title: High-dose intensity-modulated radiotherapy for prostate cancer using daily fiducial marker-based position verification: acute and late toxicity in 331 patients.
abstract: We evaluated the acute and late toxicity after high-dose intensity-modulated radiotherapy (IMRT) with fiducial marker-based position verification for prostate cancer. Between 2001 and 2004, 331 patients with prostate cancer received 76 Gy in 35 fractions using IMRT combined with fiducial marker-based position verification. The symptoms before treatment (pre-treatment) and weekly during treatment (acute toxicity) were scored using the Common Toxicity Criteria (CTC). The goal was to score late toxicity according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) scale with a follow-up time of at least three years. Twenty-two percent of the patients experienced pre-treatment grade > or = 2 genitourinary (GU) complaints and 2% experienced grade 2 gastrointestinal (GI) complaints. Acute grade 2 GU and GI toxicity occurred in 47% and 30%, respectively. Only 3% of the patients developed acute grade 3 GU and no grade > or = 3 GI toxicity occurred. After a mean follow-up time of 47 months with a minimum of 31 months for all patients, the incidence of late grade 2 GU and GI toxicity was 21% and 9%, respectively. Grade > or = 3 GU and GI toxicity rates were 4% and 1%, respectively, including one patient with a rectal fistula and one patient with a severe hemorrhagic cystitis (both grade 4). In conclusion, high-dose intensity-modulated radiotherapy with fiducial marker-based position verification is well tolerated. The low grade > or = 3 toxicity allows further dose escalation if the same dose constraints for the organs at risk will be used.
authors.affiliation: Department of Radiation Oncology, University Medical Center Utrecht, The Netherlands. i.m.lips@umcutrecht.nl
authors.forename: Irene M
authors.initials: IM
authors.lastname: Lips
authors.forename: Homan
authors.initials: H
authors.lastname: Dehnad
authors.forename: Carla H
authors.initials: CH
authors.lastname: van Gils
authors.forename: Arto E
authors.initials: AE
authors.lastname: Boeken Kruger
authors.forename: Uulke A
authors.initials: UA
authors.lastname: van der Heide
authors.forename: Marco
authors.initials: M
authors.lastname: van Vulpen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D014566:Urogenital System / Q000528:radiation effects*