Baseline status and dose to the penile bulb predict impotence 1 year after radiotherapy for prostate cancer

Cozzarini, C.; Rancati, T.; Badenchini, F.; Palorini, F.; Avuzzi, B.; Esposti, C. Degli; Girelli, G.; Improta, Ilaria; Vavassori, V.; Valdagni, Riccardo; Fiorino, Claudio

doi:10.1007/s00066-016-0964-1

Cited by 12 publications

(8 citation statements)

References 33 publications

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“…Fractionation schedules were protocol defined and IMRT +/À IGRT was used in all cases. Our results are in accord with an interim analysis of the DUE-01 study which found maximum PB dose as a predictive factor for ED [21]. However, due to the small PB volume and potential substantial impact inter-observer contouring variability has on dose-volume parameters [19], we suggest that mean PB dose is likely to be a more robust metric for use in radiotherapy planning.…”

Section: Discussionsupporting

confidence: 88%

“…The anterior border of the PB contour in the most cranial slice was used to guide the anterior border on the more caudal slices. Three-dimensional physical dose distributions were converted into equivalent dose in 2 Gy/f (EQD2) distributions by applying Withers formula [20] with a/b = 3 Gy [12,21] to each dose grid voxel. EQD2-based and physical dose-based PB dose-volume histogram data were exported from the analysis software.…”

Section: Penile Bulb Dosimetric Analysismentioning

confidence: 99%

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Evaluation of erectile potency and radiation dose to the penile bulb using image guided radiotherapy in the CHHiP trial

Murray

Gulliford

Griffin

et al. 2020

Clinical and Translational Radiation Oncology

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Background and purpose: The penile bulb (PB) dose may be critical in development of post prostate radiotherapy erectile dysfunction (ED). This study aimed to generate PB dose constraints based on dosevolume histograms (DVHs) in patients treated with prostate radiotherapy, and to identify clinical and dosimetric parameters that predict the risk of ED post prostate radiotherapy. Materials and methods: Penile bulb DVHs were generated for 276 patients treated within the randomised IGRT substudy of the multicentre randomised trial, CHHiP. Incidence of ED in relation to dose and randomised IGRT groups were evaluated using Wilcoxon rank sum, Chi-squared test and atlases of complication incidence. Youden index was used to find dose-volume constraints that discriminated for ED. Multivariate analysis (MVA) of effect of dosimetry, clinical and patient-related variables was performed. Results: Reduced treatment margins using IGRT (IGRT-R) produced significantly reduced mean PB dose compared with standard margins (IGRT-S) (median: 25 Gy (IGRT-S) versus 11 Gy (IGRT-R); p < 0.0001). Significant difference in both mean (median: 23 Gy (ED) vs. 18 Gy (no ED); p = 0.011) and maximum (median: 59 Gy (ED) vs. 52 Gy (no ED); p = 0.018) PB doses between those with and without clinician reported ED were identified. Mean PB dose cut-point for ED was derived at around 20 Gy. On MVA, PB mean dose and age predicted for impotence. Conclusion: PB dose appears predictive of post-radiotherapy ED with calculated threshold mean dose of around 20 Gy, substantially lower than published recommendations. IGRT-R enables favourable PB dosimetry and can be recommended provided prostate coverage is not compromised.

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Section: Discussionsupporting

confidence: 88%

Section: Penile Bulb Dosimetric Analysismentioning

confidence: 99%

Evaluation of erectile potency and radiation dose to the penile bulb using image guided radiotherapy in the CHHiP trial

Murray

Gulliford

Griffin

et al. 2020

Clinical and Translational Radiation Oncology

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“…Radiotherapy may negatively influence sexual functioning of patients, especially causing erectile dysfunction, and it is suggested that this fact is associated with the dose delivered to the penile bulb [ 23 , 24 ]. However, this seems to be less pronounced in modern radiotherapy techniques than with older ones.…”

Section: Discussionmentioning

confidence: 99%

A comparison of treatment outcome between fiducial-based and bone-based image guided radiotherapy in prostate cancer patients

et al. 2018

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Background and purposeTo compare the clinical outcome in prostate cancer patients treated with radiotherapy using two forms of image guidance: bone-based (BB) or fiducial-based (FB).Material and methodsThis retrospective study consisted of 180 patients treated with kV-kV image-guided radiotherapy (IGRT) between the years 2008 and 2011. A total of 89 patients were aligned to pelvic bone (Group BB) and 91 patients to the fiducial implanted into prostate for image guidance (Group FB). Patients were treated to a total dose of 76 Gy in 38 fractions. The Cox Regression Model was used to evaluate the influence of clinical and treatment-related parameters on overall survival, biochemical progression and progression-free survival. Acute and late toxicity were evaluated based on the RTOG/EORTC criteria. Sexual function was assessed with QLQ PR-25 (EORTC QLQ forms). An assessment of the differences in patient daily set-up from the time of simulation was performed.ResultsThe incidence of acute G2/G3 genitourinary (GU) and gastrointestinal (GI) toxicity was similar between groups. In the BB group, 34 patients had G2 and 5 had G3 GU acute toxicity - compared to 40 patients with G2 and 2 with G3 in the FB group. G2 and G3 GI acute toxicity was observed respectively in 24 patients and in 1 patient in the BB group compared to 18 patients with G2 and 1 patient with G3 toxicity in the FB group. The five-year incidence of late ≥G2 GU toxicity was 12% in both groups (p = 0.98) and ≥ G2 GI toxicity 19% (BB) vs 15% (FB, p = 0.55), respectively. The five-year progression-free survival rate was 87% in BB and 81% in the FB Group (p = 0.15). The 5-year Overall Survival rate (OS) was 80% (BB) vs 91% % (FB, p = 0.20), but the difference was most pronounced in the intermediate-risk group: 5-year OS of 93% (FB) and 75% (BB), respectively (p = 0.06). No significant changes were observed in sexual or erectile functioning as compared to that specified at the beginning of radiotherapy and between the FB and BB Groups.ConclusionWhen comparing bone-based to fiducial-based techniques, no differences in clinical outcomes or late toxicity were seen in this population. However, intermediate risk prostate cancer patients are those who might benefit most from implementation of fiducial-based IGRT.

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“…A number of authors reported on the relationship between the dose to the anorectal or anal wall and the incidence of radiation proctitis symptoms [31][32][33][34]. Also, research by Nguyen showed that V60anterialwall was associated with a decrease in gastro-intestinal HRQoL [35]. However, no evidence exists on the relationship between the dose to specific anatomical regions and rectal pain or painful cramping.…”

Section: The Impact Of Rectal Discomfort On Hrqol and Possible Clinicmentioning

confidence: 99%

“…Impotence and orgasmic dysfunction are part of a patient's sexual functioning and have an impact on their and their partner's quality of life after prostate radiotherapy [33]. Recent studies [34,35] show that dose to the corpus cavernosum, the penile bulb and the total penile structure are predictive of a decreased sexual functioning after radiotherapy. Proton therapy may decrease the dose to the penile structures and may thereby offer the opportunity to even further enhance a patients' quality of life after radiotherapy.…”

Section: Genitourinary Side Effectsmentioning

confidence: 99%

Radiation-induced toxicity in prostate cancer: prediction and impact on quality of life

Schaake¹

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Baseline status and dose to the penile bulb predict impotence 1 year after radiotherapy for prostate cancer

Abstract: A significant reduction in the risk may be expected mainly when sparing the bulb in patients with no/mild baseline impotency (IIEF1-5 > 17).

Cited by 12 publications

References 33 publications

Evaluation of erectile potency and radiation dose to the penile bulb using image guided radiotherapy in the CHHiP trial

Evaluation of erectile potency and radiation dose to the penile bulb using image guided radiotherapy in the CHHiP trial

A comparison of treatment outcome between fiducial-based and bone-based image guided radiotherapy in prostate cancer patients

Radiation-induced toxicity in prostate cancer: prediction and impact on quality of life

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