Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy

Carlos Vargas, Alvaro Martinez, Larry L. Kestin, Di Yan, Inga Grills, Donald S. Brabbins, David M. Lockman, Jian Liang, Gary S. Gustafson, Peter Y. Chen, Frank A. Vicini, John Wong

Research output: Contribution to journalArticle

Abstract

Purpose: We analyzed our experience treating localized prostate cancer with image-guided off-line correction with adaptive high-dose radiotherapy (ART) in our Phase II dose escalation study to identify factors predictive of chronic rectal toxicity. Materials and Methods: From 1999-2002, 331 patients with clinical stage T1-T3N0M0 prostate cancer were prospectively treated in our Phase II 3D conformal dose escalation ART study to a median dose of 75.6 Gy (range, 63.0-79.2 Gy), minimum dose to confidence limited-planning target volume (cl-PTV) in 1.8 Gy fractions (median isocenter dose = 79.7 Gy). Seventy-four patients (22%) also received neoadjuvant/adjuvant androgen deprivation therapy. A patient-specific cl-PTV was constructed using 5 computed tomography scans and 4 sets of electronic portal images by applying an adaptive process to assure target accuracy and minimize PTV margin. For each case, the rectum (rectal solid) was contoured from the sacroiliac joints or rectosigmoid junction (whichever was higher) to the anal verge or ischial tuberosities (whichever was lower), with a median volume of 81.2 cc. The rectal wall was defined using the rectal solid with an individualized 3-mm wall thickness (median volume = 29.8 cc). Rectal wall dose-volume histogram was used to determine the prescribed dose. Toxicity was quantified using the National Cancer Institute Common Toxicity Criteria 2.0. Multiple dose-volume endpoints were evaluated for their association with chronic rectal toxicity. Results: Median follow-up was 1.6 years. Thirty-four patients (crude rate = 10.3%) experienced Grade 2 chronic rectal toxicity at a median interval of 1.1 years. Nine patients (crude rate = 2.7%) experienced Grade 40% respectively. The volume of rectum or rectal wall radiated to

Original languageEnglish (US)
Pages (from-to)1297-1308
Number of pages12
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume62
Issue number5
DOIs
StatePublished - Aug 1 2005
Externally publishedYes

Fingerprint

Image-Guided Radiotherapy
toxicity
radiation therapy
Prostatic Neoplasms
cancer
dosage
predictions
Rectum
rectum
Therapeutics
Sacroiliac Joint
National Cancer Institute (U.S.)
planning
confidence
grade
Androgens
Radiotherapy
deprivation
Tomography
histograms

Keywords

  • Dose escalation
  • Dose-volume histogram
  • Prostate cancer
  • Rectal toxicity
  • Three-dimensional conformal radiation

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. / Vargas, Carlos; Martinez, Alvaro; Kestin, Larry L.; Yan, Di; Grills, Inga; Brabbins, Donald S.; Lockman, David M.; Liang, Jian; Gustafson, Gary S.; Chen, Peter Y.; Vicini, Frank A.; Wong, John.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 62, No. 5, 01.08.2005, p. 1297-1308.

Research output: Contribution to journalArticle

Vargas, C, Martinez, A, Kestin, LL, Yan, D, Grills, I, Brabbins, DS, Lockman, DM, Liang, J, Gustafson, GS, Chen, PY, Vicini, FA & Wong, J 2005, 'Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy', International Journal of Radiation Oncology, Biology, Physics, vol. 62, no. 5, pp. 1297-1308. https://doi.org/10.1016/j.ijrobp.2004.12.052
Vargas, Carlos ; Martinez, Alvaro ; Kestin, Larry L. ; Yan, Di ; Grills, Inga ; Brabbins, Donald S. ; Lockman, David M. ; Liang, Jian ; Gustafson, Gary S. ; Chen, Peter Y. ; Vicini, Frank A. ; Wong, John. / Dose-volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. In: International Journal of Radiation Oncology, Biology, Physics. 2005 ; Vol. 62, No. 5. pp. 1297-1308.
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abstract = "Purpose: We analyzed our experience treating localized prostate cancer with image-guided off-line correction with adaptive high-dose radiotherapy (ART) in our Phase II dose escalation study to identify factors predictive of chronic rectal toxicity. Materials and Methods: From 1999-2002, 331 patients with clinical stage T1-T3N0M0 prostate cancer were prospectively treated in our Phase II 3D conformal dose escalation ART study to a median dose of 75.6 Gy (range, 63.0-79.2 Gy), minimum dose to confidence limited-planning target volume (cl-PTV) in 1.8 Gy fractions (median isocenter dose = 79.7 Gy). Seventy-four patients (22{\%}) also received neoadjuvant/adjuvant androgen deprivation therapy. A patient-specific cl-PTV was constructed using 5 computed tomography scans and 4 sets of electronic portal images by applying an adaptive process to assure target accuracy and minimize PTV margin. For each case, the rectum (rectal solid) was contoured from the sacroiliac joints or rectosigmoid junction (whichever was higher) to the anal verge or ischial tuberosities (whichever was lower), with a median volume of 81.2 cc. The rectal wall was defined using the rectal solid with an individualized 3-mm wall thickness (median volume = 29.8 cc). Rectal wall dose-volume histogram was used to determine the prescribed dose. Toxicity was quantified using the National Cancer Institute Common Toxicity Criteria 2.0. Multiple dose-volume endpoints were evaluated for their association with chronic rectal toxicity. Results: Median follow-up was 1.6 years. Thirty-four patients (crude rate = 10.3{\%}) experienced Grade 2 chronic rectal toxicity at a median interval of 1.1 years. Nine patients (crude rate = 2.7{\%}) experienced Grade 40{\%} respectively. The volume of rectum or rectal wall radiated to",
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AU - Martinez, Alvaro

AU - Kestin, Larry L.

AU - Yan, Di

AU - Grills, Inga

AU - Brabbins, Donald S.

AU - Lockman, David M.

AU - Liang, Jian

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KW - Rectal toxicity

KW - Three-dimensional conformal radiation

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