Dose escalation using ultra-high dose IMRT in intermediate risk prostate cancer without androgen deprivation therapy: Preliminary results of toxicity and biochemical control

Maria Grazia Petrongari, Valeria Landoni, Biancamaria Saracino, Sara Gomellini, Stefano Arcangeli, Giuseppe Iaccarino, Paola Pinnarò, Giorgio Arcangeli, Lidia Strigari

Research output: Contribution to journalArticle

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Abstract

Background: To investigate the feasibility of dose escalation (86 Gy at 2 Gy/fraction) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer without androgen deprivation therapy. Methods. Patients with histologically proven adenocarcinoma of the prostate, intermediate prognostic category, were enrolled in this study. Early and late toxicity were scored according to the Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. Treatment outcome was stated in terms of biochemical failure, biopsy result and clinical failure. Results: 39 patients with a median follow-up of 71 months were analyzed. No patient experienced G3 or G4 acute gastrointestinal (GI) or genitourinary (GU) toxicity. G2 acute GI and GU toxicity were observed in 17 (44%) and 20 (51%) patients, respectively. Fourteen patients (36%) did not experience acute GI toxicity and 4 patients (10%) did not experience acute GU toxicity. G2 late GI bleeding occurred in 7 of 39 patients (18%). Both G3 and G4 late GI toxicity were seen only in one patient (2.5%). Two patients (5%) experienced G2 late GU toxicity, while G3 late GU toxicity occurred in 3 patients (8%). The 5-year actuarial freedom from biochemical failure (FFBF) was 87%. Thirty-four patients (87%) did not show biochemical relapse. Seventeen patients (44%) underwent biopsy two year after radiotherapy; of these only two were non-negative and both did not show evidence of biochemical disease. Conclusions: IMRT treatment of patients with localized intermediate-risk prostate cancer at high dose levels without using androgen deprivation therapy (ADT) seems to give good disease control. Nevertheless, future trials should aim at further decreasing toxicity by exploiting image guidance techniques and by reducing the dose delivered at the interface between organs at risk and prostate.

Original languageEnglish
Article number103
JournalJournal of Experimental and Clinical Cancer Research
Volume32
Issue number1
DOIs
Publication statusPublished - Dec 13 2013

Fingerprint

Androgens
Prostatic Neoplasms
Radiotherapy
Therapeutics
Prostate
Organs at Risk
Biopsy
Program Evaluation
Terminology
Adenocarcinoma
Hemorrhage
Recurrence

Keywords

  • Absence of ADT
  • Dose escalation
  • Intermediate risk
  • Outcome
  • Prostate cancer
  • Toxicity

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Dose escalation using ultra-high dose IMRT in intermediate risk prostate cancer without androgen deprivation therapy : Preliminary results of toxicity and biochemical control. / Petrongari, Maria Grazia; Landoni, Valeria; Saracino, Biancamaria; Gomellini, Sara; Arcangeli, Stefano; Iaccarino, Giuseppe; Pinnarò, Paola; Arcangeli, Giorgio; Strigari, Lidia.

In: Journal of Experimental and Clinical Cancer Research, Vol. 32, No. 1, 103, 13.12.2013.

Research output: Contribution to journalArticle

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abstract = "Background: To investigate the feasibility of dose escalation (86 Gy at 2 Gy/fraction) with intensity modulated radiation therapy (IMRT) in intermediate-risk prostate cancer without androgen deprivation therapy. Methods. Patients with histologically proven adenocarcinoma of the prostate, intermediate prognostic category, were enrolled in this study. Early and late toxicity were scored according to the Cancer Therapy Evaluation Program, Common Terminology Criteria for Adverse Events, Version 3.0. Treatment outcome was stated in terms of biochemical failure, biopsy result and clinical failure. Results: 39 patients with a median follow-up of 71 months were analyzed. No patient experienced G3 or G4 acute gastrointestinal (GI) or genitourinary (GU) toxicity. G2 acute GI and GU toxicity were observed in 17 (44{\%}) and 20 (51{\%}) patients, respectively. Fourteen patients (36{\%}) did not experience acute GI toxicity and 4 patients (10{\%}) did not experience acute GU toxicity. G2 late GI bleeding occurred in 7 of 39 patients (18{\%}). Both G3 and G4 late GI toxicity were seen only in one patient (2.5{\%}). Two patients (5{\%}) experienced G2 late GU toxicity, while G3 late GU toxicity occurred in 3 patients (8{\%}). The 5-year actuarial freedom from biochemical failure (FFBF) was 87{\%}. Thirty-four patients (87{\%}) did not show biochemical relapse. Seventeen patients (44{\%}) underwent biopsy two year after radiotherapy; of these only two were non-negative and both did not show evidence of biochemical disease. Conclusions: IMRT treatment of patients with localized intermediate-risk prostate cancer at high dose levels without using androgen deprivation therapy (ADT) seems to give good disease control. Nevertheless, future trials should aim at further decreasing toxicity by exploiting image guidance techniques and by reducing the dose delivered at the interface between organs at risk and prostate.",
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AU - Gomellini, Sara

AU - Arcangeli, Stefano

AU - Iaccarino, Giuseppe

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