Rectal bleeding, fecal incontinence, and high stool frequency after conformal radiotherapy for prostate cancer: Normal tissue complication probability modeling

Peeters, Stéphanie; Hoogeman, M.; Heemsbergen, Wilma D.; Hart, A. A. M.; Koper, P.; Lebesque, Joos V.

doi:10.1016/j.ijrobp.2006.03.034

Cited by 157 publications

(130 citation statements)

References 34 publications

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“…Our current advices to the patients lead us to the bladders of volumes around 100 cm 3 . We assume that with bladders filled up to 200 cm 3 the dose on bladder decrease.…”

Section: Discussionmentioning

confidence: 99%

“…8 Combined with SCS technique the dose decrease would be even more important. Therefore, we are preparing to change our current advice to patient to result in bladders of volumes around 200 cm 3 .…”

Section: Discussionmentioning

confidence: 99%

“…Perirectal nodes are not included in CTV N due to the otherwise unacceptable toxicity on rectum. 3,4 To lower the dose on rectum and sigmoid colon and due to the low incidence of the appearance in the area, 5 presacral nodes are not entirely included in CTV N. Margins of PTV1 are uniform 1cm, but are also reduced when necessary in order to attain the treatment plan that respects the restrictions on rectum.…”

Section: Introductionmentioning

confidence: 99%

“…With the restrictions we are applying the irradiation toxicity on OR are still acceptable: 3,4 Rectum: V50<64%, V60<45%, V70<25%, Dmean<45 Gy, Anus: V55<16%, V60<5%, Dmean< 40Gy.…”

Section: Introductionmentioning

confidence: 99%

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The sigmoid colon and bladder shielding in whole pelvic irradiation at prostate cancer (forward planned IMRT from Institute of Oncology Ljubljana)

Grabec¹,

Kragelj²

2009

Radiology and Oncology

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“…Our current advices to the patients lead us to the bladders of volumes around 100 cm 3 . We assume that with bladders filled up to 200 cm 3 the dose on bladder decrease.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…With the restrictions we are applying the irradiation toxicity on OR are still acceptable: 3,4 Rectum: V50<64%, V60<45%, V70<25%, Dmean<45 Gy, Anus: V55<16%, V60<5%, Dmean< 40Gy.…”

Section: Introductionmentioning

confidence: 99%

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The sigmoid colon and bladder shielding in whole pelvic irradiation at prostate cancer (forward planned IMRT from Institute of Oncology Ljubljana)

Grabec¹,

Kragelj²

2009

Radiology and Oncology

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“…[8][9][10][11][12][13][14][15][16][17][18][19][20][21][22] The reliability of DVH constraints in predicting the risk of late rectal toxicity is highly influenced by the management of rectal filling: A ''full'' rectum at the planning scan is less likely to represent the dose actually delivered to the rectum, 23 and the practice of emptying the rectum also reduces the differences in calculating the DVH of the whole rectum (including filling) and of the wall. 24 Conversely, it is also very important to remember that most studies that have assessed DVH constraints for late rectal bleeding have used a very similar ''anatomic-based'' definition of the cranial-caudal extension of the rectum.…”

Section: Dose-volume Modeling Of Rectal Toxicitymentioning

confidence: 99%

Predictive models of toxicity in external radiotherapy

Fiorino

Rancati

Valdagni

2009

Cancer

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Dose-volume modeling of late and acute toxicity in radiotherapy for prostate cancer is a rapidly evolving field of investigation. The availability of individual, 3-dimensional dose distribution and dose-volume histograms (DVHs) permits the quantitative assessment of dose-volume relations for specific endpoints by investigating the correlation between individual dose-volume data and clinical outcomes. These studies often entail a huge effort in collecting data from large populations that have been followed properly for long time. The rectum is the most investigated organ, especially concerning late bleeding, and a good consensus regarding serial-like behavior for this endpoint comes from various investigations. Concerning the bladder, the existence of a clear dose effect when the organ is wholly or partially irradiated is well known. Concerning erectile dysfunctions, the wide use of hormone therapy and drugs against impotence suggests that large, prospectively scored populations will be necessary to definitively assess dose-volume relations.Bowel irradiation during prostate cancer radiotherapy occurs during pelvic lymph node irradiation, and severe acute toxicity has yet to be modeled clearly. Evidence of a correlation between the DVH of the intestinal cavity and bowel toxicity recently was reported, providing important information about optimal dose-volume constraints to be used during whole-pelvis irradiation with intensity-modulated radiotherapy. KEY WORDS: radiotherapy, radiation-induced effects, toxicity, dose-volume models.Dose-volume modeling of late and acute toxicity in the radiotherapy of prostate cancer is a rapidly evolving field of investigation. The prostate is in close proximity to organs at risk, such as the rectum and bladder, which should be spared as much as possible; conversely, evidence of a dose-effect relation in the probability of local control, at least in some subgroups of patients, suggests the advisability of escalation to very high doses. Intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) exploit new tools and methods for dose painting distributions strictly tailored around the planning target volumes (PTV) to reduce the fraction of organs at risk irradiated to moderate/high doses while escalating the dose and/or the dose per fraction.

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Predictive models of toxicity with external radiotherapy for prostate cancer

Valdagni

Rancati

Fiorino

2009

Cancer

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The objective of the current study was to analyze the state of the art and present limitations of available predictive clinical models (when available) estimating the risk of genitourinary tract and small bowel complications, erectile dysfunction, and acute and late symptoms of the rectal syndrome caused by prostate cancer external irradiation. An analysis of the literature indicated that very limited attention has been devoted to the development of “integrated,” patient‐tailored, user‐friendly, and clinically usable tools for the prediction of external beam radiotoxicity. In this article, the authors reported on the multivariate correlation between late genitourinary and gastrointestinal toxicities and clinical/dosimetric risk factors, as well as on the first set of nomograms developed to predict acute and late rectal side effects. At the present state of knowledge, the use of nomograms as predictive instruments of radiotoxicity appears to be particularly attractive for several main reasons. They are “user friendly” and easily developed using the results of multivariate analyses, as they weigh the combined effects of multiple independent factors found to be correlated with the selected clinical endpoint. The integrated evaluation of clinical and dosimetric parameters in the single patient can help to provide a tailored probability of the specific outcome considered. Predicting a high probability of toxicity could avoid unnecessary daily costs for the individual patient in terms of quality of life modification during and after treatment, helping patients in the decision‐making process of choosing the best individual, quality of life–related treatment, and clinicians in better tailoring the treatment to patient's characteristics. Cancer 2009;115(13 suppl):3141–9. © 2009 American Cancer Society.

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Rectal bleeding, fecal incontinence, and high stool frequency after conformal radiotherapy for prostate cancer: Normal tissue complication probability modeling

Cited by 157 publications

References 34 publications

The sigmoid colon and bladder shielding in whole pelvic irradiation at prostate cancer (forward planned IMRT from Institute of Oncology Ljubljana)

The sigmoid colon and bladder shielding in whole pelvic irradiation at prostate cancer (forward planned IMRT from Institute of Oncology Ljubljana)

Predictive models of toxicity in external radiotherapy

Predictive models of toxicity with external radiotherapy for prostate cancer

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