Dose escalation with IMRT technique versus IMRT + HDR BRT in patients with high-risk carcinoma of the prostate – comparison of acute toxicity
Authors:
Renata Soumarová; Hana Perková; Luboš Homola; Martin Bulik; Markéta Jašková; Stanislav Machala; Halina Richterová
Authors‘ workplace:
Nový Jičín
; Komplexní onkologické centrum
Published in:
Ces Urol 2010; 14(3): 164-172
Category:
Original article
Overview
Aim:
Radiotherapy (RT) in combination with hormonal therapy is standard treatment option in high-risk prostate cancer patients. Although trials of prostate plus whole pelvic RT have not improved prostate cancer outcomes in randomized trials relative to prostate RT alone in the setting of neoadjuvant and concurrent androgen suppression, elective treatment of the pelvic lymph nodes might improve diseasefree survival. A dose escalation to the prostate is possible to provide intensity-modulated RT (IMRT) or high-dose rate brachytherapy (HDR BRT) technique. We compared two subgroups of high-risk patients (T3, GS 8–10 or PSA > 20).
Material and method:
The both groups underwent pelvic RT using IMRT technique (45–50.4 Gy in 25–28 fractions) and HT (goserelin + flutamid), neoadjuvant 3–4 months prior RT, concomitant HT together with RT and adjuvant HT (bicalutamid). The dose escalation was performed using IMRT 26 Gy in 13 fractions in the first subgroup or 16 Gy in 2 fractions to the reference isodose in HDR BRT subgroup. Acute toxicity scores were recorded weekly during RT and in 3 month interval post-RT using RTOG (Radiation Therapy Oncology Group) acute toxicity scales.
Results:
125 patients with a histological diagnosis were enrolled, 83 in the group with IMRT, 42 in the group with HDR BRT. Follow-up median was 18 months. Patients in IMRT subgroup were older in general, median age 68 years versus 65 years in HDR BRT subgroup (p = 0.044). The prostate volume was larger in IMRT group (median 28.7 vs. 22.5 ccm, p = 0.0001). Input IPSS was higher in IMRT group (10 vs. 5). Acute GU toxicity was significantly higher in IMRT group (GU toxicity grade 0 30% vs. 37%, grade 1 56% vs. 60%, grade 2 13% vs. 3%, grade 3 1% vs. 0%, p = 0.002). The largest difference we found in grade 2 GU toxicity. The effect of pretreatment IPSS, prostate volume or the age wasn’t observed. Also acute GIT toxicity was finded as significantly higher in the group with IMRT (G0 30% vs. 60%, G1 41% vs. 37%, G2 27% vs. 3%, G3 2% vs. 0%, p < 0.01). Again the largest difference was recorded in grade 2 GIT toxicity. G3 toxicity wasn’t noted in HDR BRT arm at all, in IMRT arm was very low.
Conclusion:
We recorded a very good therapy toleration in both study arms. Pelvic IMRT with boost to the prostate was well tolerated in this series, with low rates of grade 3 or greater acute toxicity. Pelvic lymphatic nodes RT in combination with HDR BRT dose escalation caused acute toxicity of minimal degree. Longer follow-up for outcome and late toxicity is required.
Key words:
prostate carcinoma, elective irradiation pelvic nodes, technique intensity modulated radiotherapy, interstitial brachytherapy, acute toxicity.
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Paediatric urologist Nephrology UrologyArticle was published in
Czech Urology
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