Abstract
BackgroundImage-guided radiotherapy (IGRT) increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically.MethodsBetween 2006 and 2009, acute toxicity data for ten symptoms were collected prospectively onto standardized assessment forms. Toxicity was scored during radiotherapy, according to the Common Terminology Criteria Adverse Events V3.0, for 275 prostate cancer patients before and after the implementation of a fiducial marker IGRT program and dose escalation from 74Gy in 37 fractions, to 78Gy in 39 fractions. Margins and planning constraints were maintained the same during the study period. The symptoms scored were urinary frequency, cystitis, bladder spasm, urinary incontinence, urinary retention, diarrhoea, haemorrhoids, proctitis, anal skin discomfort and fatigue. Analysis was conducted for the maximum grade of toxicity and the median number of days from the onset of that toxicity to the end of treatment.ResultsIn the IGRT group, 14228 toxicity scores were analysed from 249 patients. In the non-IGRT group, 1893 toxicity scores were analysed from 26 patients. Urinary frequency ≥G3 affected 23% and 7% in the non-IGRT and IGRT group respectively (p = 0.0188). Diarrhoea ≥G2 affected 15% and 3% of patients in the non-IGRT and IGRT groups (p = 0.0174). Fatigue ≥G2 affected 23% and 8% of patients in the non-IGRT and IGRT groups (p = 0.0271). The median number of days with a toxicity was higher for ≥G2 (p = 0.0179) and ≥G3 frequency (p = 0.0027), ≥G2 diarrhoea (p = 0.0033) and ≥G2 fatigue (p = 0.0088) in the non-IGRT group compared to the IGRT group. Other toxicities were not of significant statistical difference.ConclusionsIn this study, prostate cancer patients treated radically with IGRT had less severe urinary frequency, diarrhoea and fatigue during treatment compared to patients treated with non-IGRT. Onset of these symptoms was earlier in the non-IGRT group. IGRT results in less acute toxicity during radiotherapy in prostate cancer.
Highlights
Image-guided radiotherapy (IGRT) increases the accuracy of treatment delivery through daily target localisation
Acute grade 2 (G2) GU toxicity was seen in 24-49% of patients treated with non-IGRT and acute G2 GI toxicity was seen in 28-57% [5]
In another cohort of 238 patients treated with IGRT, Soete et al reported a higher rate of 16% with grade 3 (G3) GU and 6% G3 GI toxicity [6]
Summary
Image-guided radiotherapy (IGRT) increases the accuracy of treatment delivery through daily target localisation. We report on toxicity symptoms experienced during radiotherapy treatment, with and without IGRT in prostate cancer patients treated radically. In a large cohort of patients treated with IGRT for prostate cancer, Lips et al reported acute grade 2 (G2) genitourinary (GU) toxicity in 47% and G2 gastrointestinal (GI) toxicity in 30% [5]. Acute G2 GU toxicity was seen in 24-49% of patients treated with non-IGRT and acute G2 GI toxicity was seen in 28-57% [5]. The wide range of GU and GI side effects across studies is due to differences in methodology employed across studies, making comparison difficult to interpret These studies use different radiotherapy planning dose constraints, treatment delivery techniques, target margins, toxicity assessment tools and patient populations across different treatment centres with varying protocols. The exact benefit of IGRT in terms of acute toxicity reduction compared to non-IGRT treated patients has yet to be determined
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