Late radiotherapy-induced lower intestinal toxicity (RILIT) of intensity-modulated radiotherapy for prostate cancer: the need for adapting toxicity scales and the appearance of the sigmoid colon as co-responsible organ for lower intestinal toxicity.
OBJECTIVE
To report on: 1. Late radiotherapy-induced lower intestinal toxicity (RILIT) after intensity-modulated radiotherapy (IMRT) for prostate cancer. 2. The correlation between late RILIT and volume parameters of the rectum, sigmoid colon and small bowel.


METHODS
We included 241 patients with a follow-up of >or=18 months for this analysis. Late RILIT consisted of 8 different symptoms, comprising the 5 symptoms from the RTOG toxicity score supplemented with urgency, fecal incontinence and anal pain. Late RILIT and late RTOG toxicity were scored prospectively and correlated with: 1. Different rectum, sigmoid colon and small bowel volume parameters. 2. Patient-related morbidity. We calculated the median, quartile and percentiles for the different volume parameters and correlated them with grade 1-3 late RILIT.


RESULTS
Median follow-up was 42 months. Three patients developed grade 3 red blood loss. We registered grade 2 RILIT and RTOG toxicity in 13% and 10%, respectively, the most frequent grade 1 symptom being fecal urgency. The intermediate rectal volume parameters were significantly correlated with late RILIT. We were able to calculate cut-off dose-volume histograms (DVHs) that predict for grade 0-2 RILIT.


CONCLUSIONS
After IMRT for prostate cancer, the overall incidence of grade >or=2 RILIT is low. Cut-off DVHs can be used for patient counseling.
Fonteyne
Valérie
V
Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium. fonteynevalerie@hotmail.com
De Neve
Wilfried
W
Villeirs
Geert
G
De Wagter
Carlos
C
De Meerleer
Gert
G
D000328:Adult; D000368:Aged; D012809:Colon, Sigmoid / Q000528:radiation effects*; D005500:Follow-Up Studies; D006801:Humans; D007421:Intestine, Small / Q000528:radiation effects; D007422:Intestines / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012002:Rectal Diseases / Q000209:etiology; D012007:Rectum / Q000528:radiation effects