Biomedical papers, 2016 (vol. 160), issue 3

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub. 2016, 160(3):435-441 | 10.5507/bp.2016.008

Early toxicity of hypofractionated radiotherapy for prostate cancer

Pavel Krupaa,b, Hana Tichac, Tomas Kazdaa, Radana Dymackovaa, Jana Zitterbartovaa, Anna Odlozilikovac, Libor Komineka, Lukas Bobeka, Ales Kudlaceka, Pavel Slampaa,b
a Clinic of Radiation Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
b Regional Centre for Applied Molecular Oncology, Masaryk Memorial Cancer Institute, Brno, Czech Republic
c Department of Medical Physics, Masaryk Memorial Cancer Institute, Brno, Czech Republic

Background: Hypofractionated accelerated radiotherapy (HART) is now a feasible option for prostate cancer treatment apropos toxicity, biochemical control and shortening of treatment. The aim of this study was to investigate hypofractionated schedules in the treatment of patients with localized prostate cancer.

Patients and Methods: Between 2011-2014, 158 patients were treated using the RapidArc technique with IGRT. The target volume for low risk patients was the prostate alone with a prescribed dose of 20x3.0 Gy (EQD2=77 Gy). Targets volumes for intermediate and high risk patients were prostate and two thirds of the seminal vesicles with a prescribed dose 21-22x3.0/2.1 Gy (EQD2=81/45.4-84.9/47.5). Based on radiobiological modelling of early toxicity, we used four fractions per week in the low risk group and four fractions in odd weeks and three fractions in even weeks in intermediate and high risk groups. The RTOG/EORTC toxicity scale was used.

Results: Early genitourinary (GU) toxicity was observed for grades 0, 1, 2, 3 and 4 in 73 (46%), 60 (38%), 22 (14%), 0 and 3 (2%), respectively; early gastrointestinal (GI) toxicity was recorded for grades 0, 1, 2 and 3 in 119 (75%), 37 (23%), and 2 (1%) patients, respectively.

Conclusion: A combination of moderate hypofractionation, number of fractions per week adapted to target volume and precise dose delivery technique with image guidance appears safe with low early toxicity. Longer follow up is needed to assess late toxicity and tumor control probability.

Keywords: hypofractionationation, VMAT, volumetric arc therapy, RapidArc, Tumor control probability, Normal tissue complication probability, alternated time schedule

Received: September 13, 2015; Accepted: February 10, 2016; Prepublished online: March 4, 2016; Published: September 20, 2016


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