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Valdagni R.,Instituto Nazionale dei Tumori | Kattan M.W.,Case Western Reserve University | Rancati T.,Instituto Nazionale dei Tumori | Yu C.,Case Western Reserve University | And 12 more authors.
International Journal of Radiation Oncology Biology Physics | Year: 2012

Purpose: Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer. Methods and Materials: This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events). Results: Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy. Conclusions: We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach. © 2012 Elsevier Inc.


Valdagni R.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Vavassori V.,Radiotherapy and Medical Physics | Rancati T.,Fondazione IRCCS Instituto Nazionale Dei Tumori | Fellin G.,Radiotherapy and Medical Physics | And 9 more authors.
Radiotherapy and Oncology | Year: 2012

Purpose: To evaluate and discuss the role of specific types of abdominal surgery (SURG) before radical radiation therapy as a risk factor for late rectal toxicity in prostate cancer patients. Methods: Results concerning questionnaire-based scored late bleeding and faecal incontinence in 718 patients with a complete follow-up of 36 months were analysed, focusing on the impact of specific pre-radiotherapy abdominal/pelvic surgery procedures. Patients were accrued in the prospective study AIROPROS 0102. Different types of surgery (rectum-sigma resection, kidney resection, cholecystectomy or appendectomy) were considered as covariates together with a number of different parameters previously found to be predictive of late toxicity and including clinical as well as dosimetric parameters. Univariate (UVA) and multivariate (MVA) logistic analyses were carried out. Results: In total 69/718 patients were previously submitted to one or more surgical procedures, mostly cholecystectomy (n = 21) and appendectomy (n = 27). Actuarial incidences of G2-G3 and G3 bleeding were 52 (7.2%) and 24 (3.3%) respectively; 19 (2.6%) chronic incontinence events were registered. Cholecystectomy was found to be highly correlated with late rectal bleeding at UVA: OR = 4.3 and p = 0.006 for G2-G3 and OR = 5.4 and p = 0.01 for G3. Considering MVA (including dosimetric and clinical factors), G2-G3 bleeding was significantly correlated to cholecystectomy (OR = 6.5, p = 0.002), V75Gy (OR = 1.074, p = 0.003) and secondarily with appendectomy (OR = 2.7, p = 0.10), presence of acute radioinduced rectal bleeding (OR = 1.70, p = 0.21) and androgen deprivation (OR = 0.67, p = 0.25). Appendectomy (OR = 5.9, p = 0.004) and cholecystectomy (OR = 5.5, p = 0.016) were very strong predictors of G3 bleeding with V75Gy playing a less significant role (OR = 1.037, p = 0.26). Conversely, no specific surgery was correlated with actuarial or chronic incontinence. Conclusions: This analysis highlights previous SURG as the best predictor of late rectal bleeding. Among the different types of abdominal surgery, cholecystectomy and appendectomy play the major role, especially for severe late bleeding. © 2011 Elsevier Ireland Ltd. All rights reserved.

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