Predictive Factors for Chronic Rectal Bleeding in Patients in patients treated with radical radiotherapy in prostate cancer
DOI:
https://doi.org/10.35954/SM2017.36.1.3Keywords:
: Prostatic Neoplasms; Radiotherapy; Radiation, Ionizing, Prostatic Neoplasms; Radiotherapy; Radiation, Ionizing.Abstract
Objective: To determine clinical and dosimetric factors which allow predicting the appearance of rectal bleeding, after external radiotherapy as a radical treatment for prostate cancer in patients attending the National Cancer Institute in Montevideo, Uruguay.
Materials and Methods: One hundred and thirty two patients were enrolled between July 2008 and July 2011.
Rectal bleeding was registered after one, three, six, twelve and eighteen months of the patient´s follow-up
with the classification of the Radiation Therapy Oncology Group / European Organization for Research and
Treatment of Cancer y Subjective, Objective, Management and Analytic/ The Late Effects on Normal
Tissues. It was applied a questionnaire prepared and validated by the Italian cooperative group: Program of Airborne Investigations and Remote Sensors. Results were matched with clinical parameters (specific prostate antigen, Gleason Score, clinical T, type of risk, hypertension and diabetes) and dosimetric parameters (Treatment and rectal volumes, Total Doses, Maximum dose of rectum, medium dose of rectum) in order to assess their influence on the appearance of rectal bleeding.
Results: The incidence of rectal bleeding after 18 months is 17,1%. The x2 model showed a correlation
between the prostate antigen specific for the diagnosis and the Radiation Therapy Oncology Group score, after a follow-up of 3 months, with a discrimination power of 72%, according to the logistic regression model.
Conclusions: The identification of determinant predictive factors implies an improvement in the quality of
life for these patients, who usually have long survival rates. Rectal bleeding is a chronic effect which might
translate a radiobiological damage of the rectal tissue, due to a defect on the damage repair of the deoxyribonucleic acid double chain.
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(1) Barrios E, Musetti C, Alonso R, Garau M.V. Atlas de mortalidad por cáncer en el Uruguay 2009-2013. Montevideo: CHLCC, 2015. 144 p.
(2) Hanks GE, Schultheiss TE, Hanlon AL, Hunt M, Lee WR, Epstein BE, et al. Optimization of conformal radiation treatment of prostate cancer: Report of a dose escalation study. Int J Radiat Oncol Biol Phys 1997; 37(3):543-550.
(3) Stephenson AJ, Scardino PT, Eastham JA, Bianco FJ Jr, Dotan ZA, Fearn PA, et al. Preoperative nomogram predicting the 10-year probability of prostate cancer recurrence after radical prostatectomy. J Natl Cancer Inst 2006; 98(10):715-17.
(4) D'Amico AV, Cote K, Loffredo M, Renshaw AA, Schultz D. Determinants of prostate cancerspecific survival after radiation therapy for patients with clinically localized prostate cancer. J Clin Oncol 2002; 20(23):4567-73.
(5) Hanks GE, Martz KL, Diamond JJ. The effect of dose on local control of prostate cancer. Int J Radiat Oncol Biol Phys 1988; 15(6):1299-1305.
(6) Pollack A, Zagars GK. External beam radiotherapy dose response of prostate cancer. Int J Radiat Oncol Biol Phys 1997; 39(5):1011-18.
(7) Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998; 41(3):491-500.
(8) Zelefsky MJ, Fuks Z, Hunt M, Lee HJ, Lombardi D, Ling CC, et al. High dose radiationdelivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001; 166(6):876-81.
(9) Zelefsky Mj, Yamada Y, Fuks Z, Zhang Z, Hunt M, Cahlon O, et al. Long-term results of conformal radiotherapy for prostate cancer: impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008; 71(4):1028-33.
(10) Mutanga TF, de Boer HC, van der Wielen GJ, Wentzler D, Barnhoorn J, Incrocci L, et al. Stereographic Targeting in prostate radiotherapy: speed and precision by dailyautomatic positioning corrections using kilovoltage/megavoltage image pairs. Int J Radiat Oncol Biol Phys 2008; 71(4):1074-1083.
(11) Kupelian P, Langen KM, Willoughby TR, Zeidan OA, Meeks SL. Image-guided radiotherapy for localized prostate cancer: treating a moving target. Semin Radiat Oncol 2008; 18(1):58-66.
(12) Roach M 3rd, DeSilvio M, Lawton C, Uhl V, Machtay M, Seider MJ, et al. Phase III trial comparing whole-pelvic versus prostate-only radiotherapy and neoadjuvant versus adjuvant combined androgen suppression: Radiation Therapy Oncology Group 9413. J Clin Oncol 2003; 21(10):1904-11.
(13) Lawton CA, DeSilvio M, Roach M 3rd, Uhl V, Kirsch R, Seider M, et al. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: Updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 2007; 69:646-655.
(14) Pommier P, Chabaud S, Lagrange JL, Richaud P, Lesaunier F, Le Prise E, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 2007; 25(34):5366-73.
(15) Bolla M, Van Tienhoven G, Warde P, Dubois JB, Mirimanoff RO, Storme G, et al. External irradiation with or without long-term androgen suppression for prostate cancer with high metastatic risk: 10-year results of an EORTC randomized study. Lancet Oncol 2010; 11(11):1066-1073.
(16) Deville C, Both S, Hwang W, Tochner, Z, Vapiwala N. Clinical Toxicities and Dosimetric Parameters after whole-pelvis versus Prostate-Only Intensity-Modulated Radiation Therapy For Prostate Cancer. Int J Radiat Oncol Biol Phys 2010; 78(3):763-72.
(17) Boersma LJ, van den Brink M, Bruce AM, Shouman T, Gras L, te Velde A, et al. Estimation of the incidence of late bladder and rectum complications after high-dose (70-78 Gy) conformal radiotherapy for prostate cancer, using dose–volume histograms. Int J Radiat Oncol Biol Phys 1998; 41(1):83-92.
(18) Jackson A, Skwarchuk MW, Zelefsky MJ, Cowen DM, Venkatraman ES, Levegrun S, et al. Late rectal bleeding after conformal radiotherapy of prostate cancer (II): Volume effects and dose-volume histograms. J Radiat Oncol Biol Phys 2001; 49(3):685-98.
(19) Vargas C, Martinez A, Kestin LL, Yan D, Grills I, Brabbins DS, et al. Dose–volume analysis of predictors for chronic rectal toxicity after treatment of prostate cancer with adaptive image-guided radiotherapy. Int J Radiat Oncol Biol Phys 2005; 62:1297-1308.
(20) Peeters ST, Lebesque JV, Heemsbergen WD, van Putten WL, Slot A, Dielwart MF, et al. Localized volume effects for late rectal and anal toxicity after radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2006; 64:1151-61.
(21) Denham JW, Steigler A, Lamb DS, Joseph D, Turner S, Matthews J, et al. Short term neoadjuvant androgen deprivation and radiotherapy for locally advanced prostate cancer: 10-year data from the TROG 96.01 randomised trial. Lancet Oncol 2011; 12(5):451-9.
(22) Thames HD, Hendry JH. Fractionation in radiotherapy. New York : Taylor & Francis; 1987. 297 p.
(23) Douglas BG, Fowler JF. The effect of multiple small doses of x rays on skin reactions in the mouse and a basic interpretation. Radiat Res 1976; 66(2):401-26.
(24) Thames HD Jr, Withers HR, Peters LJ, Fletcher GH. Changes in early and late radiation responses with altered dose fractionation: Implications for dose-survival relationships. Int J Radiat Oncol Bio Phys 1982; 8(2):219-226.
(25) Brenner DJ. Fractionation and late rectal toxicity. Int J Radiat Oncol Biol Phys 2004; 60(4):1013-15.
(26) Cox J, Stetz J, Pajak T. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and European Organization for Research and Treatment of Cancer (EORTC). Int J Radiat Oncol Biol Phys 1995; 31(5):1341-46.
(27) Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, et al. Prostate cancer radiation dose response: Results of the M.D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002; 53(5):1097-1105.
(28) van Tol-Geerdink JJ, Stalmeier PF, Pasker-de Jong PC, Huizenga H, van Lin EN, Schimmel EC, et al. Systematic review of the effect of radiation dose on tumor control and morbidity in the treatment of prostate cancer by3D-CRT. Int J Radiat Oncol Biol Phys 2006; 64(2):534-43.
(29) Partin AW, Yoo J, Carter HB, Pearson JD, Chan DW, Epstein JI, et al. The use of prostate Specific Antigen, clinical stage and Gleason Score to predict pathological stage in men with localized prostate cancer. J Urol 1993; 150(1):110-14.
(30) Kattan MW, Zelefsky MJ, Kupelian PA, Scardino PT, Fuks Z, Leibel SA. Pretreatment nomogram for predicting the outcome of three-dimensional conformal radiothe-rapy in prostate cancer. J Clin Oncol 2000; 18(19):3352-59.
(31) Fellin G, Fiorino C, Rancati T, Vavassori V, Baccolini M, Bianchi C, et al. Clinical and dosimetric predictors of late rectal toxicity after conformal radiation for localized prostate cancer: results of a large multicenter observa-tional study. Radiother Oncol 2009; 93(2):197-202.
(32) Valdagni R, Rancati T, Ghilotti M, Cozzarini C, Vavassori V, Fellin et al. To bleed or not to bleed. A prediction based on individual gene profiling combined with dose-volume histogram shapes in prostate cancer patients undergoing three-dimensional conformal radiation therapy. Int J Radiat Oncol Biol Phys 2009; 74(5):1431-40.
(33) Lyman JT. Complication probability as assessed from dose-volume histograms. Radiat Res Suppl 1985; 8:S13-S19.
(34) Kutcher GJ, Burman C. Calculation of complication probabilityfactorsfornon-uniformnormaltissue irradiation: The effective volume method. Int J Radiat Oncol Biol Phys 1989; 16(6):1623-30.
(35) Tucker SL, Thames HD, Michalski JF, Bosch WR, Mohan R, Winter K, et al. Estimation of α/βfor late rectal toxicity based on RTOG 94-06. Int J Radiat Oncol Biol Phys 2011; 81(2):600-5.
(36) Van Oorschot B, Hovingh S, Moerland P, Medema JP, Stalpers L, Vrieling H, et al. Reduced Activity of Double-Strand Break Repair Genes in Prostate Cancer Patients With Late Normal Tissue Radiation Toxicity. Int J Radiat Oncol Biol Phys 2014; 88(3):664-70.
(37) Michalski JM, Gay H, Jackson A, Tucker SL, Deasy JO. Radiation dose-volume effects in radiation-induced rectal injury. Int J Radiat Oncol Biol Phys 2010; 76(3 Suppl):S123-9.
(38) Ebert MA, Foo K, Haworth A, Gulliford SL, Kennedy A,JosephDJ,DenhamJW.Gastrointestinaldose-histogrameffectsinthecontextofdose-volume-constrained prostate radiation therapy: analysis of data from the RADAR prostate radiation therapy trial. Int J Radiat Oncol Biol Phys 2015; 91(3):595-603.
(39) Valdagni R, Rancati T. Reducing rectal injury during external beam radiotherapy for prostate cancer. Nat Rev Urol 2013; 10(6):345-57.
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