Abstract
Purpose
To compare relative and absolute dose–volume parameters (DV) of the rectum and their clinical correlation with acute and late radiation proctitis (RP) after radiotherapy (RT) for prostate cancer (PCa).
Patients and methods
366 patients received RT for PCa. In total, 49.2% received definitive RT, 20.2% received postoperative RT and 30.6% received salvage RT for biochemical recurrence. In 77.9% of patients, RT was delivered to the prostate or prostate bed, and additional whole pelvic RT was performed in 22.1%. 33.9% received 3D-RT, and 66.1% received IMRT. The median follow-up was 59.5 months (18.0–84.0 months). The relative (in %) and absolute (in ccm) rectal doses from 20–75 Gy including the receiver operating characteristics curves (rAUC) from 30–65 Gy (in % and ccm) and several other clinical parameters were analyzed in univariate and multivariate analyses. We performed the statistical analyses separately for the entire cohort (n = 366), patients with (n = 81) and without (n = 285) pelvic RT, comparing RP vs. RP ≥ grade I.
Results
With the exception of the V50Gyccm (p = 0.02) in the univariate analyses for acute RP in the entire patient cohort, no absolute DV parameter (in ccm) was statistically significant associated with either acute or late RP. In the multivariate analyses, 3D-RT (p < 0.008) and rAUCV30–50 Gy% (p = 0.006) were significant parameters for acute RP for the entire cohort, and the V50Gy% (p = 0.01) was the significant parameter for patients with pelvic RT. The rAUCV40–50 Gy% (p = 0.004) was significant for RT to the prostate/prostate bed. Regarding the statistical analysis for late RP, the rAUCV30–65 Gy% (p = 0.001) was significant for the entire cohort, and rAUCV30–50 Gy% (p = 0.001) was significant for RT of the prostate/prostate bed. No parameter was significant in patients with pelvic RT.
Conclusion
Absolute DV parameters in ccm are not required for RT in PCa patients.
Zusammenfassung
Ziel
Vergleich von absoluter und relativer Dosisvolumenbelastung des Rektums und Korrelation mit akuter und später radiogener Proktitis (RP) nach Radiotherapie (RT) beim Prostatakarzinom (PCa)
Patienten und Methodik
366 PCa-Patienten erhielten eine RT: 49,2 % eine definitive, 20,2 % eine postoperative und 30,9 % eine Salvage-RT. Bei 78,3 % wurde Prostata oder Prostatabett bestrahlt und bei 21,7 % zusätzlich der Beckenlymphabfluss. Die Dosen betrugen 60 Gy bei postoperativer, 66 Gy bei Salvage- und 74–78 Gy bei definitiver RT. Eine 3D-RT erhielten 33,9 %, eine IMRT 66,1 %. Das mediane Follow-up betrug 59.5 Monate (18.0–84.0 Monate). Die relativen (%) und absoluten (ccm) rektalen Dosisvolumina (DV) von 20–75 Gy, sowie die Fläche unter der Kurve (rAUC) von 30–65 Gy (in % und ccm) und weitere klinische Parameter wurden univariat und multivariat untersucht. Die statistische Auswertung hinsichtlich keine RP vs. RP ≥ Grad I wurde für das gesamte Kollektiv (n = 366), für Patienten mit (n = 81) und ohne (n = 285) pelvine RT durchgeführt.
Ergebnisse
Mit Ausnahme der V50Gyccm (p = 0,02) in der univariaten Analyse für die akute RP im Gesamtkollektiv war kein absoluter DV-Parameter in ccm signifikant mit akuter oder später RP assoziiert. In der multivariaten Analyse waren die 3‑D-RT (p < 0,008) und die rAUCVGy30–50% (p = 0,006) im Gesamtkollektiv und die V50Gy% (p = 0,01) bei pelviner RT signifikant mit einer akuten RP assoziiert. Die rAUCVGy40–50% (p = 0,004) war bei der Bestrahlung beschränkt auf Prostata/Prostatabett multivariat signifikant. Hinsichtlich der späten RP war die rAUCVGy30–65% (p = 0,001) für das Gesamtkollektiv und die rAUCVGy30–50% (p = 0.001) für die Bestrahlung von Prostata/Prostatabett signifikant. Kein Parameter war multivariat signifikant für die späte RP bei additiver Beckenbestrahlung.
Schlussfolgerung
Absolute DV-Parameter in ccm zusätzlich zu relativen DV „constraints“ des Rektums werden für die RT beim PCa nicht benötigt.
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R. Paleny, M. Bremer, D. Walacides, S. Mainwaring, K. Weber and C. Henkenberens declare that they have no competing interests.
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Paleny, R., Bremer, M., Walacides, D. et al. Comparison of relative and absolute rectal dose–volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients. Strahlenther Onkol 195, 103–112 (2019). https://doi.org/10.1007/s00066-018-1365-4
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DOI: https://doi.org/10.1007/s00066-018-1365-4