Patient-reported urinary incontinence after radiotherapy for prostate cancer: Quantifying the doseâeffect
Radiotherapy & Oncology Aug 24, 2017
Cozzarini C, et al. Â The unknown doseÂeffect relationship for late patientÂreported urinary incontinence (LPRUI) was examined. For prostate cancer (PCa), LPRUI after radiotherapy (RT) dramatically depended on 2 Gy equivalent dose (EQD2) and few clinical factors. A consistency was observed between results and a larger than expected impact of moderate hypoÂfractionation on the risk of LPRUI. As expected, a link was noted between baseline symptoms, as captured by ICIQÂSF, and an increased risk of LPRUI.
- The multi-centric study DUE01 incorporated patients.
- Researchers gathered clinical and dosimetry data including the prescribed 2 Gy equivalent dose (EQD2).
- Via the ICIQ-SF questionnaire filled in by the patients at RT start/end and therefore every 6 months, LPRUI was evaluated.
- Conventional (74Â80 Gy, 1.8Â2 Gy/fr) or moderately hypo-fractionated RT (65Â75.2 Gy, 2.2Â2.7 Gy/fr) in 5 fractions/week with intensity-modulated radiotherapy had been given to patients.
- They considered six different end-points of 3-year LPRUI, including or not patientÂs perception (respectively, subjective and objective end-points).
- For each end-point, multivariable logistic models were developed.
- They examined data of 298 patients.
- 5.1% was the incidence of the most severe end-point (ICIQ-SF>12).
- In addition, EQD2 calculated with alphaÂbeta=0.8 Gy showed the best performance in fitting data: the risk of LPRUI markedly increased for EQD2>80 Gy.
- The clinical factors more significantly predictive of LPRUI were previous abdominal/pelvic surgery and previous TURP.
- Confirmed by bootstrap-based internal validation, models showed excellent performances in terms of goodness-of-fit and calibration.
- Baseline symptoms were a major predictor for 5 out of six end-points when included in the analyses.
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