Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial
BACKGROUND AND PURPOSE: The phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The a...
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Veröffentlicht in: | RADIOTHERAPY AND ONCOLOGY 2021-09, Vol.162, p.98-104 |
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creator | Groen, Veerle H Zuithoff, Nicolaas P.A van Schie, Marcel Monninkhof, Evelyn M Kunze-Busch, Martina de Boer, Hans C.J van Zyp, Jochem van der Voort Pos, Floris J Smeenk, Robert Jan Haustermans, Karin Isebaert, Sofie Draulans, Cedric Depuydt, Tom Verkooijen, Helena M van der Heide, Uulke A Kerkmeijer, Linda G.W |
description | BACKGROUND AND PURPOSE: The phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). MATERIAL AND METHODS: All patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose-effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. RESULTS: A dose-effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13-1.21, p |
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JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). MATERIAL AND METHODS: All patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose-effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. RESULTS: A dose-effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13-1.21, p < 0.0001) and 1.20 (95% CI 1.14-1.25, p < 0.0001) for GI toxicity, respectively. CONCLUSION: Although there was no difference in toxicity between study arms, a higher radiation dose to the anorectum was associated with a statistically significant increase in GI toxicity following EBRT for prostate cancer. This dose-effect relation was present for both large and small anorectal volumes. Therefore, further increase in dose to the anorectum should be weighed against the benefit of focal dose escalation for prostate cancer.</description><identifier>ISSN: 0167-8140</identifier><language>eng</language><publisher>ELSEVIER IRELAND LTD</publisher><ispartof>RADIOTHERAPY AND ONCOLOGY, 2021-09, Vol.162, p.98-104</ispartof><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,315,780,784,27860</link.rule.ids></links><search><creatorcontrib>Groen, Veerle H</creatorcontrib><creatorcontrib>Zuithoff, Nicolaas P.A</creatorcontrib><creatorcontrib>van Schie, Marcel</creatorcontrib><creatorcontrib>Monninkhof, Evelyn M</creatorcontrib><creatorcontrib>Kunze-Busch, Martina</creatorcontrib><creatorcontrib>de Boer, Hans C.J</creatorcontrib><creatorcontrib>van Zyp, Jochem van der Voort</creatorcontrib><creatorcontrib>Pos, Floris J</creatorcontrib><creatorcontrib>Smeenk, Robert Jan</creatorcontrib><creatorcontrib>Haustermans, Karin</creatorcontrib><creatorcontrib>Isebaert, Sofie</creatorcontrib><creatorcontrib>Draulans, Cedric</creatorcontrib><creatorcontrib>Depuydt, Tom</creatorcontrib><creatorcontrib>Verkooijen, Helena M</creatorcontrib><creatorcontrib>van der Heide, Uulke A</creatorcontrib><creatorcontrib>Kerkmeijer, Linda G.W</creatorcontrib><title>Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial</title><title>RADIOTHERAPY AND ONCOLOGY</title><description>BACKGROUND AND PURPOSE: The phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). MATERIAL AND METHODS: All patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose-effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. RESULTS: A dose-effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13-1.21, p < 0.0001) and 1.20 (95% CI 1.14-1.25, p < 0.0001) for GI toxicity, respectively. CONCLUSION: Although there was no difference in toxicity between study arms, a higher radiation dose to the anorectum was associated with a statistically significant increase in GI toxicity following EBRT for prostate cancer. This dose-effect relation was present for both large and small anorectal volumes. Therefore, further increase in dose to the anorectum should be weighed against the benefit of focal dose escalation for prostate cancer.</description><issn>0167-8140</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>FZOIL</sourceid><recordid>eNqVjEFOwzAQRb0oEoX2DrPrAkVy4jYJywq1YgE79tHgTIrB2NF4CuklODMu4gCw-v_rPf2Zmuuyboq2XOtLdZXSq9a60qaZq69tiExW0EMfExU0DHkBk0dxMSQYIkPuBAdMwtEFoSQuZF_i5KyTU1a8j58uHIAmIT6zZ8J3YOxdlBdiHE8_PyPHJOcvi8ESgwuQMewfto87EHboF-piQJ9o-ZvXarXfPd3dF29HT8cPCl2fRrTUlZVZb-qmve3q1rSbyvzHvPmb2ckk5hvOYmT9</recordid><startdate>202109</startdate><enddate>202109</enddate><creator>Groen, Veerle H</creator><creator>Zuithoff, Nicolaas P.A</creator><creator>van Schie, Marcel</creator><creator>Monninkhof, Evelyn M</creator><creator>Kunze-Busch, Martina</creator><creator>de Boer, Hans C.J</creator><creator>van Zyp, Jochem van der Voort</creator><creator>Pos, Floris J</creator><creator>Smeenk, Robert Jan</creator><creator>Haustermans, Karin</creator><creator>Isebaert, Sofie</creator><creator>Draulans, Cedric</creator><creator>Depuydt, Tom</creator><creator>Verkooijen, Helena M</creator><creator>van der Heide, Uulke A</creator><creator>Kerkmeijer, Linda G.W</creator><general>ELSEVIER IRELAND LTD</general><scope>FZOIL</scope></search><sort><creationdate>202109</creationdate><title>Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial</title><author>Groen, Veerle H ; Zuithoff, Nicolaas P.A ; van Schie, Marcel ; Monninkhof, Evelyn M ; Kunze-Busch, Martina ; de Boer, Hans C.J ; van Zyp, Jochem van der Voort ; Pos, Floris J ; Smeenk, Robert Jan ; Haustermans, Karin ; Isebaert, Sofie ; Draulans, Cedric ; Depuydt, Tom ; Verkooijen, Helena M ; van der Heide, Uulke A ; Kerkmeijer, Linda G.W</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-kuleuven_dspace_123456789_6838523</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Groen, Veerle H</creatorcontrib><creatorcontrib>Zuithoff, Nicolaas P.A</creatorcontrib><creatorcontrib>van Schie, Marcel</creatorcontrib><creatorcontrib>Monninkhof, Evelyn M</creatorcontrib><creatorcontrib>Kunze-Busch, Martina</creatorcontrib><creatorcontrib>de Boer, Hans C.J</creatorcontrib><creatorcontrib>van Zyp, Jochem van der Voort</creatorcontrib><creatorcontrib>Pos, Floris J</creatorcontrib><creatorcontrib>Smeenk, Robert Jan</creatorcontrib><creatorcontrib>Haustermans, Karin</creatorcontrib><creatorcontrib>Isebaert, Sofie</creatorcontrib><creatorcontrib>Draulans, Cedric</creatorcontrib><creatorcontrib>Depuydt, Tom</creatorcontrib><creatorcontrib>Verkooijen, Helena M</creatorcontrib><creatorcontrib>van der Heide, Uulke A</creatorcontrib><creatorcontrib>Kerkmeijer, Linda G.W</creatorcontrib><collection>Lirias (KU Leuven Association)</collection><jtitle>RADIOTHERAPY AND ONCOLOGY</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Groen, Veerle H</au><au>Zuithoff, Nicolaas P.A</au><au>van Schie, Marcel</au><au>Monninkhof, Evelyn M</au><au>Kunze-Busch, Martina</au><au>de Boer, Hans C.J</au><au>van Zyp, Jochem van der Voort</au><au>Pos, Floris J</au><au>Smeenk, Robert Jan</au><au>Haustermans, Karin</au><au>Isebaert, Sofie</au><au>Draulans, Cedric</au><au>Depuydt, Tom</au><au>Verkooijen, Helena M</au><au>van der Heide, Uulke A</au><au>Kerkmeijer, Linda G.W</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial</atitle><jtitle>RADIOTHERAPY AND ONCOLOGY</jtitle><date>2021-09</date><risdate>2021</risdate><volume>162</volume><spage>98</spage><epage>104</epage><pages>98-104</pages><issn>0167-8140</issn><abstract>BACKGROUND AND PURPOSE: The phase III FLAME trial (NCT01168479) showed an increase in five-year biochemical disease-free survival, with no significant increase in toxicity when adding a focal boost to external beam radiotherapy (EBRT) for localized prostate cancer [Kerkmeijer et al. JCO 2021]. The aim of this study was to investigate the association between delivered radiation dose to the anorectum and gastrointestinal (GI) toxicity (grade ≥2). MATERIAL AND METHODS: All patients in the FLAME trial were analyzed, irrespective of treatment arm. The dose-effect relation of the anorectal dose parameters (D2cm3 and D50%) and GI toxicity grade ≥2 in four years of follow-up was assessed using a mixed model analysis for repeated measurements, adjusted for age, cardiovascular disease, diabetes mellitus, T-stage, baseline toxicity grade ≥1, hormonal therapy and institute. RESULTS: A dose-effect relation for D2cm3 and D50% was observed with adjusted odds ratios of 1.17 (95% CI 1.13-1.21, p < 0.0001) and 1.20 (95% CI 1.14-1.25, p < 0.0001) for GI toxicity, respectively. CONCLUSION: Although there was no difference in toxicity between study arms, a higher radiation dose to the anorectum was associated with a statistically significant increase in GI toxicity following EBRT for prostate cancer. This dose-effect relation was present for both large and small anorectal volumes. Therefore, further increase in dose to the anorectum should be weighed against the benefit of focal dose escalation for prostate cancer.</abstract><pub>ELSEVIER IRELAND LTD</pub><oa>free_for_read</oa></addata></record> |
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title | Anorectal dose-effect relations for late gastrointestinal toxicity following external beam radiotherapy for prostate cancer in the FLAME trial |
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