Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect

C Cozzarini, T Rancati, F Palorini, B Avuzzi, E Garibaldi, D Balestrini, D Cante, F Munoz, P Franco, G Girelli, C Sini, V Vavassori, R Valdagni, C Fiorino

Research output: Contribution to journalArticle

Abstract

Background and purpose: Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). Methods and materials: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2. Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6. months. Patients were treated with conventional (74-80. Gy, 1.8-2. Gy/fr) or moderately hypo-fractionated RT (65-75.2. Gy, 2.2-2.7. Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. Results: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF. > . 12) was 5.1%. EQD2 calculated with alpha-beta = 0.8. Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2. > . 80. Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. Conclusions: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI. © 2017 Elsevier B.V.
Original languageEnglish
Pages (from-to)101-106
Number of pages6
JournalRadiotherapy and Oncology
Volume125
Issue number1
DOIs
Publication statusPublished - 2017

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Urinary Incontinence
Prostatic Neoplasms
Radiotherapy
Intensity-Modulated Radiotherapy
Transurethral Resection of Prostate
Calibration

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Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect. / Cozzarini, C; Rancati, T; Palorini, F; Avuzzi, B; Garibaldi, E; Balestrini, D; Cante, D; Munoz, F; Franco, P; Girelli, G; Sini, C; Vavassori, V; Valdagni, R; Fiorino, C.

In: Radiotherapy and Oncology, Vol. 125, No. 1, 2017, p. 101-106.

Research output: Contribution to journalArticle

Cozzarini, C ; Rancati, T ; Palorini, F ; Avuzzi, B ; Garibaldi, E ; Balestrini, D ; Cante, D ; Munoz, F ; Franco, P ; Girelli, G ; Sini, C ; Vavassori, V ; Valdagni, R ; Fiorino, C. / Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect. In: Radiotherapy and Oncology. 2017 ; Vol. 125, No. 1. pp. 101-106.
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T1 - Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the dose-effect

AU - Cozzarini, C

AU - Rancati, T

AU - Palorini, F

AU - Avuzzi, B

AU - Garibaldi, E

AU - Balestrini, D

AU - Cante, D

AU - Munoz, F

AU - Franco, P

AU - Girelli, G

AU - Sini, C

AU - Vavassori, V

AU - Valdagni, R

AU - Fiorino, C

PY - 2017

Y1 - 2017

N2 - Background and purpose: Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). Methods and materials: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2. Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6. months. Patients were treated with conventional (74-80. Gy, 1.8-2. Gy/fr) or moderately hypo-fractionated RT (65-75.2. Gy, 2.2-2.7. Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. Results: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF. > . 12) was 5.1%. EQD2 calculated with alpha-beta = 0.8. Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2. > . 80. Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. Conclusions: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI. © 2017 Elsevier B.V.

AB - Background and purpose: Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). Methods and materials: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2. Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6. months. Patients were treated with conventional (74-80. Gy, 1.8-2. Gy/fr) or moderately hypo-fractionated RT (65-75.2. Gy, 2.2-2.7. Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. Results: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF. > . 12) was 5.1%. EQD2 calculated with alpha-beta = 0.8. Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2. > . 80. Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. Conclusions: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI. © 2017 Elsevier B.V.

U2 - 10.1016/j.radonc.2017.07.029

DO - 10.1016/j.radonc.2017.07.029

M3 - Article

VL - 125

SP - 101

EP - 106

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

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