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Title: Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial

Abstract

Objective: To report late toxicity outcomes from a randomized trial comparing conventional and hypofractionated prostate radiation therapy and to identify dosimetric and clinical parameters associated with late toxicity after hypofractionated treatment. Methods and Materials: Men with localized prostate cancer were enrolled in a trial that randomized men to either conventionally fractionated intensity modulated radiation therapy (CIMRT, 75.6 Gy in 1.8-Gy fractions) or to dose-escalated hypofractionated IMRT (HIMRT, 72 Gy in 2.4-Gy fractions). Late (≥90 days after completion of radiation therapy) genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively evaluated and scored according to modified Radiation Therapy Oncology Group criteria. Results: 101 men received CIMRT and 102 men received HIMRT. The median age was 68, and the median follow-up time was 6.0 years. Twenty-eight percent had low-risk, 71% had intermediate-risk, and 1% had high-risk disease. There was no difference in late GU toxicity in men treated with CIMRT and HIMRT. The actuarial 5-year grade ≥2 GU toxicity was 16.5% after CIMRT and 15.8% after HIMRT (P=.97). There was a nonsignificant numeric increase in late GI toxicity in men treated with HIMRT compared with men treated with CIMRT. The actuarial 5-year grade ≥2 GI toxicity was 5.1% after CIMRT and 10.0% after HIMRT (P=.11). In menmore » receiving HIMRT, the proportion of rectum receiving 36.9 Gy, 46.2 Gy, 64.6 Gy, and 73.9 Gy was associated with the development of late GI toxicity (P<.05). The 5-year actuarial grade ≥2 GI toxicity was 27.3% in men with R64.6Gy ≥ 20% but only 6.0% in men with R64.6Gy < 20% (P=.016). Conclusions: Dose-escalated IMRT using a moderate hypofractionation regimen (72 Gy in 2.4-Gy fractions) can be delivered safely with limited grade 2 or 3 late toxicity. Minimizing the proportion of rectum that receives moderate and high dose decreases the risk of late rectal toxicity after this hypofractionation regimen.« less

Authors:
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Publication Date:
OSTI Identifier:
22416521
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 88; Journal Issue: 5; Other Information: Copyright (c) 2014 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; COMPARATIVE EVALUATIONS; FRACTIONATED IRRADIATION; HAZARDS; MEN; NEOPLASMS; PROSTATE; RADIATION DOSES; RADIOTHERAPY; RECTUM; TOXICITY

Citation Formats

Hoffman, Karen E., E-mail: khoffman1@mdanderson.org, Voong, K. Ranh, Pugh, Thomas J., Skinner, Heath, Levy, Lawrence B., Takiar, Vinita, Choi, Seungtaek, Du, Weiliang, Frank, Steven J., Johnson, Jennifer, Kanke, James, Kudchadker, Rajat J., Lee, Andrew K., Mahmood, Usama, McGuire, Sean E., and Kuban, Deborah A. Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial. United States: N. p., 2014. Web. doi:10.1016/J.IJROBP.2014.01.015.
Hoffman, Karen E., E-mail: khoffman1@mdanderson.org, Voong, K. Ranh, Pugh, Thomas J., Skinner, Heath, Levy, Lawrence B., Takiar, Vinita, Choi, Seungtaek, Du, Weiliang, Frank, Steven J., Johnson, Jennifer, Kanke, James, Kudchadker, Rajat J., Lee, Andrew K., Mahmood, Usama, McGuire, Sean E., & Kuban, Deborah A. Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial. United States. https://doi.org/10.1016/J.IJROBP.2014.01.015
Hoffman, Karen E., E-mail: khoffman1@mdanderson.org, Voong, K. Ranh, Pugh, Thomas J., Skinner, Heath, Levy, Lawrence B., Takiar, Vinita, Choi, Seungtaek, Du, Weiliang, Frank, Steven J., Johnson, Jennifer, Kanke, James, Kudchadker, Rajat J., Lee, Andrew K., Mahmood, Usama, McGuire, Sean E., and Kuban, Deborah A. 2014. "Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial". United States. https://doi.org/10.1016/J.IJROBP.2014.01.015.
@article{osti_22416521,
title = {Risk of Late Toxicity in Men Receiving Dose-Escalated Hypofractionated Intensity Modulated Prostate Radiation Therapy: Results From a Randomized Trial},
author = {Hoffman, Karen E., E-mail: khoffman1@mdanderson.org and Voong, K. Ranh and Pugh, Thomas J. and Skinner, Heath and Levy, Lawrence B. and Takiar, Vinita and Choi, Seungtaek and Du, Weiliang and Frank, Steven J. and Johnson, Jennifer and Kanke, James and Kudchadker, Rajat J. and Lee, Andrew K. and Mahmood, Usama and McGuire, Sean E. and Kuban, Deborah A.},
abstractNote = {Objective: To report late toxicity outcomes from a randomized trial comparing conventional and hypofractionated prostate radiation therapy and to identify dosimetric and clinical parameters associated with late toxicity after hypofractionated treatment. Methods and Materials: Men with localized prostate cancer were enrolled in a trial that randomized men to either conventionally fractionated intensity modulated radiation therapy (CIMRT, 75.6 Gy in 1.8-Gy fractions) or to dose-escalated hypofractionated IMRT (HIMRT, 72 Gy in 2.4-Gy fractions). Late (≥90 days after completion of radiation therapy) genitourinary (GU) and gastrointestinal (GI) toxicity were prospectively evaluated and scored according to modified Radiation Therapy Oncology Group criteria. Results: 101 men received CIMRT and 102 men received HIMRT. The median age was 68, and the median follow-up time was 6.0 years. Twenty-eight percent had low-risk, 71% had intermediate-risk, and 1% had high-risk disease. There was no difference in late GU toxicity in men treated with CIMRT and HIMRT. The actuarial 5-year grade ≥2 GU toxicity was 16.5% after CIMRT and 15.8% after HIMRT (P=.97). There was a nonsignificant numeric increase in late GI toxicity in men treated with HIMRT compared with men treated with CIMRT. The actuarial 5-year grade ≥2 GI toxicity was 5.1% after CIMRT and 10.0% after HIMRT (P=.11). In men receiving HIMRT, the proportion of rectum receiving 36.9 Gy, 46.2 Gy, 64.6 Gy, and 73.9 Gy was associated with the development of late GI toxicity (P<.05). The 5-year actuarial grade ≥2 GI toxicity was 27.3% in men with R64.6Gy ≥ 20% but only 6.0% in men with R64.6Gy < 20% (P=.016). Conclusions: Dose-escalated IMRT using a moderate hypofractionation regimen (72 Gy in 2.4-Gy fractions) can be delivered safely with limited grade 2 or 3 late toxicity. Minimizing the proportion of rectum that receives moderate and high dose decreases the risk of late rectal toxicity after this hypofractionation regimen.},
doi = {10.1016/J.IJROBP.2014.01.015},
url = {https://www.osti.gov/biblio/22416521}, journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 88,
place = {United States},
year = {Tue Apr 01 00:00:00 EDT 2014},
month = {Tue Apr 01 00:00:00 EDT 2014}
}