Phase I-II Study of Hypofractionated Simultaneous Integrated Boost With Tomotherapy for Prostate Cancer

Nadia Di Muzio, Claudio Fiorino, Cesare Cozzarini, Filippo Alongi, Sara Broggi, Paola Mangili, Giorgio Guazzoni, Riccardo Valdagni, Riccardo Calandrino, Ferruccio Fazio

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Abstract

Purpose: To report planning and acute toxicity data of the first 60 patients treated within a Phase I-II study with moderate hypofractionation by image-guided helical tomotherapy. Methods and Materials: Various clinical target volumes (CTVs) were defined: CTV1-pelvic nodes; CTV2-upper portion of seminal vesicles; CTV3-lower portion of SV; CTV4-prostate; overlap between planning target volume (PTV) 4 and rectum. Different doses to each PTV were simultaneously delivered in 28 fractions. For 31 low-risk patients: 56.0, 61.6, and 71.4 Gy for PTV2-4, respectively; for 20 intermediate-risk patients: 51.8, 61.6, 65.5, and 74.2 Gy for PTV1-4, respectively; for 9 high-risk patients: 51.8 and 65.5 Gy for PTV1-2 and 74.2 Gy for PTV3-4. For all patients, the dose to overlap was 65.5 Gy. Results: The mean fraction of rectum receiving more than 65 Gy (V65) and rectal Dmax were 10% and 70.8 Gy respectively. In cases of pelvic node irradiation, the intestinal cavity (outside PTV) receiving > 45 and 50 Gy was 86 and 12 cc, respectively. A homogeneous dose distribution within each PTV was guaranteed. Acute genitourinary toxicity according to RTOG scoring system was as follows: 21/60 (35%) Grade 1, 12/60 (20%) Grade 2, 2/60 (3%) Grade 3. Acute rectal toxicities were: 18/60 (30%) Grade 1. Twelve (20%) patients showed Grade 1 upper intestinal toxicity (uGI). No patients experienced ≥ Grade 2 acute rectal or uGI side effects. Conclusions: This study shows excellent results with regard to acute toxicity. Further research is necessary to assess definitive late toxicity and tumor control outcome.

Original languageEnglish
Pages (from-to)392-398
Number of pages7
JournalInternational Journal of Radiation Oncology Biology Physics
Volume74
Issue number2
DOIs
Publication statusPublished - Jun 1 2009

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acceleration (physics)
Prostatic Neoplasms
toxicity
cancer
grade
planning
rectum
Rectum
dosage
Intensity-Modulated Radiotherapy
scoring
Seminal Vesicles
Prostate
tumors
cavities
irradiation
Research
Neoplasms

Keywords

  • Acute toxicity
  • Hypofractionation
  • Prostate cancer
  • Simultaneous integrated boost
  • Tomotherapy

ASJC Scopus subject areas

  • Cancer Research
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Phase I-II Study of Hypofractionated Simultaneous Integrated Boost With Tomotherapy for Prostate Cancer. / Di Muzio, Nadia; Fiorino, Claudio; Cozzarini, Cesare; Alongi, Filippo; Broggi, Sara; Mangili, Paola; Guazzoni, Giorgio; Valdagni, Riccardo; Calandrino, Riccardo; Fazio, Ferruccio.

In: International Journal of Radiation Oncology Biology Physics, Vol. 74, No. 2, 01.06.2009, p. 392-398.

Research output: Contribution to journalArticle

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abstract = "Purpose: To report planning and acute toxicity data of the first 60 patients treated within a Phase I-II study with moderate hypofractionation by image-guided helical tomotherapy. Methods and Materials: Various clinical target volumes (CTVs) were defined: CTV1-pelvic nodes; CTV2-upper portion of seminal vesicles; CTV3-lower portion of SV; CTV4-prostate; overlap between planning target volume (PTV) 4 and rectum. Different doses to each PTV were simultaneously delivered in 28 fractions. For 31 low-risk patients: 56.0, 61.6, and 71.4 Gy for PTV2-4, respectively; for 20 intermediate-risk patients: 51.8, 61.6, 65.5, and 74.2 Gy for PTV1-4, respectively; for 9 high-risk patients: 51.8 and 65.5 Gy for PTV1-2 and 74.2 Gy for PTV3-4. For all patients, the dose to overlap was 65.5 Gy. Results: The mean fraction of rectum receiving more than 65 Gy (V65) and rectal Dmax were 10{\%} and 70.8 Gy respectively. In cases of pelvic node irradiation, the intestinal cavity (outside PTV) receiving > 45 and 50 Gy was 86 and 12 cc, respectively. A homogeneous dose distribution within each PTV was guaranteed. Acute genitourinary toxicity according to RTOG scoring system was as follows: 21/60 (35{\%}) Grade 1, 12/60 (20{\%}) Grade 2, 2/60 (3{\%}) Grade 3. Acute rectal toxicities were: 18/60 (30{\%}) Grade 1. Twelve (20{\%}) patients showed Grade 1 upper intestinal toxicity (uGI). No patients experienced ≥ Grade 2 acute rectal or uGI side effects. Conclusions: This study shows excellent results with regard to acute toxicity. Further research is necessary to assess definitive late toxicity and tumor control outcome.",
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AU - Di Muzio, Nadia

AU - Fiorino, Claudio

AU - Cozzarini, Cesare

AU - Alongi, Filippo

AU - Broggi, Sara

AU - Mangili, Paola

AU - Guazzoni, Giorgio

AU - Valdagni, Riccardo

AU - Calandrino, Riccardo

AU - Fazio, Ferruccio

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N2 - Purpose: To report planning and acute toxicity data of the first 60 patients treated within a Phase I-II study with moderate hypofractionation by image-guided helical tomotherapy. Methods and Materials: Various clinical target volumes (CTVs) were defined: CTV1-pelvic nodes; CTV2-upper portion of seminal vesicles; CTV3-lower portion of SV; CTV4-prostate; overlap between planning target volume (PTV) 4 and rectum. Different doses to each PTV were simultaneously delivered in 28 fractions. For 31 low-risk patients: 56.0, 61.6, and 71.4 Gy for PTV2-4, respectively; for 20 intermediate-risk patients: 51.8, 61.6, 65.5, and 74.2 Gy for PTV1-4, respectively; for 9 high-risk patients: 51.8 and 65.5 Gy for PTV1-2 and 74.2 Gy for PTV3-4. For all patients, the dose to overlap was 65.5 Gy. Results: The mean fraction of rectum receiving more than 65 Gy (V65) and rectal Dmax were 10% and 70.8 Gy respectively. In cases of pelvic node irradiation, the intestinal cavity (outside PTV) receiving > 45 and 50 Gy was 86 and 12 cc, respectively. A homogeneous dose distribution within each PTV was guaranteed. Acute genitourinary toxicity according to RTOG scoring system was as follows: 21/60 (35%) Grade 1, 12/60 (20%) Grade 2, 2/60 (3%) Grade 3. Acute rectal toxicities were: 18/60 (30%) Grade 1. Twelve (20%) patients showed Grade 1 upper intestinal toxicity (uGI). No patients experienced ≥ Grade 2 acute rectal or uGI side effects. Conclusions: This study shows excellent results with regard to acute toxicity. Further research is necessary to assess definitive late toxicity and tumor control outcome.

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KW - Simultaneous integrated boost

KW - Tomotherapy

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