Correlation between dose-volume parameters and rectal bleeding after 12 fractions of carbon ion radiotherapy for prostate cancer

doi:10.4329/wjr.v16.i7.256

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World Journal of Radiology

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World J Radiol. Jul 28, 2024; 16(7): 256-264
Published online Jul 28, 2024. doi: 10.4329/wjr.v16.i7.256

Correlation between dose-volume parameters and rectal bleeding after 12 fractions of carbon ion radiotherapy for prostate cancer

Takashi Ono, Hiraku Sato, Yuya Miyasaka, Yasuhito Hagiwara, Natsuko Yano, Hiroko Akamatsu, Mayumi Harada, Mayumi Ichikawa

Takashi Ono, Hiraku Sato, Yasuhito Hagiwara, Natsuko Yano, Hiroko Akamatsu, Mayumi Harada, Mayumi Ichikawa, Department of Radiation Oncology, Faculty of Medicine, Yamagata University, Yamagata 990-9585, Japan

Yuya Miyasaka, Department of Heavy Particle Medical Science, Yamagata University Graduate School of Medical Science, Yamagata 990-9585, Japan

Author contributions: Ono T designed and performed the research and wrote present paper; Sato H designed and supervised the report; Miyasaka Y provided clinical advice; Hagiwara Y, Yano N, Akamatsu H, Harada M, and Ichikawa M contributed to data analysis.

Institutional review board statement: This study was reviewed and approved by the Ethics Committee of the Faculty of Medicine at Yamagata University (approval number: 2023-51).

Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written informed consent. When consenting to treatment, we also informed patients of the possibility of their use in research, and they agreed to this, so we do not believe it is necessary to obtain new consent for this study. For full disclosure, the details of the study are published on the home page of Faculty of Medicine at Yamagata University.

Conflict-of-interest statement: All authors report no relevant conflicts of interest for this article.

Data sharing statement: Data sharing is not applicable to this article.

Corresponding author: Takashi Ono, MD, PhD, Doctor, Department of Radiation Oncology, Faculty of Medicine, Yamagata University, 2-2-2 Iida-Nishi, Yamagata 990-9585, Japan. abc1123513@gmail.com

Received: May 21, 2024
Revised: July 8, 2024
Accepted: July 10, 2024
Published online: July 28, 2024
Processing time: 63 Days and 21.9 Hours

Abstract

BACKGROUND

Carbon ion radiotherapy (CIRT) is currently used to treat prostate cancer. Rectal bleeding is a major cause of toxicity even with CIRT. However, to date, a correlation between the dose and volume parameters of the 12 fractions of CIRT for prostate cancer and rectal bleeding has not been shown. Similarly, the clinical risk factors for rectal bleeding were absent after 12 fractions of CIRT.

AIM

To identify the risk factors for rectal bleeding in 12 fractions of CIRT for prostate cancer.

METHODS

Among 259 patients who received 51.6 Gy [relative biological effectiveness (RBE)], in 12 fractions of CIRT, 15 had grade 1 (5.8%) and nine had grade 2 rectal bleeding (3.5%). The dose-volume parameters included the volume (cc) of the rectum irradiated with at least x Gy (RBE) (Vx) and the minimum dose in the most irradiated x cc normal rectal volume (Dx).

RESULTS

The mean values of D6cc, D2cc, V10 Gy (RBE), V20 Gy (RBE), V30 Gy (RBE), and V40 Gy (RBE) were significantly higher in the patients with rectal bleeding than in those without. The cutoff values were D6cc = 34.34 Gy (RBE), D2cc = 46.46 Gy (RBE), V10 Gy (RBE) = 9.85 cc, V20 Gy (RBE) = 7.00 cc, V30 Gy (RBE) = 6.91 cc, and V40 Gy (RBE) = 4.26 cc. The D2cc, V10 Gy (RBE), and V20 Gy (RBE) cutoff values were significant predictors of grade 2 rectal bleeding.

CONCLUSION

The above dose-volume parameters may serve as guidelines for preventing rectal bleeding after 12 fractions of CIRT for prostate cancer.

Keywords: Carbon ion radiotherapy; Prostate cancer; Rectal bleeding; Dose volume parameters; Prevention

Core Tip: This study identified the risk factors for rectal bleeding, including dose–volume parameters of 51.6 Gy [relative biological effectiveness (RBE)] in 12 fractions of carbon ion radiotherapy (CIRT) for prostate cancer. The cutoff values of D2cc = 46.46 Gy (RBE), V10 Gy (RBE) = 9.85 cc, and V20 Gy (RBE) = 7.00 cc were significant factors for the occurrence rate of grade 2 rectal bleeding. When planning CIRT for prostate cancer, the rate of rectal bleeding may decrease if these values are used.