No increase in toxicity of pelvic irradiation when intensity modulation is employed: clinical and dosimetric data of 208 patients treated with post-prostatectomy radiotherapy.
OBJECTIVE
To compare the toxicity of image-guided intensity-modulated radiotherapy (IG-IMRT) to the pelvis or prostate bed (PB) only. To test the hypothesis that the potentially injurious effect of pelvic irradiation can be counterbalanced by reduced irradiated normal tissue volume using IG-IMRT.


METHODS
Between February 2010 and February 2012, 208 patients with prostate cancer were treated with adjuvant or salvage IG-IMRT to the PB (102 patients, Group PB) or the pelvis and prostate bed (P) (106 patients, Group P). The Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer criteria were used to evaluate toxicity.


RESULTS
Median follow-up was 27 months. Toxicity G ≥ 2 in Group PB: in the bowel acute and late toxicities were 11.8% and 10%, respectively; urinary acute and late toxicities were 10.8% and 15%, respectively. Toxicity G ≥ 2 in Group P: in the bowel acute and late toxicities were both 13.2%; urinary acute and late toxicities were 13.2% and 15.1%, respectively. No statistical difference in acute or late toxicity between the groups was found (bowel: p = 0.23 and p = 0.89 for acute and late toxicity, respectively; urinary: p = 0.39 and p = 0.66 for acute and late toxicity, respectively). Of the clinical variables, only previous abdominal surgery was correlated with acute bowel toxicity. Dosimetric parameters that correlated with bowel toxicity were identified.


CONCLUSIONS
The toxicity rates were low and similar in both groups, suggesting that IG-IMRT allows for a safe post-operative irradiation of larger volumes. Further investigation is warranted to exclude bias owing to non-randomized character of the study.


CONCLUSIONS
Our report shows that modern radiotherapy technology and careful planning allow maintaining the toxicity of pelvic lymph node treatment at the acceptable level, as it is in the case of PB radiotherapy.
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Barbara A
BA
Jereczek-Fossa
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
Delia
http://orcid.org/0000-0001-6691-0208
D
Ciardo
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Silvia
S
Ferrario
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Piero
P
Fossati
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Giuseppe
G
Fanetti
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
Dario
D
Zerini
3 University of Milan, Milan, Italy.
Davide
D
Zannoni
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.
Cristiana
C
Fodor
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Marianna A
MA
Gerardi
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Alessia
A
Surgo
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Matteo
M
Muto
4 Division of Medical Physics, European Institute of Oncology, Milan, Italy.
Raffaella
R
Cambria
2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.|5 Division of Urology, European Institute of Oncology, Milan, Italy.
Ottavio
O
De Cobelli
1 Division of Radiation Oncology, European Institute of Oncology, Milan, Italy.|2 Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy.
Roberto
R
Orecchia
D000368:Aged; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010388:Pelvis / Q000473:pathology; D011467:Prostate / Q000528:radiation effects; D011468:Prostatectomy; D011471:Prostatic Neoplasms / Q000532:radiotherapy*; D011832:Radiation Injuries / Q000517:prevention & control*; D011879:Radiotherapy Dosage; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012189:Retrospective Studies