Journal
RADIOTHERAPY AND ONCOLOGY
Volume 104, Issue 1, Pages 109-113Publisher
ELSEVIER IRELAND LTD
DOI: 10.1016/j.radonc.2012.04.023
Keywords
Prostate cancer; Acute rectal toxicity; Dose-volume histogram; Normal-tissue complication probability; Lyman model
Funding
- National Cancer Institute, National Institutes of Health, USA [R01 CA104342, U24 CA81647, U10 CA21661, U10 CA37422, U10 CA32115]
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Background and purpose: For toxicities occurring during the course of radiotherapy, it is conceptually inaccurate to perform normal-tissue complication probability analyses using the complete dose-volume histogram. The goal of this study was to analyze acute rectal toxicity using a novel approach in which the fit of the Lyman-Kutcher-Burman (LKB) model is based on the fractional rectal dose-volume histogram (DVH). Materials and methods: Grade >= 2 acute rectal toxicity was analyzed in 509 patients treated on Radiation Therapy Oncology Group (RTOG) protocol 94-06. These patients had no field reductions or treatment-plan revisions during therapy, allowing the fractional rectal DVH to be estimated from the complete rectal DVH based on the total number of dose fractions delivered. Results: The majority of patients experiencing Grade >= 2 acute rectal toxicity did so before completion of radiotherapy (70/80 = 88%). Acute rectal toxicity depends on fractional mean rectal dose, with no significant improvement in the LKB model fit when the volume parameter differs from n = 1. The incidence of toxicity was significantly lower for patients who received hormone therapy (P = 0.024). Conclusions: Variations in fractional mean dose explain the differences in incidence of acute rectal toxicity, with no detectable effect seen here for differences in numbers of dose fractions delivered. (C) 2012 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 104 (2012) 109-113
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