Dose escalation in image-guided, intensity-modulated radiotherapy of carcinoma prostate: initial experience in India.
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.
Swamy
Kumara
K
Department of Radiation Oncology, Ruby Hall Cancer Center, Ruby Hall Clinic, 40, Sassoon Road, Pune-411 001, Maharashtra, India.
Sathiya Narayanan
V K
VK
Basu
Sumeet
S
Maiya
Vikram
V
Achari
Rimpa
R
Deshpande
Shrikant
S
Bhangle
Janhavi
J
Gupta
Kamlesh Kumar
KK
Babu
Nirmal
N
Pawar
Surendra
S
Atre
Ashish
A
Balachandra
Kashyapi
K
Koppiker
C B
CB
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