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Rectal toxicity predictors in prostate cancer radiotherapy determined
Hormonal therapy and anticoagulants/anti-aggregants protect against acute rectal and intestinal toxicity in men receiving three dimensional conformal radiotherapy (3D-CRT) for prostate cancer, conclude Italian scientists.
Conformal radiotherapy was introduced to allow dose escalation to the prostate while minimizing the radiation to normal tissues, and thus reduce related adverse effects, primarily to the rectum. However, the risk of adverse effects has not been eliminated entirely.
In order to determine predictors of rectal and intestinal toxicity, Claudio Fiorino, from Ospedale San Raffaele in Milan, and colleagues studied 1123 prostate cancer patients treated with ≥70 Gy 3D-CRT between 2002 and 2004.
The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale was used to measure toxicity, along with baseline and follow-up changes in the scores of a self-administered questionnaire on rectal/intestinal toxicity.
In all, 375 patients had Grade 1 RTOG/EORTC toxicity, 265 had Grade 2 toxicity, and 28 had Grade 3 toxicity, the researchers report in theInternational Journal of Radiation Oncology Biology Physics.
For toxicity of Grade 2 or worse, the most predictive parameter was found to be average rectal dose, at an odds ratio of 1.035. In contrast, the use of anticoagulants/anti-aggregants was protective, at an odds ratio of 0.63, as was hormonal therapy, at an odds ratio of 0.65.
Greater average rectal dose was revealed, on the self-administered questionnaire, to be linked to a greater risk of bleeding. In addition, larger irradiated volumes were associated with frequency, tenesmus, incontinence, and bleeding. Hormonal therapy protected against frequency and tenesmus, hemorrhoids were linked to an increased risk of tenesmus and bleeding, and diabetes was highly associated with diarrhea.
The researchers conclude: “The results of the present analysis have demonstrated that a mean rectal dose is highly predictive for acute RTOG/EORTC rectal/gastrointestinal toxicity in prostate cancer 3D-CRT, and androgen deprivation and the use of anticoagulants/anti-aggregants are protective.”
