Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer

Biancamaria Saracino, Michele Gallucci, Piero De Carli, Antonella Soriani, Rocco Papalia, Simona Marzi, Valeria Landoni, Maria Grazia Petrongari, Stefano Arcangeli, Ester Forastiere, Steno Sentinelli, Giorgio Arcangeli

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

Purpose: Recent studies have suggested an α/β ratio in prostate cancer of 1.5-3 Gy, which is lower than that assumed for late-responsive normal tissues. Therefore the administration of a single, intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer. Materials and Methods: Between February 2002 and June 2004, 34 patients with localized prostate cancer with only one risk factor (Gleason score ≥7, Clinical Stage [cT] ≥2c, or prostate-specific antigen [PSA] of 11-20 ng/mL) and without clinical evidence of lymph node metastases were treated with radical prostatectomy (RP) and intraoperative radiotherapy on the tumor bed. A dose-finding procedure based on the Fibonacci method was employed. Dose levels of 16, 18, and 20 Gy were selected, which are biologically equivalent to total doses of about 60-80 Gy administered with conventional fractionation, using an α/β ratio value of 3. Results: At a median follow-up of 41 months, 24 (71%) patients were alive with an undetectable PSA value. No patients died from disease, whereas 2 patients died from other malignancies. Locoregional failures were detected in 3 (9%) patients, 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field. A PSA rise without local or distant disease was observed in 7 (21%) cases. The overall 3-year biochemical progression-free survival rate was 77.3%. Conclusions: Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose.

Original languageEnglish
Pages (from-to)1049-1056
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume71
Issue number4
DOIs
Publication statusPublished - Jul 15 2008

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Prostatectomy
radiation therapy
Prostatic Neoplasms
Radiotherapy
cancer
dosage
Prostate-Specific Antigen
antigens
beds
Neoplasm Grading
Feasibility Studies
irradiation
lymphatic system
Disease-Free Survival
metastasis
Prostate
Neoplasms
progressions
fractionation
Survival Rate

Keywords

  • α/β ratio
  • Intraoperative radiotherapy
  • Prostate cancer
  • Radical prostatectomy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer. / Saracino, Biancamaria; Gallucci, Michele; De Carli, Piero; Soriani, Antonella; Papalia, Rocco; Marzi, Simona; Landoni, Valeria; Petrongari, Maria Grazia; Arcangeli, Stefano; Forastiere, Ester; Sentinelli, Steno; Arcangeli, Giorgio.

In: International Journal of Radiation Oncology Biology Physics, Vol. 71, No. 4, 15.07.2008, p. 1049-1056.

Research output: Contribution to journalArticle

Saracino, Biancamaria ; Gallucci, Michele ; De Carli, Piero ; Soriani, Antonella ; Papalia, Rocco ; Marzi, Simona ; Landoni, Valeria ; Petrongari, Maria Grazia ; Arcangeli, Stefano ; Forastiere, Ester ; Sentinelli, Steno ; Arcangeli, Giorgio. / Phase I-II Study of Intraoperative Radiation Therapy (IORT) After Radical Prostatectomy for Prostate Cancer. In: International Journal of Radiation Oncology Biology Physics. 2008 ; Vol. 71, No. 4. pp. 1049-1056.
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AU - Saracino, Biancamaria

AU - Gallucci, Michele

AU - De Carli, Piero

AU - Soriani, Antonella

AU - Papalia, Rocco

AU - Marzi, Simona

AU - Landoni, Valeria

AU - Petrongari, Maria Grazia

AU - Arcangeli, Stefano

AU - Forastiere, Ester

AU - Sentinelli, Steno

AU - Arcangeli, Giorgio

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AB - Purpose: Recent studies have suggested an α/β ratio in prostate cancer of 1.5-3 Gy, which is lower than that assumed for late-responsive normal tissues. Therefore the administration of a single, intraoperative dose of irradiation should represent a convenient irradiation modality in prostate cancer. Materials and Methods: Between February 2002 and June 2004, 34 patients with localized prostate cancer with only one risk factor (Gleason score ≥7, Clinical Stage [cT] ≥2c, or prostate-specific antigen [PSA] of 11-20 ng/mL) and without clinical evidence of lymph node metastases were treated with radical prostatectomy (RP) and intraoperative radiotherapy on the tumor bed. A dose-finding procedure based on the Fibonacci method was employed. Dose levels of 16, 18, and 20 Gy were selected, which are biologically equivalent to total doses of about 60-80 Gy administered with conventional fractionation, using an α/β ratio value of 3. Results: At a median follow-up of 41 months, 24 (71%) patients were alive with an undetectable PSA value. No patients died from disease, whereas 2 patients died from other malignancies. Locoregional failures were detected in 3 (9%) patients, 2 in the prostate bed and 1 in the common iliac node chain outside the radiation field. A PSA rise without local or distant disease was observed in 7 (21%) cases. The overall 3-year biochemical progression-free survival rate was 77.3%. Conclusions: Our dose-finding study demonstrated the feasibility of intraoperative radiotherapy in prostate cancer also at the highest administered dose.

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