• Riccardo Valdagni, Michael W Kattan, Tiziana Rancati, Changhong Yu, Vittorio Vavassori, Giovanni Fellin, Elena Cagna, Pietro Gabriele, Flora Anna Mauro, Micaela Baccolini, Carla Bianchi, Loris Menegotti, Angelo F Monti, Michele Stasi, Maria Olga Giganti, and Claudio Fiorino.
• Prostate Program, Scientific Directorate, Fondazione IRCCS-Istituto Nazionale Tumori, Milan, Italy.
• Int. J. Radiat. Oncol. Biol. Phys. 2012 Apr 1; 82 (5): 1957-66.

PurposeDevelopment of user-friendly tools for the prediction of single-patient probability of late rectal toxicity after conformal radiotherapy for prostate cancer.Methods And MaterialsThis multicenter protocol was characterized by the prospective evaluation of rectal toxicity through self-assessed questionnaires (minimum follow-up, 36 months) by 718 adult men in the AIROPROS 0102 trial. Doses were between 70 and 80 Gy. Nomograms were created based on multivariable logistic regression analysis. Three endpoints were considered: G2 to G3 late rectal bleeding (52/718 events), G3 late rectal bleeding (24/718 events), and G2 to G3 late fecal incontinence (LINC, 19/718 events).ResultsInputs for the nomogram for G2 to G3 late rectal bleeding estimation were as follows: presence of abdominal surgery before RT, percentage volume of rectum receiving >75 Gy (V75Gy), and nomogram-based estimation of the probability of G2 to G3 acute gastrointestinal toxicity (continuous variable, which was estimated using a previously published nomogram). G3 late rectal bleeding estimation was based on abdominal surgery before RT, V75Gy, and NOMACU. Prediction of G2 to G3 late fecal incontinence was based on abdominal surgery before RT, presence of hemorrhoids, use of antihypertensive medications (protective factor), and percentage volume of rectum receiving >40 Gy.ConclusionsWe developed and internally validated the first set of nomograms available in the literature for the prediction of radio-induced toxicity in prostate cancer patients. Calculations included dosimetric as well as clinical variables to help radiation oncologists predict late rectal morbidity, thus introducing the possibility of RT plan corrections to better tailor treatment to the patient's characteristics, to avoid unnecessary worsening of quality of life, and to provide support to the patient in selecting the best therapeutic approach.Copyright © 2012 Elsevier Inc. All rights reserved.

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