Acute Toxicity in High-Risk Prostate Cancer Patients Treated With Androgen Suppression and Hypofractionated Intensity-Modulated Radiotherapy

Journal Article · Fri Jan 15 00:00:00 EST 2010 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2009.01.048· OSTI ID:21367585

Pervez, Nadeem ^[1]; Small, Cormac ^[1]; MacKenzie, Marc ^[2]; Yee, Don; Parliament, Matthew ^[1]; Ghosh, Sunita ^[3]; Mihai, Alina; Amanie, John; Murtha, Albert ^[1]; Field, Colin ^[2]; Murray, David ^[3]; Fallone, Gino ^[2]; Pearcey, Robert ^[1]

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1. Division of Radiation Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada)
2. Division of Medical Physics, Cross Cancer Institute, Edmonton, Alberta (Canada)
3. Division of Experimental Oncology, Cross Cancer Institute, Edmonton, Alberta (Canada)

Purpose: To report acute toxicity resulting from radiotherapy (RT) dose escalation and hypofractionation using intensity-modulated RT (IMRT) treatment combined with androgen suppression in high-risk prostate cancer patients. Methods and Materials: Sixty patients with a histological diagnosis of high-risk prostatic adenocarcinoma (having either a clinical Stage of >=T3a or an initial prostate-specific antigen [PSA] level of >=20 ng/ml or a Gleason score of 8 to 10 or a combination of a PSA concentration of >15 ng/ml and a Gleason score of 7) were enrolled. RT prescription was 68 Gy in 25 fractions (2.72 Gy/fraction) over 5 weeks to the prostate and proximal seminal vesicles. The pelvic lymph nodes and distal seminal vesicles concurrently received 45 Gy in 25 fractions. The patients were treated with helical TomoTherapy-based IMRT and underwent daily megavoltage CT image-guided verification prior to each treatment. Acute toxicity scores were recorded weekly during RT and at 3 months post-RT, using Radiation Therapy Oncology Group acute toxicity scales. Results: All patients completed RT and follow up for 3 months. The maximum acute toxicity scores were as follows: 21 (35%) patients had Grade 2 gastrointestinal (GI) toxicity; 4 (6.67%) patients had Grade 3 genitourinary (GU) toxicity; and 30 (33.33%) patients had Grade 2 GU toxicity. These toxicity scores were reduced after RT; there were only 8 (13.6%) patients with Grade 1 GI toxicity, 11 (18.97%) with Grade 1 GU toxicity, and 5 (8.62%) with Grade 2 GU toxicity at 3 months follow up. Only the V60 to the rectum correlated with the GI toxicity. Conclusion: Dose escalation using a hypofractionated schedule to the prostate with concurrent pelvic lymph node RT and long-term androgen suppression therapy is well tolerated acutely. Longer follow up for outcome and late toxicity is required.

• OSTI ID: 21367585
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Vol. 76, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2009.01.048; PII: S0360-3016(09)00193-X; Copyright (c) 2010 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; ISSN 0360-3016
• Country of Publication: United States
• Language: English

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62 RADIOLOGY AND NUCLEAR MEDICINE
ANDROGENS
ANTIGENS
CARCINOMAS
CAT SCANNING
CT-GUIDED RADIOTHERAPY
INHIBITION
LYMPH NODES
PROSTATE
RECTUM
TOXICITY
ANDROSTANES
BODY
COMPUTERIZED TOMOGRAPHY
DIAGNOSTIC TECHNIQUES
DIGESTIVE SYSTEM
DISEASES
GASTROINTESTINAL TRACT
GLANDS
HORMONES
INTESTINES
LARGE INTESTINE
LYMPHATIC SYSTEM
MALE GENITALS
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NEOPLASMS
NUCLEAR MEDICINE
ORGANIC COMPOUNDS
ORGANS
RADIOLOGY
RADIOTHERAPY
STEROID HORMONES
STEROIDS
THERAPY
TOMOGRAPHY