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Table 2 Literature review of dose-volume relationship for late rectal bleeding in radiotherapy of prostate cancer

From: Distinct effects of rectum delineation methods in 3D-confromal vs. IMRT treatment planning of prostate cancer

Author Patients Follow up Persription Doses Treatment technique Classification of toxicity Endpoint Events Dosimetric parameter Rectum delineation Results
Hartford 1996 [29] 41 Minimum 4 years 50.4Gy 25.2CGE 4 field Perineal proton boost RTOG ≥ Grad I rectal bleeding 14 DWH ant. RW From superior limit of anus to 2 cm superior to prostate Cut-off:
Continuously between 60Gy to 70% and 75Gy to 30%
Boersma 1998 [30] 130 Median 24 months 70 – 76Gy 3 field 3D-CRT SOMA/LENT and RTOG/EORTC ≥ Grad III rectal bleeding 2 DWH 15 mm caudal to the apex of the prostate to boarder to sigmoid Cut-off:
≥ 65Gy to >40%
≥ 70Gy to >30%
≥ 75Gy to >5%
(no correlation for grade I/II rectal bleeding)
Storey 2000 [31] 189 Minimum 2 years 70Gy 78Gy 4 field box 4 field box, 6 field 3D-CRT boost Modified RTOG ≥ Grad II late rectal toxicity 28 DVH Rectum included within 11 cm of initial APPA field For patients treated to 78Gy:
Cut-off:
≥ 70Gy to >25%
Jackson 2001 [32] 451 Minimum 30 months 70.2Gy 75.6Gy 6 field arrangement 3D-CRT RTOG ≥ Grad III late rectal bleeding 49 DWH below sigmoid flexure to above anal verge Correlation with:
# area under the average percent volume DWH
# Exposure to ~62% and to ~102% of prescription dose
Fenwick 2001 [33] 79 Minimum 2 years 60 – 64Gy 3 field
• 3D-CRT
• Conventional
RTOG Grade I – III rectal bleeding ? DSH up to level of rectosigmoid junction Correlation with:
% of RS exposed to > 57Gy
Wachter 2001 [34] 109 Median 30 months 66Gy 4 field 3D-CRT EORTC/RTOG Grade II rectal bleeding 15 DVH From lower to upper boarder of 4 field Cut-off:
≥ 60Gy to >57%
Kupelian 2002 [35] 128 Median 24 months 78Gy 70Gy 4 field (42Gy) 6 field boost (36Gy): 3D-CRT IMRT (SD 2.5Gy) RTOG Grade I – III rectal bleeding 9 DVH From 1 cm above to 1 cm below the target Cut-off:
Absolute rectal volume:
≥ 78Gy to >15 cm3
Huang 2002 [36] 163 Median 62 months 74 – 78Gy 4 field conventional (46Gy) 6 field boost 3D-CRT Modified RTOG ≥ Grad II late rectal toxicity 38 DVH 11 cm in length starting at 2 cm below the inferiormost aspect of the ischial tuberosities Cut-off:
V60 below 40%
V70 below 25%
V75.6 below 15%
V78 below 5%
Fiorino 2003 [37] 245 Median 2 years 70 – 78Gy 3 to 4 field 3D-CRT Modified RTOG Grade II – III rectal bleeding 23 DVH Above anal verge to sigmoid Cut-off:
V50 below 60–65%
V60 below 50–55%
V70 below 25–30%
Greco 2003 [38] 135 Median 28 months 76Gy 6 field 3D-CRT RTOG ≥ Grad II late rectal toxicity 24 DVH from just below the sigmoid flexure to just above the anal verge Cut-off:
V40 below 60%
V50 below 50%
V60 below 25%
V72 below 15%
V76 below 5%
Akimoto 2004 [39] 52 Median 31 months 69Gy SD 3Gy unblocked 4 field technique to the prostate RTOG ≥ Grad II late rectal toxicity 13 DVH above anal verge to point at which it turns into the sigmoid colon Cut-off (equivalent 83Gy prescription dose):
V30 (V24.9) to ≥ 60%
V50 (V41.5) to ≥ 40%
V80 (V66.4) to ≥ 40%
V90 (V74.7) to ≥ 15%
Koper 2004 [40] 266 Minimum 2 years 66Gy Conventional (n = 125) 3 field 3D-CRT (n = 123) RTOG ≥ Grad I late rectal toxicity 57%
47%
DVH (separately for proximal, middle and distal part of rectum) length of intestinal structures was limited to cranial and caudal field borders Correlation with:
Distal rectal volume exposed to ≥ 90% tumor dose
Lee 2005 [41] 212 Median 86 months 35 months 66 70 – 74Gy Conventional 3D-CRT Modified RTOG/Lent and RTOG ≥ Grad II late rectal toxicity 34 DVH ? Cut-offs:
≥ 60Gy to >51.5%
≥ 70Gy to >41.5%
Vargas 2005 [11] 331 Median 19 months 70.2Gy to 79.2Gy Adaptive 3D-CRT CTC 2.0 ≥ Grad II late rectal toxicity 43 DVH, DWH from the anal verge or ischial tuberosities (whichever was higher) to the sacroiliac joints or rectosigmoid junction (whichever was lower) Association with:
DWH: V50, V60, V66.6, V70, V72
DVH V60–V72
Peeters 2006 [42] 614 Median: 44 months 68Gy vs 78Gy 3D-CRT Adapted RTOG/EORTC ≥ Grad II rectal bleeding 31 DWH anorectal, rectal, and anal wall dose volume histogram Correlation with:
anorectal V55–V65