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Dose-Volume Predictors for Patient-reported Late Diarrhoea, Faecal Incontinence and Urgency after Pelvic

R Jadon1, L Hanna2, P Parsons3

  • 1Department of Clinical Oncology, Velindre Cancer Centre, Cardiff, UK; Department of Clinical Oncology, Addenbrooke's Hospital, Cambridge, UK.

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Summary

Pelvic radiotherapy can cause bowel issues like faecal incontinence. This study identified dose-volume predictors for these late toxicities and derived new constraints for organs at risk to minimize patient side effects.

Keywords:
Bowel toxicitydose–volume constraintspatient-reported toxicitypelvic radiotherapy

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Area of Science:

  • Radiation Oncology
  • Clinical Oncology
  • Medical Physics

Background:

  • Pelvic radiotherapy is crucial for treating pelvic malignancies but often causes significant late bowel toxicities, impacting patient quality of life.
  • Despite advanced techniques, optimal strategies to minimize these late effects, such as defining dose-volume constraints for organs at risk (OARs), are still needed.

Purpose of the Study:

  • To identify dose-volume predictors for patient-reported late bowel toxicities following pelvic radiotherapy.
  • To derive and validate clinical dose-volume constraints for OARs to reduce the risk of these toxicities.

Main Methods:

  • Retrospective analysis of 203 patients treated for gynaecological and urological cancers between 2012-2014.
  • Patient-reported toxicity questionnaires administered at 12 and 24 months post-treatment.
  • Dose-volume data analysis using multivariate modeling to identify significant predictors and derive constraints.

Main Results:

  • Faecal urgency, incontinence, and diarrhoea occurred in 52%, 23.5%, and 18.7% of patients at 12 months, respectively.
  • Dose-volume parameters for the sigmoid colon and large bowel were significant predictors of these toxicities.
  • Promising dose-volume constraints for these OARs were derived and a published constraint for bowel loops was validated.

Conclusions:

  • The sigmoid colon and large bowel are critical OARs influencing the development of faecal urgency, incontinence, and diarrhoea.
  • Derived dose-volume constraints show promise for reducing late bowel toxicities but require further validation before clinical implementation.