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Toxicity after Intensity-Modulated, Image-Guided Radiotherapy for Prostate Cancer

Toxizität nach intensitätsmodulierter, bildgeführter Strahlentherapie des Prostatakarzinoms

Strahlentherapie und Onkologie volume 186, pages 535–543 (2010)Cite this article

An Erratum to this article was published on 29 November 2010

An Erratum to this article was published on 29 November 2010

Abstract

Purpose:

To evaluate toxicity after dose-escalated radiotherapy for prostate cancer using intensity-modulated treatment planning (IMRT) and image-guided treatment (IGRT) delivery.

Patients and Methods:

100 patients were treated with simultaneous integrated boost (SIB) IMRT for prostate cancer: doses of 76.23 Gy and 60 Gy in 33 fractions were prescribed to the prostate and the seminal vesicles, respectively, for intermediate- and high-risk patients (n = 74). The total dose was 73.91 Gy in 32 fractions for low-risk patients and after transurethral resection of the prostate (n = 26). The pelvic lymphatics were treated with 46 Gy in 25 fractions in patients with high risk of lymph node metastases using an SIB to the prostate (n = 25). IGRT was practiced with cone-beam computed tomography. Acute and late gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated prospectively (CTCAE v3.0).

Results:

Treatment was completed as planned by all patients. Acute GI and GU toxicity grade ≥ 2 was observed in 12% and 42% of the patients, respectively, with 4% suffering from GU toxicity grade 3. 6 weeks after treatment, the incidence of acute toxicity grade ≥ 2 had decreased to 12%. With a median follow-up of 26 months, late GI and GU toxicity grade ≥ 2 was seen in 1.5% and 7.7% of the patients at 24 months. Four patients developed late toxicity grade 3 (GI n = 1; GU n = 3). Presence of acute GI and GU toxicity was significantly associated with late GI (p = 0.0007) and GU toxicity (p = 0.006).

Conclusion:

High-dose radiotherapy for prostate cancer using IMRT and IGRT resulted in low rates of acute toxicity and preliminary results of late toxicity are promising.

Zusammenfassung

Ziel:

Erfassung der Toxizität nach intensitätsmodulierter (IMRT), bildgeführter Strahlentherapie (IGRT) des Prostatakarzinoms.

Patienten und Methodik:

100 Patienten wurden wegen eines Prostatakarzinoms mittels IMRT und simultanen integrierten Boosts (SIB) primar bestrahlt: Gesamtdosen von 76,23 Gy bzw. 60 Gy in 33 Fraktionen wurden im Boostzielvolumen und in den Samenblasen geplant, falls ein hohes oder intermediares Risikoprofil vorlag (n = 74). Bei niedrigem Risiko und Zustand nach transurethraler Prostataresektion wurde eine Gesamtdosis von 73,91 Gy in 32 Fraktionen angewendet (n = 26). Das pelvine Lymphabflussgebiet wurde bei hohem Risiko eines Lymphknotenbefalls mit 46 Gy in 25 Fraktionen behandelt (n = 25), ebenfalls mit einem SIB auf die Prostata. IGRT wurde mittels Cone-Beam-Computertomographie praktiziert. Die akute und chronische gastrointestinale (GI) und urogenitale (GU) Toxizitat wurde prospektiv nach CTCAE v3.0 erfasst.

Ergebnisse:

Die Behandlung wurde bei allen Patienten planmäßig beendet. Akute GI- und GU-Toxizitat ≥ Grad 2 wurde bei 12% bzw. 42% der Patienten beobachtet; 4% entwickelten eine GU-Toxizitat Grad 3. 6 Wochen nach Therapie war die Inzidenz einer Toxizität ≥ Grad 2 auf 12% zurückgegangen. Nach einer medianen Nachbeobachtungszeit von 26 Monaten wurde eine 2-Jahres-GI-bzw. -GU-Toxizitat ≥ Grad 2 bei 1,5% bzw. 7,7% der Patienten beobachtet. Vier Patienten entwickelten eine Spätnebenwirkung Grad 3 (GI n = 1; GU n = 3). Das Vorhandensein von akuter GI- und GU-Toxizität war mit einer signifikant höheren Inzidenz an späten GI- (p = 0,0007) und GU-Nebenwirkungen (p = 0,006) assoziiert.

Schlussfolgerung:

Radiotherapie mit hohen Bestrahlungsdosen resultierte in geringer Akuttoxizitat bei Anwendung von IMRT und IGRT; vorläufige Daten zur chronischen Toxizität sind vielversprechend.

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Author information

Affiliations

  1. Department of Radiotherapy, University Hospital Würzburg, Würzburg, Germany

    Matthias Guckenberger, Sami Ok, Bülent Polat, Reinhart A. Sweeney & Michael Flentje

  2. Klinik und Poliklinik für Strahlentherapie, Universitätsklinikum Würzburg, Josef-Schneider-Straße 11, 97080, Würzburg, Germany

    Matthias Guckenberger

Authors
  1. Matthias Guckenberger
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  2. Sami Ok
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  3. Bülent Polat
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  4. Reinhart A. Sweeney
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  5. Michael Flentje
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Correspondence to Matthias Guckenberger.

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An erratum to this article can be found at http://dx.doi.org/10.1007/s00066-010-7144-5

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Guckenberger, M., Ok, S., Polat, B. et al. Toxicity after Intensity-Modulated, Image-Guided Radiotherapy for Prostate Cancer. Strahlenther Onkol 186, 535–543 (2010). https://doi.org/10.1007/s00066-010-2144-z

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  • DOI: https://doi.org/10.1007/s00066-010-2144-z

Key Words

  • Prostate cancer
  • External-beam radiotherapy
  • Intensity-modulated radiotherapy (IMRT)
  • Image-guided radiotherapy (IGRT)
  • Toxicity

Schlüsselwörter

  • Prostatakarzinom
  • Perkutane Strahlentherapie
  • Intensitätsmodulierte Strahlentherapie (IMRT)
  • Bildgeführte Strahlentherapie (IGRT)
  • Toxizität