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Author Ebert, Martin A. ♦ Foo, Kerwyn ♦ Haworth, Annette ♦ Gulliford, Sarah L. ♦ Kennedy, Angel ♦ Joseph, David J. ♦ Denham, James W.
Source United States Department of Energy Office of Scientific and Technical Information
Content type Text
Language English
Subject Keyword RADIOLOGY AND NUCLEAR MEDICINE ♦ ANATOMY ♦ ANIMAL TISSUES ♦ CARCINOMAS ♦ DATA ANALYSIS ♦ DATASETS ♦ DIARRHEA ♦ MULTIVARIATE ANALYSIS ♦ PLANNING ♦ PROSTATE ♦ RADAR ♦ RADIATION DOSES ♦ RADIOTHERAPY ♦ RECTUM ♦ TOXICITY
Abstract 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.
ISSN 03603016
Educational Use Research
Learning Resource Type Article
Publisher Date 2015-03-01
Publisher Place United States
Journal International Journal of Radiation Oncology, Biology and Physics
Volume Number 91
Issue Number 3


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