title: Intensity-modulated radiotherapy with simultaneous integrated boost to dominant intraprostatic lesion: preliminary report on toxicity.
abstract: OBJECTIVE
  To evaluate the feasibility of intensity-modulated radiotherapy with simultaneous integrated boost to the dominant intraprostatic lesion for definitive treatment of prostate cancer.
  
  
  METHODS
  Patients were deemed eligible for the study if they had histologically proven stage cT2-T3 N0M0 prostate adenocarcinoma. In addition <20% risk of lymph nodal involvement according to Roach formula, was required for enrollment. Patients were treated with intensity-modulated radiotherapy with simultaneous integrated boost technique to the dominant intraprostatic lesion defined by magnetic resonance imaging. The prescribed dose to the prostate and seminal vesicles was 72 Gy (1.8 Gy per fraction). The dose delivered to the intraprostatic lesion received was 80 Gy (2 Gy per fraction). Acute gastrointestinal (GI) and genitourinary (GU) toxicity was evaluated weekly during treatment, and at 1 and 3 months thereafter. Late GI and GU toxicity was evaluated by Kaplan Meier method.
  
  
  RESULTS
  Forty patients were deemed evaluable. Acute and late GI and GU toxicity were evaluated in all patients. Two patients (5%) developed acute grade 3 GI toxicity and 1 patient (2.5%) developed acute grade 3 GU toxicity. No grade 4 acute GI or GU toxicity occurred. With a median follow-up of 19 months (interquartile range, 15 to 26 mo), the 2-year actuarial cumulative incidence of grade ≥2 rectal toxicity was 9.5%. The 2-year actuarial cumulative incidence of grade ≥2 urinary toxicity was 13.3%.
  
  
  CONCLUSIONS
  Treatment related acute toxicity was low in our cohort. Prolonged observation with a larger series of patients is necessary to evaluate late toxicity and local control.
authors.affiliation: Radiotherapy Unit, "John Paul II" Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
authors.forename: Edy
authors.initials: E
authors.lastname: Ippolito
authors.forename: Giovanna
authors.initials: G
authors.lastname: Mantini
authors.forename: Alessio G
authors.initials: AG
authors.lastname: Morganti
authors.forename: Ercole
authors.initials: E
authors.lastname: Mazzeo
authors.forename: Gilbert D A
authors.initials: GD
authors.lastname: Padula
authors.forename: Cinzia
authors.initials: C
authors.lastname: Digesù
authors.forename: Savino
authors.initials: S
authors.lastname: Cilla
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Frascino
authors.forename: Stefano
authors.initials: S
authors.lastname: Luzi
authors.forename: Mariangela
authors.initials: M
authors.lastname: Massaccesi
authors.forename: Gabriella
authors.initials: G
authors.lastname: Macchia
authors.forename: Francesco
authors.initials: F
authors.lastname: Deodato
authors.forename: Gian Carlo
authors.initials: GC
authors.lastname: Mattiucci
authors.forename: Angelo
authors.initials: A
authors.lastname: Piermattei
authors.forename: Numa
authors.initials: N
authors.lastname: Cellini
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use*; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use*; D019583:Dose Fractionation, Radiation; D005240:Feasibility Studies; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy / Q000379:methods; D009367:Neoplasm Staging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D016896:Treatment Outcome
chemical_list: D000726:Androgen Antagonists; D018931:Antineoplastic Agents, Hormonal