dc.contributor.author | Ferreira, MR | |
dc.contributor.author | Thomas, K | |
dc.contributor.author | Truelove, L | |
dc.contributor.author | Khan, A | |
dc.contributor.author | Parker, C | |
dc.contributor.author | Dearnaley, DP | |
dc.contributor.author | Gulliford, S | |
dc.date.accessioned | 2019-04-10T09:57:23Z | |
dc.date.issued | 2019-06-01 | |
dc.identifier.citation | Clinical oncology (Royal College of Radiologists (Great Britain)), 2019, 31 (6), pp. 374 - 384 | |
dc.identifier.issn | 0936-6555 | |
dc.identifier.uri | https://repository.icr.ac.uk/handle/internal/3174 | |
dc.identifier.eissn | 1433-2981 | |
dc.identifier.doi | 10.1016/j.clon.2019.02.012 | |
dc.description.abstract | AIMS: Pelvic lymph node (PLN) radiotherapy for high-risk prostate cancer is limited by late gastrointestinal toxicity. Application of rectal and bowel constraints may reduce risks of side-effects. We evaluated associations between intensity-modulated radiotherapy (IMRT) dose-volume data and long-term gastrointestinal toxicity. MATERIALS AND METHODS: Data from a single-centre dose-escalation trial of PLN-IMRT were analysed, including conventionally fractionated (CFRT) and hypofractionated (HFRT) radiotherapy schedules. Associations between volumes of rectum and bowel receiving specified doses and clinician- and patient-reported toxicity outcomes were investigated independently. A metric, δ median (δM), was defined as the difference in the medians of a volume between groups with and without toxicity at a specified dose and was used to test for statistically significant differences. RESULTS: Constraints were respected in most patients and, when exceeded, led to higher rates of gastrointestinal toxicity. Biologically relevant associations between rectum dose-points and toxicity were more numerous with both mild and moderate toxicity thresholds, but statistical significance was limited after correction for false discovery rate. Rectal V50Gy (CFRT) associated with grade 2+ bleeding; bowel V43Gy and V47 (HFRT/4 days/week schedule) associated with patient-reported loose stools and diarrhoea, respectively. Further investigation showed that CFRT patients with rectal bleeding had a mean rectal V50Gy above the treatment planning constraint. CONCLUSIONS: When dose-volume parameters are kept below tight constraints, toxicity is low. Residual dosimetry loses much of its predictive power for gastrointestinal toxicity in the setting of PLN-IMRT for prostate cancer. We have benchmarked dose-volume constraints for safely delivering PLN-IMRT using CFRT or HFRT. | |
dc.format | Print-Electronic | |
dc.format.extent | 374 - 384 | |
dc.language | eng | |
dc.language.iso | eng | |
dc.publisher | ELSEVIER SCIENCE LONDON | |
dc.rights.uri | https://creativecommons.org/licenses/by/4.0 | |
dc.subject | Pelvis | |
dc.subject | Intestine, Large | |
dc.subject | Rectum | |
dc.subject | Lymph Nodes | |
dc.subject | Humans | |
dc.subject | Prostatic Neoplasms | |
dc.subject | Lymphatic Metastasis | |
dc.subject | Radiometry | |
dc.subject | Aged | |
dc.subject | Aged, 80 and over | |
dc.subject | Middle Aged | |
dc.subject | Male | |
dc.subject | Radiotherapy, Intensity-Modulated | |
dc.title | Dosimetry and Gastrointestinal Toxicity Relationships in a Phase II Trial of Pelvic Lymph Node Radiotherapy in Advanced Localised Prostate Cancer. | |
dc.type | Journal Article | |
dcterms.dateAccepted | 2019-02-04 | |
rioxxterms.versionofrecord | 10.1016/j.clon.2019.02.012 | |
rioxxterms.licenseref.uri | https://creativecommons.org/licenses/by-nc-nd/4.0 | |
rioxxterms.licenseref.startdate | 2019-06 | |
rioxxterms.type | Journal Article/Review | |
dc.relation.isPartOf | Clinical oncology (Royal College of Radiologists (Great Britain)) | |
pubs.issue | 6 | |
pubs.notes | Not known | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Closed research teams | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Closed research teams/Clinical Academic Radiotherapy (Dearnaley) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Radiotherapy Physics Modelling | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.organisational-group | /ICR | |
pubs.organisational-group | /ICR/Primary Group | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Closed research teams | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Closed research teams/Clinical Academic Radiotherapy (Dearnaley) | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging | |
pubs.organisational-group | /ICR/Primary Group/ICR Divisions/Radiotherapy and Imaging/Radiotherapy Physics Modelling | |
pubs.organisational-group | /ICR/Primary Group/Royal Marsden Clinical Units | |
pubs.publication-status | Published | |
pubs.volume | 31 | |
pubs.embargo.terms | Not known | |
icr.researchteam | Clinical Academic Radiotherapy (Dearnaley) | |
icr.researchteam | Radiotherapy Physics Modelling | |
dc.contributor.icrauthor | Dearnaley, David | |