Treatment outcome of high-dose image-guided intensity-modulated radiotherapy using intra-prostate fiducial markers for localized prostate cancer at a single institute in Japan

Radiation Oncology

Shogo Yamada²  Keiichi Jingu²  Yoichi Arai⁴  Shigeto Ishidoya⁴  Koichi Chida³  Haruo Matsushita²  Suguru Dobashi³  Maiko Kozumi²  Takaya Yamamoto²  Yohjiro Ishikawa²  Yuko Shirata²  Keiko Abe²  Eiji Shimizu²  Masaki Kubozono²  Toshiyuki Sugawara²  Yukio Fujita²  Noriyuki Kadoya²  Rei Umezawa²  Masatoshi Mitsuya¹  Kakutaro Narazaki⁵  Yoshihiro Takai⁶  Ken Takeda³ 

[1] Sendai Radiation Oncology and Imaging Clinic, Sendai, Japan;Department of Radiation Oncology, Tohoku University Hospital, Sendai, Japan;Department of Radiological Technology, School of Health Sciences, Faculty of medicine, Tohoku University, Sendai, Japan;Department of Urology, Tohoku University Hospital, Sendai, Japan;Department of Radiation Oncology, Sendai medical Center, Sendai, Japan;Department of Radiology and Radiation Oncology, Hirosaki University School of medicine, Hirosaki, Japan

关键词: Toxicity;    Biochemical control;    Prostate cancer;    Image-guided radiotherapy;   

Others  :  1160811
DOI  :  10.1186/1748-717X-7-105

 received in 2012-03-31, accepted in 2012-07-02,  发布年份 2012

【 摘 要 】

Background

Several studies have confirmed the advantages of delivering high doses of external beam radiotherapy to achieve optimal tumor-control outcomes in patients with localized prostate cancer. We evaluated the medium-term treatment outcome after high-dose, image-guided intensity-modulated radiotherapy (IMRT) using intra-prostate fiducial markers for clinically localized prostate cancer.

Methods

In total, 141 patients with localized prostate cancer treated with image-guided IMRT (76 Gy in 13 patients and 80 Gy in 128 patients) between 2003 and 2008 were enrolled in this study. The patients were classified according to the National Comprehensive Cancer Network-defined risk groups. Thirty-six intermediate-risk patients and 105 high-risk patients were included. Androgen-deprivation therapy was performed in 124 patients (88%) for a median of 11 months (range: 2–88 months). Prostate-specific antigen (PSA) relapse was defined according to the Phoenix-definition (i.e., an absolute nadir plus 2 ng/ml dated at the call). The 5-year actuarial PSA relapse-free survival, the 5-year distant metastasis-free survival, the 5-year cause-specific survival (CSS), the 5-year overall survival (OS) outcomes and the acute and late toxicities were analyzed. The toxicity data were scored according to the Common Terminology Criteria for Adverse Events, version 4.0. The median follow-up was 60 months.

Results

The 5-year PSA relapse-free survival rates were 100% for the intermediate-risk patients and 82.2% for the high-risk patients; the 5-year actuarial distant metastasis-free survival rates were 100% and 95% for the intermediate- and high-risk patients, respectively; the 5-year CSS rates were 100% for both patient subsets; and the 5-year OS rates were 100% and 91.7% for the intermediate- and high-risk patients, respectively. The Gleason score (<8 vs. ≥8) was significant for the 5-year PSA relapse-free survival on multivariate analysis (p = 0.044). There was no grade 3 or 4 acute toxicity. The incidence of grade 2 acute gastrointestinal (GI) and genitourinary (GU) toxicities were 1.4% and 8.5%, respectively. The 5-year actuarial likelihood of late grade 2–3 GI and GU toxicities were 6% and 6.3%, respectively. No grade 4 GI or GU late toxicity was observed.

Conclusions

These medium-term results demonstrate a good tolerance of high-dose image-guided IMRT. However, further follow-up is needed to confirm the long-term treatment outcomes.

【 授权许可】

   
2012 Takeda et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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