Impact of treatment planning and delivery factors on gastrointestinal toxicity: an analysis of data from the RADAR prostate radiotherapy trial

Radiation Oncology

Jim W Denham⁶  David J Joseph³  Michele Krawiec¹  Sharon Richardson¹  Angel Kennedy¹  Kerwyn Foo²  Rachel Kearvell¹  Annette Haworth⁴  Max Bulsara⁵  Martin A Ebert¹  Noorazrul Yahya⁷ 

[1] Department of Radiation Oncology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia;Sydney Medical School, University of Sydney, Sydney, New South Wales, Australia;School of Surgery, University of Western Australia, Crawley, Western Australia, Australia;Sir Peter MacCallum Department of Oncology, University of Melbourne, Victoria, Australia;Institute for Health Research, University of Notre Dame, Fremantle, Western Australia, Australia;School of Medicine and Public Health, University of Newcastle, Newcastle, New South Wales, Australia;School of Health Sciences, National University of Malaysia, Bangi, Malaysia

关键词: Dose-volume histogram;    Technical modifications;    Prostate cancer;    Gastrointestinal toxicity;   

Others  :  1150583
DOI  :  10.1186/s13014-014-0282-7

 received in 2014-09-30, accepted in 2014-12-01,  发布年份 2014

【 摘 要 】

Background

To assess the impact of incremental modifications of treatment planning and delivery technique, as well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate radiotherapy trial.

Methods

The RADAR trial accrued 813 external beam radiotherapy participants during 2003–2008 from 23 centres. Following review and archive to a query-able database, digital treatment plans and data describing treatment technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features, were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and 54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and anal canal.

Results

A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242–0.783, corrected p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency compared to patients with no dietary intervention (OR: 3.639, CI: 1.502–8.818, corrected p = 0.04). Despite higher risks of toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH values between EQD2₃ = 15 Gy and EQD2₃ = 35 Gy. Planning target volume (PTV), conformity index, rectal width and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy, treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional area did not affect the risk of toxicities.

Conclusions

The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal toxicity. A number of interesting associations were subsequently found and some factors, previously hypothesised to influence toxicity, did not demonstrate any significant impact. We recommend trial registries be encouraged to record technical modifications introduced during the trial in order for more powerful evidence to be gathered regarding the impact of the interventions.

【 授权许可】

   
2014 Yahya et al. ; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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