title: Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer.
abstract: OBJECTIVE
  The aim was to evaluate treatment-related morbidity after intensity-modulated (IMRT) and image-guided (IGRT) radiotherapy with a total dose of 76 Gy in comparison to conventional conformal radiotherapy (3DCRT) up to 70.2-72 Gy for patients with prostate cancer.
  
  
  METHODS
  All patients were prospectively surveyed prior to, on the last day, as well as after a median time of 2 and 16 months after RT using a validated questionnaire (Expanded Prostate Cancer Index Composite). Criteria for the 78 matched pairs after IMRT vs. 3DCRT were patient age, use of antiandrogens, treatment volume (± whole pelvis), prognostic risk group, and urinary/bowel/sexual quality of life (QoL) before treatment.
  
  
  RESULTS
  QoL changes after dose-escalated IMRT were found to be similar to QoL changes after 3DCRT in all domains. Only sexual function scores more than 1 year after RT decreased slightly more after 3DCRT in comparison to IMRT (mean 9 vs. 6 points; p = 0.04), with erections firm enough for intercourse in 14% vs. 30% (p = 0.03). Painful bowel movements were reported more frequently after 3DCRT vs. IMRT 2 months after treatment (≥ once a day in 10% vs. 1%; p = 0.03), but a tendency for higher rectal bleeding rates was found after IMRT vs. 3DCRT more than 1 year after RT (≥ rarely in 20% vs. 9%; p = 0.06).
  
  
  CONCLUSIONS
  Combination of dose escalation with technological advances (IMRT and IGRT) is not associated with increased morbidity for patients with prostate cancer.
authors.affiliation: Klinik für Strahlentherapie, RWTH Aachen, Aachen, Germany. mpinkawa@ukaachen.de
authors.forename: Michael
authors.initials: M
authors.lastname: Pinkawa
authors.forename: Marc D
authors.initials: MD
authors.lastname: Piroth
authors.forename: Richard
authors.initials: R
authors.lastname: Holy
authors.forename: Victoria
authors.initials: V
authors.lastname: Djukic
authors.forename: Jens
authors.initials: J
authors.lastname: Klotz
authors.forename: Barbara
authors.initials: B
authors.lastname: Krenkel
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Eble
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000465:Algorithms; D007172:Erectile Dysfunction / Q000209:etiology; D005500:Follow-Up Studies; D006801:Humans; D021621:Imaging, Three-Dimensional / Q000009:adverse effects* / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D011788:Quality of Life; D011832:Radiation Injuries / Q000209:etiology*; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000009:adverse effects* / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000009:adverse effects / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D012007:Rectum / Q000528:radiation effects