Improvement in toxicity in high risk prostate cancer patients treated with image-guided intensity-modulated radiotherapy compared to 3D conformal radiotherapy without daily image guidance

Radiation Oncology

Svend Aage Engelholm³  Peter Meidahl Petersen¹  Tobias Pommer³  Jung Hun Oh²  Joseph O Deasy²  Per Munck af Rosenschöld³  Joen Sveistrup³ 

[1] Department of Oncology, Rigshospitalet, Copenhagen, Denmark;Department of Medical Physics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA;Department of Radiation Oncology, Section 3994, Rigshospitalet, Blegdamsvej 9, Copenhagen 2100, Denmark

关键词: Toxicity;    Intensity-modulated radiotherapy (IMRT);    Image-guided radiotherapy (IGRT);    Radiotherapy;    Prostate cancer;   

Others  :  814844
DOI  :  10.1186/1748-717X-9-44

 received in 2013-10-07, accepted in 2014-01-29,  发布年份 2014

【 摘 要 】

Background

Image-guided radiotherapy (IGRT) facilitates the delivery of a very precise radiation dose. In this study we compare the toxicity and biochemical progression-free survival between patients treated with daily image-guided intensity-modulated radiotherapy (IG-IMRT) and 3D conformal radiotherapy (3DCRT) without daily image guidance for high risk prostate cancer (PCa).

Methods

A total of 503 high risk PCa patients treated with radiotherapy (RT) and endocrine treatment between 2000 and 2010 were retrospectively reviewed. 115 patients were treated with 3DCRT, and 388 patients were treated with IG-IMRT. 3DCRT patients were treated to 76 Gy and without daily image guidance and with 1–2 cm PTV margins. IG-IMRT patients were treated to 78 Gy based on daily image guidance of fiducial markers, and the PTV margins were 5–7 mm. Furthermore, the dose-volume constraints to both the rectum and bladder were changed with the introduction of IG-IMRT.

Results

The 2-year actuarial likelihood of developing grade > = 2 GI toxicity following RT was 57.3% in 3DCRT patients and 5.8% in IG-IMRT patients (p < 0.001). For GU toxicity the numbers were 41.8% and 29.7%, respectively (p = 0.011). On multivariate analysis, 3DCRT was associated with a significantly increased risk of developing grade > = 2 GI toxicity compared to IG-IMRT (p < 0.001, HR = 11.59 [CI: 6.67-20.14]). 3DCRT was also associated with an increased risk of developing GU toxicity compared to IG-IMRT.

The 3-year actuarial biochemical progression-free survival probability was 86.0% for 3DCRT and 90.3% for IG-IMRT (p = 0.386). On multivariate analysis there was no difference in biochemical progression-free survival between 3DCRT and IG-IMRT.

Conclusion

The difference in toxicity can be attributed to the combination of the IMRT technique with reduced dose to organs-at-risk, daily image guidance and margin reduction.

【 授权许可】

   
2014 Sveistrup et al.; licensee BioMed Central Ltd.

【 图 表 】

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