface parameters were predictive, other than ΔIBDQ5 ≥ 3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20 > 470 cc, V30 > 245 cc, V42 > 110 cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2 = 0.92) and was found to be robust after bootstrap-based internal validation. Conclusions Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.

Original languageEnglish
Pages (from-to)296-301
Number of pages6
JournalRadiotherapy and Oncology
Volume124
Issue number2
DOIs
Publication statusPublished - Aug 1 2017

Fingerprint

Intensity-Modulated Radiotherapy
Pelvis
Prostatic Neoplasms
Sigmoid Colon
Inflammatory Bowel Diseases
Calibration
Radiotherapy
Logistic Models

Keywords

  • Acute bowel toxicity
  • Diarrhea
  • Intensity-modulated radiotherapy
  • Predictive models
  • Prostate cancer

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy : First quantification of bowel dose–volume effects. / Sini, Carla; Noris Chiorda, Barbara; Gabriele, Pietro; Sanguineti, Giuseppe; Morlino, Sara; Badenchini, Fabio; Cante, Domenico; Carillo, Viviana; Gaetano, Marcella; Giandini, Tommaso; Landoni, Valeria; Maggio, Angelo; Perna, Lucia; Petrucci, Edoardo; Sacco, Vincenzo; Valdagni, Riccardo; Rancati, Tiziana; Fiorino, Claudio; Cozzarini, Cesare.

In: Radiotherapy and Oncology, Vol. 124, No. 2, 01.08.2017, p. 296-301.

Research output: Contribution to journalArticle

Sini, Carla ; Noris Chiorda, Barbara ; Gabriele, Pietro ; Sanguineti, Giuseppe ; Morlino, Sara ; Badenchini, Fabio ; Cante, Domenico ; Carillo, Viviana ; Gaetano, Marcella ; Giandini, Tommaso ; Landoni, Valeria ; Maggio, Angelo ; Perna, Lucia ; Petrucci, Edoardo ; Sacco, Vincenzo ; Valdagni, Riccardo ; Rancati, Tiziana ; Fiorino, Claudio ; Cozzarini, Cesare. / Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy : First quantification of bowel dose–volume effects. In: Radiotherapy and Oncology. 2017 ; Vol. 124, No. 2. pp. 296-301.
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abstract = "Background and purpose Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose–volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. Materials and methods Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8 Gy (range 50.4–54.4, 1.7–2 Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose–volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. Results Analyses were focused on the four questions showing a median ΔIBDQ-B > 0. No dose volume/surface parameters were predictive, other than ΔIBDQ5 ≥ 3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20 > 470 cc, V30 > 245 cc, V42 > 110 cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2 = 0.92) and was found to be robust after bootstrap-based internal validation. Conclusions Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.",
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author = "Carla Sini and {Noris Chiorda}, Barbara and Pietro Gabriele and Giuseppe Sanguineti and Sara Morlino and Fabio Badenchini and Domenico Cante and Viviana Carillo and Marcella Gaetano and Tommaso Giandini and Valeria Landoni and Angelo Maggio and Lucia Perna and Edoardo Petrucci and Vincenzo Sacco and Riccardo Valdagni and Tiziana Rancati and Claudio Fiorino and Cesare Cozzarini",
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T2 - First quantification of bowel dose–volume effects

AU - Sini, Carla

AU - Noris Chiorda, Barbara

AU - Gabriele, Pietro

AU - Sanguineti, Giuseppe

AU - Morlino, Sara

AU - Badenchini, Fabio

AU - Cante, Domenico

AU - Carillo, Viviana

AU - Gaetano, Marcella

AU - Giandini, Tommaso

AU - Landoni, Valeria

AU - Maggio, Angelo

AU - Perna, Lucia

AU - Petrucci, Edoardo

AU - Sacco, Vincenzo

AU - Valdagni, Riccardo

AU - Rancati, Tiziana

AU - Fiorino, Claudio

AU - Cozzarini, Cesare

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N2 - Background and purpose Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose–volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. Materials and methods Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8 Gy (range 50.4–54.4, 1.7–2 Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose–volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. Results Analyses were focused on the four questions showing a median ΔIBDQ-B > 0. No dose volume/surface parameters were predictive, other than ΔIBDQ5 ≥ 3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20 > 470 cc, V30 > 245 cc, V42 > 110 cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2 = 0.92) and was found to be robust after bootstrap-based internal validation. Conclusions Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.

AB - Background and purpose Intestinal toxicity is commonly experienced during whole-pelvis intensity-modulated radiotherapy (WPRT) for prostate cancer. The aim of the current study was to assess bowel dose–volume relationships for acute patient-reported intestinal symptoms of patients treated with WPRT for prostate cancer. Materials and methods Complete data of 206 patients were available; the median dose to pelvic nodes was 51.8 Gy (range 50.4–54.4, 1.7–2 Gy/fr). Intestinal symptoms were assessed as changes in the Inflammatory Bowel Disease Questionnaire scores relative to the Bowel Domain (IBDQ-B) between baseline and radiotherapy mid-point/end. The 25th percentiles of the most severe worsening from baseline (ΔIBDQ-B) were set as end-points. The impact of bowel loops and sigmoid colon dose–volume/surface parameters as well as selected clinical parameters were investigated using multivariate logistic regression. Results Analyses were focused on the four questions showing a median ΔIBDQ-B > 0. No dose volume/surface parameters were predictive, other than ΔIBDQ5 ≥ 3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20 > 470 cc, V30 > 245 cc, V42 > 110 cc; low risk: all the remaining patients), a two-variable model including high-risk DVH-shape (OR: 9.3) and age (protective, OR: 0.94) was assessed. The model showed good calibration (slope: 1.003, R2 = 0.92) and was found to be robust after bootstrap-based internal validation. Conclusions Constraining the bowel loops may reduce the risk of loose stools. The risk is higher for younger patients.

KW - Acute bowel toxicity

KW - Diarrhea

KW - Intensity-modulated radiotherapy

KW - Predictive models

KW - Prostate cancer

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