Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy

Lucia Perna, Filippo Alongi, Claudio Fiorino, Sara Broggi, Mauro Cattaneo Giovanni, Cesare Cozzarini, Nadia Di Muzio, Riccardo Calandrino

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Purpose/objective: Whole pelvis irradiation with IMRT (WPRT-IMRT) after prostatectomy is efficient in reducing acute toxicity: however, a number of patients still experience moderate acute bowel toxicity. Materials and methods: Ninety-six patients treated with WPRT-IMRT after prostatectomy with adjuvant or salvage intent were analysed. A number of parameters were individually recovered, including the DVHs of the intestinal cavity outside PTV and of the loops referred to both the WPRT phase and the whole treatment. Correlation between clinical-dosimetric parameters and acute bowel toxicity was investigated by logistic analyses. Best predictive cut-off values for continuous variables were assessed by ROC curves. Results: 15/96 (15.6%) Patients experienced grade 2 toxicity (no grade 3). Best dose-volume predictors were the fraction of loops receiving more than 45, 50 and 55 Gy (respectively, V45TL ≥ 50 cc, V50TL ≥ 13 cc, V55TL ≥ 3 cc; p-values ranging from 0.005 to 0.027). Age, GU acute toxicity, rectal acute toxicity and time between prostatectomy and IMRT were also predictors of acute bowel toxicity. Multivariate analysis showed that the most predictive independent parameters were age (OR: 1.13; 95%CI: 1.02-1.25; p = 0.021) and V50TL (≥13 cc, OR: 8.2; 95%CI: 1.7-40; p = 0.009). Conclusions: The risk of moderate acute uGI toxicity during WPRT-IMRT for post-operatively treated patients increases with age; the risk is substantially reduced in patients with small overlap between PTV and loops.

Original languageEnglish
Pages (from-to)71-75
Number of pages5
JournalRadiotherapy and Oncology
Volume97
Issue number1
DOIs
Publication statusPublished - Oct 2010

Fingerprint

Prostatectomy
Pelvis
ROC Curve
Multivariate Analysis
Therapeutics

Keywords

  • Dose-volume effects
  • IMRT
  • Post-operative radiotherapy
  • Prostate cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy. / Perna, Lucia; Alongi, Filippo; Fiorino, Claudio; Broggi, Sara; Cattaneo Giovanni, Mauro; Cozzarini, Cesare; Di Muzio, Nadia; Calandrino, Riccardo.

In: Radiotherapy and Oncology, Vol. 97, No. 1, 10.2010, p. 71-75.

Research output: Contribution to journalArticle

@article{6aea00860b774d1e9e702d84eda80e99,
title = "Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy",
abstract = "Purpose/objective: Whole pelvis irradiation with IMRT (WPRT-IMRT) after prostatectomy is efficient in reducing acute toxicity: however, a number of patients still experience moderate acute bowel toxicity. Materials and methods: Ninety-six patients treated with WPRT-IMRT after prostatectomy with adjuvant or salvage intent were analysed. A number of parameters were individually recovered, including the DVHs of the intestinal cavity outside PTV and of the loops referred to both the WPRT phase and the whole treatment. Correlation between clinical-dosimetric parameters and acute bowel toxicity was investigated by logistic analyses. Best predictive cut-off values for continuous variables were assessed by ROC curves. Results: 15/96 (15.6{\%}) Patients experienced grade 2 toxicity (no grade 3). Best dose-volume predictors were the fraction of loops receiving more than 45, 50 and 55 Gy (respectively, V45TL ≥ 50 cc, V50TL ≥ 13 cc, V55TL ≥ 3 cc; p-values ranging from 0.005 to 0.027). Age, GU acute toxicity, rectal acute toxicity and time between prostatectomy and IMRT were also predictors of acute bowel toxicity. Multivariate analysis showed that the most predictive independent parameters were age (OR: 1.13; 95{\%}CI: 1.02-1.25; p = 0.021) and V50TL (≥13 cc, OR: 8.2; 95{\%}CI: 1.7-40; p = 0.009). Conclusions: The risk of moderate acute uGI toxicity during WPRT-IMRT for post-operatively treated patients increases with age; the risk is substantially reduced in patients with small overlap between PTV and loops.",
keywords = "Dose-volume effects, IMRT, Post-operative radiotherapy, Prostate cancer",
author = "Lucia Perna and Filippo Alongi and Claudio Fiorino and Sara Broggi and {Cattaneo Giovanni}, Mauro and Cesare Cozzarini and {Di Muzio}, Nadia and Riccardo Calandrino",
year = "2010",
month = "10",
doi = "10.1016/j.radonc.2010.02.025",
language = "English",
volume = "97",
pages = "71--75",
journal = "Radiotherapy and Oncology",
issn = "0167-8140",
publisher = "Elsevier Ireland Ltd",
number = "1",

}

TY - JOUR

T1 - Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy

AU - Perna, Lucia

AU - Alongi, Filippo

AU - Fiorino, Claudio

AU - Broggi, Sara

AU - Cattaneo Giovanni, Mauro

AU - Cozzarini, Cesare

AU - Di Muzio, Nadia

AU - Calandrino, Riccardo

PY - 2010/10

Y1 - 2010/10

N2 - Purpose/objective: Whole pelvis irradiation with IMRT (WPRT-IMRT) after prostatectomy is efficient in reducing acute toxicity: however, a number of patients still experience moderate acute bowel toxicity. Materials and methods: Ninety-six patients treated with WPRT-IMRT after prostatectomy with adjuvant or salvage intent were analysed. A number of parameters were individually recovered, including the DVHs of the intestinal cavity outside PTV and of the loops referred to both the WPRT phase and the whole treatment. Correlation between clinical-dosimetric parameters and acute bowel toxicity was investigated by logistic analyses. Best predictive cut-off values for continuous variables were assessed by ROC curves. Results: 15/96 (15.6%) Patients experienced grade 2 toxicity (no grade 3). Best dose-volume predictors were the fraction of loops receiving more than 45, 50 and 55 Gy (respectively, V45TL ≥ 50 cc, V50TL ≥ 13 cc, V55TL ≥ 3 cc; p-values ranging from 0.005 to 0.027). Age, GU acute toxicity, rectal acute toxicity and time between prostatectomy and IMRT were also predictors of acute bowel toxicity. Multivariate analysis showed that the most predictive independent parameters were age (OR: 1.13; 95%CI: 1.02-1.25; p = 0.021) and V50TL (≥13 cc, OR: 8.2; 95%CI: 1.7-40; p = 0.009). Conclusions: The risk of moderate acute uGI toxicity during WPRT-IMRT for post-operatively treated patients increases with age; the risk is substantially reduced in patients with small overlap between PTV and loops.

AB - Purpose/objective: Whole pelvis irradiation with IMRT (WPRT-IMRT) after prostatectomy is efficient in reducing acute toxicity: however, a number of patients still experience moderate acute bowel toxicity. Materials and methods: Ninety-six patients treated with WPRT-IMRT after prostatectomy with adjuvant or salvage intent were analysed. A number of parameters were individually recovered, including the DVHs of the intestinal cavity outside PTV and of the loops referred to both the WPRT phase and the whole treatment. Correlation between clinical-dosimetric parameters and acute bowel toxicity was investigated by logistic analyses. Best predictive cut-off values for continuous variables were assessed by ROC curves. Results: 15/96 (15.6%) Patients experienced grade 2 toxicity (no grade 3). Best dose-volume predictors were the fraction of loops receiving more than 45, 50 and 55 Gy (respectively, V45TL ≥ 50 cc, V50TL ≥ 13 cc, V55TL ≥ 3 cc; p-values ranging from 0.005 to 0.027). Age, GU acute toxicity, rectal acute toxicity and time between prostatectomy and IMRT were also predictors of acute bowel toxicity. Multivariate analysis showed that the most predictive independent parameters were age (OR: 1.13; 95%CI: 1.02-1.25; p = 0.021) and V50TL (≥13 cc, OR: 8.2; 95%CI: 1.7-40; p = 0.009). Conclusions: The risk of moderate acute uGI toxicity during WPRT-IMRT for post-operatively treated patients increases with age; the risk is substantially reduced in patients with small overlap between PTV and loops.

KW - Dose-volume effects

KW - IMRT

KW - Post-operative radiotherapy

KW - Prostate cancer

UR - http://www.scopus.com/inward/record.url?scp=77957859238&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=77957859238&partnerID=8YFLogxK

U2 - 10.1016/j.radonc.2010.02.025

DO - 10.1016/j.radonc.2010.02.025

M3 - Article

C2 - 20307910

AN - SCOPUS:77957859238

VL - 97

SP - 71

EP - 75

JO - Radiotherapy and Oncology

JF - Radiotherapy and Oncology

SN - 0167-8140

IS - 1

ER -