Normal tissue complication probabilities correlated with late effects in the rectum after prostate conformal radiotherapy

Purpose: Radiation therapy of deep-sited tumours will always result in norm al tissue doses to some extent. The aim of this study was to calculate diff erent risk estimates of late effects in the rectum for a group of cancer pr ostate patients treated with conformal radiation therapy (CRT) and correlat e these estimates with the occurrences of late effects. Since the rectum is a hollow organ, several ways of generating dose-volume distributions over the organ are possible, and we wanted to investigate two of them. Methods and Materials: A mathematical model, known as the Lyman-Kutcher mod el, conventionally used to estimate normal tissue complication probabilitie s (NTCP) associated with radiation therapy, was applied to a material of 52 cancer prostate patients. The patients were treated with a four field box technique, with the rectum as organ at risk. Dose-volume histograms (DVH) w ere generated for the whole rectum (including the cavity) and of the rectum wall. One to two years after the treatment, the patients completed a quest ionnaire concerning bowel (rectum) related morbidity quantifying the extent of late effects. Results: A correlation analysis using Spearman's rank correlation coefficie nt, for NTCP values calculated from the DVHs and the patients' scores, gave correlation coefficients which were not statistically significant at the p < 0.01 level. The correlation coefficients based on histograms of the whol e rectum were larger than those derived from histograms of the rectum wall. Also, simpler descriptive measures as D-max, of the whole rectum, correlat ed better to observed late toxicity than D-max derived from histograms of t he rectum wall. Correlation coefficients from "high-dose" measures were lar ger than those calculated from the NTCP values. Accordingly, as the volume parameter of the Lyman-Kutcher model was reduced, raising the impact of sma ll high-dose volumes on the NTCP values, the correlation between observed e ffects and NTCP values became significant at p < 0.01 level. Conclusions: 1) High-dose levels corresponding to small volume fractions of the cumulative dose-volume histograms were best correlated with the occurr ences of late effects in the rectum as measured with questionnaires. This i s compatible with a more serial organisation of the rectal tissue architect ure than previously reported. 2) Reducing the Lyman-Kutcher model's volume parameter, thus allowing small high-dose regions to determine the NTCP, imp roved the correlation, but not beyond that of high-dose levels correspondin g to small volume fractions of the cumulative dose-volume histograms. (C) 1 999 Elsevier Science Inc.