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Selected Works of Max Bulsara
Article
Impact of treatment planning and delivery factors on gastrointestinal toxicity: an analysis of data from the RADAR prostate radiotherapy trial
Radiation Oncology (2014)
  • Noorazrul Yahya, The University of Western Australia
  • Martin Ebert, The University of Western Australia
  • Max Bulsara, The University of Notre Dame Australia
  • Annette Haworth, The University of Melbourne
  • Rachel Kearvell, Sir Charles Gairdner Hospital
  • Kerwyn Foo, The University of Sydney
  • Angel Kennedy, Sir Charles Gairdner Hospital
  • Sharon Richardson, Sir Charles Gairdner Hospital
  • Michele Krawiec, Sir Charles Gairdner Hospital
  • David Joseph, Sir Charles Gairdner Hospital
  • James Denham, The University of Newcastle
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Abstract
Background: To assess the impact of incremental modifications of treatment planning and delivery technique, as
well as patient anatomical factors, on late gastrointestinal toxicity using data from the TROG 03.04 RADAR prostate
radiotherapy trial.
Methods: The RADAR trial accrued 813 external beam radiotherapy participants during 2003–2008 from 23 centres.
Following review and archive to a query-able database, digital treatment plans and data describing treatment
technique for 754 patients were available for analysis. Treatment demographics, together with anatomical features,
were assessed using uni- and multivariate regression models against late gastrointestinal toxicity at 18-, 36- and
54-month follow-up. Regression analyses were reviewed in the context of dose-volume data for the rectum and
anal canal.
Results: A multivariate analysis at 36-month follow-up shows that patients planned using a more rigorous dose
calculation algorithm (DCA) was associated with a lower risk of stool frequency (OR: 0.435, CI: 0.242–0.783, corrected
p = 0.04). Patients using laxative as a method of bowel preparation had higher risk of having increased stool frequency
compared to patients with no dietary intervention (OR: 3.639, CI: 1.502–8.818, corrected p = 0.04). Despite higher risks of
toxicities, the anorectum, anal canal and rectum dose-volume histograms (DVH) indicate patients using laxative had
unremarkably different planned dose distributions. Patients planned with a more rigorous DCA had lower median DVH
values between EQD23 = 15 Gy and EQD23 = 35 Gy. Planning target volume (PTV), conformity index, rectal width
and prescription dose were not significant when adjusted for false discovery rate. Number of beams, beam energy,
treatment beam definition, positioning orientation, rectum-PTV separation, rectal length and mean cross sectional
area did not affect the risk of toxicities.
Conclusions: The RADAR study dataset has allowed an assessment of technical modifications on gastrointestinal
toxicity. A number of interesting associations were subsequently found and some factors, previously hypothesised
to influence toxicity, did not demonstrate any significant impact. We recommend trial registries be encouraged to
record technical modifications introduced during the trial in order for more powerful evidence to be gathered
regarding the impact of the interventions.
Disciplines
Publication Date
2014
DOI
10.1186/s13014-014-0282-7
Citation Information
Yahya, N., Ebert, M., Bulsara, M., Haworth, A., Kearvell, R., Foo, K., Kennedy, A., Richardson, S., Krawiec, M., Joseph, D., and Denham, J. (2014). Impact of treatment planning and delivery factors on gastrointestinal toxicity: an analysis of data from the RADAR prostate radiotherapy trial. Radiation Oncology, 9. DOI: 10.1186/s13014-014-0282-7