Dose escalation to the intraprostatic lesion – the results of acute and early late toxicity
Authors:
Martin Doležel 1,2,3; Karel Odrážka 1,2; Jaroslav Vaňásek 1; Milan Mrklovský 1; Petr Hoffmann 4; Karel Lucký 5; Igor Hartmann 3,6
Authors‘ workplace:
KOC Pardubická krajská nemocnice a. s. a Multiscan s. r. o., Pardubice
1; 1. lékařská fakulta, Univerzita Karlova v Praze
2; Lékařská fakulta UP, Olomouc
3; Radiologická klinika FN, Hradec Králové
4; Urologické oddělení, Pardubická krajská nemocnice a. s.
5; Urologická klinika FN, Olomouc
6
Published in:
Ces Urol 2013; 17(3): 175-182
Category:
Original article
Overview
Aim:
To evaluate the feasibility and toxicity of dose escalation to the intraprostatic lesion to 84.84 Gy in 40 fractions using simultaneous integrated boost (SIB).
Methods:
Between September 2009 and September 2012, we treated 41 patients with intensity-modulated radiotherapy (IMRT) for prostate cancer using SIB. Intraprostatic lesion was defined by MRI or MRI plus spectroscopy, transrectal ultrasound and physical examination. The prescribed doses were 84.84 Gy, 80 Gy and 76 Gy in 40 fractions to the intraprostatic lesion, high risk volume and prostate with seminal vesicles (SIB 84.84). Late toxicity was prospectively scored according to the RTOG/FC-LENT scale. The results were compared to 138 patients treated with IMRT covering the prostate and base of seminal vesicles to 78 Gy (IMRT 78).
Results:
Acute genitourinary toxicity grade ≥ 2 was observed in 9.6% (SIB 84.84) and 33.3% (IMRT 78), with a significant difference (p < 0.01). Acute gastrointestinal toxicity grade ≥ 2 occurred in 16% of patients treated with IMRT and in 2.5% receiving SIB with a significant difference (p = 0.01). With a median follow up of 24.1 months, the cumulative incidence of grade ≥ 2 late genitourinary toxicity was 10.2% for IMRT 78 and 5% for SIB 84.84. This difference did not reach statistical difference (p = 0.24). The late gastrointestinal toxicity grade ≥ 2 developed in 13% of cases in the IMRT 78 group and 7.4% in SIB 84.84 group which was not statistically significant (log rank p = 0.24).
Conclusion:
Simultaneous integrated boost enables dose escalation up to 84.84 Gy in 40 fractions to the intraprostatic lesion with a low rate of gastrointestinal and genitourinary toxicity.
Key words:
prostate cancer, radiotherapy, simultaneous integrated boost.
Sources
1. Hanks GE, Hanlon AL, Epstein B, et al. Dose response in prostate cancer with 8-12 years follow-up. Int J Radiat Oncol Biol Phys 2002; 54: 427–435.
2. Levegrün S, Jackson A, Zelefsky MJ, et al. Risk group dependence of dose-response for biopsy outcome after three-dimensional conformal radiation therapy of prostate cancer. Radiother Oncol 2002; 63: 11–26.
3. Zelefsky MJ, Leibel SA, Gaudin PB, et al. Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998; 41: 491–500.
4. Zelefsky MJ, Reuter VE, Fuks Z, et al. Influence of local tumor control on distant metastases and cancer related mortality after external beam radiotherapy for prostate cancer. J Urol 2004; 179: 1368–1373.
5. Zelefsky MJ, Yamada Y, Fuks Z, et al. Long-term results of conformal radiotherapy for prostate cancer: impact of dose escalation on biochemical tumor control and distant metastases-free survival outcomes. Int J Radiat Oncol Biol Phys 2008; 71 1028–1033.
6. Al-Mamgani A, van Putten WLJ, Heemsbergen WD, et al. Update of the Dutch multicenter dose escalation trial of radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 72: 980–988.
7. Dearnaley DP, Hall E, Lawrence D, et al. Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects. B J Cancer 2005; 92: 488–498.
8. Kuban DA, Tucker SL, Dong L, et al. Long-term results of the M. D. Anderson randomized dose-escalation trial for prostate cancer. Int J Radiat Oncol Biol Phys 2008; 71: 67–74.
9. Zietman AL, DeSilvio ML, Slater JD, et al. Comparison of conventional-dose vs high dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: A randomized controlled trial. JAMA 2005; 294: 1233–1239.
10. Odrazka K, Zouhar M, Petera J, et al. Comparison of rectal dose-volume constraints for IMRT prostate treatment planning. Phys Med 2005; 21: 129–135.
11. Zelefsky MJ, Fuks Z, Happersett L, et al. Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 2000; 55: 241–249.
12. Langen KM, Willoughby TR, Meeks SL, et al. Observations on real-time prostate gland motion using electromagnetic tracking. Int J Radiat Oncol Biol Phys 2008; 71: 1084–1090.
13. Zelefsky MJ, Kollmeier M, Cox B, et al. Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2012; 84: 125–129.
14. Wise AM, Stamey TA, McNeal JE, et al. Morphologic and clinical significance of multifocal prostate cancers in radical prostatectomy specimens. Urology 2002; 60: 264–269.
15. Cellini N, Morganti AG, Mattiucci GC, et al. Analysis of intraprostatic failures in patients treated with hormonal therapy and radiotherapy: implications for conformal therapy planning. Int J Radiat Oncol Biol Phys 2002; 53: 595–599.
16. Pucar D, Hricak H, Shukla-Dave A, et al. Clinically significant prostate cancer local recurrence after radiation therapy occurs at the site of primary tumor: magnetic resonance imaging and step-section pathology evidence. Int J Radiat Oncol Biol Phys 2007; 69: 62–69.
17. Dolezel M, Odrazka K, Vaculikova M, et al. Dose escalation in prostate radiotherapy up to 82 Gy using simultaneous integrated boost: direct comparison of acute and late toxicity with 3D-CRT 74 Gy and IMRT 78 Gy. Strahlenther Onkol 2010; 186: 197–202.
18. Doležel M. Cílená radioterapie karcinomu prostaty. Hradec Králové: Nukleus 2011.
19. Fonteyne V, Villeirs G, Speleers B, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion. Int J Radiat Oncol Biol Phys 2008; 72: 799–807.
20. Pinkawa M, Attieh C, Piroth MD, et al. Dose-escalation using intensity-modulated radiotherapy for prostate cancer--evaluation of the dose distribution with and without 18F-choline PET-CT detected simultaneous integrated boost. Radiother Oncol 2009; 93: 213–219.
21. Teshima T, Hanks GE, Hanlon AL, et al. Rectal bleeding after conformal 3D treatment of prostate cancer: time to occurrence, response to treatment and duration of morbidity. IntJ Radiat Oncol Biol Phys 1997; 39: 77–83.
22. Marks LB, Carroll PR, Dugan TC, et al. The response of the urinary bladder, urethra, and ureter to radiation and chemotherapy. Int J Radiat Oncol Biol Phys 1995; 31: 1257–1280.
23. Zelefsky MJ, Cowen D, Fuks Z, et al. Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma. Cancer 1999; 85: 2460–2468.
24. Odrážka K. Trojrozměrná konformní radioterapie karcinomu prostaty. Praha: Galén 2002.
25. Odrazka K, Dolezel M, Vanasek J, et al. Late toxicity after conformal and intensity-modulated radiation therapy for prostate cancer: impact of previous surgery for benign prostatic hyperplasia. Int J Urol 2010; 17: 784–790.
26. Odrážka K, Vaculíková M, Doležel M, et al. Chronická toxicita trojrozměrné konformní radioterapie (3D-CRT) karcinomu prostaty. Klin Onkol 2006; 19: 222–227.
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Paediatric urologist Nephrology UrologyArticle was published in
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