A novel method for predicting late genitourinary toxicity after prostate radiation therapy and the need for age-based risk-adapted dose constraints

Awad A. Ahmed, Brian Egleston, Pino Alcantara, Linna Li, Alan Pollack, Eric M. Horwitz, Mark K. Buyyounouski

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

Background: There are no well-established normal tissue sparing dose-volume histogram (DVH) criteria that limit the risk of urinary toxicity from prostate radiation therapy (RT). The aim of this study was to determine which criteria predict late toxicity among various DVH parameters when contouring the entire solid bladder and its contents versus the bladder wall. The area under the histogram curve (AUHC) was also analyzed. Methods and Materials: From 1993 to 2000, 503 men with prostate cancer received 3-dimensional conformal RT (median follow-up time, 71 months). The whole bladder and the bladder wall were contoured in all patients. The primary endpoint was grade ≥2 genitourinary (GU) toxicity occurring ≥3 months after completion of RT. Cox regressions of time to grade ≥2 toxicity were estimated separately for the entire bladder and bladder wall. Concordance probability estimates (CPE) assessed model discriminative ability. Before training the models, an external random test group of 100 men was set aside for testing. Separate analyses were performed based on the mean age (≤ 68 vs >68 years). Results: Age, pretreatment urinary symptoms, mean dose (entire bladder and bladder wall), and AUHC (entire bladder and bladder wall) were significant (P<.05) in multivariable analysis. Overall, bladder wall CPE values were higher than solid bladder values. The AUHC for bladder wall provided the greatest discrimination for late bladder toxicity when compared with alternative DVH points, with CPE values of 0.68 for age ≤68 years and 0.81 for age >68 years. Conclusion: The AUHC method based on bladder wall volumes was superior for predicting late GU toxicity. Age >68 years was associated with late grade ≥2 GU toxicity, which suggests that risk-adapted dose constraints based on age should be explored.

Original languageEnglish
Pages (from-to)709-715
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume86
Issue number4
DOIs
StatePublished - Jul 15 2013

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bladder
toxicity
Prostate
radiation therapy
Urinary Bladder
Radiotherapy
dosage
histograms
Area Under Curve
grade
curves
pretreatment
regression analysis
Prostatic Neoplasms
education
cancer

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

A novel method for predicting late genitourinary toxicity after prostate radiation therapy and the need for age-based risk-adapted dose constraints. / Ahmed, Awad A.; Egleston, Brian; Alcantara, Pino; Li, Linna; Pollack, Alan; Horwitz, Eric M.; Buyyounouski, Mark K.

In: International Journal of Radiation Oncology Biology Physics, Vol. 86, No. 4, 15.07.2013, p. 709-715.

Research output: Contribution to journalArticle

Ahmed, Awad A. ; Egleston, Brian ; Alcantara, Pino ; Li, Linna ; Pollack, Alan ; Horwitz, Eric M. ; Buyyounouski, Mark K. / A novel method for predicting late genitourinary toxicity after prostate radiation therapy and the need for age-based risk-adapted dose constraints. In: International Journal of Radiation Oncology Biology Physics. 2013 ; Vol. 86, No. 4. pp. 709-715.
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