Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects

C. Sini, B. Noris Chiorda, P. Gabriele, G. Sanguineti, S. Morlino, F. Badenchini, D. Cante, V. Carillo, M. Gaetano, T. Giandini, V. Landoni, A. Maggio, L. Perna, E. Petrucci, V. Sacco, R. Valdagni, T. Rancati, C. Fiorino, C. 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 51.8Gy (range 50.4-54.4, 1.7-2Gy/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 (DeltaIBDQ-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 DeltaIBDQ-B>0. No dose volume/surface parameters were predictive, other than DeltaIBDQ5>/=3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; 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
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

Cite this

Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects. / Sini, C.; Chiorda, B. Noris; Gabriele, P.; Sanguineti, G.; Morlino, S.; Badenchini, F.; Cante, D.; Carillo, V.; Gaetano, M.; Giandini, T.; Landoni, V.; Maggio, A.; Perna, L.; Petrucci, E.; Sacco, V.; Valdagni, R.; Rancati, T.; Fiorino, C.; Cozzarini, C.

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

Research output: Contribution to journalArticle

Sini, C, Chiorda, BN, Gabriele, P, Sanguineti, G, Morlino, S, Badenchini, F, Cante, D, Carillo, V, Gaetano, M, Giandini, T, Landoni, V, Maggio, A, Perna, L, Petrucci, E, Sacco, V, Valdagni, R, Rancati, T, Fiorino, C & Cozzarini, C 2017, 'Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects', Radiotherapy and Oncology, vol. 124, no. 2, pp. 296-301. https://doi.org/10.1016/j.radonc.2017.07.005.
Sini, C. ; Chiorda, B. Noris ; Gabriele, P. ; Sanguineti, G. ; Morlino, S. ; Badenchini, F. ; Cante, D. ; Carillo, V. ; Gaetano, M. ; Giandini, T. ; Landoni, V. ; Maggio, A. ; Perna, L. ; Petrucci, E. ; Sacco, V. ; Valdagni, R. ; Rancati, T. ; Fiorino, C. ; Cozzarini, C. / 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 51.8Gy (range 50.4-54.4, 1.7-2Gy/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 (DeltaIBDQ-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 DeltaIBDQ-B>0. No dose volume/surface parameters were predictive, other than DeltaIBDQ5>/=3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; 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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T1 - Patient-reported intestinal toxicity from whole pelvis intensity-modulated radiotherapy: First quantification of bowel dose-volume effects

AU - Sini, C.

AU - Chiorda, B. Noris

AU - Gabriele, P.

AU - Sanguineti, G.

AU - Morlino, S.

AU - Badenchini, F.

AU - Cante, D.

AU - Carillo, V.

AU - Gaetano, M.

AU - Giandini, T.

AU - Landoni, V.

AU - Maggio, A.

AU - Perna, L.

AU - Petrucci, E.

AU - Sacco, V.

AU - Valdagni, R.

AU - Rancati, T.

AU - Fiorino, C.

AU - Cozzarini, C.

N1 - LR: 20170725; CI: Copyright (c) 2017; JID: 8407192; OTO: NOTNLM; 2016/10/11 [received]; 2017/06/06 [revised]; 2017/07/06 [accepted]; aheadofprint

PY - 2017/8/1

Y1 - 2017/8/1

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 51.8Gy (range 50.4-54.4, 1.7-2Gy/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 (DeltaIBDQ-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 DeltaIBDQ-B>0. No dose volume/surface parameters were predictive, other than DeltaIBDQ5>/=3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; 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 51.8Gy (range 50.4-54.4, 1.7-2Gy/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 (DeltaIBDQ-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 DeltaIBDQ-B>0. No dose volume/surface parameters were predictive, other than DeltaIBDQ5>/=3 (loose stools): when grouping patients according to bowel DVHs (high risk: V20>470cc, V30>245cc, V42>110cc; 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

U2 - 10.1016/j.radonc.2017.07.005.

DO - 10.1016/j.radonc.2017.07.005.

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VL - 124

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EP - 301

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

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