Identification of a rectal subregion highly predictive of rectal bleeding in prostate cancer IMRT

Abstract : Background and purpose: To identify rectal subregions at risks (SRR) highly predictive of 3-year rectal bleeding (RB) in prostate cancer IMRT. Materials and methods: Overall, 173 prostate cancer patients treated with IMRT/IGRT were prospectively analyzed, divided into "training" (n =118) and "validation" cohorts (n = 53). Dose-volume histograms (DVHs) were calculated in three types of rectal subregions: "geometric", intuitively defined (hemi-rectum,...); "personalized", obtained by non-rigid registration followed by voxel-wise statistical analysis (SRRp); "generic", mapped from SRRps, located within 8 x 8 rectal subsections (SRRg). DVHs from patients with and without RB were compared and used for toxicity prediction. Results:- Training cohort SRRps were primarily within the inferior anterior hemi-rectum and upper anal canal, with 3.8 Gy mean dose increase for Grade >= 1 RB patients. The SRRg, representing 15% of the absolute rectal volume, was located in 10 inferior-anterior rectal subsections. V18-V70 for SRRps and V58-V65 for SRRg were significantly higher for RB patients than non-RB. Maximum areas under the curve (AUCs) for SRRp and SRRg RB prediction were 71% and 64%, respectively. The validation cohort confirmed the predictive value of SRRg for Grade >= 1 RB. The total cohort confirmed the predictive value of SRRg for Grade >= 2 RB. Geometrical subregions were not RB predictors. Conclusion: The inferior-anterior hemi anorectum was highly predictive of RB. (C) 2016 Elsevier Ireland Ltd. All rights reserved.
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Submitted on : Wednesday, September 7, 2016 - 1:54:29 PM
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Gwenaelle Correge, Jean-L. Lagrange, Gilles Créhange, Antoine Simon, Pascal Haigron, et al.. Identification of a rectal subregion highly predictive of rectal bleeding in prostate cancer IMRT. Radiotherapy and Oncology, Elsevier, 2016, 119 (3), pp.388--397. ⟨10.1016/j.radonc.2016.04.023⟩. ⟨hal-01361503⟩

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