Hypofractionated accelerated radiotherapy using concomitant intensity-modulated radiotherapy boost technique for localized high-risk prostate cancer: acute toxicity results.
OBJECTIVE
To evaluate the acute toxicities of hypofractionated accelerated radiotherapy (RT) using a concomitant intensity-modulated RT boost in conjunction with elective pelvic nodal irradiation for high-risk prostate cancer.


METHODS
This report focused on 66 patients entered into this prospective Phase I study. The eligible patients had clinically localized prostate cancer with at least one of the following high-risk features (Stage T3, Gleason score >or=8, or prostate-specific antigen level >20 ng/mL). Patients were treated with 45 Gy in 25 fractions to the pelvic lymph nodes using a conventional four-field technique. A concomitant intensity-modulated radiotherapy boost of 22.5 Gy in 25 fractions was delivered to the prostate. Thus, the prostate received 67.5 Gy in 25 fractions within 5 weeks. Next, the patients underwent 3 years of adjuvant androgen ablative therapy. Acute toxicities were assessed using the Common Terminology Criteria for Adverse Events, version 3.0, weekly during treatment and at 3 months after RT.


RESULTS
The median patient age was 71 years. The median pretreatment prostate-specific antigen level and Gleason score was 18.7 ng/L and 8, respectively. Grade 1-2 genitourinary and gastrointestinal toxicities were common during RT but most had settled at 3 months after treatment. Only 5 patients had acute Grade 3 genitourinary toxicity, in the form of urinary incontinence (n = 1), urinary frequency/urgency (n = 3), and urinary retention (n = 1). None of the patients developed Grade 3 or greater gastrointestinal or Grade 4 or greater genitourinary toxicity.


CONCLUSIONS
The results of the present study have indicated that hypofractionated accelerated RT with a concomitant intensity-modulated RT boost and pelvic nodal irradiation is feasible with acceptable acute toxicity.
Lim
Tee S
TS
Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, ON, Canada.
Cheung
Patrick C F
PC
Loblaw
D Andrew
DA
Morton
Gerard
G
Sixel
Katharina E
KE
Pang
Geordi
G
Basran
Parminder
P
Zhang
Liying
L
Tirona
Romeo
R
Szumacher
Ewa
E
Danjoux
Cyril
C
Choo
Richard
R
Thomas
Gillian
G
D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D006801:Humans; D015182:Lymphatic Irradiation / Q000009:adverse effects*; D008297:Male; D008875:Middle Aged; D010388:Pelvis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D012307:Risk Factors; D001743:Urinary Bladder / Q000528:radiation effects; D014555:Urination Disorders / Q000209:etiology*
D000726:Androgen Antagonists; D017430:Prostate-Specific Antigen