Predictors for rectal and intestinal acute toxicities during prostate cancer high-dose 3D-CRT: results of a prospective multicenter study.
OBJECTIVE
To find predictors for rectal and intestinal acute toxicity in patients with prostate cancer treated with > or =70 Gy conformal radiotherapy.


METHODS
Between July 2002 and March 2004, 1,132 patients were entered into a cooperative study (AIROPROS01-02). Toxicity was scored using the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer scale and by considering the changes (before and after treatment) of the scores of a self-administered questionnaire on rectal/intestinal toxicity. The correlation with a number of parameters was assessed by univariate and multivariate analyses. Concerning the questionnaire, only moderate/severe complications were considered.


RESULTS
Of 1,132 patients, 1,123 were evaluable. Of these patients, 375, 265, and 28 had Grade 1, 2, and 3 Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer toxicity, respectively. The mean rectal dose was the most predictive parameter (p = 0.0004; odds ratio, 1.035) for Grade 2 or worse toxicity, and the use of anticoagulants/antiaggregants (p = 0.02; odds ratio, 0.63) and hormonal therapy (p = 0.04, odds ratio, 0.65) were protective. The questionnaire-based scoring revealed that a greater mean rectal dose was associated with a greater risk of bleeding; larger irradiated volumes were associated with frequency, tenesmus, incontinence, and bleeding; hormonal therapy was protective against frequency and tenesmus; hemorrhoids were associated with a greater risk of tenesmus and bleeding; and diabetes associated highly with diarrhea.


CONCLUSIONS
The mean rectal dose correlated with acute rectal/intestinal toxicity in three-dimensional conformal radiotherapy for prostate cancer, and hormonal therapy and the use of anticoagulants/antiaggregants were protective. According to the moderate/severe injury scores on the self-assessed questionnaire, several clinical and dose-volume parameters were independently predictive for particular symptoms.
Vavassori
Vittorio
V
Department of Radiotherapy, Ospedale di Circolo, Varese, Italy.
Fiorino
Claudio
C
Rancati
Tiziana
T
Magli
Alessandro
A
Fellin
Gianni
G
Baccolini
Michela
M
Bianchi
Carla
C
Cagna
Emanuela
E
Mauro
Flora A
FA
Monti
Angelo F
AF
Munoz
Fernando
F
Stasi
Michele
M
Franzone
Paola
P
Valdagni
Riccardo
R
D000925:Anticoagulants / Q000009:adverse effects; D016009:Chi-Square Distribution; D006484:Hemorrhoids / Q000150:complications; D006801:Humans; D007422:Intestines / Q000528:radiation effects; D008297:Male; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D012007:Rectum / Q000528:radiation effects*; D012044:Regression Analysis; D012307:Risk Factors
D000925:Anticoagulants; D010975:Platelet Aggregation Inhibitors