Impact of treatment planning and delivery factors on gastrointestinal toxicity: An analysis of data from the RADAR prostate radiotherapy trial

Noorazrul Azmie Yahya, Martin A. Ebert, Max Bulsara, Annette Haworth, Rachel Kearvell, Kerwyn Foo, Angel Kennedy, Sharon Richardson, Michele Krawiec, David J. Joseph, Jim W. Denham

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Background: To assess the impact of incremental modifications of treatment planning and delivery technique, as well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate radiotherapy trial. Methods: The RADAR trial accrued 813 external beam radiotherapy participants during 2003-2008 from 23 centres. Following review and archive to a query-able database, digital treatment plans and data describing treatment technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features, were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and 54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and anal canal. Results: A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242-0.783, corrected p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency compared to patients with no dietary intervention (OR: 3.639, CI: 1.502-8.818, corrected p = 0.04). Despite higher risks of toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH values between EQD23 = 15 Gy and EQD23 = 35 Gy. Planning target volume (PTV), conformity index, rectal width and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy, treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional area did not affect the risk of toxicities. Conclusions: The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal toxicity. A number of interesting associations were subsequently found and some factors, previously hypothesised to influence toxicity, did not demonstrate any significant impact. We recommend trial registries be encouraged to record technical modifications introduced during the trial in order for more powerful evidence to be gathered regarding the impact of the interventions.

Original languageEnglish
Article number282
JournalRadiation Oncology
Volume9
Issue number1
DOIs
Publication statusPublished - 13 Dec 2014

Fingerprint

Prostate
Radiotherapy
Rectum
Laxatives
Anal Canal
Therapeutics
Planning Techniques
Prescriptions
Registries
Multivariate Analysis
Regression Analysis
Demography
Databases

Keywords

  • Dose-volume histogram
  • Gastrointestinal toxicity
  • Prostate cancer
  • Technical modifications

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Impact of treatment planning and delivery factors on gastrointestinal toxicity : An analysis of data from the RADAR prostate radiotherapy trial. / Yahya, Noorazrul Azmie; Ebert, Martin A.; Bulsara, Max; Haworth, Annette; Kearvell, Rachel; Foo, Kerwyn; Kennedy, Angel; Richardson, Sharon; Krawiec, Michele; Joseph, David J.; Denham, Jim W.

In: Radiation Oncology, Vol. 9, No. 1, 282, 13.12.2014.

Research output: Contribution to journalArticle

Yahya, NA, Ebert, MA, Bulsara, M, Haworth, A, Kearvell, R, Foo, K, Kennedy, A, Richardson, S, Krawiec, M, Joseph, DJ & Denham, JW 2014, 'Impact of treatment planning and delivery factors on gastrointestinal toxicity: An analysis of data from the RADAR prostate radiotherapy trial', Radiation Oncology, vol. 9, no. 1, 282. https://doi.org/10.1186/s13014-014-0282-7
Yahya, Noorazrul Azmie ; Ebert, Martin A. ; Bulsara, Max ; Haworth, Annette ; Kearvell, Rachel ; Foo, Kerwyn ; Kennedy, Angel ; Richardson, Sharon ; Krawiec, Michele ; Joseph, David J. ; Denham, Jim W. / Impact of treatment planning and delivery factors on gastrointestinal toxicity : An analysis of data from the RADAR prostate radiotherapy trial. In: Radiation Oncology. 2014 ; Vol. 9, No. 1.
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AU - Kearvell, Rachel

AU - Foo, Kerwyn

AU - Kennedy, Angel

AU - Richardson, Sharon

AU - Krawiec, Michele

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AU - Denham, Jim W.

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N2 - Background: To assess the impact of incremental modifications of treatment planning and delivery technique, as well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate radiotherapy trial. Methods: The RADAR trial accrued 813 external beam radiotherapy participants during 2003-2008 from 23 centres. Following review and archive to a query-able database, digital treatment plans and data describing treatment technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features, were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and 54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and anal canal. Results: A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242-0.783, corrected p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency compared to patients with no dietary intervention (OR: 3.639, CI: 1.502-8.818, corrected p = 0.04). Despite higher risks of toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH values between EQD23 = 15 Gy and EQD23 = 35 Gy. Planning target volume (PTV), conformity index, rectal width and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy, treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional area did not affect the risk of toxicities. Conclusions: The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal toxicity. A number of interesting associations were subsequently found and some factors, previously hypothesised to influence toxicity, did not demonstrate any significant impact. We recommend trial registries be encouraged to record technical modifications introduced during the trial in order for more powerful evidence to be gathered regarding the impact of the interventions.

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