title: Predicting toxicity in radiotherapy for prostate cancer.
abstract: This comprehensive review addresses most organs at risk involved in planning optimization for prostate cancer. It can be considered an update of a previous educational review that was published in 2009 (Fiorino et al., 2009). The literature was reviewed based on PubMed and MEDLINE database searches (from January 2009 up to September 2015), including papers in press; for each section/subsection, key title words were used and possibly combined with other more general key-words (such as radiotherapy, dose-volume effects, NTCP, DVH, and predictive model). Publications generally dealing with toxicity without any association with dose-volume effects or correlations with clinical risk factors were disregarded, being outside the aim of the review. A focus was on external beam radiotherapy, including post-prostatectomy, with conventional fractionation or moderate hypofractionation (<4Gy/fraction); extreme hypofractionation is the topic of another paper in this special issue. Gastrointestinal and urinary toxicity are the most investigated endpoints, with quantitative data published in the last 5years suggesting both a dose-response relationship and the existence of a number of clinical/patient related risk factors acting as dose-response modifiers. Some results on erectile dysfunction, bowel toxicity and hematological toxicity are also presented.
authors.affiliation: Medical Physics, Istituto Nazionale Tumori Regina Elena, Rome, Italy.
authors.forename: Valeria
authors.initials: V
authors.lastname: Landoni
authors.affiliation: Medical Physics, Raffaele Scientific Institute IRCCS, Milan, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Fiorino
authors.affiliation: Radiotherapy, Raffaele Scientific Institute, Milan, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Cozzarini
authors.affiliation: Radiotherapy, Istituto Nazionale Tumori Regina Elena, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.affiliation: Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Clinical Sciences and Community Health, University of Milan, Milan, Italy.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Valdagni
authors.affiliation: Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. Electronic address: tiziana.rancati@istitutotumori.mi.it.
authors.forename: Tiziana
authors.initials: T
authors.lastname: Rancati
mesh_terms: D019583:Dose Fractionation, Radiation; D005242:Fecal Incontinence / Q000209:etiology; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D006801:Humans; D008297:Male; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control; D011880:Radiotherapy Planning, Computer-Assisted; D012007:Rectum / Q000528:radiation effects; D001743:Urinary Bladder / Q000528:radiation effects
keywords: Acute and late toxicity; Dose–volume models; Prostate cancer; Radiotherapy