Journal article
Predictors of rectal tolerance observed in a dose-escalated phase 1-2 trial of stereotactic body radiation therapy for prostate cancer
International journal of radiation oncology, biology, physics, Vol.89(3), pp.509-517
07/01/2014
DOI: 10.1016/j.ijrobp.2014.03.012
PMID: 24929162
Abstract
To convey the occurrence of isolated cases of severe rectal toxicity at the highest dose level tested in 5-fraction stereotactic body radiation therapy (SBRT) for localized prostate cancer; and to rationally test potential causal mechanisms to guide future studies and experiments to aid in mitigating or altogether avoiding such severe bowel injury. Clinical and treatment planning data were analyzed from 91 patients enrolled from 2006 to 2011 on a dose-escalation (45, 47.5, and 50 Gy in 5 fractions) phase 1/2 clinical study of SBRT for localized prostate cancer. At the highest dose level, 6.6% of patients treated (6 of 91) developed high-grade rectal toxicity, 5 of whom required colostomy. Grade 3+ delayed rectal toxicity was strongly correlated with volume of rectal wall receiving 50 Gy >3 cm(3) (P<.0001), and treatment of >35% circumference of rectal wall to 39 Gy (P=.003). Grade 2+ acute rectal toxicity was significantly correlated with treatment of >50% circumference of rectal wall to 24 Gy (P=.010). Caution is advised when considering high-dose SBRT for treatment of tumors near bowel structures, including prostate cancer. Threshold dose constraints developed from physiologic principles are defined, and if respected can minimize risk of severe rectal toxicity.
Details
- Title: Subtitle
- Predictors of rectal tolerance observed in a dose-escalated phase 1-2 trial of stereotactic body radiation therapy for prostate cancer
- Creators
- D W Nathan Kim - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasL Chinsoo Cho - Department of Radiation Oncology, University of Minnesota, Minneapolis, MinnesotaChristopher Straka - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasAlana Christie - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TexasYair Lotan - Department of Urology, University of Texas Southwestern Medical Center, Dallas, TexasDavid Pistenmaa - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasBrian D Kavanagh - Department of Radiation Oncology, University of Colorado, Denver, ColoradoAkash Nanda - Department of Radiation Oncology, University of Florida Health Cancer Center at Orlando Health, Orlando, FloridaPatrick Kueplian - Department of Radiation Oncology, University of California, Los Angeles, Los Angeles, CaliforniaJeffrey Brindle - Prairie Lakes Hospital, Watertown, South DakotaSusan Cooley - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasAlida Perkins - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, TexasDavid Raben - Department of Radiation Oncology, University of Colorado, Denver, ColoradoXian-Jin Xie - Harold C. Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, Dallas, TexasRobert D Timmerman - Department of Radiation Oncology, University of Texas Southwestern Medical Center, Dallas, Texas. Electronic address: robert.timmerman@utsouthwestern.edu
- Resource Type
- Journal article
- Publication Details
- International journal of radiation oncology, biology, physics, Vol.89(3), pp.509-517
- Publisher
- United States
- DOI
- 10.1016/j.ijrobp.2014.03.012
- PMID
- 24929162
- ISSN
- 0360-3016
- eISSN
- 1879-355X
- Language
- English
- Date published
- 07/01/2014
- Academic Unit
- Preventive and Community Dentistry; Biostatistics; Dental Research
- Record Identifier
- 9983917660002771
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