Hypofractionation with VMAT versus 3DCRT in post-operative patients with prostate cancer

Filippo Alongi, Luca Cozzi, Antonella Fogliata, Cristina Iftode, Tiziana Comito, Alessandro Clivio, Elisa Villa, Francesca Lobefalo, Piera Navarria, Giacomo Reggiori, Pietro Mancosu, Elena Clerici, Stefano Tomatis, Gianluigi Taverna, Pierpaolo Graziotti, Marta Scorsetti

Research output: Contribution to journalArticle

17 Citations (Scopus)

Abstract

Aims: To retrospectively evaluate and compare the incidence of acute genitourinary (aGU), upper gastrointestinal (uGI) and rectal (lGI) injuries after radiotherapy with hypofractionation by volumetric modulation arc therapy (VMAT, the Hypo-RapidArc group) and conventional fractionation by three-dimensional conformal radiotherapy (3DCRT) in patients with localized prostate cancer treated, after radical prostatectomy, with prostatic bed irradiation. Patients and Methods: Between 2007 and 2012, 84 consecutive patients with clinically localized prostate cancer submitted to radical prostatectomy were also treated with irradiation to the prostate bed. Forty-five received 3DCRT and 39 Hypo-RapidArc. The median age was 67 and 69 years for 3DCRT and Hypo-RapidArc groups respectively. The median dose to the prostatic bed was 70 Gy in both groups: 2 Gy/fraction in the 3DCRT group and 2.5 Gy/fraction in the Hypo-RapidArc group. After radical prostatectomy, the median time-to-RT was 15 and 16 months respectively. Acute and late toxicities were scored according to the Radiation Therapy and Oncology Group/European Organization for Research and Treatment of Cancer system. Results: Grade 2aGU was recorded in 16% of cases in the 3DRCT group and in 10% in the Hypo-RapidArc group. No acute grade 2 upper gastrointestinal (uGI) toxicities were found in the 3DCRT versus 5% in the Hypo-RapidArc group. The incidence of grade 2 lower gastrointestinal (lGI) toxicities was 22% in the 3DCRT group versus 15% in the Hypo-RapidArc group. No grade 3 or greater toxicities were found in either group. In both groups, good planning target volume coverage was achieved: V95% was recorded as 96.3±3.6% (mean±standard deviation) and 95.7±8.9 for the 3DRCT and the Hypo-RapidArc groups, respectively. The mean rectal volume dose receiving at least 70 Gy was 9.1±10.8% and 0.1±0.6% respectively. The mean dose to the bladder was 49.5±12.3 Gy and 37.2±5.2 Gy respectively. Significant correlation between late rectal toxicity and the maximum dose to the rectum, V70Gy, was found in the 3DCRT group, while no significant correlations were found for acute toxicity. Conclusion: The results presented in this study demonstrate the feasibility of a moderate hypo-fractionation regimen with RapidArc in the postoperative setting. Longer-term data are needed to confirm late toxicity profiles.

Original languageEnglish
Pages (from-to)4537-4544
Number of pages8
JournalAnticancer Research
Volume33
Issue number10
Publication statusPublished - Oct 2013

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Prostatectomy
Prostatic Neoplasms
Radiotherapy
Conformal Radiotherapy
Radiation Oncology
Incidence
Feasibility Studies
Rectum
Prostate
Urinary Bladder
Wounds and Injuries
Therapeutics
Research
Neoplasms

Keywords

  • Hypofractionation
  • Prostate cancer
  • RapidArc
  • VMAT

ASJC Scopus subject areas

  • Cancer Research
  • Oncology

Cite this

Hypofractionation with VMAT versus 3DCRT in post-operative patients with prostate cancer. / Alongi, Filippo; Cozzi, Luca; Fogliata, Antonella; Iftode, Cristina; Comito, Tiziana; Clivio, Alessandro; Villa, Elisa; Lobefalo, Francesca; Navarria, Piera; Reggiori, Giacomo; Mancosu, Pietro; Clerici, Elena; Tomatis, Stefano; Taverna, Gianluigi; Graziotti, Pierpaolo; Scorsetti, Marta.

In: Anticancer Research, Vol. 33, No. 10, 10.2013, p. 4537-4544.

Research output: Contribution to journalArticle

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abstract = "Aims: To retrospectively evaluate and compare the incidence of acute genitourinary (aGU), upper gastrointestinal (uGI) and rectal (lGI) injuries after radiotherapy with hypofractionation by volumetric modulation arc therapy (VMAT, the Hypo-RapidArc group) and conventional fractionation by three-dimensional conformal radiotherapy (3DCRT) in patients with localized prostate cancer treated, after radical prostatectomy, with prostatic bed irradiation. Patients and Methods: Between 2007 and 2012, 84 consecutive patients with clinically localized prostate cancer submitted to radical prostatectomy were also treated with irradiation to the prostate bed. Forty-five received 3DCRT and 39 Hypo-RapidArc. The median age was 67 and 69 years for 3DCRT and Hypo-RapidArc groups respectively. The median dose to the prostatic bed was 70 Gy in both groups: 2 Gy/fraction in the 3DCRT group and 2.5 Gy/fraction in the Hypo-RapidArc group. After radical prostatectomy, the median time-to-RT was 15 and 16 months respectively. Acute and late toxicities were scored according to the Radiation Therapy and Oncology Group/European Organization for Research and Treatment of Cancer system. Results: Grade 2aGU was recorded in 16{\%} of cases in the 3DRCT group and in 10{\%} in the Hypo-RapidArc group. No acute grade 2 upper gastrointestinal (uGI) toxicities were found in the 3DCRT versus 5{\%} in the Hypo-RapidArc group. The incidence of grade 2 lower gastrointestinal (lGI) toxicities was 22{\%} in the 3DCRT group versus 15{\%} in the Hypo-RapidArc group. No grade 3 or greater toxicities were found in either group. In both groups, good planning target volume coverage was achieved: V95{\%} was recorded as 96.3±3.6{\%} (mean±standard deviation) and 95.7±8.9 for the 3DRCT and the Hypo-RapidArc groups, respectively. The mean rectal volume dose receiving at least 70 Gy was 9.1±10.8{\%} and 0.1±0.6{\%} respectively. The mean dose to the bladder was 49.5±12.3 Gy and 37.2±5.2 Gy respectively. Significant correlation between late rectal toxicity and the maximum dose to the rectum, V70Gy, was found in the 3DCRT group, while no significant correlations were found for acute toxicity. Conclusion: The results presented in this study demonstrate the feasibility of a moderate hypo-fractionation regimen with RapidArc in the postoperative setting. Longer-term data are needed to confirm late toxicity profiles.",
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author = "Filippo Alongi and Luca Cozzi and Antonella Fogliata and Cristina Iftode and Tiziana Comito and Alessandro Clivio and Elisa Villa and Francesca Lobefalo and Piera Navarria and Giacomo Reggiori and Pietro Mancosu and Elena Clerici and Stefano Tomatis and Gianluigi Taverna and Pierpaolo Graziotti and Marta Scorsetti",
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T1 - Hypofractionation with VMAT versus 3DCRT in post-operative patients with prostate cancer

AU - Alongi, Filippo

AU - Cozzi, Luca

AU - Fogliata, Antonella

AU - Iftode, Cristina

AU - Comito, Tiziana

AU - Clivio, Alessandro

AU - Villa, Elisa

AU - Lobefalo, Francesca

AU - Navarria, Piera

AU - Reggiori, Giacomo

AU - Mancosu, Pietro

AU - Clerici, Elena

AU - Tomatis, Stefano

AU - Taverna, Gianluigi

AU - Graziotti, Pierpaolo

AU - Scorsetti, Marta

PY - 2013/10

Y1 - 2013/10

N2 - Aims: To retrospectively evaluate and compare the incidence of acute genitourinary (aGU), upper gastrointestinal (uGI) and rectal (lGI) injuries after radiotherapy with hypofractionation by volumetric modulation arc therapy (VMAT, the Hypo-RapidArc group) and conventional fractionation by three-dimensional conformal radiotherapy (3DCRT) in patients with localized prostate cancer treated, after radical prostatectomy, with prostatic bed irradiation. Patients and Methods: Between 2007 and 2012, 84 consecutive patients with clinically localized prostate cancer submitted to radical prostatectomy were also treated with irradiation to the prostate bed. Forty-five received 3DCRT and 39 Hypo-RapidArc. The median age was 67 and 69 years for 3DCRT and Hypo-RapidArc groups respectively. The median dose to the prostatic bed was 70 Gy in both groups: 2 Gy/fraction in the 3DCRT group and 2.5 Gy/fraction in the Hypo-RapidArc group. After radical prostatectomy, the median time-to-RT was 15 and 16 months respectively. Acute and late toxicities were scored according to the Radiation Therapy and Oncology Group/European Organization for Research and Treatment of Cancer system. Results: Grade 2aGU was recorded in 16% of cases in the 3DRCT group and in 10% in the Hypo-RapidArc group. No acute grade 2 upper gastrointestinal (uGI) toxicities were found in the 3DCRT versus 5% in the Hypo-RapidArc group. The incidence of grade 2 lower gastrointestinal (lGI) toxicities was 22% in the 3DCRT group versus 15% in the Hypo-RapidArc group. No grade 3 or greater toxicities were found in either group. In both groups, good planning target volume coverage was achieved: V95% was recorded as 96.3±3.6% (mean±standard deviation) and 95.7±8.9 for the 3DRCT and the Hypo-RapidArc groups, respectively. The mean rectal volume dose receiving at least 70 Gy was 9.1±10.8% and 0.1±0.6% respectively. The mean dose to the bladder was 49.5±12.3 Gy and 37.2±5.2 Gy respectively. Significant correlation between late rectal toxicity and the maximum dose to the rectum, V70Gy, was found in the 3DCRT group, while no significant correlations were found for acute toxicity. Conclusion: The results presented in this study demonstrate the feasibility of a moderate hypo-fractionation regimen with RapidArc in the postoperative setting. Longer-term data are needed to confirm late toxicity profiles.

AB - Aims: To retrospectively evaluate and compare the incidence of acute genitourinary (aGU), upper gastrointestinal (uGI) and rectal (lGI) injuries after radiotherapy with hypofractionation by volumetric modulation arc therapy (VMAT, the Hypo-RapidArc group) and conventional fractionation by three-dimensional conformal radiotherapy (3DCRT) in patients with localized prostate cancer treated, after radical prostatectomy, with prostatic bed irradiation. Patients and Methods: Between 2007 and 2012, 84 consecutive patients with clinically localized prostate cancer submitted to radical prostatectomy were also treated with irradiation to the prostate bed. Forty-five received 3DCRT and 39 Hypo-RapidArc. The median age was 67 and 69 years for 3DCRT and Hypo-RapidArc groups respectively. The median dose to the prostatic bed was 70 Gy in both groups: 2 Gy/fraction in the 3DCRT group and 2.5 Gy/fraction in the Hypo-RapidArc group. After radical prostatectomy, the median time-to-RT was 15 and 16 months respectively. Acute and late toxicities were scored according to the Radiation Therapy and Oncology Group/European Organization for Research and Treatment of Cancer system. Results: Grade 2aGU was recorded in 16% of cases in the 3DRCT group and in 10% in the Hypo-RapidArc group. No acute grade 2 upper gastrointestinal (uGI) toxicities were found in the 3DCRT versus 5% in the Hypo-RapidArc group. The incidence of grade 2 lower gastrointestinal (lGI) toxicities was 22% in the 3DCRT group versus 15% in the Hypo-RapidArc group. No grade 3 or greater toxicities were found in either group. In both groups, good planning target volume coverage was achieved: V95% was recorded as 96.3±3.6% (mean±standard deviation) and 95.7±8.9 for the 3DRCT and the Hypo-RapidArc groups, respectively. The mean rectal volume dose receiving at least 70 Gy was 9.1±10.8% and 0.1±0.6% respectively. The mean dose to the bladder was 49.5±12.3 Gy and 37.2±5.2 Gy respectively. Significant correlation between late rectal toxicity and the maximum dose to the rectum, V70Gy, was found in the 3DCRT group, while no significant correlations were found for acute toxicity. Conclusion: The results presented in this study demonstrate the feasibility of a moderate hypo-fractionation regimen with RapidArc in the postoperative setting. Longer-term data are needed to confirm late toxicity profiles.

KW - Hypofractionation

KW - Prostate cancer

KW - RapidArc

KW - VMAT

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