title: Image-guided radiotherapy for prostate cancer: a prospective trial of concomitant boost using indium-111-capromab pendetide (ProstaScint) imaging.
abstract: OBJECTIVE
  To evaluate, in a prospective study, the use of (111)In-capromab pendetide (ProstaScint) scan to guide the delivery of a concomitant boost to intraprostatic region showing increased uptake while treating the entire gland with intensity-modulated radiotherapy for localized prostate cancer.
  
  
  METHODS
  From September 2002 to November 2005, 71 patients were enrolled. Planning pelvic CT and (111)In-capromab pendetide scan images were coregistered. The entire prostate gland received 75.6 Gy/42 fractions, whereas areas of increased uptake in (111)In-capromab pendetide scan received 82 Gy. For patients with T3/T4 disease, or Gleason score ≥8, or prostate-specific antigen level >20 ng/mL, 12 months of adjuvant androgen deprivation therapy was given. In January 2005 the protocol was modified to give 6 months of androgen deprivation therapy to patients with a prostate-specific antigen level of 10-20 ng/mL or Gleason 7 disease.
  
  
  RESULTS
  Thirty-one patients had low-risk, 30 had intermediate-risk, and 10 had high-risk disease. With a median follow-up of 66 months, the 5-year biochemical control rates were 94% for the entire cohort and 97%, 93%, and 90% for low-, intermediate-, and high-risk groups, respectively. Maximum acute and late urinary toxicities were Grade 2 for 38 patients (54%) and 28 patients (39%) and Grade 3 for 1 and 3 patients (4%), respectively. One patient had Grade 4 hematuria. Maximum acute and late gastrointestinal toxicities were Grade 2 for 32 patients (45%) and 15 patients (21%), respectively. Most of the side effects improved with longer follow-up.
  
  
  CONCLUSIONS
  Concomitant boost to areas showing increased uptake in (111)In-capromab pendetide scan to 82 Gy using intensity-modulated radiotherapy while the entire prostate received 75.6 Gy was feasible and tolerable, with 94% biochemical control rate at 5 years.
authors.affiliation: Department of Radiation Oncology, Mayo Clinic Arizona, Scottsdale, AZ 85259, USA. wong.william@mayo.edu
authors.forename: William W
authors.initials: WW
authors.lastname: Wong
authors.forename: Steven E
authors.initials: SE
authors.lastname: Schild
authors.forename: Sujay A
authors.initials: SA
authors.lastname: Vora
authors.forename: Gary A
authors.initials: GA
authors.lastname: Ezzell
authors.forename: Ba D
authors.initials: BD
authors.lastname: Nguyen
authors.forename: Panol C
authors.initials: PC
authors.lastname: Ram
authors.forename: Michael C
authors.initials: MC
authors.lastname: Roarke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000726:Androgen Antagonists / Q000627:therapeutic use; D000911:Antibodies, Monoclonal / Q000493:pharmacokinetics; D017024:Chemotherapy, Adjuvant / Q000379:methods; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D007202:Indicators and Reagents / Q000493:pharmacokinetics; D007205:Indium Radioisotopes / Q000493:pharmacokinetics; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D011446:Prospective Studies; D011467:Prostate / Q000000981:diagnostic imaging; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000000981:diagnostic imaging* / Q000188:drug therapy / Q000473:pathology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000000981:diagnostic imaging / Q000473:pathology; D011877:Radionuclide Imaging; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods; D018570:Risk Assessment; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D000726:Androgen Antagonists; D000911:Antibodies, Monoclonal; D007202:Indicators and Reagents; D007205:Indium Radioisotopes; C101315:Capromab Pendetide; D017430:Prostate-Specific Antigen