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Dose-response relationships for an atomized symptom of fecal incontinence after gynecological radiotherapy.
Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden / Department of Oncology-Pathology, Division of Medical Radiation Physics, Karolinska Institutet, Sweden.
Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden.
Department of Oncology-Pathology, Division of Clinical Cancer Epidemiology, Karolinska Institutet, Stockholm, Sweden / Department of Hospital Physics, Karolinska University Hospital, Stockholm, Sweden.
Department of Oncology, Clinical Cancer Epidemiology, the Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden / Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
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2013 (English)In: Acta Oncologica, ISSN 0284-186X, E-ISSN 1651-226X, Vol. 52, no 4, 719-26 p.Article in journal (Refereed) Published
Abstract [en]

PURPOSE: The aim of this study was to investigate what bowel organ and delivered dose levels are most relevant for the development of 'emptying of all stools into clothing without forewarning' so that the related dose-responses could be derived as an aid in avoiding this distressing symptom in the future.

MATERIAL AND METHODS: Of the 77 gynecological cancer survivors treated with radiotherapy (RT) for gynecological cancer, 13 developed the symptom. The survivors were treated between 1991 and 2003. The anal-sphincter region, the rectum, the sigmoid and the small intestines were all delineated and the dose-volume histograms were exported for each patient. The dose-volume parameters were estimated fitting the data to the Relative Seriality (RS), the Lyman and the generalized Equivalent Uniform Dose (gEUD) model.

RESULTS: The dose-response parameters for all three models and four organs at risk (OARs) were estimated. The data from the sigmoid fits the studied models best: D50 was 58.8 and 59.5 Gy (RS, Lyman), γ50 was 1.60 and 1.57 (RS, Lyman), s was 0.32, n was 0.13 and a was 7.7 (RS, Lyman, gEUD). The estimated volume parameters indicate that the investigated OARs behave serially for this endpoint. Our results for the three models studied indicate that they have the same predictive power (similar LL values) for the symptom as a function of the dose for all investigated OARs.

CONCLUSIONS: In our study, the anal-sphincter region and sigmoid fit our data best, but all OARs were found to have steep dose-responses for 'emptying of all stools into clothing without forewarning' and thus, the outcome can be predicted with an NTCP model. In addition, the dose to the four studied OARs may be considered when minimizing the risk of the symptom.

Place, publisher, year, edition, pages
Taylor & Francis, 2013. Vol. 52, no 4, 719-26 p.
National Category
Radiology, Nuclear Medicine and Medical Imaging
Identifiers
URN: urn:nbn:se:liu:diva-116615DOI: 10.3109/0284186X.2012.734924ISI: 000317239200005PubMedID: 23113592OAI: oai:DiVA.org:liu-116615DiVA: diva2:798992
Available from: 2015-03-27 Created: 2015-03-27 Last updated: 2017-12-04

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Åvall Lundqvist, Elisabeth

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