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Evaluation of late rectal toxicity after conformal radiotherapy for prostate cancer

A comparison between dose-volume constraints and NTCP use

Bewertung der rektalen Spättoxizität nach konformaler Strahlentherapie des Prostatakarzinoms. Vergleich zwischen Dosis-Volumen-Beschränkungen und NTCP-Anwendung

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Purpose:

To analyze the reliability of different methods used in evaluating the risk of late rectal toxicity.

Patients and Methods:

The treatment plans of 57 patients treated at the authors' institute between September 1999 and September 2000 for localized prostate cancer using three-dimensional conformal radiotherapy (3D-CRT) were analyzed retrospectively. The expected rate of late rectal toxicity was analyzed (a) by means of the dose-volume histogram (DVH) constraints; (b) by calculating the normal-tissue complication probability (NTCP) using the Lyman-Kutcher-Burman (LKB) model with the radiobiological parameters of either Emami (1991; for toxicity of grade ≥ 2) or Rancati (2004; for toxicity of grade ≥ 2 and ≥ 3). Patients were divided into high-/low-risk (HR/LR) groups and the results were compared to the clinical outcome.

Results:

(a) The HR percentages were 24% and 5% for radical and postsurgical 3D-CRT, respectively. When applying high-dose constraints only, HR percentages were 18% and 5%, respectively. (b) In the case of the NTCP (grade ≥ 2), Emami (1991) HR rates were 16% and 11%, and Rancati (2004) HR rates 29% and 11%, for radical and postsurgical treatment, respectively. Only one case with higher-grade toxicity was found. The reported clinical toxicity was 17.8% and 6.7% for grade ≥ 2 toxicity, and 3.7% and 0.7% for grade ≥ 3 toxicity, for radical and postsurgical treatment, respectively.

Conclusion:

This study demonstrated that there is an agreement between the toxicity rate evaluated by DVH constraints and by the LKB model and the clinical outcome. In this case, the use of the LKB model can be as reliable as the use of DVH constraints.

Ziel:

Analyse der Zuverlässigkeit verschiedener Methoden zur Bewertung des Risikos rektaler Spättoxizität.

Patienten und Methodik:

Die Bestrahlungspläne von 57 Patienten mit lokal begrenztem Prostatakarzinom, die sich von September 1999 bis September 2000 am Institut der Autoren einer dreidimensionalen konformalen Strahlentherapie (3D-CRT) unterzogen, wurden retrospektiv analysiert. Die erwartete rektale Spättoxizität wurde anhand von a) Dosis-Volumen-Histogramm-(DVH-)Beschränkungen und b) Wahrscheinlichkeitsberechnungen von Normalgewebskomplikationen mit dem Lyman-Kutcher-Burman-(LKB-)Modell sowie mit den radiobiologischen Parametern nach Emami et al. (1991; für Toxizitätsgrad ≥ 2) oder Rancati et al. (2004; für Toxizitätsgrade ≥ 2 and ≥ 3) untersucht. Die Patienten wurden in je eine Gruppe mit hohem und geringem Risiko (HR/LR) unterteilt, und die Ergebnisse wurden mit den klinischen Daten verglichen.

Ergebnisse:

a) Der HR-Anteil lag für die radikale 3D-CRT bei 24% und für die 3D-CRT nach Resektion bei 5%. Bei alleiniger Anwendung der Hochdosiseinschränkungen betrug der HR-Anteil 18% bzw. 5%. b) Bei Einsatz der NTCP (Grad ≥ 2) ergaben sich HR-Raten nach Emami et al. (1991) von 16% und 11% sowie nach Rancati et al. (2004) von 29% und 11% für die radikale und die postoperative Bestrahlung. Nur in einem Fall fand sich eine höhergradige Toxizität. Die berichtete klinische Toxizitätsrate betrug 17,8% bzw. 6,7% (Toxizitätsgrad ≥ 2) sowie 3,7% bzw. 0,7% (Toxizitätsgrad ≥ 3) für die radikale bzw. postoperative Behandlung.

Schlussfolgerung:

Die Studie zeigt, dass es eine Übereinstimmung zwischen der mit DVH-Beschränkungen und dem LKB-Modell ermittelten Toxizitätsrate und den klinischen Ergebnissen gibt. In diesem Fall kann sich die Verwendung des LKB-Modells als ebenso zuverlässig wie die DVH-Beschränkungen erweisen.

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Authors and Affiliations

  1. Department of Medical Physics, Istituto Europeo di Oncologia, Milan, Italy

    Raffaella Cambria, Federica Cattani, Cristina Garibaldi & Guido Pedroli

  2. Department of Radiation Oncology, Istituto Europeo di Oncologia, Milan, Italy

    Barbara A. Jereczek-Fossa, Dario Zerini, Cristiana Fodor, Flavia Serafini & Roberto Orecchia

  3. Università degli Studi di Milano, Milan, Italy

    Barbara A. Jereczek-Fossa & Roberto Orecchia

  4. Fisica Sanitaria, Istituto Europeo di Oncologia, Via Ripamonti 435, 20141, Milano, Italy

    Raffaella Cambria

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  1. Raffaella Cambria
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  2. Barbara A. Jereczek-Fossa
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  3. Federica Cattani
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Correspondence to Raffaella Cambria.

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Cambria, R., Jereczek-Fossa, B.A., Cattani, F. et al. Evaluation of late rectal toxicity after conformal radiotherapy for prostate cancer. Strahlenther Onkol 185, 384–389 (2009). https://doi.org/10.1007/s00066-009-1933-8

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  • DOI: https://doi.org/10.1007/s00066-009-1933-8

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