title: Treatment-related morbidity in prostate cancer: a comparison of 3-dimensional conformal radiation therapy with and without image guidance using implanted fiducial markers.
abstract: OBJECTIVE
  To estimate the prevalence of rectal and urinary dysfunctional symptoms using image guided radiation therapy (IGRT) with fiducials and magnetic resonance planning for prostate cancer.
  
  
  METHODS
  During the implementation stages of IGRT between September 2008 and March 2010, 367 consecutive patients were treated with prostatic irradiation using 3-dimensional conformal radiation therapy with and without IGRT (non-IGRT). In November 2010, these men were asked to report their bowel and bladder symptoms using a postal questionnaire. The proportions of patients with moderate to severe symptoms in these groups were compared using logistic regression models adjusted for tumor and treatment characteristic variables.
  
  
  RESULTS
  Of the 282 respondents, the 154 selected for IGRT had higher stage tumors, received higher prescribed doses, and had larger volumes of rectum receiving high dosage than did the 128 selected for non-IGRT. The follow-up duration was 8 to 26 months. Compared with the non-IGRT group, improvement was noted in all dysfunctional rectal symptoms using IGRT. In multivariable analyses, IGRT improved rectal pain (odds ratio [OR] 0.07 [0.009-0.7], P=.02), urgency (OR 0.27 [0.11-0.63], P=<.01), diarrhea (OR 0.009 [0.02-0.35], P<.01), and change in bowel habits (OR 0.18 [0.06-0.52], P<.010). No correlation was observed between rectal symptom levels and dose-volume histogram data. Urinary dysfunctional symptoms were similar in both treatment groups.
  
  
  CONCLUSIONS
  In comparison with men selected for non-IGRT, a significant reduction of bowel dysfunctional symptoms was confirmed in men selected for IGRT, even though they had larger volumes of rectum treated to higher doses.
authors.affiliation: Calvary Mater Newcastle, Newcastle, Australia. drsingh.j@gmail.com
authors.forename: Jasmeet
authors.initials: J
authors.lastname: Singh
authors.forename: Peter B
authors.initials: PB
authors.lastname: Greer
authors.forename: Martin A
authors.initials: MA
authors.lastname: White
authors.forename: Joel
authors.initials: J
authors.lastname: Parker
authors.forename: Jackie
authors.initials: J
authors.lastname: Patterson
authors.forename: Colin I
authors.initials: CI
authors.lastname: Tang
authors.forename: Anne
authors.initials: A
authors.lastname: Capp
authors.forename: Christopher
authors.initials: C
authors.lastname: Wratten
authors.forename: James W
authors.initials: JW
authors.lastname: Denham
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D059026:Diagnostic Self Evaluation; D003967:Diarrhea / Q000209:etiology / Q000517:prevention & control; D057918:Fiducial Markers; D006046:Gold; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects*; D010146:Pain / Q000209:etiology / Q000517:prevention & control; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000097:blood / Q000473:pathology / Q000532:radiotherapy*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects* / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods; D012007:Rectum / Q000528:radiation effects*; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D047368:Tumor Burden; D001743:Urinary Bladder / Q000528:radiation effects*; D014555:Urination Disorders / Q000209:etiology / Q000517:prevention & control
chemical_list: D006046:Gold; D017430:Prostate-Specific Antigen