title: Dose escalation in image-guided, intensity-modulated radiotherapy of carcinoma prostate: initial experience in India.
abstract: BACKGROUND
  Increasing incidence and significant stage migration from distant metastases to a localized disease, due to screening application of PSA, is taking place in carcinoma prostate. Also, role of radiotherapy is increasing in carcinoma prostate due to rapid strides in technology.
  
  
  OBJECTIVE
  The present retrospective study, evaluates escalating the dose in the treatment of localized carcinoma prostate using integration of multiple advanced techniques.
  
  
  METHODS
  The settings designed are: a) use of gold seed internal fiducial markers: b) clinical application of emerging Megavoltage Cone Beam Computed Tomography (MVCBCT) technology for Image Guided Radiotherapy (IGRT); c) Intensity Modulated Radiotherapy (IMRT); d) adopting biochemical method for follow-up.
  
  
  METHODS
  Twelve consecutive, biopsy proven localized cancer of prostate patients, treated with dose escalation IMRT & IGRT protocol between August 2006 and January 2008, were analyzed. Gold seed markers in prostate were used for daily localization with MVCBCT or Electronic Portal Imaging (EPI). All patients underwent clinical and biochemical follow-up. STATISTICAL ANALYSIS & RESULTS: Planned dose of 7740 cGy was delivered in 10 out of 12 patients (83%). While one patient had migration of maximum of 3 mm, two others had 1 mm migration of one seed during course of treatment. One patient (8%) developed Grade II proctitis at 12th month. During the mean follow-up duration of 12.2 months, 92% (11/12) had biochemical control within 3 months of treatment.
  
  
  CONCLUSIONS
  IGRT technique using MVCBCT for implanted fiducial gold seed localization was feasible for IMRT dose escalation in carcinoma prostate with excellent results.
authors.affiliation: Department of Radiation Oncology, Ruby Hall Cancer Center, Ruby Hall Clinic, 40, Sassoon Road, Pune-411 001, Maharashtra, India.
authors.forename: Kumara
authors.initials: K
authors.lastname: Swamy
authors.forename: V K
authors.initials: VK
authors.lastname: Sathiya Narayanan
authors.forename: Sumeet
authors.initials: S
authors.lastname: Basu
authors.forename: Vikram
authors.initials: V
authors.lastname: Maiya
authors.forename: Rimpa
authors.initials: R
authors.lastname: Achari
authors.forename: Shrikant
authors.initials: S
authors.lastname: Deshpande
authors.forename: Janhavi
authors.initials: J
authors.lastname: Bhangle
authors.forename: Kamlesh Kumar
authors.initials: KK
authors.lastname: Gupta
authors.forename: Nirmal
authors.initials: N
authors.lastname: Babu
authors.forename: Surendra
authors.initials: S
authors.lastname: Pawar
authors.forename: Ashish
authors.initials: A
authors.lastname: Atre
authors.forename: Kashyapi
authors.initials: K
authors.lastname: Balachandra
authors.forename: C B
authors.initials: CB
authors.lastname: Koppiker
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002277:Carcinoma / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D007194:India; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011878:Radiotherapy / Q000379:methods*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D025321:Surgery, Computer-Assisted