International Journal of Radiation Oncology*Biology*Physics
Clinical investigation: prostateShort-course intensity-modulated radiotherapy (70 GY at 2.5 GY per fraction) for localized prostate cancer: preliminary results on late toxicity and quality of life☆
Introduction
Hypofractionation in the treatment of prostate cancer offers several advantages: shorter treatment course, increased convenience for patients, and decreased cost. It also possibly offers an improved therapeutic ratio, due to a presumed low α/β ratio of prostate cancer tissues 1, 2, 3. The technique and acute toxicity associated with short-course intensity-modulated radiotherapy (SCIM-RT) have been previously described (4). With a median follow-up of 18 months, the same initial 51 patients constitute the sample studied in this report. The emphasis in this report is late toxicity. In addition, a thorough quality-of-life (QOL) assessment is done with a newly validated QOL instrument.
Section snippets
Technique
The SCIM-RT technique has been previously described (4). Inverse planning was done on the Corvus planning system. The outlining of the target and critical structures was performed by the treating physician (P.A.K.). Two risk groups were considered with respect to the definition of the target tissues: low-risk (stage T1-T2, pretreatment prostate-specific antigen [PSA] ≤ 10, and biopsy Gleason ≤ 6) and high-risk disease (stage T3 or pretreatment PSA > 10 or biopsy Gleason ≥ 7). The target was the
Acute toxicity
The RTOG acute bladder toxicity scores for the 51 SCIM-RT cases were as follows: 0 in 4 cases (8%), 1 in 37 cases (72%), and 2 in 10 cases (20%). The RTOG acute rectal toxicity scores for SCIM-RT cases were as follows: 0 in 10 cases (19%), 1 in 34 cases (67%), and 2 in 7 cases (14%). No Grade 3 or 4 acute toxicity was observed.
Late toxicity
The late toxicity profile in all 51 cases has been exceptionally unremarkable. Only one patient developed temporary minimal hematuria; this was scored as a Grade 1
Discussion
Dose escalation studies of three-dimensional CRT techniques have been safely used at dose levels as high as 81 Gy, with improved response seen at higher doses 6, 13, 14, 15, 16, 17. However, these schedules involve up to 8 to 9 weeks of daily treatments. In addition to decreasing the inconvenience of lengthy treatments, there could be a biologic benefit in decreasing the overall treatment time by increasing the daily fraction size. Due to our previous experience with doses in the 78 Gy range
References (18)
Toward optimal external-beam fractionation for prostate cancer
Int J Radiat Oncol Biol Phys
(2000)- et al.
Fractionation and protraction for radiotherapy of prostate carcinoma
Int J Radiat Oncol Biol Phys
(1999) - et al.
Short-course intensity-modulated radiotherapy for localized prostate cancer with daily transabdominal ultrasound localization of the prostate gland
Int J Radiat Oncol Biol Phys
(2000) - et al.
Indications for excluding the seminal vesicles when treating clinically localized prostatic adenocarcinoma with radiotherapy alone
Int J Radiat Oncol Biol Phys
(1997) - et al.
Higher than standard radiation doses (72 Gy or greater) with or without androgen deprivation in the treatment of localized prostate cancer
Int J Radiat Oncol Biol Phys
(2000) - et al.
Conventional vs. conformal radiotherapy for prostate cancerPreliminary results of dosimetry and acute toxicity
Int J Radiat Oncol Biol Phys
(1996) - et al.
Ultrasound-based stereotactic guidance of precision conformal external beam radiation therapy in clinically localized prostate cancer
Urology
(2000) - et al.
Daily transabdominal ultrasound localization of the prostate gland with the BAT system2705 alignments from 100 patients
Int J Radiat Oncol Biol Phys
(2000) - et al.
Development and validation of the expanded prostate cancer index composite (EPIC) for comprehensive assessment of health-related quality of life in men with prostate cancer
Urology
(2000)
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