Urinary symptoms following external beam radiotherapy of the prostate

Dose-symptom correlates with multiple-event and event-count models

Noorazrul Azmie Yahya, Martin A. Ebert, Max Bulsara, Michael J. House, Angel Kennedy, David J. Joseph, James W. Denham

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background and purpose This study aimed to compare urinary dose-symptom correlates after external beam radiotherapy of the prostate using commonly utilised peak-symptom models to multiple-event and event-count models which account for repeated events. Materials and methods Urinary symptoms (dysuria, haematuria, incontinence and frequency) from 754 participants from TROG 03.04-RADAR trial were analysed. Relative (R1-R75 Gy) and absolute (A60-A75 Gy) bladder dose-surface area receiving more than a threshold dose and equivalent uniform dose using exponent a (range: aâ [1 ... 100]) were derived. The dose-symptom correlates were analysed using; peak-symptom (logistic), multiple-event (generalised estimating equation) and event-count (negative binomial regression) models. Results Stronger dose-symptom correlates were found for incontinence and frequency using multiple-event and/or event-count models. For dysuria and haematuria, similar or better relationships were found using peak-symptom models. Dysuria, haematuria and high grade (≥2) incontinence were associated to high dose (R61-R71 Gy). Frequency and low grade (≥1) incontinence were associated to low and intermediate dose-surface parameters (R13-R41 Gy). Frequency showed a parallel behaviour (a = 1) while dysuria, haematuria and incontinence showed a more serial behaviour (a = 4 to a ≥ 100). Relative dose-surface showed stronger dose-symptom associations. Conclusions For certain endpoints, the multiple-event and event-count models provide stronger correlates over peak-symptom models. Accounting for multiple events may be advantageous for a more complete understanding of urinary dose-symptom relationships.

Original languageEnglish
Pages (from-to)277-282
Number of pages6
JournalRadiotherapy and Oncology
Volume117
Issue number2
DOIs
Publication statusPublished - 1 Nov 2015

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Dysuria
Hematuria
Prostate
Radiotherapy
Statistical Models
Urinary Bladder

Keywords

  • Event-count model
  • Multiple-event model
  • Normal tissue complications
  • Prostate radiotherapy
  • Urinary symptoms

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Hematology

Cite this

Urinary symptoms following external beam radiotherapy of the prostate : Dose-symptom correlates with multiple-event and event-count models. / Yahya, Noorazrul Azmie; Ebert, Martin A.; Bulsara, Max; House, Michael J.; Kennedy, Angel; Joseph, David J.; Denham, James W.

In: Radiotherapy and Oncology, Vol. 117, No. 2, 01.11.2015, p. 277-282.

Research output: Contribution to journalArticle

Yahya, Noorazrul Azmie ; Ebert, Martin A. ; Bulsara, Max ; House, Michael J. ; Kennedy, Angel ; Joseph, David J. ; Denham, James W. / Urinary symptoms following external beam radiotherapy of the prostate : Dose-symptom correlates with multiple-event and event-count models. In: Radiotherapy and Oncology. 2015 ; Vol. 117, No. 2. pp. 277-282.
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abstract = "Background and purpose This study aimed to compare urinary dose-symptom correlates after external beam radiotherapy of the prostate using commonly utilised peak-symptom models to multiple-event and event-count models which account for repeated events. Materials and methods Urinary symptoms (dysuria, haematuria, incontinence and frequency) from 754 participants from TROG 03.04-RADAR trial were analysed. Relative (R1-R75 Gy) and absolute (A60-A75 Gy) bladder dose-surface area receiving more than a threshold dose and equivalent uniform dose using exponent a (range: a{\^a} [1 ... 100]) were derived. The dose-symptom correlates were analysed using; peak-symptom (logistic), multiple-event (generalised estimating equation) and event-count (negative binomial regression) models. Results Stronger dose-symptom correlates were found for incontinence and frequency using multiple-event and/or event-count models. For dysuria and haematuria, similar or better relationships were found using peak-symptom models. Dysuria, haematuria and high grade (≥2) incontinence were associated to high dose (R61-R71 Gy). Frequency and low grade (≥1) incontinence were associated to low and intermediate dose-surface parameters (R13-R41 Gy). Frequency showed a parallel behaviour (a = 1) while dysuria, haematuria and incontinence showed a more serial behaviour (a = 4 to a ≥ 100). Relative dose-surface showed stronger dose-symptom associations. Conclusions For certain endpoints, the multiple-event and event-count models provide stronger correlates over peak-symptom models. Accounting for multiple events may be advantageous for a more complete understanding of urinary dose-symptom relationships.",
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