title: Hypofractionated Volumetric Modulated Arc Radiotherapy with simultaneous Elective Nodal Irradiation is feasible in prostate cancer patients: A single institution experience.
abstract: OBJECTIVE
  To assess feasibility, toxicity and biochemical relapse-free survival (b-RFS) for a group of organ confined (OC) Saudi prostate cancer patients treated by hypo-fractionated Volumetric Modulated Arc Radiation Therapy (VMAT) Simultaneous Integrated Boost (SIB) Elective Nodal Irradiation (ENI) whole pelvic radiotherapy (WPRT).
  
  
  METHODS
  Between March 2009 and January 2014, 29 OC prostate cancer patients; median age 64years, PS 0-1 were treated in King Faisal Specialist Hospital - Riyadh, Kingdom of Saudi Arabia using VMAT-SIB-ENI-WPRT, to a total dose of 70Gy in 28 fractions. Twenty Four patients (83%) were treated with neo-adjuvant; concurrent androgen deprivation therapy (ADT). Median follow-up (FU) was 42months (range: 18-72months).
  
  
  RESULTS
  The 3-year actuarial b-RFS for low/intermediate and high risk groups were 100%, and 48%, respectively (p=0.09) with a median FU period of 34months (range: 14-53months). Gleason Score (p=0.02), and pretreatment PSA (p=0.01) were predictive for biochemical failure on univariate analysis; with no observed prostate cancer-related deaths. Grade 2 acute/late GI and GU toxicities were 28%/0% and 17%/10% respectively with no reported grade 3/4 toxicities. Four (50%) out of the 8 patients with baseline partial potency, retained sexual function on long term follow-up.
  
  
  CONCLUSIONS
  Hypo-fractionation dose escalation VMAT-SIB-ENI-WPRT using 2 arcs is a feasible technique for intermediate/high risk OC prostate cancer patients, with acceptable rates of acute/late toxicities, much favorable planning target volume (PTV) coverage, and shorter overall treatment time. Prospective randomized controlled trials are encouraged to confirm its equivalence to other fractionation schemes.
authors.affiliation: Department of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Department of Clinical Oncology & Nuclear Medicine, Zagazig Faculty of Medicine, Egypt. Electronic address: mhegazy@kfshrc.edu.sa.
authors.forename: Mohamed W
authors.initials: MW
authors.lastname: Hegazy
authors.affiliation: Department of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Electronic address: rmahmood99@kfshrc.edu.sa.
authors.forename: Rana I
authors.initials: RI
authors.lastname: Mahmood
authors.affiliation: Department of Urology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia. Electronic address: otaibim@kfshrc.edu.sa.
authors.forename: Mohammed F
authors.initials: MF
authors.lastname: Al Otaibi
authors.affiliation: Department of Radiation Oncology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia; Radiation Oncology & Nuclear Medicine Department, NCI, Cairo University, Egypt. Electronic address: ehab.khalil@nci.cu.edu.eg.
authors.forename: Ehab M
authors.initials: EM
authors.lastname: Khalil
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D006801:Humans; D008198:Lymph Nodes / Q000528:radiation effects*; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010388:Pelvis; D011446:Prospective Studies; D017430:Prostate-Specific Antigen / Q000097:blood; D011471:Prostatic Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D000069473:Radiation Dose Hypofractionation; D011832:Radiation Injuries / Q000175:diagnosis / Q000453:epidemiology; D061089:Radiotherapy, Image-Guided / Q000379:methods*; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects / Q000379:methods*; D012529:Saudi Arabia
chemical_list: D017430:Prostate-Specific Antigen
keywords: Hypo-fractionation; Prostate cancer; Radiotherapy; VMAT-intensity modulation