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

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