Correlation Between Acute and Late Toxicity in 973 Prostate Cancer Patients Treated With Three-Dimensional Conformal External Beam Radiotherapy

Jereczek-Fossa, Barbara A.; Zerini, Dario; Fodor, Cristiana; Santoro, Luigi; Serafini, Flavia; Cambria, Raffaella; Vavassori, Andrea; Cattani, Federica; Garibaldi, Cristina; Gherardi, Federica; Ferrari, Annamaria; Rocco, Bernardo; Scardino, Epifanio; de Cobelli, Ottavio; Orecchia, Roberto

doi:10.1016/j.ijrobp.2009.07.1742

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Volume 78, Issue 1 , Pages 26-34, 1 September 2010

Correlation Between Acute and Late Toxicity in 973 Prostate Cancer Patients Treated With Three-Dimensional Conformal External Beam Radiotherapy

Presented in part at the XVIII Conference of the Italian Association of Oncological Radiotherapy, Milan, Italy, November 15–18, 2008.

Barbara A. Jereczek-Fossa, M.D., Ph.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
- Reprint requests to: Barbara Alicja Jereczek-Fossa, M.D., Ph.D., Department of Radiotherapy, European Institute of Oncology, via Ripamonti 435, Milano 20141 Italia. Tel: (0039) 025-748-9037; Fax: (0039) 029-437-9227
Dario Zerini, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
Cristiana Fodor, M.Sc.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
Luigi Santoro, M.Sc.
- Department of Epidemiology and Biostatistics, European Institute of Oncology, Milan, Italy
Flavia Serafini, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
Raffaella Cambria, M.Sc.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
Andrea Vavassori, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
Federica Cattani, M.Sc.
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
Cristina Garibaldi, M.Sc.
- Department of Medical Physics, European Institute of Oncology, Milan, Italy
Federica Gherardi, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
- University of Milan, Milan, Italy
Annamaria Ferrari, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy
Bernardo Rocco, M.D.
- Department of Urology, European Institute of Oncology, Milan, Italy
Epifanio Scardino, M.D.
- Department of Urology, European Institute of Oncology, Milan, Italy
Ottavio de Cobelli, M.D.
- University of Milan, Milan, Italy
- Department of Urology, European Institute of Oncology, Milan, Italy
Roberto Orecchia, M.D.
- Department of Radiotherapy, European Institute of Oncology, Milan, Italy

Received 12 May 2009; received in revised form 11 July 2009; accepted 16 July 2009. published online 03 February 2010.

Purpose

To analyze the correlation between acute and late injury in 973 prostate cancer patients treated with radiotherapy and to evaluate the effect of patient-, tumor-, and treatment-related variables on toxicity.

Methods and Materials

Of the 973 patients, 542 and 431 received definitive or postprostatectomy radiotherapy, respectively. Three-dimensional conformal radiotherapy included a six-field technique and two-dynamic arc therapy. Toxicity was classified according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. The correlation between acute and late toxicity (incidence and severity) was assessed.

Results

Multivariate analysis showed that age ≤65 years (p = .06) and use of the three-dimensional, six-field technique (p <.0001) correlated significantly with greater acute rectal toxicity. The three-dimensional, six-field technique (p = .0002), dose >70 Gy (p = .014), and radiotherapy duration (p = .05) correlated with greater acute urinary toxicity. Acute rectal toxicity (p <.0001) was the only factor that correlated with late rectal injury on multivariate analysis. Late urinary toxicity correlated with acute urinary events (p <.0001) and was inversely related to the use of salvage radiotherapy (p = .018). A highly significant correlation was found between the incidence of acute and late events for both rectal (p <.001) and urinary (p <.001) reactions. The severity of acute toxicity (Grade 2 or greater) was predictive for the severity of late toxicity for both rectal and urinary events (p <.001).

Conclusion

The results of our study have shown that the risk of acute reactions depends on both patient-related (age) and treatment-related (dose, technique) factors. Acute toxicity was an independent significant predictor of late toxicity. These findings might help to predict and prevent late radiotherapy-induced complications.

Prostate cancer, radiotherapy, acute and late toxicity, side effects, correlation