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High-Dose (80 Gy) Intensity-Modulated Radiation Therapy with Daily Image-Guidance as Primary treatment for Localized Prostate Cancer

Intensitätsmodulierte Hochdosis-Radiotherapie (80 Gy) mit täglicher Image Guidance als Primärtherapie beim lokalisierten Prostatakarzinom

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Abstract

Purpose:

To report acute and late toxicity in prostate cancer patients treated by high-dose intensity-modulated radiation therapy (IMRT) with daily image-guidance.

Patients and Methods:

From 06/2004–03/2008, 102 men were treated with 80 Gy IMRT with daily image-guidance. The risk groups were as follows: low, intermediate, and high risk in 21%, 27%, and 52% of patients, respectively. Hormone therapy was given to 65% of patients. Toxicity was scored according to the CTC scale version 3.0.

Results:

Median age was 69 years and median follow-up was 39 months (range, 16–61 months). Acute and late grade 2 gastrointestinal (GI) toxicity occurred in 2% and 5% of patients, respectively, while acute and late grade 3 GI toxicity was absent. Grade 2 and 3 pretreatment genitourinary (GU) morbidity (PGUM) were 15% and 2%, respectively. Acute grade 2 and 3 GU toxicity were 43% and 5% and late grade 2 and 3 GU toxicity were 21% and 1%, respectively. After multiple Cox regression analysis, PGUM was an independent predictor of decreased late ≥ grade 2 GU toxicity-free survival (hazard ratio = 9.4 (95% confidence interval: 4.1, 22.0), p < 0.001). At the end of follow-up, the incidence of late grade 2 and 3 GU toxicity decreased to 7% and 1%, respectively.

Conclusion:

GI toxicity rates after IMRT with daily image-guidance were excellent. GU toxicity rates were acceptable and strongly related to PGUM.

Zusammenfassung

Ziel:

Beschreibung der Akut- und Spätnebenwirkungen bei Patienten mit Prostatakarzinom, die mit intensitätsmodulierter Hochdosis- Radiotherapie (IMRT) und täglicher Image Guidance behandelt wurden.

Patienten und Methodik:

Von 06/2004 bis 03/2008 wurden 102 Männer mit 80 Gy IMRT behandelt. Die Zuordnung zu Risikogruppen ergab: niedrig bei 21%, mittelhoch bei 27% und hoch bei 52% der Patienten. Hormontherapie erhielten 65% der Patienten. Die Toxizität wurde anhand der CTC Kriterien Version 3.0 bestimmt.

Ergebnisse:

Das mediane Alter betrug 69 Jahre und die mediane Nachbeobachtungszeit war 39 Monate (Spannbreite, 16–61 Monate). Akute und späte Grad-2-gastrointestinale (GI) Nebenwirkungen traten in 2% und 5% der Fälle auf; akute oder späte Grad-3-GI Nebenwirkungen wurden nicht beobachtet. Die Grad-2- und -3-urogenitale (GU) Morbidität, welche bereits vor IMRT bestand (PGUM), betrug 15% und 2%. Akute Grad-2- und -3-GU Nebenwirkungen lagen bei 43% und 5% und späte Grad-2- und -3-GU Nebenwirkungen bei 21% und 1%. In der multiplen Cox Regressionsanalyse erwies sich PGUM als unabhängiger Prädiktor für ein verkürztes (spät) ≥ Grad-2-GU nebenwirkungsfreies Überleben (hazard ratio = 9.4 [95% confidence interval: 4.1, 22.0], p < 0.001). Am Ende des Nachbeobachtungszeitraumes sank die Inzidenz von späten Grad-2 und -3-GU Nebenwirkungen auf 7% und 1%.

Schlussfolgerung:

Die GI Nebenwirkungsrate nach IMRT mit täglicher Image Guidance war exzellent. GU Nebenwirkungsraten waren akzeptabel und standen in engem Zusammenhang den urogenitalen Beschwerden vor Radiotherapie.

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Authors and Affiliations

  1. Department of Radiation Oncology with Division of Medical Radiation Physics, Inselspital, University Hospital, and University of Bern, Bern, Switzerland

    Pirus Ghadjar, Nicole Gwerder, Peter Manser, Jacqueline Vock, Axel Madlung, Roberto Mini &  Daniel M. Aebersold

  2. Department of Radiation Oncology, University of Bern, Inselspital, Freiburgstr., 3011, Bern, Switzerland

    Daniel M. Aebersold

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  1. Pirus Ghadjar
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  2. Nicole Gwerder
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  4. Jacqueline Vock
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Correspondence to Daniel M. Aebersold.

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Ghadjar, P., Gwerder, N., Manser, P. et al. High-Dose (80 Gy) Intensity-Modulated Radiation Therapy with Daily Image-Guidance as Primary treatment for Localized Prostate Cancer. Strahlenther Onkol 186, 687–692 (2010). https://doi.org/10.1007/s00066-010-2180-8

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  • DOI: https://doi.org/10.1007/s00066-010-2180-8

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