open access

Vol 24, No 4 (2019)
Original research articles
Published online: 2019-07-01
Submitted: 2019-01-09
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Definitive, intensity modulated tomotherapy with a simultaneous integrated boost for prostate cancer patients – Long term data on toxicity and biochemical control

Kilian Schiller, Michael Geier, Marciana Nona Duma, Carsten Nieder, Michael Molls, Stephanie E. Combs, Hans Geinitz
DOI: 10.1016/j.rpor.2019.05.004
·
Rep Pract Oncol Radiother 2019;24(4):315-321.

open access

Vol 24, No 4 (2019)
Original research articles
Published online: 2019-07-01
Submitted: 2019-01-09

Abstract

Aim

To report long-term data regarding biochemical control and late toxicity of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) with tomotherapy in patients with localized prostate cancer.

Background

Dose escalation improves cancer control after curative intended radiation therapy (RT) to patients with localized prostate cancer, without increasing toxicity, if IMRT is used.

Materials and methods

In this retrospective analysis, we evaluated long-term toxicity and biochemical control of the first 40 patients with intermediate risk prostate cancer receiving SIB-IMRT. Primary target volume (PTV) 1 including the prostate and proximal third of the seminal vesicles with safety margins was treated with 70Gy in 35 fractions. PTV 2 containing the prostate with smaller safety margins was treated as SIB to a total dose of 76Gy with 2.17Gy per fraction. Toxicity was evaluated using an adapted CTCAE-Score (Version 3).

Results

Median follow-up of living patients was 66 (20–78) months. No late genitourinary toxicity higher than grade 2 has been reported. Grade 2 genitourinary toxicity rates decreased from 58% at the end of the treatment to 10% at 60 months. Late gastrointestinal (GI) toxicity was also moderate, though the prescribed PTV Dose of 76Gy was accepted at the anterior rectal wall. 74% of patients reported any GI toxicity during follow up and no toxicity rates higher than grade 2 were observed. Grade 2 side effects were reported by 13% of the patients at 60 months. 5-year freedom from biochemical failure was 95% at our last follow up.

Conclusion

SIB-IMRT using daily MV-CT guidance showed excellent long-term biochemical control and low toxicity rates.

Abstract

Aim

To report long-term data regarding biochemical control and late toxicity of simultaneous integrated boost intensity modulated radiotherapy (SIB-IMRT) with tomotherapy in patients with localized prostate cancer.

Background

Dose escalation improves cancer control after curative intended radiation therapy (RT) to patients with localized prostate cancer, without increasing toxicity, if IMRT is used.

Materials and methods

In this retrospective analysis, we evaluated long-term toxicity and biochemical control of the first 40 patients with intermediate risk prostate cancer receiving SIB-IMRT. Primary target volume (PTV) 1 including the prostate and proximal third of the seminal vesicles with safety margins was treated with 70Gy in 35 fractions. PTV 2 containing the prostate with smaller safety margins was treated as SIB to a total dose of 76Gy with 2.17Gy per fraction. Toxicity was evaluated using an adapted CTCAE-Score (Version 3).

Results

Median follow-up of living patients was 66 (20–78) months. No late genitourinary toxicity higher than grade 2 has been reported. Grade 2 genitourinary toxicity rates decreased from 58% at the end of the treatment to 10% at 60 months. Late gastrointestinal (GI) toxicity was also moderate, though the prescribed PTV Dose of 76Gy was accepted at the anterior rectal wall. 74% of patients reported any GI toxicity during follow up and no toxicity rates higher than grade 2 were observed. Grade 2 side effects were reported by 13% of the patients at 60 months. 5-year freedom from biochemical failure was 95% at our last follow up.

Conclusion

SIB-IMRT using daily MV-CT guidance showed excellent long-term biochemical control and low toxicity rates.

Get Citation

Keywords

Prostate Cancer; Late toxicity; Rectal toxicity; Fractionation; Long term follow up; Tomotherapy

About this article
Title

Definitive, intensity modulated tomotherapy with a simultaneous integrated boost for prostate cancer patients – Long term data on toxicity and biochemical control

Journal

Reports of Practical Oncology and Radiotherapy

Issue

Vol 24, No 4 (2019)

Pages

315-321

Published online

2019-07-01

DOI

10.1016/j.rpor.2019.05.004

Bibliographic record

Rep Pract Oncol Radiother 2019;24(4):315-321.

Keywords

Prostate Cancer
Late toxicity
Rectal toxicity
Fractionation
Long term follow up
Tomotherapy

Authors

Kilian Schiller
Michael Geier
Marciana Nona Duma
Carsten Nieder
Michael Molls
Stephanie E. Combs
Hans Geinitz

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