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Int J Radiat Oncol Biol Phys. 2017 Jun 1;98(2):400-408. doi: 10.1016/j.ijrobp.2017.02.005. Epub 2017 Feb 13.

Predictors of Radiation Therapy-Related Gastrointestinal Toxicity From Anal Cancer Dose-Painted Intensity Modulated Radiation Therapy: Secondary Analysis of NRG Oncology RTOG 0529.

Author information

1
University of Colorado Denver, Aurora, Colorado. Electronic address: Jeffrey.R.Olsen@ucdenver.edu.
2
NRG Oncology Statistics and Data Management Center, Philadelphia, Pennsylvania.
3
Washington University, St. Louis, Missouri.
4
Baptist Hospital of Miami, Miami, Florida.
5
Summa Akron City Hospital accruals for Akron City Hospital, Akron, Ohio.
6
Florida Radiation Oncology Group-Baptist Regional, Jacksonville, Florida.
7
University of Colorado Denver, Aurora, Colorado.
8
University of Rochester Medical Center, Rochester, New York.
9
London Regional Cancer Program-University of Western Ontario, London, Ontario, Canada.
10
Michigan Cancer Research Consortium CCOP, Ann Arbor, Michigan.
11
University of California San Francisco, San Francisco, California.
12
Memorial Sloan Kettering Cancer Center, New York, New York.
13
Vanderbilt University Medical Center, Nashville, Tennessee.

Abstract

PURPOSE:

NRG Oncology RTOG 0529 assessed the feasibility of dose-painted intensity modulated radiation therapy (DP-IMRT) to reduce the acute morbidity of chemoradiation with 5-fluorouracil (5FU) and mitomycin-C (MMC) for T2-4N0-3M0 anal cancer. This secondary analysis was performed to identify patient and treatment factors associated with acute and late gastrointestinal (GI) adverse events (AEs).

METHODS AND MATERIALS:

NRG Oncology RTOG 0529 treatment plans were reviewed to extract dose-volume data for tightly contoured small bowel, loosely contoured anterior pelvic contents (APC), and uninvolved colon outside the target volume (UC). Univariate logistic regression was performed to evaluate association between volumes of each structure receiving doses ≥5 to 60 Gy (V5-V60) in 5-Gy increments between patients with and without grade ≥2 acute and late GI AEs, and grade ≥3 acute GI AEs. Additional patient and treatment factors were evaluated in multivariate logistic regression (acute AEs) or Cox proportional hazards models (late AEs).

RESULTS:

Among 52 evaluable patients, grade ≥2 acute, grade ≥2 late, and grade ≥3 acute GI AEs were observed in 35, 17, and 10 patients, respectively. Trends (P<.05) toward statistically significant associations were observed between grade ≥2 acute GI AEs and small bowel dose (V20-V40), grade ≥2 late GI AEs and APC dose (V60), grade ≥3 acute GI AEs and APC dose (V5-V25), increasing age, tumor size >4 cm, and worse Zubrod performance status. Small bowel volumes of 186.0 cc, 155.0 cc, 41.0 cc, and 30.4 cc receiving doses greater than 25, 30, 35, and 40 Gy, respectively, correlated with increased risk of acute grade ≥2 GI AEs.

CONCLUSIONS:

Acute and late GI AEs from 5FU/MMC chemoradiation using DP-IMRT correlate with radiation dose to the small bowel and APC. Such associations will be incorporated in the dose-volume normal tissue constraint design for future NRG oncology anal cancer studies.

PMID:
28463160
PMCID:
PMC5639877
DOI:
10.1016/j.ijrobp.2017.02.005
[Indexed for MEDLINE]
Free PMC Article

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