New Rectum Dose Surface Mapping Methodology to Identify Rectal Subregions Associated with Toxicities Following Prostate Cancer Radiotherapy

Overview

Journal Phys Imaging Radiat Oncol

Date 2025 Feb 10

PMID 39927213

Authors

Artemis Bouzaki

Dylan Green

Marcel Van Herk

Jane Shortall

Tanuj Puri

Sarah Kerns

David Azria

Marrie-Pierre Farcy-Jacquet

Jenny Chang-Claude

Ananya Choudhury

Alison Dunning

Maarten Lambrecht

Barbara Avuzzi

Dirk De Ruysscher

Petra Seibold

Elena Sperk

Christopher Talbot

Ana Vega

Liv Veldeman

Adam Webb

Barry Rosenstein

Catharine M West

Eliana Gioscio

Tiziana Rancati

Eliana Vasquez Osorio

Alan McWilliam

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Growing evidence suggests that spatial dose variations across the rectal surface influence toxicity risk after radiotherapy. Existing methodologies employ a fixed, arbitrary physical extent for rectal dose mapping, limiting their analysis. We developed a method to standardise rectum contours, unfold them into 2D cylindrical surface maps, and identify subregions where higher doses increase rectal toxicities.

Materials And Methods: Data of 1,048 patients with prostate cancer from the REQUITE study were used. Deep learning based automatic segmentations were generated to ensure consistency. Rectum length was standardised using linear transformations superior and inferior to the prostate. The automatic contours were validated against the manual contours through contour variation assessment with cylindrical mapping. Voxel-based analysis of the dose surface maps for the manual and automatic contours against individual rectal toxicities was performed using Student's t permutation test and Cox Proportional Hazards Model (CPHM). Significance was defined by permutation testing.

Results: Our method enabled the analysis of 1,048 patients using automatic segmentation. Student's -test showed significance (p < 0.05) in the lower posterior for clinical-reported proctitis and patient-reported bowel urgency. Univariable CPHM identified a 3 % increased risk per Gy for clinician-reported proctitis and a 2 % increased risk per Gy for patient-reported bowel urgency in the lower posterior. No other endpoints were significant.

Conclusion: We developed a methodology that unfolds the rectum to a 2D surface map. The lower posterior was significant for clinician-reported proctitis and patient-reported bowel urgency, suggesting that reducing the dose in the region could decrease toxicity risk.

References

Hoogeman M, Van Herk M, de Bois J, Muller-Timmermans P, Koper P, Lebesque J . Quantification of local rectal wall displacements by virtual rectum unfolding. Radiother Oncol. 2004; 70(1):21-30. DOI: 10.1016/j.radonc.2003.11.015. View

van Herk M, Bruce A, Kroes A, Shouman T, Touw A, Lebesque J . Quantification of organ motion during conformal radiotherapy of the prostate by three dimensional image registration. Int J Radiat Oncol Biol Phys. 1995; 33(5):1311-20. DOI: 10.1016/0360-3016(95)00116-6. View

Sebastian S, OConnor H, OMorain C, Buckley M . Argon plasma coagulation as first-line treatment for chronic radiation proctopathy. J Gastroenterol Hepatol. 2004; 19(10):1169-73. DOI: 10.1111/j.1440-1746.2004.03448.x. View

Someya M, Hori M, Tateoka K, Nakata K, Takagi M, Saito M . Results and DVH analysis of late rectal bleeding in patients treated with 3D-CRT or IMRT for localized prostate cancer. J Radiat Res. 2014; 56(1):122-7. PMC: 4572600. DOI: 10.1093/jrr/rru080. View

Chicas-Sett R, Celada-Alvarez F, Roldan S, Rodriguez-Villalba S, Santos-Olias M, Soler-Catalan P . Interobserver variability in rectum contouring in high-dose-rate brachytherapy for prostate cancer: A multi-institutional prospective analysis. Brachytherapy. 2017; 17(1):208-213. DOI: 10.1016/j.brachy.2017.09.015. View

Smeenk R, Hoffmann A, Hopman W, van Lin E, Kaanders J . Dose-effect relationships for individual pelvic floor muscles and anorectal complaints after prostate radiotherapy. Int J Radiat Oncol Biol Phys. 2011; 83(2):636-44. DOI: 10.1016/j.ijrobp.2011.08.007. View

Green A, Vasquez Osorio E, Aznar M, McWilliam A, Van Herk M . Image Based Data Mining Using Per-voxel Cox Regression. Front Oncol. 2020; 10:1178. PMC: 7386130. DOI: 10.3389/fonc.2020.01178. View

Acosta O, Drean G, Ospina J, Simon A, Haigron P, Lafond C . Voxel-based population analysis for correlating local dose and rectal toxicity in prostate cancer radiotherapy. Phys Med Biol. 2013; 58(8):2581-95. PMC: 3984588. DOI: 10.1088/0031-9155/58/8/2581. View

Sosa-Marrero C, Acosta O, Pasquier D, Thariat J, Delpon G, Fiorino C . Voxel-wise analysis: A powerful tool to predict radio-induced toxicity and potentially perform personalised planning in radiotherapy. Cancer Radiother. 2023; 27(6-7):638-642. DOI: 10.1016/j.canrad.2023.06.024. View

10.

Lin L, Dou Q, Jin Y, Zhou G, Tang Y, Chen W . Deep Learning for Automated Contouring of Primary Tumor Volumes by MRI for Nasopharyngeal Carcinoma. Radiology. 2019; 291(3):677-686. DOI: 10.1148/radiol.2019182012. View

11.

Scaife J, Thomas S, Harrison K, Romanchikova M, Sutcliffe M, Forman J . Accumulated dose to the rectum, measured using dose-volume histograms and dose-surface maps, is different from planned dose in all patients treated with radiotherapy for prostate cancer. Br J Radiol. 2015; 88(1054):20150243. PMC: 4730972. DOI: 10.1259/bjr.20150243. View

12.

Dearnaley D, Syndikus I, Mossop H, Khoo V, Birtle A, Bloomfield D . Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: 5-year outcomes of the randomised, non-inferiority, phase 3 CHHiP trial. Lancet Oncol. 2016; 17(8):1047-1060. PMC: 4961874. DOI: 10.1016/S1470-2045(16)30102-4. View

13.

Palma G, Monti S, Cella L . Voxel-based analysis in radiation oncology: A methodological cookbook. Phys Med. 2020; 69:192-204. DOI: 10.1016/j.ejmp.2019.12.013. View

14.

Drean G, Acosta O, Lafond C, Simon A, de Crevoisier R, Haigron P . Interindividual registration and dose mapping for voxelwise population analysis of rectal toxicity in prostate cancer radiotherapy. Med Phys. 2016; 43(6):2721-2730. DOI: 10.1118/1.4948501. View

15.

Swaminath A, Massey C, Brierley J, Dinniwell R, Wong R, Kim J . Accumulated Delivered Dose Response of Stereotactic Body Radiation Therapy for Liver Metastases. Int J Radiat Oncol Biol Phys. 2015; 93(3):639-48. DOI: 10.1016/j.ijrobp.2015.07.2273. View

16.

Gual-Arnau X, Ibanez-Gual M, Lliso F, Roldan S . Organ contouring for prostate cancer: interobserver and internal organ motion variability. Comput Med Imaging Graph. 2005; 29(8):639-47. DOI: 10.1016/j.compmedimag.2005.06.002. View

17.

Buettner F, Gulliford S, Webb S, Sydes M, Dearnaley D, Partridge M . The dose-response of the anal sphincter region--an analysis of data from the MRC RT01 trial. Radiother Oncol. 2012; 103(3):347-52. DOI: 10.1016/j.radonc.2012.03.002. View

18.

Pinkawa M, Klotz J, Djukic V, Schubert C, Escobar-Corral N, Caffaro M . Learning curve in the application of a hydrogel spacer to protect the rectal wall during radiotherapy of localized prostate cancer. Urology. 2013; 82(4):963-8. DOI: 10.1016/j.urology.2013.07.014. View

19.

Stenmark M, Conlon A, Johnson S, Daignault S, Litzenberg D, Marsh R . Dose to the inferior rectum is strongly associated with patient reported bowel quality of life after radiation therapy for prostate cancer. Radiother Oncol. 2014; 110(2):291-7. DOI: 10.1016/j.radonc.2014.01.007. View

20.

Seibold P, Webb A, Aguado-Barrera M, Azria D, Bourgier C, Brengues M . REQUITE: A prospective multicentre cohort study of patients undergoing radiotherapy for breast, lung or prostate cancer. Radiother Oncol. 2019; 138:59-67. DOI: 10.1016/j.radonc.2019.04.034. View