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Hypofractionated boost to the dominant tumor region with intensity modulated stereotactic radiotherapy for prostate cancer: a sequential dose escalation pilot study

Molla, Meritxell
Rouzaud, Michel
Hidalgo, Alberto
Toscas, Jose Ignacio
Lozano, Joan
Sanz, Sergi
Ares, Carmen
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Published in International Journal of Radiation Oncology, Biology, Physics. 2010, vol. 78, no. 1, p. 50-57
Abstract PURPOSE: To evaluate the feasibility, tolerability, and preliminary outcomes in patients with prostate cancer treated according to a hypofractionated dose escalation protocol to boost the dominant tumor-bearing region of the prostate. METHODS AND MATERIALS: After conventional fractionated external radiotherapy to 64 to 64.4 Gy, 50 patients with nonmetastatic prostate cancer were treated with an intensity-modulated radiotherapy hypofractionated boost under stereotactic conditions to a reduced prostate volume to the dominant tumor region. A rectal balloon inflated with 60 cc of air was used for internal organ immobilization. Five, 8, and 8 patients were sequentially treated with two fractions of 5, 6, or 7 Gy, respectively (normalized total dose in 2 Gy/fraction [NTD(2 Gy)] < 100 Gy, low-dose group), whereas 29 patients received two fractions of 8 Gy each (NTD(2 Gy) > 100 Gy, high-dose group). Androgen deprivation was given to 33 patients. Acute and late toxicities were assessed according to the Radiation Therapy Oncology Group/European Organisation for Research and Treatment of Cancer (RTOG/EORTC) scoring system. RESULTS: Two patients presented with Grade 3 acute urinary toxicity. The 5-year probabilities of ≥ Grade 2 late urinary and late low gastrointestinal (GI) toxicity-free survival were 82.2% +/- 7.4% and 72.2% +/- 7.6%, respectively. The incidence and severity of acute or late toxicities were not correlated with low- vs. high-dose groups, pelvic irradiation, age, or treatment with or without androgen deprivation. The 5-year biochemical disease-free survival (b-DFS) and disease-specific survival were 98% +/- 1.9% and 100%, respectively. CONCLUSION: Intensity-modulated radiotherapy hypofractionated boost dose escalation under stereotactic conditions was feasible, and showed excellent outcomes with acceptable long-term toxicity. This approach may well be considered an alternative to high-dose-rate brachytherapy.
Keywords AgedAndrogen Antagonists/therapeutic useFeasibility StudiesGastrointestinal Tract/radiation effectsHumansImmobilization/instrumentation/methodsMalePilot ProjectsProstateProstatic Neoplasms/drug therapy/pathology/*radiotherapyRadiation Injuries/pathologyRadiation ToleranceRadiotherapy DosageRadiotherapy, Intensity-Modulated/adverse effects/*methodsTumor BurdenUrinary Bladder/radiation effects
PMID: 19910135
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Research group Groupe Mirabell Raymond (radio-oncologie) (685)
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MIRALBELL, Raymond et al. Hypofractionated boost to the dominant tumor region with intensity modulated stereotactic radiotherapy for prostate cancer: a sequential dose escalation pilot study. In: International Journal of Radiation Oncology, Biology, Physics, 2010, vol. 78, n° 1, p. 50-57. https://archive-ouverte.unige.ch/unige:21145

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Deposited on : 2012-05-23

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