title: Long term rectal function after high-dose prostatecancer radiotherapy: results from a prospective cohort study.
abstract: OBJECTIVE
  To prospectively evaluate long-term late rectal bleeding (lrb) and faecal incontinence (linc) after high-dose radiotherapy (RT) for prostate cancer in the AIROPROS 0102 population, and to assess clinical/dosimetric risk factors.
  
  
  METHODS
  Questionnaires of 515 patients with G0 baseline incontinence and bleeding scores (follow-up ≥6 years) were analysed. Correlations between lrb/linc and many clinical and dosimetric parameters were investigated by univariate and multivariate logistic analyses. The correlation between lrb/linc and symptoms during the first 3 years after RT was also investigated.
  
  
  RESULTS
  Of 515 patients lrb G1, G2 and G3 was found in 32 (6.1%), 2 (0.4%) and 3 (0.6%) patients while linc G1, G2 and G3 was detected in 50 (9.7%), 3 (0.6%) and 3 (0.6%), respectively. The prevalence of G2-G3 lrb events was significantly reduced compared to the first 3-years (1% vs 2.7%, p=0.016) ≥G1 lrb was significantly associated with V75 Gy (OR=1.07). In multivariate analysis, ≥G1 linc was associated with V40 Gy (OR=1.015), use of antihypertensive medication (OR=0.38), abdominal surgery before RT (OR=4.7), haemorrhoids (OR=2.6), and G2-G3 acute faecal incontinence (OR=4.4), a nomogram to predict the risk of long-term ≥G1 linc was proposed. Importantly, the prevalence of ≥G1 linc was significantly correlated with the mean incontinence score during the first 3 years after RT (OR=16.3).
  
  
  CONCLUSIONS
  Long-term (median: 7 years) rectal symptoms are prevalently mild and strongly correlated with moderate/severe events occurring in the first 3 years after RT. Linc was associated with several risk factors.
authors: Department of Radiotherapy, Ospedale Santa Chiara, Trento, Italy.
authors: Gianni
authors: G
authors: Fellin
authors: Prostate Cancer Program, Ospedale San Raffaele, Milan, Italy. Electronic address: tiziana.rancati@istitutotumori.mi.it.
authors: Tiziana
authors: T
authors: Rancati
authors: Department of Medical Physics, Milan, Italy.
authors: Claudio
authors: C
authors: Fiorino
authors: Department of Radiotherapy, Ospedale di Circolo, Varese, Italy.
authors: Vittorio
authors: V
authors: Vavassori
authors: Department of Radiotherapy, Ospedale di Circolo, Varese, Italy.
authors: Paolo
authors: P
authors: Antognoni
authors: Department of Medical Physics, Ospedale Villa Maria Cecilia, Lugo di Romagna, Italy.
authors: Michela
authors: M
authors: Baccolini
authors: Department of Medical Physics, Ospedale di Circolo, Varese, Italy.
authors: Carla
authors: C
authors: Bianchi
authors: Department of Radiotherapy, Ospedale Sant'Anna, Como, Italy.
authors: Emanuela
authors: E
authors: Cagna
authors: Department of Medical Physics, Ospedale ASL 9, Ivrea, Italy.
authors: Valeria Casanova
authors: VC
authors: Borca
authors: Department of Radiotherapy, Ospedale ASL 9, Ivrea, Italy.
authors: Giuseppe
authors: G
authors: Girelli
authors: Department of Radiotherapy, Policlinico Sant'Orsola Malpighi, Bologna, Italy.
authors: Bruno
authors: B
authors: Iacopino
authors: Department of Radiotherapy, IRCC Candiolo, Italy.
authors: Giuseppe
authors: G
authors: Maliverni
authors: Department of Radiotherapy, Ospedale Villa Maria Cecilia, Lugo di Romagna, Italy.
authors: Flora A
authors: FA
authors: Mauro
authors: Department of Medical Physics, Ospedale Santa Chiara, Trento, Italy.
authors: Loris
authors: L
authors: Menegotti
authors: Department of Medical Physics, Ospedale Sant'Anna, Como, Italy.
authors: Angelo F
authors: AF
authors: Monti
authors: Department of Medical Physics, Policlinico Sant'Orsola Malpighi Bologna, Italy.
authors: Fabrizio
authors: F
authors: Romani
authors: Department of Medical Physics, IRCC Candiolo, Italy.
authors: Michele
authors: M
authors: Stasi
authors: Prostate Cancer Program, Ospedale San Raffaele, Milan, Italy; Department of Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy.
authors: Riccardo
authors: R
authors: Valdagni
mesh_terms: D015331:Cohort Studies; D005242:Fecal Incontinence / Q000209:etiology / Q000503:physiopathology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology / Q000503:physiopathology; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D049451:Nomograms; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000503:physiopathology* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology* / Q000503:physiopathology*; D011879:Radiotherapy Dosage; D020266:Radiotherapy, Conformal / Q000009:adverse effects; D012007:Rectum / Q000503:physiopathology* / Q000528:radiation effects*
keywords: Dose–volume effects; Late toxicity; Normal tissue complication probability modeling; Prostate cancer; Radiotherapy