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Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer

Report of feasibility and acute toxicity

Moderate Hypofraktionierung und simultan integrierter Boost mit volumetrisch modulierter Bogentherapie (RapidArc) bei Prostatakrebs

Ein Bericht über Machbarkeit und akute Toxizität

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Abstract

Purpose

In the present study, the acute toxicity profiles for prostate patients treated with simultaneous integrated boost (SIB) with volumetric modulated arcs in a hypofractionated regime are reported.

Patients and methods

A total of 70 patients treated with RapidArc between May 2010 and September 2011 were retrospectively evaluated. Patients were stratified into low (36%), intermediate (49%), and high-risk (16%) groups. Target volumes (expanded to define the planning volumes (PTV)) were clinical target volume (CTV) 1: prostate; CTV2: CTV1 + seminal vesicles; CTV3: CTV2 + pelvic nodes. Low-risk patients received 71.4 Gy to PTV1; intermediate-risk 74.2 Gy to PTV1 and 61.6 or 65.5 Gy to PTV2; high-risk 74.2 Gy to PTV1, 61.6 or 65.5 Gy to PTV2, and 51.8 Gy to PTV3. All treatments were in 28 fractions. The median follow-up was 11 months (range 3.5–23 months). The acute rectal, gastrointestinal (GI) and genitourinary (GU) toxicities were scored according to EORTC/RTOG scales.

Results

Acute toxicities were recorded for the GU [G0 = 31/70 (44%), G1 = 22/70 (31%); G2 = 16/70 (23%); G3 = 1/70 (1%)], the rectum [G0 = 46/70 (66%); G1 = 12/70 (17%); G2 = 12/70 (17%); no G3], and the GI [G0 = 54/69 (77%); G1 = 11/69 (16%); G2 = 4/69 (6%); no G3]. Median time to rectal, GU, and GI toxicities were 27, 30, and 33 days, respectively. Only the GI toxicity correlated with stage and pelvic irradiation. Univariate analysis presented significant correlations between GI toxicity and intestinal irradiation (V50 Gy and V60 Gy). In the multivariate analysis, the only significant dosimetric variable was V50 Gy for the intestinal cavity.

Conclusion

Moderate hypofractionation with SIB and RapidArc was shown to be safe, with acceptable acute toxicity. Longer follow-up is needed to assess late toxicity and clinical outcome.

Zusammenfassung

Zielsetzungen

In der vorliegenden Studie wird über die akuten Toxizitätsprofile von Patienten mit Prostatakarzinom, die mit volumetrisch modulierter Bogentherapie und simultan integriertem Boost (SIB) in einem hypofraktionierten Regime behandelt wurden, berichtet.

Patienten und Methoden

Insgesamt 70 Patienten, die von Mai 2010 bis September 2011 mithilfe der RapidArc-Technik behandelt wurden, wurden retrospektiv analysiert. Es erfolgte eine Unterteilung in eine Niedrig- (36%), eine Mittel- (49%) und eine Hochrisikogruppe (16%). Die Zielvolumina, die jeweils entsprechend in den Planungszielvolumina (PTV) angepasst wurden, definieren sich folgendermaßen: klinisches Zielvolumen (CTV) 1: Prostata; CTV2: CTV1 + Samenbläschen; CTV3: CTV2 + Beckenlymphknoten. Bei Patienten der Niedrigrisikogruppe wurde eine Dosis von 71,4 Gy im PTV1, bei denen der Mittelrisikogruppe 74,2 Gy im PTV1 und 61,6 oder 65,5 Gy im PTV2 und in der Hochrisikogruppe 74,2 Gy im PTV1, 61,6 oder 65,5 Gy im PTV2 und 51,8 Gy im PTV3 appliziert. Bei allen Patienten wurde die Dosis in 28 Fraktionen verabreicht. Die mittlere Nachbeobachtungszeit betrug 330 Tage. Die akuten rektalen, gastrointestinalen und urogenitalen Toxizitäten wurden gemäß der Klassifikation der European Organisation for Research and Treatment of Cancer (EORTC) und der Radiation Therapy Oncology Group (RTOG) bewertet.

Ergebnisse

Folgende akute Toxizitäten wurden beobachtet: urogenital [G0 = 31/70 (44%); G1 = 22/70 (31%); G2 = 16/70 (23%); G3 = 1/70 (1%)], rektal [G0 = 46/70 (66%); G1 = 12/70 (17%); G2 = 12/70 (17%); G3 = 0], gastrointestinal [G0 = 54/69 (77%); G1 = 11/69 (16%); G2 = 4/69 (6%); G3 = 0]. Der mittlere Zeitraum bis zum Auftreten der akuten Toxizitäten betrug rektal 27 Tage, urogenital 30 Tage und gastrointestinal 33 Tage. Nur die gastrointestinale Toxizität korrelierte mit dem Staging und der Beckenbestrahlung. In der univariaten Analyse wurde eine signifikante Korrelation zwischen der gastrointestinalen Toxizität und der intestinalen Bestrahlung (V50 Gy und V60 Gy) beobachtet. Die alleinige signifikante dosimetrische Variable in der multivariaten Analyse war die Applikation V50 Gy für die Abdominalhöhle.

Schlussfolgerung

Die moderate Hypofraktionierung und SIB mithilfe der RapidArc-Technik ist eine sichere Behandlungsform mit akzeptablen akuten Toxizitäten. Eine längere Nachbeobachtungszeit ist notwendig, um Spättoxizitäten und das Behandlungsergebnis beurteilen zu können.

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Conflict of interest

On behalf of all authors, the corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. Department of Radiotherapy, Humanitas Cancer Center, Istituto Clinico Humanitas, Via Manzoni 56, 20089, Rozzano, Milan, Italy

    F. Alongi, P. Navarria, A. Tozzi, P. Mancosu, F. Lobefalo, G. Reggiori & M. Scorsetti

  2. Medical Physics Unit, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland

    A. Fogliata, A. Clivio & L. Cozzi

Authors
  1. F. Alongi
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  2. A. Fogliata
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  3. P. Navarria
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  4. A. Tozzi
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  5. P. Mancosu
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  6. F. Lobefalo
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  7. G. Reggiori
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  8. A. Clivio
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  9. L. Cozzi
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  10. M. Scorsetti
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Correspondence to F. Alongi.

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Alongi, F., Fogliata, A., Navarria, P. et al. Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer. Strahlenther Onkol 188, 990–996 (2012). https://doi.org/10.1007/s00066-012-0171-7

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