Purpose: To analyze the correlation between acute and late injury in 973 prostate cancer patients treated with radiotherapy and to evaluate the effect of patient-, tumor-, and treatment-related variables on toxicity. Methods and Materials: Of the 973 patients, 542 and 431 received definitive or postprostatectomy radiotherapy, respectively. Three-dimensional conformal radiotherapy included a six-field technique and two-dynamic arc therapy. Toxicity was classified according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. The correlation between acute and late toxicity (incidence and severity) was assessed. Results: Multivariate analysis showed that age <= 65 years (p=.06) and use of the three-dimensional, six-field technique (p<0001) correlated significantly with greater acute rectal toxicity. The three-dimensional, six-field technique (p=.0002), dose >70 Gy (p=.014), and radiotherapy duration (p=.05) correlated with greater acute urinary toxicity. Acute rectal toxicity (p<.0001) was the only factor that correlated with late rectal injury on multivariate analysis. Late urinary toxicity correlated with acute urinary events (p<.0001) and was inversely related to the use of salvage radiotherapy (p=.018). A highly significant correlation was found between the incidence of acute and late events for both rectal (p<.001) and urinary (p<.001) reactions. The severity of acute toxicity (Grade 2 or greater) was predictive for the severity of late toxicity for both rectal and urinary events (p<.001). Conclusion: The results of our study have shown that the risk of acute reactions depends on both patient-related (age) and treatment-related (dose, technique) factors. Acute toxicity was an independent significant predictor of late toxicity. These findings might help to predict and prevent late radiotherapy-induced complications. (C) 2010 Elsevier Inc.
CORRELATION BETWEEN ACUTE AND LATE TOXICITY IN 973 PROSTATE CANCER PATIENTS TREATED WITH THREE-DIMENSIONAL CONFORMAL EXTERNAL BEAM RADIOTHERAPY / Jereczek Fossa, B.a., Zerini, D., Fodor, C., Santoro, L., Serafini, F., Cambria, R., Vavassori, A., Cattani, F., Garibaldi, C., Gherardi, F., Ferrari, A., Rocco, B.M.C., Scardino, E., De Cobelli, O., Orecchia, R.. - In: INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS. - ISSN 0360-3016. - 78:1(2010), pp. 26-34. [10.1016/j.ijrobp.2009.07.1742]
CORRELATION BETWEEN ACUTE AND LATE TOXICITY IN 973 PROSTATE CANCER PATIENTS TREATED WITH THREE-DIMENSIONAL CONFORMAL EXTERNAL BEAM RADIOTHERAPY
ROCCO, Bernardo Maria Cesare;
2010
Abstract
Purpose: To analyze the correlation between acute and late injury in 973 prostate cancer patients treated with radiotherapy and to evaluate the effect of patient-, tumor-, and treatment-related variables on toxicity. Methods and Materials: Of the 973 patients, 542 and 431 received definitive or postprostatectomy radiotherapy, respectively. Three-dimensional conformal radiotherapy included a six-field technique and two-dynamic arc therapy. Toxicity was classified according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria. The correlation between acute and late toxicity (incidence and severity) was assessed. Results: Multivariate analysis showed that age <= 65 years (p=.06) and use of the three-dimensional, six-field technique (p<0001) correlated significantly with greater acute rectal toxicity. The three-dimensional, six-field technique (p=.0002), dose >70 Gy (p=.014), and radiotherapy duration (p=.05) correlated with greater acute urinary toxicity. Acute rectal toxicity (p<.0001) was the only factor that correlated with late rectal injury on multivariate analysis. Late urinary toxicity correlated with acute urinary events (p<.0001) and was inversely related to the use of salvage radiotherapy (p=.018). A highly significant correlation was found between the incidence of acute and late events for both rectal (p<.001) and urinary (p<.001) reactions. The severity of acute toxicity (Grade 2 or greater) was predictive for the severity of late toxicity for both rectal and urinary events (p<.001). Conclusion: The results of our study have shown that the risk of acute reactions depends on both patient-related (age) and treatment-related (dose, technique) factors. Acute toxicity was an independent significant predictor of late toxicity. These findings might help to predict and prevent late radiotherapy-induced complications. (C) 2010 Elsevier Inc.
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