title: Comparison of acute and late toxicities for three modern high-dose radiation treatment techniques for localized prostate cancer.
abstract: OBJECTIVE
  We compared acute and late genitourinary (GU) and gastrointestinal (GI) toxicities in prostate cancer patients treated with three different high-dose radiation techniques.
  
  
  METHODS
  A total of 1,903 patients with localized prostate cancer were treated with definitive RT at William Beaumont Hospital from 1992 to 2006: 22% with brachytherapy alone (BT), 55% with image-guided external beam (EB-IGRT), and 23% external beam with high-dose-rate brachytherapy boost (EBRT+HDR). Median dose with BT was 120 Gy for LDR and 38 Gy for HDR (9.5 Gy × 4). Median dose with EB-IGRT was 75.6 Gy (PTV) to prostate with or without seminal vesicles. For EBRT+HDR, the pelvis was treated to 46 Gy with an additional 19 Gy (9.5 Gy × 2) delivered via HDR. GI and GU toxicity was evaluated utilizing the NCI-CTC criteria (v.3.0). Median follow-up was 4.8 years.
  
  
  RESULTS
  The incidences of any acute ≥ Grade 2 GI or GU toxicities were 35%, 49%, and 55% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Any late GU toxicities ≥ Grade 2 were present in 22%, 21%, and 28% for BT, EB-IGRT, and EBRT+HDR (p = 0.01), respectively. Patients receiving EBRT+HDR had a higher incidence of urethral stricture and retention, whereas dysuria was most common in patients receiving BT. Any Grade ≥ 2 late GI toxicities were 2%, 20%, and 9% for BT, EB-IGRT, and EBRT+HDR (p < 0.001). Differences were most pronounced for rectal bleeding, with 3-year rates of 0.9%, 20%, and 6% (p < 0.001) for BT, EB-IGRT, and EBRT+HDR respectively.
  
  
  CONCLUSIONS
  Each of the three modern high-dose radiation techniques for localized prostate cancer offers a different toxicity profile. These data can help patients and physicians to make informed decisions regarding radiotherapy for prostate andenocarcinoma.
authors.affiliation: Department of Radiation Oncology, William Beaumont Hospital, Royal Oak, MI 48073, USA.
authors.forename: Nasiruddin
authors.initials: N
authors.lastname: Mohammed
authors.forename: Larry
authors.initials: L
authors.lastname: Kestin
authors.forename: Mihai
authors.initials: M
authors.lastname: Ghilezan
authors.forename: Daniel
authors.initials: D
authors.lastname: Krauss
authors.forename: Frank
authors.initials: F
authors.lastname: Vicini
authors.forename: Donald
authors.initials: D
authors.lastname: Brabbins
authors.forename: Gary
authors.initials: G
authors.lastname: Gustafson
authors.forename: Hong
authors.initials: H
authors.lastname: Ye
authors.forename: Alavaro
authors.initials: A
authors.lastname: Martinez
mesh_terms: D000208:Acute Disease; D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy / Q000009:adverse effects* / Q000379:methods; D005500:Follow-Up Studies; D006471:Gastrointestinal Hemorrhage / Q000209:etiology; D041981:Gastrointestinal Tract / Q000528:radiation effects*; D006801:Humans; D008297:Male; D008875:Middle Aged; D058958:Organs at Risk / Q000528:radiation effects; D011349:Proctitis / Q000209:etiology; D011467:Prostate / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000150:complications; D011879:Radiotherapy Dosage; D061089:Radiotherapy, Image-Guided / Q000009:adverse effects* / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods; D012007:Rectum / Q000528:radiation effects; D012669:Seminal Vesicles / Q000528:radiation effects; D014521:Urethra / Q000528:radiation effects; D014525:Urethral Stricture / Q000209:etiology; D001743:Urinary Bladder / Q000528:radiation effects; D016055:Urinary Retention / Q000209:etiology; D014566:Urogenital System / Q000528:radiation effects*