Comparison of relative and absolute rectal dose-volume parameters and clinical correlation with acute and late radiation proctitis in prostate cancer patients

Abstract

Purpose: To compare relative and absolute dose-volume parameters (DV) of the rectum and their clinical correlation with acute and late radiation proctitis (RP) after radiotherapy (RT) for prostate cancer (PCa).

Patients and methods: 366 patients received RT for PCa. In total, 49.2% received definitive RT, 20.2% received postoperative RT and 30.6% received salvage RT for biochemical recurrence. In 77.9% of patients, RT was delivered to the prostate or prostate bed, and additional whole pelvic RT was performed in 22.1%. 33.9% received 3D-RT, and 66.1% received IMRT. The median follow-up was 59.5 months (18.0-84.0 months). The relative (in %) and absolute (in ccm) rectal doses from 20-75 Gy including the receiver operating characteristics curves (rAUC) from 30-65 Gy (in % and ccm) and several other clinical parameters were analyzed in univariate and multivariate analyses. We performed the statistical analyses separately for the entire cohort (n = 366), patients with (n = 81) and without (n = 285) pelvic RT, comparing RP vs. RP ≥ grade I.

Results: With the exception of the V50_Gyccm (p = 0.02) in the univariate analyses for acute RP in the entire patient cohort, no absolute DV parameter (in ccm) was statistically significant associated with either acute or late RP. In the multivariate analyses, 3D-RT (p < 0.008) and rAUC_{V30-50 Gy%} (p = 0.006) were significant parameters for acute RP for the entire cohort, and the V50_Gy% (p = 0.01) was the significant parameter for patients with pelvic RT. The rAUC_{V40-50 Gy%} (p = 0.004) was significant for RT to the prostate/prostate bed. Regarding the statistical analysis for late RP, the rAUC_{V30-65 Gy%} (p = 0.001) was significant for the entire cohort, and rAUC_{V30-50 Gy%} (p = 0.001) was significant for RT of the prostate/prostate bed. No parameter was significant in patients with pelvic RT.

Conclusion: Absolute DV parameters in ccm are not required for RT in PCa patients.

Keywords: Dose–volume parameter; Prostate cancer; Radiation proctitis; Radiotherapy.