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Dosimetric predictors of erectile dysfunction in Moroccan men treated with volumetric modulated arc therapy for
Ihsane Skitioui1, Karima Nouni1, Salma Ichou1
1Department of Radiation Therapy, National Institute of Oncology, Faculty of Medicine and Pharmacy of Rabat, Mohammed V University, Rabat, Morocco.
Background:
Erectile dysfunction (ED) is a frequent and impactful side effect of prostate cancer radiotherapy. Data on the relationship between radiation dose to the penile bulb (PB) and ED severity in North African populations remain limited. This study aimed to assess ED prevalence and severity in Moroccan men treated with volumetric modulated arc therapy (VMAT) and identify associated clinical and dosimetric predictors.
Materials And Methods:
A retrospective analysis was performed on 52 Moroccan patients treated with VMAT for localized or locally advanced prostate cancer (2021-2024). Erectile function was evaluated using the Sexual Health Inventory for Men (SHIM) score. Analyzed dosimetric variables included PB mean dose, PB V30, PB V50, PB V60, and doses to 25-90% of the PB volume (PB D25, PB D50, PB D75, PB D90). Statistical methods included ANOVA, Pearson correlation, ROC curve analysis, and multivariate logistic regression.
Results:
Moderate to severe ED was found in 65.4% of patients. Strongest correlations with SHIM score were seen for PB D25 (r = -0.47), PB mean dose (r = -0.45), PB V30 (r = -0.41), and PB D50 (r = -0.41). ROC analysis identified PB V30 > 64.9% and PB D50 > 38.7 Gy as optimal cutoffs for predicting ED. ISUP grade was significantly associated with ED severity (p = 0.007), while TNM stage and D'Amico classification were not. No significant association was observed with hypertension, diabetes, or smoking.
Conclusions:
This study highlights the importance of PB dosimetry in predicting post-radiotherapy ED. PB V30 and PB D50 emerged as reliable predictors, underscoring the need to integrate PB constraints in VMAT planning to preserve erectile function in prostate cancer survivors.
