title: Postoperative intensity-modulated radiotherapy with simultaneous integrated boost in prostate cancer: a dose-escalation trial.
abstract: OBJECTIVE
  To determine the recommended phase II dose of postoperative accelerated intensity modulated radiotherapy (IMRT) for prostate cancer.
  
  
  METHODS
  Step and shoot IMRT with simultaneous integrated boost (SIB) was delivered in 25 fractions over 5 weeks to patients with high risk resected prostate adenocarcinoma (stage pT3-4 and/or positive surgical margins). Pelvic nodes received 45 Gy at 1.8 Gy/fraction; dose escalation was performed only to the prostate bed (planned dose escalation: 56.8 Gy at 2.27 Gy/fraction, 59.7 Gy at 2.39 Gy/fraction, 61.25 Gy at 2.45 Gy/fraction, 62.5 Gy at 2.5 Gy/fraction). Dose-limiting toxicity (DLT) was any grade ≥ 3 acute toxicity (RTOG score).
  
  
  RESULTS
  Twenty-five patients were treated: 7 patients at the 56.75 Gy dose level, 6 patients at each subsequent dose level. Pathologic stages were: pT2c: 2; pT3a: 11; pT3b: 12; pN0: 22; pN1: 3; R0: 7; R1: 18. Median follow-up time was 19 months (range: 6-36 months). No patient experienced DLT. Grade 1-2 acute rectal and urologic toxicity was common (17 and 22 patients, respectively).
  
  
  CONCLUSIONS
  The recommended dose was 62.5 Gy in 2.5 Gy/fraction. Postoperative hypofractionated IMRT SIB for prostate cancer seemed to be well tolerated and could be tested in phase II studies.
authors: Department of Radiotherapy, John Paul II Center for High Technology Research and Education in Biomedical Sciences, Catholic University, Campobasso, Italy.
authors: Edy
authors: E
authors: Ippolito
authors: Numa
authors: N
authors: Cellini
authors: Cinzia
authors: C
authors: Digesù
authors: Savino
authors: S
authors: Cilla
authors: Giovanna
authors: G
authors: Mantini
authors: Mario
authors: M
authors: Balducci
authors: Alessandra
authors: A
authors: Di Lallo
authors: Francesco
authors: F
authors: Deodato
authors: Gabriella
authors: G
authors: Macchia
authors: Mariangela
authors: M
authors: Massaccesi
authors: Gian Carlo
authors: GC
authors: Mattiucci
authors: Luca
authors: L
authors: Tagliaferri
authors: Angelo
authors: A
authors: Piermattei
authors: Daniele
authors: D
authors: Cuscunà
authors: Alessio G
authors: AG
authors: Morganti
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D000368:Aged; D017322:Clinical Trials, Phase II as Topic; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010388:Pelvis / Q000473:pathology / Q000601:surgery; D011184:Postoperative Period; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D020266:Radiotherapy, Conformal; D050397:Radiotherapy, Intensity-Modulated