Dose–Volume Relationships for Acute Bowel Toxicity in Patients Treated With Pelvic Nodal Irradiation for Prostate Cancer
Received 11 July 2008; received in revised form 28 October 2008; accepted 29 October 2008. published online 20 May 2009.
Purpose
To find correlation between dose-volume histograms (DVHs) of the intestinal cavity (IC) and moderate-severe acute bowel toxicity in men with prostate cancer treated with pelvic nodal irradiation.
Methods and Materials
The study group consisted of 191 patients with localized prostate cancer who underwent whole-pelvis radiotherapy with radical or adjuvant/salvage intent during January 2004 to November 2007. Complete planning/clinical data were available in 175 of these men, 91 of whom were treated with a conventional four-field technique (50.4 Gy, 1.8 Gy/fraction) and 84 of whom were treated with IMRT using conventional Linac (n = 26, 50.4 Gy, 1.8 Gy/fraction) or Helical TomoTherapy (n = 58, 50–54 Gy, 1.8–2 Gy/fraction). The IC outside the planning target volume (PTV) was contoured and the DVH for the first 6 weeks of treatment was recovered in all patients. The correlation between a number of clinical and DVH (V10–V55) variables and toxicity was investigated in univariate and multivariate analyses. The correlation between DVHs for the IC outside the PTV and DVHs for the whole IC was also assessed.
Results
Twenty-two patients experienced toxicity (3/22 in the IMRT/tomotherapy group). Univariate analyses showed a significant correlation between V20–V50 and toxicity (p = 0.0002–0.001), with a higher predictive value observed for V40–V50. Previous prostatectomy (p = 0.066) and abdominal/pelvic surgery (p = 0.12) also correlated with toxicity. Multivariate analysis that included V45, abdominal/pelvic surgery, and prostatectomy showed that the most predictive parameters were V45 (p = 0.002) and abdominal/pelvic surgery (p = 0.05, HR = 2.4)
Conclusions
Our avoidance IMRT approach drastically reduces the incidence of acute bowel toxicity. V40–V50 of IC and, secondarily, previous abdominal/pelvic surgery were the main predictors of acute bowel toxicity.
∗Department of Medical Physics, San Raffaele Scientific Institute, Milan, Italy
†Department of Radiotherapy, San Raffaele Scientific Institute, Milan, Italy
‡Istituto di Bioimaging e Fisiologia Molecolare–Consiglio Nazionale delle Ricerche, Unità Operativa Supporto, Cefalù, Italy
Reprint requests to: Claudio Fiorino, Ph.D., Medical Physics, Scientific Institute San Raffaele, via Olgettina 60, 20132 Milan. Tel: (+39) 02-26432278; Fax: (+39) 02-26432773
ABSTRACT