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Fitting late rectal bleeding data using different NTCP models: results from an Italian multi-centric study

T Rancati1, C Fiorino, G Gagliardi

  • 1Department of Physics, University of Milan, Milan, Italy.

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
|October 7, 2004
PubMed
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This study shows that rectal dose-volume patterns accurately predict late rectal bleeding after prostate radiotherapy. Equivalent Uniform Dose (EUD) is a reliable parameter for assessing bleeding risk, with the rectum behaving less serially for grade 2 bleeding.

Area of Science:

  • Radiation Oncology
  • Medical Physics
  • Clinical Oncology

Background:

  • Late rectal toxicity is correlated with rectal dose-volume patterns.
  • Normal Tissue Complication Probability (NTCP) models can predict complications.
  • Reducing dose-volume histograms (DVH) to a single complication probability value is desirable.

Purpose of the Study:

  • To fit different NTCP models to clinical outcomes of late rectal bleeding.
  • To evaluate the relationship between rectal dose-volume patterns and rectal bleeding after prostate radiotherapy.

Main Methods:

  • Analysis of DVH and clinical records from 547 prostate cancer patients.
  • Inclusion of patients treated with varying radiotherapy doses and techniques.
  • Application and parameter fitting of four NTCP models (Lyman, logistic, Poisson, relative seriality) using maximum likelihood analysis.

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Main Results:

  • Forty-six out of 547 patients experienced grade 2/3 late rectal bleeding.
  • The risk of rectal bleeding is well-calculated by a 'smooth' function of Equivalent Uniform Dose (EUD) with a seriality parameter n=0.23.
  • Different NTCP models demonstrated good fits to observed complication rates, with results confirmed in subgroups.

Conclusions:

  • Various NTCP models accurately fit clinical data for late rectal bleeding.
  • The rectum exhibits a 'less serial' behavior for grade 2 bleeding compared to previous studies.
  • EUD is a robust and simple parameter correlated with the risk of late rectal bleeding.