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Published in: Radiation Oncology 1/2008

Open Access 01-12-2008 | Research

Acute and late toxicity in prostate cancer patients treated by dose escalated intensity modulated radiation therapy and organ tracking

Authors: Pirus Ghadjar, Jacqueline Vock, Daniel Vetterli, Peter Manser, Roland Bigler, Jan Tille, Axel Madlung, Frank Behrensmeier, Roberto Mini, Daniel M Aebersold

Published in: Radiation Oncology | Issue 1/2008

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Abstract

Background

To report acute and late toxicity in prostate cancer patients treated by dose escalated intensity-modulated radiation therapy (IMRT) and organ tracking.

Methods

From 06/2004 to 12/2005 39 men were treated by 80 Gy IMRT along with organ tracking. Median age was 69 years, risk of recurrence was low 18%, intermediate 21% and high in 61% patients. Hormone therapy (HT) was received by 74% of patients. Toxicity was scored according to the CTC scale version 3.0. Median follow-up (FU) was 29 months.

Results

Acute and maximal late grade 2 gastrointestinal (GI) toxicity was 3% and 8%, late grade 2 GI toxicity dropped to 0% at the end of FU. No acute or late grade 3 GI toxicity was observed. Grade 2 and 3 pre-treatment genitourinary (GU) morbidity (PGUM) was 20% and 5%. Acute and maximal late grade 2 GU toxicity was 56% and 28% and late grade 2 GU toxicity decreased to 15% of patients at the end of FU. Acute and maximal late grade 3 GU toxicity was 8% and 3%, respectively. Decreased late ≥ grade 2 GU toxicity free survival was associated with higher age (P = .025), absence of HT (P = .016) and higher PGUM (P < .001).

Discussion

GI toxicity rates after IMRT and organ tracking are excellent, GU toxicity rates are strongly related to PGUM.
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Literature
1.
go back to reference Bracarda S, de Cobelli O, Greco C, Prayer-Galetti T, Valdagni R, Gatta G, de Braud F, Bartsch G: Cancer of the prostate. Crit Rev Oncol Haematol 2005, 56: 379-396. 10.1016/j.critrevonc.2005.03.010CrossRef Bracarda S, de Cobelli O, Greco C, Prayer-Galetti T, Valdagni R, Gatta G, de Braud F, Bartsch G: Cancer of the prostate. Crit Rev Oncol Haematol 2005, 56: 379-396. 10.1016/j.critrevonc.2005.03.010CrossRef
2.
go back to reference Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ: Cancer statistics, 2006. CA Cancer J Clin 2006, 56: 106-130.CrossRefPubMed Jemal A, Siegel R, Ward E, Murray T, Xu J, Smigal C, Thun MJ: Cancer statistics, 2006. CA Cancer J Clin 2006, 56: 106-130.CrossRefPubMed
3.
go back to reference D' Amico AV, Hanks GE: Three-dimensional conformal radiation therapy for prostate cancer. In Radiotherapeutic management of prostate adenocarcinoma. Boston: Arnold; 1999:21-50. D' Amico AV, Hanks GE: Three-dimensional conformal radiation therapy for prostate cancer. In Radiotherapeutic management of prostate adenocarcinoma. Boston: Arnold; 1999:21-50.
4.
go back to reference Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Burman CM, Hunt M, Wolfe T, Venkatraman ES, Jackson A, Skwarchuk M, Leibel SA: Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 2000, 55: 241-249. 10.1016/S0167-8140(99)00100-0CrossRefPubMed Zelefsky MJ, Fuks Z, Happersett L, Lee HJ, Ling CC, Burman CM, Hunt M, Wolfe T, Venkatraman ES, Jackson A, Skwarchuk M, Leibel SA: Clinical experience with intensity modulated radiation therapy (IMRT) in prostate cancer. Radiother Oncol 2000, 55: 241-249. 10.1016/S0167-8140(99)00100-0CrossRefPubMed
5.
go back to reference Leibel SA, Fuks Z, Zelefsky MJ, Hunt M, Burman CM, Mageras GS, Chui CS, Jackson A, Amols HI, Ling CC: Technological advances in external-beam radiation therapy for the treatment of localized prostate cancer. Semin Oncol 2003,30(5):596-615. 10.1016/S0093-7754(03)00354-3CrossRefPubMed Leibel SA, Fuks Z, Zelefsky MJ, Hunt M, Burman CM, Mageras GS, Chui CS, Jackson A, Amols HI, Ling CC: Technological advances in external-beam radiation therapy for the treatment of localized prostate cancer. Semin Oncol 2003,30(5):596-615. 10.1016/S0093-7754(03)00354-3CrossRefPubMed
6.
go back to reference Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, Young RH, Shipley JW, Zietman AL, Biggs PJ, et al.: Advanced prostate cancer: The results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys 1995, 32: 3-12.CrossRefPubMed Shipley WU, Verhey LJ, Munzenrider JE, Suit HD, Urie MM, McManus PL, Young RH, Shipley JW, Zietman AL, Biggs PJ, et al.: Advanced prostate cancer: The results of a randomized comparative trial of high dose irradiation boosting with conformal protons compared with conventional dose irradiation using photons alone. Int J Radiat Oncol Biol Phys 1995, 32: 3-12.CrossRefPubMed
7.
go back to reference Hanks GE, Hanlon AL, Schultheiss TE, Pinover WH, Movsas B, Epstein BE, Hunt MA: Dose escalation with 3D conformal treatment: 5 year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys 1998, 41: 501-510. 10.1016/S0360-3016(98)00089-3CrossRefPubMed Hanks GE, Hanlon AL, Schultheiss TE, Pinover WH, Movsas B, Epstein BE, Hunt MA: Dose escalation with 3D conformal treatment: 5 year outcomes, treatment optimization, and future directions. Int J Radiat Oncol Biol Phys 1998, 41: 501-510. 10.1016/S0360-3016(98)00089-3CrossRefPubMed
8.
go back to reference Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, Reuter VE, Fair WR, Ling CC, Fuks Z: Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998, 41: 491-500. 10.1016/S0360-3016(98)00091-1CrossRefPubMed Zelefsky MJ, Leibel SA, Gaudin PB, Kutcher GJ, Fleshner NE, Venkatramen ES, Reuter VE, Fair WR, Ling CC, Fuks Z: Dose escalation with three-dimensional conformal radiation therapy affects the outcome in prostate cancer. Int J Radiat Oncol Biol Phys 1998, 41: 491-500. 10.1016/S0360-3016(98)00091-1CrossRefPubMed
9.
go back to reference Zelefsky MJ, Fuks Z, Hunt M, Lee HJ, Lombardi D, Ling CC, Reuter VE, Venkatraman ES, Leibel SA: High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001, 166: 876-881. 10.1016/S0022-5347(05)65855-7CrossRefPubMed Zelefsky MJ, Fuks Z, Hunt M, Lee HJ, Lombardi D, Ling CC, Reuter VE, Venkatraman ES, Leibel SA: High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001, 166: 876-881. 10.1016/S0022-5347(05)65855-7CrossRefPubMed
10.
go back to reference Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, von Eschenbach AC, Kuban DA, Rosen I: Prostate cancer radiation dose response: Results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002, 53: 1097-1105. 10.1016/S0360-3016(02)02829-8CrossRefPubMed Pollack A, Zagars GK, Starkschall G, Antolak JA, Lee JJ, Huang E, von Eschenbach AC, Kuban DA, Rosen I: Prostate cancer radiation dose response: Results of the M. D. Anderson phase III randomized trial. Int J Radiat Oncol Biol Phys 2002, 53: 1097-1105. 10.1016/S0360-3016(02)02829-8CrossRefPubMed
11.
go back to reference Sathya JR, Davis IR, Julian JA, Guo Q, Daya D, Dayes IS, Lukka HR, Levine M: Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005, 23: 1192-1199. 10.1200/JCO.2005.06.154CrossRefPubMed Sathya JR, Davis IR, Julian JA, Guo Q, Daya D, Dayes IS, Lukka HR, Levine M: Randomized trial comparing iridium implant plus external-beam radiation therapy with external-beam radiation therapy alone in node-negative locally advanced cancer of the prostate. J Clin Oncol 2005, 23: 1192-1199. 10.1200/JCO.2005.06.154CrossRefPubMed
12.
go back to reference Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, Shipley WU: Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: A randomized controlled trial. JAMA 2005, 294: 1233-1239. 10.1001/jama.294.10.1233CrossRefPubMed Zietman AL, DeSilvio ML, Slater JD, Rossi CJ Jr, Miller DW, Adams JA, Shipley WU: Comparison of conventional-dose vs high-dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: A randomized controlled trial. JAMA 2005, 294: 1233-1239. 10.1001/jama.294.10.1233CrossRefPubMed
13.
go back to reference Boersma LJ, Brink M, Bruce AM, Shouman T, Gras L, te Velde A, Lebesque JV: Estimation of the incidence of late bladder and rectum complications after high-dose (70–78 GY) conformal radiotherapy for prostate cancer using dose-volume histograms. Int J Radiat Oncol Biol Phys 1998, 41: 83-92.CrossRefPubMed Boersma LJ, Brink M, Bruce AM, Shouman T, Gras L, te Velde A, Lebesque JV: Estimation of the incidence of late bladder and rectum complications after high-dose (70–78 GY) conformal radiotherapy for prostate cancer using dose-volume histograms. Int J Radiat Oncol Biol Phys 1998, 41: 83-92.CrossRefPubMed
14.
go back to reference Storey MR, Pollack A, Zagars G, Smith L, Antolak J, Rosen I: Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 2000, 48: 635-42.CrossRefPubMed Storey MR, Pollack A, Zagars G, Smith L, Antolak J, Rosen I: Complications from radiotherapy dose escalation in prostate cancer: preliminary results of a randomized trial. Int J Radiat Oncol Biol Phys 2000, 48: 635-42.CrossRefPubMed
15.
go back to reference Steenbakkers RJ, Deurloo KE, Nowak PJ, Lebesque JV, van Herk M, Rasch CR: Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate. Int J Radiat Oncol Biol Phys 2003, 57: 1269-79.CrossRefPubMed Steenbakkers RJ, Deurloo KE, Nowak PJ, Lebesque JV, van Herk M, Rasch CR: Reduction of dose delivered to the rectum and bulb of the penis using MRI delineation for radiotherapy of the prostate. Int J Radiat Oncol Biol Phys 2003, 57: 1269-79.CrossRefPubMed
16.
go back to reference Sobin LH, Wittekind CH: The prostate. In TNM Classification of Malignant Tumors. New York, Wiley-Liss; 2002:184-187. Sobin LH, Wittekind CH: The prostate. In TNM Classification of Malignant Tumors. New York, Wiley-Liss; 2002:184-187.
17.
go back to reference Vetterli D, Riem H, Aebersold DM, Greiner RH, Manser P, Cossmann P, Kemmerling L, Born EJ, Mini R: Introduction of a novel dose saving acquisition mode for the PortalVision aS500 EPID to facilitate on-line patient setup verification. Med Phys 2004, 31: 828-31. 10.1118/1.1668391CrossRefPubMed Vetterli D, Riem H, Aebersold DM, Greiner RH, Manser P, Cossmann P, Kemmerling L, Born EJ, Mini R: Introduction of a novel dose saving acquisition mode for the PortalVision aS500 EPID to facilitate on-line patient setup verification. Med Phys 2004, 31: 828-31. 10.1118/1.1668391CrossRefPubMed
18.
go back to reference Roach M 3rd: Re: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993, 150: 1923-24.PubMed Roach M 3rd: Re: The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol 1993, 150: 1923-24.PubMed
19.
go back to reference Vetterli D, Thalmann S, Behrensmeier F, Kemmerling L, Born EJ, Mini R, Greiner RH, Aebersold DM: Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode. Radiother Oncol 2006, 79: 101-108. 10.1016/j.radonc.2006.03.005CrossRefPubMed Vetterli D, Thalmann S, Behrensmeier F, Kemmerling L, Born EJ, Mini R, Greiner RH, Aebersold DM: Daily organ tracking in intensity-modulated radiotherapy of prostate cancer using an electronic portal imaging device with a dose saving acquisition mode. Radiother Oncol 2006, 79: 101-108. 10.1016/j.radonc.2006.03.005CrossRefPubMed
20.
go back to reference Harris EK, Albert A: Survivorship analysis for clinical studies. New York, NY: Marcel Dekker; 1991:5-125. Harris EK, Albert A: Survivorship analysis for clinical studies. New York, NY: Marcel Dekker; 1991:5-125.
21.
go back to reference Cox DR, Oakes D: Analysis of survival data. London, United Kingdom: Chapman and Hall; 1984:110-120. Cox DR, Oakes D: Analysis of survival data. London, United Kingdom: Chapman and Hall; 1984:110-120.
22.
go back to reference Skala M, Rosewall T, Dawson L, Divanbeigi L, Lockwood G, Thomas C, Crook J, Chung P, Warde P, Catton C: Patient-assessed late toxicity rates and principal component analysis after image-guided radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2007, 68: 690-698.CrossRefPubMed Skala M, Rosewall T, Dawson L, Divanbeigi L, Lockwood G, Thomas C, Crook J, Chung P, Warde P, Catton C: Patient-assessed late toxicity rates and principal component analysis after image-guided radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 2007, 68: 690-698.CrossRefPubMed
23.
go back to reference Lips IM, Dehnad H, van Gils CH, Boeken Kruger AE, Heide UA, van Vulpen M: High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients. Radiat Oncol 2008, 3: 15. 10.1186/1748-717X-3-15PubMedCentralCrossRefPubMed Lips IM, Dehnad H, van Gils CH, Boeken Kruger AE, Heide UA, van Vulpen M: High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients. Radiat Oncol 2008, 3: 15. 10.1186/1748-717X-3-15PubMedCentralCrossRefPubMed
24.
go back to reference Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W: Long-term treatment sequelae after external beam irradiation with or without hormonal manipulation for adenocarcinoma of the prostate: Analysis of Radiation Therapy Oncology Group studies 85-31, 86-10, and 92-02. Int J Radiat Oncol Biol Phys 2008, 70: 437-41.PubMedCentralCrossRefPubMed Lawton CA, Bae K, Pilepich M, Hanks G, Shipley W: Long-term treatment sequelae after external beam irradiation with or without hormonal manipulation for adenocarcinoma of the prostate: Analysis of Radiation Therapy Oncology Group studies 85-31, 86-10, and 92-02. Int J Radiat Oncol Biol Phys 2008, 70: 437-41.PubMedCentralCrossRefPubMed
Metadata
Title
Acute and late toxicity in prostate cancer patients treated by dose escalated intensity modulated radiation therapy and organ tracking
Authors
Pirus Ghadjar
Jacqueline Vock
Daniel Vetterli
Peter Manser
Roland Bigler
Jan Tille
Axel Madlung
Frank Behrensmeier
Roberto Mini
Daniel M Aebersold
Publication date
01-12-2008
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2008
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-3-35

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