Long term rectal function after high-dose prostatecancer radiotherapy: Results from a prospective cohort study

作者：Fellin Gianni; Rancati Tiziana^*; Fiorino Claudio; Vavassori Vittorio; Antognoni Paolo; Baccolini Michela; Bianchi Carla; Cagna Emanuela; Borca Valeria Casanova; Girelli Giuseppe; Iacopino Bruno; Maliverni Giuseppe; Mauro Flora A; Menegotti Loris; Monti Angelo F; Romani Fabrizio; Stasi Michele; Valdagni Riccardo

来源：Radiotherapy and Oncology, 2014, 110(2): 272-277.

DOI：10.1016/j.radonc.2013.09.028

• Prostate cancer
• Late toxicity
• Radiotherapy
• Dose-volume effects
• Normal tissue complication probability modeling

Purpose: To prospectively evaluate long-term late rectal bleeding (lrb) and faecal incontinence (linc) after high-dose radiotherapy (RT) for prostate cancer in the AIROPROS 0102 population, and to assess clinical/dosimetric risk factors.
Materials and methods: Questionnaires of 515 patients with GO baseline incontinence and bleeding scores (follow-up >= 6 years) were analysed. Correlations between lrb/linc and many clinical and dosimetric parameters were investigated by univariate and multivariate logistic analyses. The correlation between lrb/linc and symptoms during the first 3 years after RT was also investigated.
Results: Of 515 patients lrb G1, G2 and G3 was found in 32(6.1%), 2(0.4%) and 3 (0.6%) patients while linc GI, G2 and G3 was detected in 50(9.7%), 3 (0.6%) and 3 (0.6%), respectively. The prevalence of G2-G3 lrb events was significantly reduced compared to the first 3-years (1% vs 2.7%, p = 0.016) >= G1 lrb was significantly associated with V75Gy (OR = 1.07). In multivariate analysis, >= G1 linc was associated with V40Gy (OR = 1.015), use of antihypertensive medication (OR = 0.38), abdominal surgery before RT (OR = 4.7), haemorrhoids (OR = 2.6), and G2-G3 acute faecal incontinence (OR = 4.4), a nomogram to predict the risk of long-term >= G1 linc was proposed.
Results: Importantly, the prevalence of >= G1 linc was significantly correlated with the mean incontinence score during the first 3 years after RT (OR = 16.3).
Conclusions: Long-term (median: 7 years) rectal symptoms are prevalently mild and strongly correlated with moderate/severe events occurring in the first 3 years after RT. Linc was associated with several risk factors.

• 出版日期2014-2