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Radiation Oncology
Published in: Radiation Oncology 1/2019

Open Access 01-12-2019 | Prostate Cancer | Research

Dose-volume analysis of predictors for acute anal toxicity after radiotherapy in prostate cancer patients

Authors: Xingsi Peng, Sha Zhou, Shiliang Liu, Jibin Li, Sijuan Huang, Xiaobo Jiang, Maosheng Lin, Shaomin Huang, Chengguang Lin, Chaonan Qian, Mengzhong Liu, Liru He

Published in: Radiation Oncology | Issue 1/2019

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Abstract

Background

This study aimed to evaluate the clinical and dosimetric factors predictive of acute anal toxicity (AAT) after radiotherapy in prostate cancer (PCa) patients with or without hemorrhoids.

Methods

We analyzed data from 347 PCa patients (248 cases treated from July 2013 to November 2017 for training cohort and 99 cases treated in 2018 for validation cohort) treated with pelvic radiotherapy at a single institution. Anal canal dose–volume histogram was used to determine the prescribed dose. Univariate and multivariate analyses were used to evaluate the risk of AAT as a function of clinical and dosimetric factors.

Results

Totally, 39.5% (98/248) and 31.3% (31/99) of the PCa patients developed AAT in training and validation cohorts, respectively. The incidence of AAT was much higher in patients with hemorrhoids than in those without hemorrhoids in both training and validation cohorts. Hemorrhoids and volume received more than 20 Gy (V20) were valuated as independent factors for predicting AAT in training cohort. Similar results were also observed in our validation cohort. The combination of hemorrhoids and high anal canal V20 (> 74.93% as determined by ROC curves) showed the highest specificity and positive predictive values for predicting AAT in both training and validation cohorts.

Conclusions

AAT occurs commonly in PCa patients with hemorrhoids during and after pelvic radiotherapy. Hemorrhoids and anal canal V20 are independent predictors of AAT. These factors should be carefully considered during treatment planning to minimize the incidence of AAT.
Literature
1.
Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018;68(6):394–424.
2.
Zhu Y-P, Ye D-W, Yao X-D, Zhang S-L, Dai B, Zhang H-L, Shen Y-J, Zhu Y, Shi G-H. Prevalence of incidental prostate cancer in patients undergoing radical cystoprostatectomy: data from China and other Asian countries. Asian J Androl. 2008;11(1):104–8.PubMedPubMedCentralCrossRef
3.
McCracken M, Olsen M, Chen MS Jr, Jemal A, Thun M, Cokkinides V, Deapen D, Ward E. Cancer incidence, mortality, and associated risk factors among Asian Americans of Chinese, Filipino, Vietnamese, Korean, and Japanese ethnicities. CA Cancer J Clin. 2007;57(4):190–205.PubMedCrossRef
4.
Sim HG, Cheng CW. Changing demography of prostate cancer in Asia. Eur J Cancer. 2005;41(6):834–45.PubMedCrossRef
5.
Linton KD, Catto JW. Gastrointestinal toxicity following radiotherapy for prostate cancer: a ring of fire. Eur Urol. 2011;60(5):917–9.PubMedCrossRef
6.
Kelsey R. Prostate cancer: Hypofractionation not associated with reduced toxicity. Nat Rev Urol. 2015;12(3):126.PubMedCrossRef
7.
Fang P, Mick R, Deville C, Both S, Bekelman JE, Christodouleas JP, Guzzo TJ, Tochner Z, Hahn SM, Vapiwala N. A case-matched study of toxicity outcomes after proton therapy and intensity-modulated radiation therapy for prostate cancer. Cancer. 2015;121(7):1118–27.PubMedCrossRef
8.
Krol R, McColl GM, Hopman WPM, Smeenk RJ. Anal and rectal function after intensity-modulated prostate radiotherapy with endorectal balloon. Radiother Oncol. 2018;128(2):364–8.PubMedCrossRef
9.
Smeenk RJ, Hoffmann AL, Hopman WP, van Lin EN, Kaanders JH. Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2012;83(2):636–44.PubMedCrossRef
10.
Yeoh EK, Russo A, Botten R, Fraser R, Roos D, Penniment M, Borg M, Sun WM. Acute effects of therapeutic irradiation for prostatic carcinoma on anorectal function. Gut. 1998;43(1):123–7.PubMedPubMedCentralCrossRef
11.
Jang H, Baek JG, Jo S. The anal canal as a risk organ in cervical cancer patients with hemorrhoids undergoing whole pelvic radiotherapy. Tumori. 2015;101(1):72–7.PubMedCrossRef
12.
Jang H, Baek JG, Yoo SJ. Acute anal toxicity after whole pelvic radiotherapy in patients with asymptomatic haemorrhoids: identification of dosimetric and patient factors. Br J Radiol. 2015;88(1050):20150022.PubMedPubMedCentralCrossRef
13.
Su MY, Chiu CT, Lin WP, Hsu CM, Chen PC. Long-term outcome and efficacy of endoscopic hemorrhoid ligation for symptomatic internal hemorrhoids. World J Gastroenterol. 2011;17(19):2431–6.PubMedPubMedCentralCrossRef
14.
15.
Lin G, Ge Q, He X, Qi H, Xu L. A novel technique for the treatment of stages III to IV hemorrhoids: homemade anal cushion suspension clamp combined with harmonic scalpel. Medicine (Baltimore). 2017;96(26):e7309.CrossRef
16.
Akobeng AK. Understanding diagnostic tests 3: receiver operating characteristic curves. Acta Paediatr. 2007;96(5):644–7.PubMedCrossRef
17.
Smeenk RJ, van Lin EN, van Kollenburg P, Kunze-Busch M, Kaanders JH. Anal wall sparing effect of an endorectal balloon in 3D conformal and intensity-modulated prostate radiotherapy. Radiother Oncol. 2009;93(1):131–6.PubMedCrossRef
18.
Koper PC, Jansen P, van Putten W, van Os M, Wijnmaalen AJ, Lebesque JV, Levendag PC. Gastro-intestinal and genito-urinary morbidity after 3D conformal radiotherapy of prostate cancer: observations of a randomized trial. Radiother Oncol. 2004;73(1):1–9.PubMedCrossRef
19.
Paydar I, Cyr RA, Yung TM, Lei S, Collins BT, Chen LN, Suy S, Dritschilo A, Lynch JH, Collins SP. Proctitis 1 week after stereotactic body radiation therapy for prostate Cancer: implications for clinical trial design. Front Oncol. 2016;6:167.PubMedPubMedCentral
20.
Rijkmans EC, van Triest B, Nout RA, Kerkhof EM, Buijsen J, Rozema T, Franssen JH, Velema LA, Laman MS, Cats A, et al. Evaluation of clinical and endoscopic toxicity after external beam radiotherapy and endorectal brachytherapy in elderly patients with rectal cancer treated in the HERBERT study. Radiother Oncol. 2018;126(3):417–23.PubMedCrossRef
21.
Wortel RC, Witte MG, van der Heide UA, Pos FJ, Lebesque JV, van Herk M, Incrocci L, Heemsbergen WD. Dose-surface maps identifying local dose-effects for acute gastrointestinal toxicity after radiotherapy for prostate cancer. Radiother Oncol. 2015;117(3):515–20.PubMedCrossRef
22.
Moreau-Claeys MV, Peiffert D. Normal tissue tolerance to external beam radiation therapy: anal canalCancer Radiother. 2010;14(4–5):359–62.PubMedCrossRef
Metadata
Title
Dose-volume analysis of predictors for acute anal toxicity after radiotherapy in prostate cancer patients
Authors
Xingsi Peng
Sha Zhou
Shiliang Liu
Jibin Li
Sijuan Huang
Xiaobo Jiang
Maosheng Lin
Shaomin Huang
Chengguang Lin
Chaonan Qian
Mengzhong Liu
Liru He
Publication date
01-12-2019
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2019
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-019-1374-1

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