Acute toxicity of whole-pelvis IMRT in 87 patients with localized prostate cancer.
OBJECTIVE
To assess the acute toxicity profile of whole pelvis IMRT (WP-IMRT) for localized prostate cancer.


METHODS
Eighty seven patients treated with definitive WP-IMRT at UTMB from May 2002 to November 2006 were retrospectively reviewed. Treatment consisted of two sequential phases, WP-IMRT to 54 Gy at 1.8 Gy per fraction to the pelvic nodes and seminal vesicles and 60 Gy at 2 Gy to the prostate, and a separate external beam boost, 3DCRT or IMRT, to bring the dose to the prostate to 76 Gy. Acute toxicity was prospectively scored weekly during treatment and at 3 month follow-up according to CTC v2.0 for 10 genitourinary (GU) and gastrointestinal (GI) domains. The proportion of patients experiencing a given level of peak acute toxicity at a given point is reported.


RESULTS
Treatment was feasible with delivered doses to PTVs not significantly lower than planned ones and with only two patients experiencing treatment gaps longer than 5 days. About 2/3 and 1/10 of the patients experienced peak grade 2 and grade 3 reactions at least once during RT, respectively. Frequency/urgency (Grade 2+: 37.9%) and diarrhea (36.7%) were the most prevalent symptoms followed by proctitis (21.8%) and dysuria (16.1%). GI reactions were generally shorter lasting compared to GU ones which accumulated progressively during treatment. At 3 months, almost half of the patients were asymptomatic and most of observed reactions (89.2%) were mild, with GI ones more likely to be fully resolved (92.5%) than GU ones (68.7%, chi(2), p=0.001).


CONCLUSIONS
Our approach is dosimetrically and clinically feasible with intense, but transient, acute toxicity.
Sanguineti
Giuseppe
G
Department of Radiation Oncology, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555, USA. gisangui@utmb.edu
Endres
Eugene J
EJ
Parker
Brent C
BC
Bicquart
Celine
C
Little
Michael
M
Chen
George
G
Berilgen
Jason
J
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003967:Diarrhea / Q000209:etiology; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011874:Radiometry; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000295:instrumentation; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000295:instrumentation; D012307:Risk Factors; D014549:Urinary Incontinence / Q000209:etiology