Postoperative intensity-modulated radiotherapy with simultaneous integrated boost in prostate cancer: A dose-escalation trial

• Published in: Urologic oncology 2013, Vol.31 (1), p.87-92
• Main Authors: Ippolito, Edy, M.D, Cellini, Numa, M.D, Digesù, Cinzia, M.D, Cilla, Savino, M.P, Mantini, Giovanna, M.D, Balducci, Mario, M.D, Di Lallo, Alessandra, M.D, Deodato, Francesco, M.D, Macchia, Gabriella, M.D, Massaccesi, Mariangela, M.D, Mattiucci, Gian Carlo, M.D, Tagliaferri, Luca, M.D, Piermattei, Angelo, M.P, Cuscunà, Daniele, M.D, Morganti, Alessio G., M.D
• Format: Article
• Language: English
• Subjects: Adenocarcinoma - pathology; Adenocarcinoma - radiotherapy; Adenocarcinoma - surgery; Aged; Clinical Trials, Phase II as Topic; Combined Modality Therapy; Dose escalation; Dose Fractionation; Follow-Up Studies; Humans; Intensity modulated radiotherapy; Lymph Nodes - pathology; Lymph Nodes - surgery; Male; Middle Aged; Neoplasm Grading; Neoplasm Staging; Pelvis - pathology; Pelvis - surgery; Postoperative; Postoperative Period; Prognosis; Prostate cancer; Prostatic Neoplasms - pathology; Prostatic Neoplasms - radiotherapy; Prostatic Neoplasms - surgery; Radiotherapy, Conformal; Radiotherapy, Intensity-Modulated; Urology
• ISSN: 1078-1439; 1873-2496
• DOI: 10.1016/j.urolonc.2010.10.005

Abstract Objectives To determine the recommended phase II dose of postoperative accelerated intensity modulated radiotherapy (IMRT) for prostate cancer. Material and methods Step and shoot IMRT with simultaneous integrated boost (SIB) was delivered in 25 fractions over 5 weeks to patients with high risk resected prostate adenocarcinoma (stage pT3-4 and/or positive surgical margins). Pelvic nodes received 45 Gy at 1.8 Gy/fraction; dose escalation was performed only to the prostate bed (planned dose escalation: 56.8 Gy at 2.27 Gy/fraction, 59.7 Gy at 2.39 Gy/fraction, 61.25 Gy at 2.45 Gy/fraction, 62.5 Gy at 2.5 Gy/fraction). Dose-limiting toxicity (DLT) was any grade ≥ 3 acute toxicity (RTOG score). Results Twenty-five patients were treated: 7 patients at the 56.75 Gy dose level, 6 patients at each subsequent dose level. Pathologic stages were: pT2c: 2; pT3a: 11; pT3b: 12; pN0: 22; pN1: 3; R0: 7; R1: 18. Median follow-up time was 19 months (range: 6–36 months). No patient experienced DLT. Grade 1–2 acute rectal and urologic toxicity was common (17 and 22 patients, respectively). Conclusions The recommended dose was 62.5 Gy in 2.5 Gy/fraction. Postoperative hypofractionated IMRT SIB for prostate cancer seemed to be well tolerated and could be tested in phase II studies.