Cesare Cozzarini1, Tiziana Rancati2, Federica Palorini2, Barbara Avuzzi3, Elisabetta Garibaldi4, Damiano Balestrini5, Domenico Cante6, Fernando Munoz7, Pierfrancesco Franco7, Giuseppe Girelli6, Carla Sini8, Vittorio Vavassori9, Riccardo Valdagni10, Claudio Fiorino11. 1. Radiotherapy, San Raffaele Scientific Institute, Milano, Italy. 2. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 3. Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy. 4. Radiotherapy, Istituto di Candiolo-Fondazione del Piemonte per l'Oncologia IRCCS, Italy. 5. Radiotherapy, Ospedale Bellaria, Bologna, Italy. 6. Radiotherapy, Ivrea Community Hospital, A.S.L. TO4, Italy. 7. Radiotherapy, Ospedale Regionale U.Parini-AUSL Valle d'Aosta, Italy. 8. Medical Physics, San Raffaele Scientific Institute, Milano, Italy. 9. Radiotherapy, Cliniche Gavazzeni-Humanitas, Bergamo, Italy. 10. Prostate Cancer Program, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Radiation Oncology 1, Fondazione IRCCS Istituto Nazionale dei Tumori, Milano, Italy; Dipartimento di Oncologia ed Emato-Oncologia, Università degli Studi di Milano, Italy. 11. Medical Physics, San Raffaele Scientific Institute, Milano, Italy. Electronic address: fiorino.claudio@hsr.it.
Abstract
BACKGROUND AND PURPOSE: Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). METHODS AND MATERIALS: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6months. Patients were treated with conventional (74-80Gy, 1.8-2Gy/fr) or moderately hypo-fractionated RT (65-75.2Gy, 2.2-2.7Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. RESULTS: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF>12) was 5.1%. EQD2 calculated with alpha-beta=0.8Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2>80Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. CONCLUSIONS: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI.
BACKGROUND AND PURPOSE:Urinary incontinence following radiotherapy (RT) for prostate cancer (PCa) has a relevant impact on patient's quality of life. The aim of the study was to assess the unknown dose-effect relationship for late patient-reported urinary incontinence (LPRUI). METHODS AND MATERIALS: Patients were enrolled within the multi-centric study DUE01. Clinical and dosimetry data including the prescribed 2Gy equivalent dose (EQD2) were prospectively collected. LPRUI was evaluated through the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6months. Patients were treated with conventional (74-80Gy, 1.8-2Gy/fr) or moderately hypo-fractionated RT (65-75.2Gy, 2.2-2.7Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy. Six different end-points of 3-year LPRUI, including or not patient's perception (respectively, subjective and objective end-points), were considered. Multivariable logistic models were developed for each end-point. RESULTS: Data of 298 patients were analyzed. The incidence of the most severe end-point (ICIQ-SF>12) was 5.1%. EQD2 calculated with alpha-beta=0.8Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2>80Gy. Previous abdominal/pelvic surgery and previous TURP were the clinical factors more significantly predictive of LPRUI. Models showed excellent performances in terms of goodness-of-fit and calibration, confirmed by bootstrap-based internal validation. When included in the analyses, baseline symptoms were a major predictor for 5 out of six end-points. CONCLUSIONS: LPRUI after RT for PCa dramatically depends on EQD2 and few clinical factors. Results are consistent with a larger than expected impact of moderate hypo-fractionation on the risk of LPRUI. As expected, baseline symptoms, as captured by ICIQ-SF, are associated to an increased risk of LPRUI.
Authors: Maria Thor; Joseph O Deasy; Rebecca Paulus; W Robert Lee; Mahul B Amin; Deborah W Bruner; Daniel A Low; Amit B Shah; Shawn C Malone; Jeff M Michalski; Ian S Dayes; Samantha A Seaward; Elizabeth M Gore; Michele Albert; Thomas M Pisansky; Sergio L Faria; Yuhchyau Chen; Bridget F Koontz; Gregory P Swanson; Stephanie L Pugh; Howard M Sandler Journal: Radiother Oncol Date: 2019-03-05 Impact factor: 6.280