Viviana Carillo1, Cesare Cozzarini2, Tiziana Rancati3, Barbara Avuzzi4, Andrea Botti5, Valeria Casanova Borca6, Gabriella Cattari7, Francesco Civardi3, Claudio Degli Esposti8, Pierfrancesco Franco9, Giuseppe Girelli10, Angelo Maggio11, Alessandro Muraglia12, Marcella Palombarini13, Alessio Pierelli14, Emanuele Pignoli15, Vittorio Vavassori16, Michele Zeverino17, Riccardo Valdagni18, Claudio Fiorino19. 1. Medical Physics, San Raffaele Scientific Institute, Milano, Italy. 2. Radiotherapy, San Raffaele Scientific Institute, Milano, Italy. 3. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy. 4. Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 5. Medical Physics, Arcispedale S.M. Nuova, Reggio Emilia, Italy. 6. Medical Physics, Ospedale ASL9, Ivrea, Italy. 7. Radiotherapy, IRCCS-Candiolo, Italy. 8. Radiotherapy, Ospedale Bellaria, Bologna, Italy. 9. Radiotherapy, Ospedale Regionale U.Parini-AUSL Valle d'Aosta, Aosta, Italy. 10. Radiotherapy, Ospedale ASL9, Ivrea, Italy. 11. Medical Physics, IRCCS-Candiolo, Italy. 12. Radiotherapy, Arcispedale S.M. Nuova, Reggio Emilia, Italy. 13. Medical Physics, Ospedale Bellaria, Bologna, Italy. 14. Medical Physics, Cliniche Gavazzeni-Humanitas, Bergamo, Italy. 15. Medical Physics, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 16. Radiotherapy, Cliniche Gavazzeni-Humanitas, Bergamo, Italy. 17. Medical Physics, Ospedale Regionale U.Parini-AUSL Valle d'Aosta, Aosta, Italy. 18. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milan, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 19. Medical Physics, San Raffaele Scientific Institute, Milano, Italy. Electronic address: fiorino.claudio@hsr.it.
Abstract
BACKGROUND AND PURPOSE: DUE01 is an observational study aimed at developing predictive models of genito-urinary toxicity of patients treated for prostate cancer with conventional (1.8-2Gy/fr, CONV) or moderate hypo-fractionation (2.35-2.7Gy/fr, HYPO). The current analysis focused on the relationship between bladder DVH/DSH and the risk of International Prostate Symptoms Score (IPSS)⩾15/20 at the end of radiotherapy. MATERIALS AND METHODS: Planning and relevant clinical parameters were prospectively collected, including DVH/DSH, LQ-corrected (DVHc/DSHc) and weekly (DVHw/DSHw) histograms. Best parameters were selected by the differences between patients with/without IPSS⩾15/20 at the end of radiotherapy. Logistic uni- and backward multi-variable (MVA) analyses were performed. RESULTS: Data of 247 patients were available (CONV: 116, HYPO: 131). Absolute DVHw/DSHw and DVHc/DSHc predicted the risk of IPSS⩾15 at the end of radiotherapy (n=77/247); an MVA model including baseline IPSS, anti-hypertensive, T stage, the absolute surface receiving ⩾8.5Gy/week and ⩾12.5Gy/week was developed (AUC=0.78, 95% CI: 0.72-0.83). Similar AUC values were found if replacing DSHw with DVHw/DVHc/DSHc parameters. The impact of dose-volume/surface parameters remained when excluding patients with baseline IPSS⩾15 and in HYPO. IPSS⩾20 at the end of radiotherapy (n=27/247) was mainly correlated to baseline IPSS and T stage. CONCLUSIONS: Although the baseline IPSS was the main predictor, constraining v8.5w<56cc and v12.5w<5cc may significantly reduce acute GU toxicity.
BACKGROUND AND PURPOSE: DUE01 is an observational study aimed at developing predictive models of genito-urinary toxicity of patients treated for prostate cancer with conventional (1.8-2Gy/fr, CONV) or moderate hypo-fractionation (2.35-2.7Gy/fr, HYPO). The current analysis focused on the relationship between bladder DVH/DSH and the risk of International Prostate Symptoms Score (IPSS)⩾15/20 at the end of radiotherapy. MATERIALS AND METHODS: Planning and relevant clinical parameters were prospectively collected, including DVH/DSH, LQ-corrected (DVHc/DSHc) and weekly (DVHw/DSHw) histograms. Best parameters were selected by the differences between patients with/without IPSS⩾15/20 at the end of radiotherapy. Logistic uni- and backward multi-variable (MVA) analyses were performed. RESULTS: Data of 247 patients were available (CONV: 116, HYPO: 131). Absolute DVHw/DSHw and DVHc/DSHc predicted the risk of IPSS⩾15 at the end of radiotherapy (n=77/247); an MVA model including baseline IPSS, anti-hypertensive, T stage, the absolute surface receiving ⩾8.5Gy/week and ⩾12.5Gy/week was developed (AUC=0.78, 95% CI: 0.72-0.83). Similar AUC values were found if replacing DSHw with DVHw/DVHc/DSHc parameters. The impact of dose-volume/surface parameters remained when excluding patients with baseline IPSS⩾15 and in HYPO. IPSS⩾20 at the end of radiotherapy (n=27/247) was mainly correlated to baseline IPSS and T stage. CONCLUSIONS: Although the baseline IPSS was the main predictor, constraining v8.5w<56cc and v12.5w<5cc may significantly reduce acute GU toxicity.
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