title: Image guided intensity modulated hypofractionated radiotherapy in high-risk prostate cancer patients treated four or five times per week: analysis of toxicity and preliminary results.
abstract: BACKGROUND
  To evaluate efficacy and toxicity of hypofractionated intensity-modulated simultaneous integrated boost (IMRT-SIB) and image-guided (IGRT) radiotherapy in the treatment of high-risk prostate cancer patients.
  
  
  METHODS
  Eighty-two patients with high-risk prostate cancer were analysed. An IMRT treatment was planned delivering 68.75 Gy to the prostate, 55 Gy to the seminal vesicles and positive nodes and 45 Gy to the pelvis in 25 fractions. The first 59 patients received 4 weekly fractions whereas the last 23 patients received 5 weekly fractions. All patients were submitted to hormonal therapy.
  
  
  RESULTS
  The median follow-up was 31 months. Acute grade 1-2 gastrointestinal (GI) toxicity rates were 13.4%. Grade 1-2 and grade 3 genitourinary (GU) toxicity rates were 22% and 1.2%, respectively.Grade 1 and 2 GI late toxicity rates were 1.2%. No grade ≥3 toxicity was recorded. Grade 1 GU late toxicity rate was 2.4%. No grade ≥2 toxicity was recorded.No significant difference was calculated in terms of acute and late toxicity between the group treated 4 or 5 times weekly.The actuarial 3-years Overall survival and Freedom from biochemical failure were 98.6% and 91.3%, respectively.
  
  
  CONCLUSIONS
  The present study demonstrated that hypofractionated IGRT-IMRT-SIB in patients with high-risk prostate cancer is efficient with acceptable toxicity profile. Outcome in terms of survival are promising, but longer follow-up is needed.
authors.affiliation: Department of Radiation Oncology, La Sapienza" University, Sant'Andrea Hospital of Rome, Rome, Italy. mauval1@libero.it.
authors.forename: Maurizio
authors.initials: M
authors.lastname: Valeriani
authors.forename: Alessia
authors.initials: A
authors.lastname: Carnevale
authors.forename: Mattia Falchetto
authors.initials: MF
authors.lastname: Osti
authors.forename: Vitaliana
authors.initials: V
authors.lastname: DE Sanctis
authors.forename: Linda
authors.initials: L
authors.lastname: Agolli
authors.forename: Riccardo
authors.initials: R
authors.lastname: Maurizi Enrici
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018931:Antineoplastic Agents, Hormonal / Q000627:therapeutic use; D019583:Dose Fractionation, Radiation; D041981:Gastrointestinal Tract / Q000528:radiation effects; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000528:radiation effects; D010865:Pilot Projects; D011471:Prostatic Neoplasms / Q000188:drug therapy / Q000453:epidemiology / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000453:epidemiology / Q000209:etiology; D061089:Radiotherapy, Image-Guided; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects* / Q000379:methods*; D012189:Retrospective Studies; D012306:Risk; D016019:Survival Analysis; D016896:Treatment Outcome; D014566:Urogenital System / Q000528:radiation effects
chemical_list: D018931:Antineoplastic Agents, Hormonal