title: The effect of radiation technique and bladder filling on the acute toxicity of pelvic radiotherapy for localized high risk prostate cancer.
abstract: OBJECTIVE
  The goal of this project was to see if using IMRT to deliver elective pelvic nodal irradiation (EPNI) for prostate cancer reduced acute treatment toxicity.
  
  
  METHODS
  Two hundred and thirty patients were enrolled into prospective trials delivering EPNI with a concomitant hypofractionated IMRT boost to the prostate. During accrual, the method of EPNI delivery changed as new literature emerged. Three methods were used (1) 4FB, (2) IMRT with 2cm CTV margins around the pelvic vessels as suggested by Shih et al. (2005) [7] (IMRT-Shih), and (3) IMRT with nodal volumes suggested by the RTOG (IMRT-RTOG). Initially patients were treated with an empty bladder, with the remainder treated with bladder full.
  
  
  RESULTS
  Patients in the 4FB group had higher rates of grade 2 acute GI toxicities compared to the IMRT-Shih and IMRT-RTOG groups (31.9% vs 20.8% vs 7.2%, p=0.0009). Patients in the 4FB group had higher rates of grade 3 urinary frequency compared to the two IMRT groups (8.5% vs 0% vs 0%, p=0.027). However, multivariate analysis suggested the factor that most influenced toxicity was bladder filling followed by IMRT.
  
  
  CONCLUSIONS
  Bladder filling appeared to be the dominant factor which predicted for acute toxicity, followed by the use of IMRT.
authors.affiliation: Department of Radiation Oncology, Odette Cancer Centre, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, ON, Canada.
authors.forename: Suneil
authors.initials: S
authors.lastname: Jain
authors.forename: D Andrew
authors.initials: DA
authors.lastname: Loblaw
authors.forename: Gerard C
authors.initials: GC
authors.lastname: Morton
authors.forename: Cyril
authors.initials: C
authors.lastname: Danjoux
authors.forename: Ewa
authors.initials: E
authors.lastname: Szumacher
authors.forename: William
authors.initials: W
authors.lastname: Chu
authors.forename: Hans T
authors.initials: HT
authors.lastname: Chung
authors.forename: Danny
authors.initials: D
authors.lastname: Vesprini
authors.forename: Arjun
authors.initials: A
authors.lastname: Sahgal
authors.forename: Liying
authors.initials: L
authors.lastname: Zhang
authors.forename: Andrea
authors.initials: A
authors.lastname: Deabreu
authors.forename: Patrick C F
authors.initials: PC
authors.lastname: Cheung
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects*; D011446:Prospective Studies; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D001743:Urinary Bladder / Q000503:physiopathology / Q000528:radiation effects*