title: Intensity-modulated radiotherapy as primary therapy for prostate cancer: report on acute toxicity after dose escalation with simultaneous integrated boost to intraprostatic lesion.
abstract: OBJECTIVE
  To report on the acute toxicity of a third escalation level using intensity-modulated radiotherapy for prostate cancer (PCa) and the acute toxicity resulting from delivery of a simultaneous integrated boost (SIB) to an intraprostatic lesion (IPL) detected on magnetic resonance imaging (MRI), with or without spectroscopy.
  
  
  METHODS
  Between January 2002 and March 2007, we treated 230 patients with intensity-modulated radiotherapy to a third escalation level as primary therapy for prostate cancer. If an IPL (defined by MRI or MRI plus spectroscopy) was present, a SIB was delivered to the IPL. To report on acute toxicity, patients were seen weekly during treatment and 1 and 3 months after treatment. Toxicity was scored using the Radiation Therapy Oncology Group toxicity scale, supplemented by an in-house-developed scoring system.
  
  
  RESULTS
  The median dose to the planning target volume was 78 Gy. An IPL was found in 118 patients. The median dose to the MRI-detected IPL and MRI plus spectroscopy-detected IPL was 81 Gy and 82 Gy, respectively. No Grade 3 or 4 acute gastrointestinal toxicity developed. Grade 2 acute gastrointestinal toxicity was present in 26 patients (11%). Grade 3 genitourinary toxicity was present in 15 patients (7%), and 95 patients developed Grade 2 acute genitourinary toxicity (41%). No statistically significant increase was found in Grade 2-3 acute gastrointestinal or genitourinary toxicity after a SIB to an IPL.
  
  
  CONCLUSIONS
  The results of our study have shown that treatment-induced acute toxicity remains low when intensity-modulated radiotherapy to 80 Gy as primary therapy for prostate cancer is used. In addition, a SIB to an IPL did not increase the severity or incidence of acute toxicity.
authors.affiliation: Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
authors.forename: Bruno
authors.initials: B
authors.lastname: Speleers
authors.forename: Wilfried
authors.initials: W
authors.lastname: De Neve
authors.forename: Carlos
authors.initials: C
authors.lastname: De Wagter
authors.forename: Nicolas
authors.initials: N
authors.lastname: Lumen
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
mesh_terms: D015415:Biomarkers / Q000097:blood; D019583:Dose Fractionation, Radiation; D006801:Humans; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000532:radiotherapy; D011467:Prostate / Q000473:pathology* / Q000528:radiation effects; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D016879:Salvage Therapy / Q000379:methods
chemical_list: D015415:Biomarkers; D017430:Prostate-Specific Antigen