title: Postoperative high-dose pelvic radiotherapy for N+ prostate cancer: toxicity and matched case comparison with postoperative prostate bed-only radiotherapy.
abstract: OBJECTIVE
  To report on toxicity of postoperative high-dose whole-pelvis radiotherapy (WPRT) with androgen deprivation therapy for lymph node metastasized (N1) prostate cancer (PC). To perform a matched-case analysis to compare this toxicity profile to postoperative prostate bed-only radiotherapy (PBRT).
  
  
  METHODS
  Forty-eight N1-PC patients were referred for WPRT and 239 node-negative patients for PBRT. Patients were matched 1:1 according to pre-treatment demographics, symptoms, treatment and tumor characteristics. Mean dose to the prostate bed was 75Gy (WPRT-PBRT) and 54Gy to the elective nodes (WPRT) in 36 or 37 fractions. End points are genito-urinary (GU) and gastro-intestinal (GI) toxicity.
  
  
  RESULTS
  After WPRT, 35% developed grade 2 (G2) and 4% G3 acute GU toxicity. Acute GI toxicity developed in 42% (G2). Late GU toxicity developed in 36% (G2) and 7% (G3). One patient had G4 incontinence. Recuperation occurred in 59%. Late GI toxicity developed in 25% (G2) with 100% recuperation. Incidence of acute and late GI toxicity was higher following WPRT compared to PBRT (p⩽0.041). GU toxicity was similar. With WPRT mean dose to bladder and rectosigmoid were higher.
  
  
  CONCLUSIONS
  Postoperative high-dose WPRT comes at the cost of a temporary increase in G2. GI toxicity compared to PBRT because larger volumes of rectosigmoid are irradiated.
authors.affiliation: Department of Urology, Ghent University Hospital, Belgium. Electronic address: charles.vanpraet@uzgent.be.
authors.forename: Charles
authors.initials: C
authors.lastname: Van Praet
authors.forename: Piet
authors.initials: P
authors.lastname: Ost
authors.forename: Nicolaas
authors.initials: N
authors.lastname: Lumen
authors.forename: Gert
authors.initials: G
authors.lastname: De Meerleer
authors.forename: Katrien
authors.initials: K
authors.lastname: Vandecasteele
authors.forename: Geert
authors.initials: G
authors.lastname: Villeirs
authors.forename: Karel
authors.initials: K
authors.lastname: Decaestecker
authors.forename: Valérie
authors.initials: V
authors.lastname: Fonteyne
mesh_terms: D000368:Aged; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010388:Pelvis / Q000528:radiation effects; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000601:surgery; D011832:Radiation Injuries / Q000209:etiology; D011878:Radiotherapy / Q000009:adverse effects; D011879:Radiotherapy Dosage
keywords: Intensity-modulated arc therapy; Lymph node involvement; Pelvic irradiation; Prostate cancer