Toxicity and outcome of pelvic IMRT for node-positive prostate cancer

Strahlenther Onkol. 2012 Nov;188(11):982-9. doi: 10.1007/s00066-012-0169-1. Epub 2012 Oct 11.

Abstract

Background and purpose: This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).

Patients and methods: Pelvic IMRT to 45-50.4 Gy was applied in 39 cases either after previous surgery of involved lymph nodes (n = 18) or with a radiation boost to suspicious nodes (n = 21) with doses of 60-70 Gy, usually combined with androgen deprivation (n = 37). The prostate and seminal vesicles received 70-74 Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66-70 Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.

Results: Acute radiation-related toxicity higher than grade 2 occurred in 2 patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1-2) after a median follow-up of 70 months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over 5 years.

Conclusion: Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Androgen Antagonists / therapeutic use
  • Biomarkers, Tumor / blood
  • Combined Modality Therapy
  • Humans
  • Kaplan-Meier Estimate
  • Lymph Node Excision
  • Lymphatic Metastasis / pathology
  • Lymphatic Metastasis / radiotherapy*
  • Male
  • Middle Aged
  • Multimodal Imaging
  • Neoplasm Grading
  • Neoplasm Staging
  • Positron-Emission Tomography
  • Prostate-Specific Antigen / blood
  • Prostatectomy
  • Prostatic Neoplasms / mortality
  • Prostatic Neoplasms / pathology
  • Prostatic Neoplasms / radiotherapy*
  • Prostatic Neoplasms / surgery
  • Radiation Injuries / etiology*
  • Radiation Injuries / mortality
  • Radiotherapy Dosage
  • Radiotherapy, Adjuvant
  • Radiotherapy, Intensity-Modulated / adverse effects*
  • Rectum / pathology
  • Rectum / radiation effects
  • Survival Analysis
  • Tomography, X-Ray Computed
  • Urinary Bladder / pathology
  • Urinary Bladder / radiation effects

Substances

  • Androgen Antagonists
  • Biomarkers, Tumor
  • Prostate-Specific Antigen