Email updates

Keep up to date with the latest news and content from Radiation Oncology and BioMed Central.

Open Access Research

Acute gastrointestinal and genitourinary toxicity of image-guided intensity modulated radiation therapy for prostate cancer using a daily water-filled endorectal balloon

Curtiland Deville13*, Stefan Both1, Viet Bui1, Wei-Ting Hwang2, Kay-See Tan2, Mattia Schaer1, Zelig Tochner1 and Neha Vapiwala1

Author Affiliations

1 Department of Radiation Oncology, Pennsylvania, USA

2 Department of Biostatistics & Epidemiology, University of Pennsylvania, Philadelphia, Pennsylvania, USA

3 University of Pennsylvania, Perelman School of Medicine, Department of Radiation Oncology, 3400 Civic Center Boulevard, TRC 2W, Philadelphia, PA 19104, USA

For all author emails, please log on.

Radiation Oncology 2012, 7:76  doi:10.1186/1748-717X-7-76

Published: 23 May 2012

Abstract

Background

Our purpose was to report acute gastrointestinal (GI) and genitourinary (GU) toxicity rates for prostate cancer patients undergoing image-guided intensity modulated radiation therapy (IG-IMRT) with a daily endorectal water-filled balloon (ERBH2O), and assess associations with planning parameters and pretreatment clinical characteristics.

Methods

The first 100 patients undergoing prostate and proximal seminal vesicle IG-IMRT with indexed-lumen 100 cc ERBH2O to 79.2 Gy in 1.8 Gy fractions at our institution from 12/2008- 12/2010 were assessed. Pretreatment characteristics, organ-at-risk dose volume histograms, and maximum GU and GI toxicities (CTCAE 3.0) were evaluated. Logistic regression models evaluated univariate association between toxicities and dosimetric parameters, and uni- and multivariate association between toxicities and pretreatment characteristics.

Results

Mean age was 68 (range 51–88). Thirty-two, 49, and 19 patients were low, intermediate, and high-risk, respectively; 40 received concurrent androgen deprivation. No grade 3 or greater toxicities were recorded. Maximum GI toxicity was grade 0, 1, and 2 in 69%, 23%, and 8%, respectively. Infield (defined as 1 cm above/below the CTV) rectal mean/median doses, D75, V30, and V40 and hemorrhoid history were associated with grade 2 GI toxicity (Ps < 0.05). Maximum acute GU toxicity was grade 0, 1, and 2 for 17%, 41%, and 42% of patients, respectively. Infield bladder V20 (P = 0.03) and pretreatment International Prostate Symptom Scale (IPSS) (P = 0.003) were associated with grade 2 GU toxicity.

Conclusion

Prostate IG-IMRT using a daily ERBH2O shows low rates of acute GI toxicity compared to previous reports of air-filled ERB IMRT when using stringent infield rectum constraints and comparable GU toxicities.

Keywords:
Rectal balloon; IMRT; Toxicity; Prostate cancer