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Strahlentherapie und Onkologie
Published in: Strahlentherapie und Onkologie 11/2012

01-11-2012 | Original article

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

Report of feasibility and acute toxicity

Authors: F. Alongi, A. Fogliata, P. Navarria, A. Tozzi, P. Mancosu, F. Lobefalo, G. Reggiori, A. Clivio, L. Cozzi, M. Scorsetti

Published in: Strahlentherapie und Onkologie | Issue 11/2012

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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.
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Metadata
Title
Moderate hypofractionation and simultaneous integrated boost with volumetric modulated arc therapy (RapidArc) for prostate cancer
Report of feasibility and acute toxicity
Authors
F. Alongi
A. Fogliata
P. Navarria
A. Tozzi
P. Mancosu
F. Lobefalo
G. Reggiori
A. Clivio
L. Cozzi
M. Scorsetti
Publication date
01-11-2012
Publisher
Springer-Verlag
Published in
Strahlentherapie und Onkologie / Issue 11/2012
Print ISSN: 0179-7158
Electronic ISSN: 1439-099X
DOI
https://doi.org/10.1007/s00066-012-0171-7

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