J Cancer 2019; 10(11):2588-2593. doi:10.7150/jca.29606

Research Paper

Developing a multivariable normal tissue complication probability model to predict late rectal bleeding following intensity-modulated radiation therapy

Chun-Chieh Huang1,2, Pei-Ju Chao1,3, Shih-Sian Guo1,3, Chong-Jong Wang1, Hao-Lun Luo4, Yu-Li Su5, Tsair-Fwu Lee1,3,6✉, Fu-Min Fang1✉

1. Department of Radiation Oncology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
2. Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Taoyuan, Taiwan
3. Medical Physics and Informatics Laboratory of Electronics Engineering, National Kaohsiung University of Science and Technology, Kaohsiung, Taiwan
4. Department of Urology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
5. Division of Hematology-Oncology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
6. Graduate Institute of Clinical Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

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Citation:
Huang CC, Chao PJ, Guo SS, Wang CJ, Luo HL, Su YL, Lee TF, Fang FM. Developing a multivariable normal tissue complication probability model to predict late rectal bleeding following intensity-modulated radiation therapy. J Cancer 2019; 10(11):2588-2593. doi:10.7150/jca.29606. Available from http://www.jcancer.org/v10p2588.htm

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Abstract

Purpose: To develop a multivariable normal tissue complication probability (NTCP) model to predict moderate to severe late rectal bleeding following intensity-modulated radiation therapy (IMRT).

Methods and materials: Sixty-eight patients with localized prostate cancer treated by IMRT from 2008 to 2011 were enrolled. The median follow-up time was 56 months. According to the criteria of D'Amico risk classifications, there were 9, 20 and 39 patients in low, intermediate and high-risk groups, respectively. Forty-two patients were combined with androgen deprivation therapy. Fifteen patients had suffered from grade 2 or more (grade 2+) late rectal bleeding. The numbers of predictors for a multivariable logistic regression NTCP model were determined by the least absolute shrinkage and selection operator (LASSO).

Results: The most important predictors for late rectal bleeding ranked by LASSO were platelet count, risk group and the relative volume of rectum receiving at least 65 Gy (V65). The NTCP model of grade 2+ rectal bleeding was as follows: S = -17.49 + Platelets (1000/μL) * (-0.025) + Risk group * Corresponding coefficient (low-risk group = 0; intermediate-risk group = 19.07; high-risk group = 20.41) + V65 * 0.045.

Conclusions: A LASSO-based multivariable NTCP model comprising three important predictors (platelet count, risk group and V65) was established to predict the incidence of grade 2+ late rectal bleeding after IMRT.

Keywords: rectal bleeding, radiation therapy, normal tissue complication probability, prostate cancer