- Title
- Gastrointestinal dose-histogram effects in the context of dose-volume-constrained prostate radiation therapy: analysis of data from the radar prostate radiation therapy trial
- Creator
- Ebert, Martin A.; Foo, Kerwyn; Haworth, Annette; Gulliford, Sarah L.; Kennedy, Angel; Joseph, David J.; Denham, James W.
- Relation
- NHMRC.300705, NHMRC.455521 & NHMRC.1006447
- Relation
- International Journal of Radiation Oncology. Biology. Physics Vol. 91, Issue 3, p. 595-603
- Publisher Link
- http://dx.doi.org/10.1016/j.ijrobp.2014.11.015
- Publisher
- Elsevier
- Resource Type
- journal article
- Date
- 2015
- Description
- Purpose: To use a high-quality multicenter trial dataset to determine dose-volume effects for gastrointestinal (GI) toxicity following radiation therapy for prostate carcinoma. Influential dose-volume histogram regions were to be determined as functions of dose, anatomical location, toxicity, and clinical endpoint. Methods and Materials: Planning datasets for 754 participants in the TROG 03.04 RADAR trial were available, with Late Effects of Normal Tissues (LENT) Subjective, Objective, Management, and Analytic (SOMA) toxicity assessment to a median of 72 months. A rank sum method was used to define dose-volume cut-points as near-continuous functions of dose to 3 GI anatomical regions, together with a comprehensive assessment of significance. Univariate and multivariate ordinal regression was used to assess the importance of cut-points at each dose. Results: Dose ranges providing significant cut-points tended to be consistent with those showing significant univariate regression odds-ratios (representing the probability of a unitary increase in toxicity grade per percent relative volume). Ranges of significant cut-points for rectal bleeding validated previously published results. Separation of the lower GI anatomy into complete anorectum, rectum, and anal canal showed the impact of mid-low doses to the anal canal on urgency and tenesmus, completeness of evacuation and stool frequency, and mid-high doses to the anorectum on bleeding and stool frequency. Derived multivariate models emphasized the importance of the high-dose region of the anorectum and rectum for rectal bleeding and mid- to low-dose regions for diarrhea and urgency and tenesmus, and low-to-mid doses to the anal canal for stool frequency, diarrhea, evacuation, and bleeding. Conclusions: Results confirm anatomical dependence of specific GI toxicities. They provide an atlas summarizing dose-histogram effects and derived constraints as functions of anatomical region, dose, toxicity, and endpoint for informing future radiation therapy planning.
- Subject
- gastrointestinal toxicity; Randomised Androgen Deprivation and Radiotherapy trial; dose-histogram; RADAR
- Identifier
- http://hdl.handle.net/1959.13/1305814
- Identifier
- uon:21106
- Identifier
- ISSN:0360-3016
- Language
- eng
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