title: Is it time to tailor the prediction of radio-induced toxicity in prostate cancer patients? Building the first set of nomograms for late rectal syndrome.
abstract: OBJECTIVE
  Development of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer.
  
  
  METHODS
  This multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events).
  
  
  RESULTS
  Inputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy.
  
  
  CONCLUSIONS
  We developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.
authors.affiliation: Prostate Program, Scientific Directorate, Fondazione IRCCS-Istituto Nazionale Tumori, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Valdagni
authors.forename: Michael W
authors.initials: MW
authors.lastname: Kattan
authors.forename: Tiziana
authors.initials: T
authors.lastname: Rancati
authors.forename: Changhong
authors.initials: C
authors.lastname: Yu
authors.forename: Vittorio
authors.initials: V
authors.lastname: Vavassori
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fellin
authors.forename: Elena
authors.initials: E
authors.lastname: Cagna
authors.forename: Pietro
authors.initials: P
authors.lastname: Gabriele
authors.forename: Flora Anna
authors.initials: FA
authors.lastname: Mauro
authors.forename: Micaela
authors.initials: M
authors.lastname: Baccolini
authors.forename: Carla
authors.initials: C
authors.lastname: Bianchi
authors.forename: Loris
authors.initials: L
authors.lastname: Menegotti
authors.forename: Angelo F
authors.initials: AF
authors.lastname: Monti
authors.forename: Michele
authors.initials: M
authors.lastname: Stasi
authors.forename: Maria Olga
authors.initials: MO
authors.lastname: Giganti
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
mesh_terms: D000005:Abdomen / Q000601:surgery; D000959:Antihypertensive Agents / Q000009:adverse effects / Q000627:therapeutic use; D005242:Fecal Incontinence / Q000209:etiology*; D006471:Gastrointestinal Hemorrhage / Q000209:etiology*; D006484:Hemorrhoids / Q000150:complications; D006801:Humans; D008297:Male; D049451:Nomograms; D011336:Probability; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000175:diagnosis* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications*; D012007:Rectum / Q000528:radiation effects*
chemical_list: D000959:Antihypertensive Agents