Proctitis after external-beam radiotherapy for prostate cancer classified by Vienna Rectoscopy Score and correlated with EORTC/RTOG score for late rectal toxicity: results of a prospective multicenter study of 166 patients.
OBJECTIVE
To evaluate the Vienna Rectoscopy Score (VRS) as a feasible and effective tool for detecting and classifying pathologic changes in the rectal mucosa after radiotherapy (RT) for prostate cancer, and, also, to correlate its findings with the European Organization for Research and Treatment of Cancer (EORTC)/Radiation Therapy Oncology Group (RTOG) score for late rectal toxicity.


METHODS
A total of 486 patients with localized prostate cancer underwent external-beam RT up to 70 or 74 Gy within an Austrian-German prospective multicenter trial. In 166 patients, voluntary rectal sigmoidoscopy was performed before and at 12 and/or 24 months after RT. Pathologic findings such as telangiectasia, congested mucosa, and ulcers were graded (Grades 0-3) and summarized according to the VRS. Late rectal side effects (EORTC/RTOG) were documented and correlated with the corresponding VRS.


RESULTS
Before RT, 99% had a VRS score of 0. The median follow-up was 40 months. Overall, a late rectal side effects grade or score 1-3 was detected in 43% by EORTC/RTOG compared with 68% by VRS (p < 0.05). Grades 0, 1, 2, and 3 late rectal side effects were found using EORTC/RTOG in 57%, 11%, 28%, and 3%, respectively; the corresponding percentages were 32%, 22%, 32%, and 14% for a VRS of 0, 1, 2, and 3, respectively. A significant coherence between the VRS and EORTC/RTOG was found (p < 0.01).


CONCLUSIONS
The VRS is a feasible and effective tool for describing and classifying pathologic findings in the rectal mucosa after RT within a multicenter trial. The VRS and EORTC/RTOG showed a high coherence. However the VRS was significantly more sensitive.
Goldner
Gregor
G
Department of Radiotherapy and Radiobiology, Vienna General Hospital, University of Vienna Medical School, Vienna, Austria. Gregor.Goldner@akhwien.at
Tomicek
Birgit
B
Becker
Gerd
G
Geinitz
Hans
H
Wachter
Stefan
S
Zimmermann
Frank
F
Wachter-Gerstner
Natascha
N
Reibenwein
Jochen
J
Glocker
Stefan
S
Bamberg
Michael
M
Feldmann
Horst
H
Pötzi
Regina
R
Molls
Michael
M
Pötter
Richard
R
D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D006801:Humans; D007413:Intestinal Mucosa / Q000473:pathology / Q000528:radiation effects; D008297:Male; D008875:Middle Aged; D011349:Proctitis / Q000473:pathology*; D011351:Proctoscopy; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000473:pathology*; D011879:Radiotherapy Dosage; D012007:Rectum / Q000473:pathology / Q000528:radiation effects*; D012720:Severity of Illness Index