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Image-guided dose-escalated radiation therapy for localized prostate cancer with helical tomotherapy

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Abstract

Purpose

To evaluate treatment outcomes for patients with localized prostate cancer who were treated with dose-escalated primary image-guided radiation therapy (IGRT).

Methods

We retrospectively analyzed 88 consecutive patients treated using helical tomotherapy with daily megavoltage CTs (MVCT). Patients were prescribed daily doses of 1.8 Gy to the planning target volume (PTV) and 2 Gy to the clinical target volume (CTV). Low- and favorable intermediate-risk patients received a minimum total dose of 72 Gy to the PTV and up to 80 Gy to the CTV. Unfavorable intermediate-risk and high-risk patients received a minimum total dose of 75.6 Gy to the PTV and up to 84 Gy to the CTV. We assessed freedom from biochemical relapse (FFBF), 5‑year biochemical recurrence-free survival (5-bRFS), distant metastasis-free survival (5-dMFS), and cancer-specific survival (5-CSS) as well as acute and late genitourinary (GU) and gastrointestinal (GI) toxicity.

Results

Among our cohort, 11.4% were low-risk, 50% intermediate-risk, and 38.6% high-risk patients according to the D’Amico criteria. Median follow-up was 66 months (range 8–83 months). FFBF was 100%, 97.7%, and 90.7%; 5‑bRFS was 100%, 92.8%, and 70.4%; 5‑dMFS was 100%, 92.7%, and 70.4%; and 5‑CSS was 100%, 97.4%, and 89.8% for low-, intermediate-, and high-risk patients, respectively. Grades 2 and 3 toxicity occurred at the following rates: acute GU toxicity 39.8% and 1.1%, acute GI toxicity 12.5% and 0%, late GU toxicity 19.3% and 4.5%, and late GI toxicity 4.5% and 1.1% of patients, respectively. No toxicity >grade 3 was observed.

Conclusion

Risk-adapted dose-escalated IGRT with helical tomotherapy of up to 84 Gy is a feasible and well-tolerable treatment scheme with promising oncological results.

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Authors and Affiliations

  1. Department of Radiation Oncology, Charité Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Tomasz Barelkowski MD, Peter Wust MD, David Kaul MD, Sebastian Zschaeck MD, Waldemar Wlodarczyk PhD, Volker Budach MD, Pirus Ghadjar MD & Marcus Beck MD

  2. Praxis Strahlentherapie Berlin Südwest, Berlin, Germany

    Tomasz Barelkowski MD

  3. Berlin Institute of Health, Berlin, Germany

    Sebastian Zschaeck MD

Authors
  1. Tomasz Barelkowski MD
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  2. Peter Wust MD
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  6. Volker Budach MD
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  8. Marcus Beck MD
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Contributions

T. Barelkowski and M. Beck performed the analysis and drafted the manuscript. T. Barelkowski, P. Ghadjar, M. Beck, W. Wlodarczyk, and P. Wust participated in the design of the study or made substantial contributions to acquisition, analysis, and interpretation of the data. P. Wust and W. Wlodarczyk treated the patients according to the treatment concept under study. V. Budach, W. Wlodarczyk, S. Zschaeck, and D. Kaul provided critical review of the manuscript for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Tomasz Barelkowski MD.

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Conflict of interest

T. Barelkowski, P. Wust, D. Kaul, S. Zschaeck, W. Wlodarczyk, V. Budach, P. Ghadjar, and M. Beck declare that they have no competing interests.

Ethical standards

This retrospective study was approved by the ethics committee of our institution.

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Barelkowski, T., Wust, P., Kaul, D. et al. Image-guided dose-escalated radiation therapy for localized prostate cancer with helical tomotherapy. Strahlenther Onkol 196, 229–242 (2020). https://doi.org/10.1007/s00066-019-01562-2

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  • DOI: https://doi.org/10.1007/s00066-019-01562-2

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