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

Toxizität nach intensitätsmodulierter, bildgeführter Strahlentherapie des Prostatakarzinoms

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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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Authors and 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

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  1. Matthias Guckenberger
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  2. Sami Ok
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  4. Reinhart A. Sweeney
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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

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