Abstract
For high risk prostate cancer, the treatment volumes and even dose levels are still a controversial issue. The aim of this study is to evaluate the dosemetric parameters and acute toxicity of dose-escalated whole pelvis (WP) Intensity Modulated Radiation Therapy (IMRT) and volumetric modulated arc therapy (VMAT) prostate boost following neoadjuvant and concomitant with androgen deprivation therapy in high-risk prostate cancer patients. This analysis included 73 high-risk prostate cancer patients treated with WP-IMRT followed by boost to the prostate by VMAT to total dose of 80 Gy; between January 2014 and October 2016. Androgen deprivation therapy (ADT) was given for all patients before and during radiation therapy. Drawing the dose volume histograms (DVHs) was done for planning target volumes (PTVs), including Prostate PTV & nodal PTV, and organs at risk including rectum, bladder, femoral heads, and bowel bag for the plans. Acute radiation toxicities were reported during the radiation course and the following 3 months. The DVH analysis showed good coverage of PTVs and organs at risk doses were acceptable. No recorded acute Grade ≥ 3 toxicity. Acute grade 1 toxicity for Gastrointestinal (GI) and Genitourinary (GU) were 65% and 35% respectively, while Grade 2 toxicity was 30% for both. The Proctitis and frequency were the commonest acute toxicity and were maximal during the 5th week of radiation therapy. Dose escalation in two phases utilizing Simultaneous integrated boost (SIB) combined with ADT in high risk prostate cancer patient is feasible and associated with acceptable acute GI and GU toxicity.
Highlights
Dose-escalated radiation therapies (80 Gy and higher) in high-risk prostate cancer patients have demonstrated improvement in outcome and biochemical disease-free survival [1] [2] [3]
The aim of this study is to evaluate the dosemetric parameters and acute toxicity of dose-escalated whole pelvis (WP) Intensity Modulated Radiation Therapy (IMRT) and volumetric modulated arc therapy (VMAT) prostate boost following neoadjuvant and concomitant with androgen deprivation therapy in high-risk prostate cancer patients
In a Phase III trial, The Radiation Therapy Oncology Group (RTOG) showed improved progression-free survival (PFS) for high-risk prostate cancer patients treated with Whole Pelvis Radiation Therapy (WPRT) compared with prostate-only radiation therapy (PORT) [4]
Summary
Dose-escalated radiation therapies (80 Gy and higher) in high-risk prostate cancer patients have demonstrated improvement in outcome and biochemical disease-free survival [1] [2] [3]. In a Phase III trial, The Radiation Therapy Oncology Group (RTOG) showed improved progression-free survival (PFS) for high-risk prostate cancer patients treated with Whole Pelvis Radiation Therapy (WPRT) compared with prostate-only radiation therapy (PORT) [4]. There is increased interest in radiation dose escalation combined with androgen deprivation in high risk prostate cancer patients [6] [7]. An ongoing GETUG-AFU-18 phase III trial is evaluating the impact of dose escalation in combination with 3-year androgen deprivation treatment on 5-year biochemical or clinical control in high-risk prostate cancer patients [8]. Planning studies on dosimetric comparison of the prostate only demonstrated that VMAT provided equal or better target coverage and normal tissue sparing over IMRT [16] [17] [18]
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