Top

Published in:

Open Access 01-12-2014 | Research

Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

Authors: Joen Sveistrup, Per Munck af Rosenschöld, Joseph O Deasy, Jung Hun Oh, Tobias Pommer, Peter Meidahl Petersen, Svend Aage Engelholm

Published in: Radiation Oncology | Issue 1/2014

Abstract

Background

Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa).

Methods

A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT.

Results

The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p < 0.001). For GU toxicity the numbers were 41.8% and 29.7%, respectively (p = 0.011). On multivariate analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p < 0.001, HR = 11.59 [CI: 6.67-20.14]). 3DCRT was also associated with an increased risk of developing GU toxicity compared to IG-IMRT.

The 3-year actuarial biochemical progression-free survival probability was 86.0% for 3DCRT and 90.3% for IG-IMRT (p = 0.386). On multivariate analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT.

Conclusion

The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction.

Available only for authorised users

Mottet N, Peneau M, Mazeron JJ, et al.: Addition of radiotherapy to long-term androgen deprivation in locally advanced prostate cancer: an open randomised phase 3 trial. Eur Urol 2012,62(2):213-219. 10.1016/j.eururo.2012.03.053CrossRefPubMed

Martin JM, Bayley A, Bristow R, et al.: Image guided dose escalated prostate radiotherapy: still room to improve. Radiat Oncol 2009, 4: 50. 10.1186/1748-717×−4-50 10.1186/1748-717X-4-50PubMedCentralCrossRefPubMed

Gill S, Thomas J, Fox C, et al.: Acute toxicity in prostate cancer patients treated with and without image-guided radiotherapy. Radiat Oncol 2011, 6: 145. 10.1186/1748-717×−6-145 10.1186/1748-717X-6-145PubMedCentralCrossRefPubMed

Zelefsky MJ, Kollmeier M, Cox B, et al.: Improved clinical outcomes with high-dose image guided radiotherapy compared with non-IGRT for the treatment of clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 2012,84(1):125-129. 10.1016/j.ijrobp.2011.11.047CrossRefPubMed

Engels B, Soete G, Verellen D, et al.: Conformal arc radiotherapy for prostate cancer: increased biochemical failure in patients with distended rectum on the planning computed tomogram despite image guidance by implanted markers. Int J Radiat Oncol Biol Phys 2009,74(2):388-391. 10.1016/j.ijrobp.2008.08.007CrossRefPubMed

D’Amico AV, Whittington R, Malkowicz SB, et al.: Biochemical outcome after radical prostatectomy, external beam radiation therapy, or interstitial radiation therapy for clinically localized prostate cancer. JAMA 1998,280(11):969-974. 10.1001/jama.280.11.969CrossRefPubMed

Roach M 3rd, Hanks G, Thames H Jr, et al.: Defining biochemical failure following radiotherapy with or without hormonal therapy in men with clinically localized prostate cancer: Recommendation of the RTOG-ASTRO Phoenix Consensus Conference. Int J Radiat Oncol Biol Phys 2006, 65: 965-974. 10.1016/j.ijrobp.2006.04.029CrossRefPubMed

Bergström P, Löfroth PO, Widmark A: High-precision conformal radiotherapy (HPCRT) of prostate cancer–a new technique for exact positioning of the prostate at the time of treatment. Int J Radiat Oncol Biol Phys 1998,42(2):305-311. 10.1016/S0360-3016(98)00229-6CrossRefPubMed

Fransson P, Bergström P, Löfroth PO, et al.: Five-year prospective patient evaluation of bladder and bowel symptoms after dose-escalated radiotherapy for prostate cancer with the BeamCath technique. Int J Radiat Oncol Biol Phys 2006,66(2):430-438. 10.1016/j.ijrobp.2006.05.007CrossRefPubMed

10.

Partin AW, Mangold LA, Lamm DM, et al.: Contemporary update of prostate cancer staging nomograms (Partin Tables) for the new millennium. Urology 2001,58(6):843-848. 10.1016/S0090-4295(01)01441-8CrossRefPubMed

11.

Aznar MC, Petersen PM, Logadottir A, et al.: Rotational radiotherapy for prostate cancer in clinical practice. Radiother Oncol 2010,97(3):480-484. Epub 2010 Oct 20 10.1016/j.radonc.2010.09.014CrossRefPubMed

12.

Schallenkamp JM, Herman MG, Kruse JJ, et al.: Prostate position relative to pelvic bony anatomy based on intraprostatic gold markers and electronic portal imaging. Int J Radiat Oncol Biol Phys 2005,63(3):800-811. 10.1016/j.ijrobp.2005.02.022CrossRefPubMed

13.

Guckenberger M, Ok S, Polat B, et al.: Toxicity after intensity-modulated, image-guided radiotherapy for prostate cancer. Strahlenther Onkol 2010,186(10):535-543. 10.1007/s00066-010-2144-zCrossRefPubMed

14.

McLaughlin PW, Troyer S, Berri S, et al.: Functional anatomy of the prostate: implications for treatment planning. Int J Radiat Oncol Biol Phys 2005,63(2):479-491. 10.1016/j.ijrobp.2005.02.036CrossRefPubMed

15.

Fransson P, Bergström P, Löfroth PO, et al.: Daily-diary evaluated side effects of dose-escalation radiotherapy of prostate cancer using the stereotactic BeamCath technique. Acta Oncol 2003,42(4):326-333. 10.1080/02841860310004346CrossRefPubMed

16.

Albert M, Tempany CM, Schultz D, et al.: Late genitourinary and gastrointestinal toxicity after magnetic resonance image-guided prostate brachytherapy with or without neoadjuvant external beam radiation therapy. Cancer 2003,98(5):949-954. 10.1002/cncr.11595CrossRefPubMed

17.

Lawton CA, Bae K, Pilepich M, et al.: 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(2):437-441. 10.1016/j.ijrobp.2007.06.050PubMedCentralCrossRefPubMed

18.

Diez P, Vogelius IS, Bentzen SM: A new method for synthesizing radiation dose–response data from multiple trials applied to prostate cancer. Int J Radiat Oncol Biol Phys 2010,77(4):1066-1071. 10.1016/j.ijrobp.2009.06.013PubMedCentralCrossRefPubMed

19.

Pinkawa M, Pursch-Lee M, Asadpour B, et al.: Image-guided radiotherapy for prostate cancer. Implementation of ultrasound-based prostate localization for the analysis of inter- and intrafraction organ motion. Strahlenther Onkol 2008,184(12):679-685. 10.1007/s00066-008-1902-7CrossRefPubMed

20.

Langsenlehner T, Döller C, Winkler P, et al.: Impact of inter- and intrafraction deviations and residual set-up errors on PTV margins. Different alignment techniques in 3D conformal prostate cancer radiotherapy. Strahlenther Onkol 2013,189(4):321-328. 10.1007/s00066-012-0303-0CrossRefPubMed

21.

Spratt DE, Pei X, Yamada J, et al.: Long-term survival and toxicity in patients treated with high-dose intensity modulated radiation therapy for localized prostate cancer. Int J Radiat Oncol Biol Phys 2012., 12: [Epub ahead of print]

22.

Abdollah F, Schmitges J, Sun M, et al.: Comparison of mortality outcomes after radical prostatectomy versus radiotherapy in patients with localized prostate cancer: a population-based analysis. Int J Urol 2012,19(9):836-844. 10.1111/j.1442-2042.2012.03052.xCrossRefPubMed

Title: Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance
Authors: Joen Sveistrup
Per Munck af Rosenschöld
Joseph O Deasy
Jung Hun Oh
Tobias Pommer
Peter Meidahl Petersen
Svend Aage Engelholm
Publication date: 01-12-2014
Publisher: BioMed Central
Published in: Radiation Oncology / Issue 1/2014
Electronic ISSN: 1748-717X
DOI: https://doi.org/10.1186/1748-717X-9-44

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2014

Reconstruction of the treatment area by use of sinogram in helical tomotherapy

Intensity-modulated radiotherapy with simultaneous integrated boost for locoregionally advanced nasopharyngeal carcinoma

Consequences of tumor planning target volume reduction in treatment of T2-T4 laryngeal cancer

Quality of life, fatigue and local response of patients with unstable spinal bone metastases under radiation therapy - a prospective trial

Treatment outcomes and late toxicities in patients with embryonal central nervous system tumors

Early results of urethral dose reduction and small safety margin in intensity-modulated radiation therapy (IMRT) for localized prostate cancer using a real-time tumor-tracking radiotherapy (RTRT) system