title: Helical tomotherapy with simultaneous integrated boost for high-risk and lymph node-positive prostate cancer: early report on acute and late toxicity.
abstract: The use of whole pelvic radiotherapy (WPRT) for high-risk and lymph node-positive prostate cancer (PC) remains controversial. The purpose of this study was to evaluate the acute toxicity associated with helical tomotherapy in the treatment of high-risk and lymph node-positive prostate cancer. To do so, twenty-eight patients were treated to a dose of 54 Gy in daily fractions of 1.8 Gy to the pelvic lymph node area, while the prostate and the seminal vesicles received a simultaneous integrated boost (SIB) to a dose of 70.5 Gy. A SIB to a dose of 60 Gy was delivered to the involved lymph node region(s) in 8 patients with pelvic lymph node metastases. All patients received concurrent hormonal treatment. The incidence of grade 2 and 3 acute gastrointestinal (GI) toxicity was 7% and 0% respectively. Grade 2 and 3 acute genito-urinary (GU) side effects were observed in 14% and 4% of the patients respectively. No grade 4 side effects occurred. No increased toxicity was observed in the 8 lymph node-positive patients receiving a simultaneous pelvic nodal dose escalation. In conclusion, WPRT with a SIB to the prostate and seminal vesicles by helical tomotherapy resulted in a favourable toxicity profile. Pelvic nodal dose escalation in node-positive patients is feasible without increasing toxicity.
authors.affiliation: Department of Radiation Oncology Oncologisch Centrum UZ Brussel Laarbeeklaan 101, B-1090 Brussels Belgium. benedikt.engels@gmail.com
authors.forename: Benedikt
authors.initials: B
authors.lastname: Engels
authors.forename: Guy
authors.initials: G
authors.lastname: Soete
authors.forename: Koen
authors.initials: K
authors.lastname: Tournel
authors.forename: Samuel
authors.initials: S
authors.lastname: Bral
authors.forename: Peter
authors.initials: P
authors.lastname: De Coninck
authors.forename: Dirk
authors.initials: D
authors.lastname: Verellen
authors.forename: Guy
authors.initials: G
authors.lastname: Storme
mesh_terms: D000368:Aged; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology / Q000528:radiation effects; D011379:Prognosis; D011467:Prostate / Q000528:radiation effects*; D011471:Prostatic Neoplasms / Q000473:pathology* / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000209:etiology*; D011881:Radiotherapy, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012669:Seminal Vesicles / Q000473:pathology / Q000528:radiation effects; D036542:Tomography, Spiral Computed / Q000295:instrumentation* / Q000379:methods