Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지
DOI QR코드

DOI QR Code

Treatment outcome of localized prostate cancer by 70 Gy hypofractionated intensity-modulated radiotherapy with a customized rectal balloon

  • Kim, Hyunjung (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Kim, Jun Won (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Hong, Sung Joon (Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Rha, Koon Ho (Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Lee, Chang-Geol (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Yang, Seung Choul (Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Choi, Young Deuk (Department of Urology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Suh, Chang-Ok (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine) ;
  • Cho, Jaeho (Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine)
  • Received : 2014.05.02
  • Accepted : 2014.09.01
  • Published : 2014.09.30
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose: We aimed to analyze the treatment outcome and long-term toxicity of 70 Gy hypofractionated intensity-modulated radiotherapy (IMRT) for localized prostate cancer using a customized rectal balloon. Materials and Methods: We reviewed medical records of 86 prostate cancer patients who received curative radiotherapy between January 2004 and December 2011 at our institution. Patients were designated as low (12.8%), intermediate (20.9%), or high risk (66.3%). Thirty patients received a total dose of 70 Gy in 28 fractions over 5 weeks via IMRT (the Hypo-IMRT group); 56 received 70.2 Gy in 39 fractions over 7 weeks via 3-dimensional conformal radiotherapy (the CF-3DRT group, which served as a reference for comparison). A customized rectal balloon was placed in Hypo-IMRT group throughout the entire radiotherapy course. Androgen deprivation therapy was administered to 47 patients (Hypo-IMRT group, 17; CF-3DRT group, 30). Late genitourinary (GU) and gastrointestinal (GI) toxicity were evaluated according to the Radiation Therapy Oncology Group criteria. Results: The median follow-up period was 74.4 months (range, 18.8 to 125.9 months). The 5-year actuarial biochemical relapse-free survival rates for low-, intermediate-, and high-risk patients were 100%, 100%, and 88.5%, respectively, for the Hypo-IMRT group and 80%, 77.8%, and 63.6%, respectively, for the CF-3DRT group (p < 0.046). No patient presented with acute or late GU toxicity ${\geq}$grade 3. Late grade 3 GI toxicity occurred in 2 patients (3.6%) in the CF-3DRT group and 1 patient (3.3%) in the Hypo-IMRT group. Conclusion: Hypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

Keywords

References

  1. Symon Z, Griffith KA, McLaughlin PW, Sullivan M, Sandler HM. Dose escalation for localized prostate cancer: substantial benefit observed with 3D conformal therapy. Int J Radiat Oncol Biol Phys 2003;57:384-90. https://doi.org/10.1016/S0360-3016(03)00569-8
  2. Pollack A, Hanlon A, Horwitz EM, Feigenberg S, Uzzo RG, Price RA. Radiation therapy dose escalation for prostate cancer: a rationale for IMRT. World J Urol 2003;21:200-8. https://doi.org/10.1007/s00345-003-0356-x
  3. Zelefsky MJ, Fuks Z, Hunt M, et al. High dose radiation delivered by intensity modulated conformal radiotherapy improves the outcome of localized prostate cancer. J Urol 2001;166:876-81. https://doi.org/10.1016/S0022-5347(05)65855-7
  4. Oliveira SM, Teixeira NJ, Fernandes L. What do we know about the ${\alpha}/{\beta}$ for prostate cancer? Med Phys 2012;39:3189-201. https://doi.org/10.1118/1.4712224
  5. Daş u A. Is the alpha/beta value for prostate tumours low enough to be safely used in clinical trials? Clin Oncol (R Coll Radiol) 2007;19:289-301. https://doi.org/10.1016/j.clon.2007.02.007
  6. Brenner DJ. Fractionation and late rectal toxicity. Int J Radiat Oncol Biol Phys 2004;60:1013-5. https://doi.org/10.1016/j.ijrobp.2004.04.014
  7. Wachter S, Gerstner N, Dorner D, et al. The influence of a rectal balloon tube as internal immobilization device on variations of volumes and dose-volume histograms during treatment course of conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2002;52:91-100. https://doi.org/10.1016/S0360-3016(01)01821-1
  8. Teh BS, McGary JE, Dong L, et al. The use of rectal balloon during the delivery of intensity modulated radiotherapy (IMRT) for prostate cancer: more than just a prostate gland immobilization device? Cancer J 2002;8:476-83. https://doi.org/10.1097/00130404-200211000-00012
  9. Cho JH, Lee CG, Kang DR, et al. Positional reproducibility and effects of a rectal balloon in prostate cancer radiotherapy. J Korean Med Sci 2009;24:894-903. https://doi.org/10.3346/jkms.2009.24.5.894
  10. Sylvester JE, Blasko JC, Grimm PD, Meier R, Malmgren JA. Tenyear biochemical relapse-free survival after external beam radiation and brachytherapy for localized prostate cancer: the Seattle experience. Int J Radiat Oncol Biol Phys 2003;57:944-52. https://doi.org/10.1016/S0360-3016(03)00739-9
  11. Roach M 3rd, Marquez C, Yuo HS, et al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys 1994;28:33-7. https://doi.org/10.1016/0360-3016(94)90138-4
  12. Thames HD, Kuban D, Levy LB, et al. The role of overall treatment time in the outcome of radiotherapy of prostate cancer: an analysis of biochemical failure in 4839 men treated between 1987 and 1995. Radiother Oncol 2010;96:6-12. https://doi.org/10.1016/j.radonc.2010.03.020
  13. Kupelian PA, Thakkar VV, Khuntia D, Reddy CA, Klein EA, Mahadevan A. Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: long-term outcomes. Int J Radiat Oncol Biol Phys 2005;63:1463-8. https://doi.org/10.1016/j.ijrobp.2005.05.054
  14. Martin JM, Rosewall T, Bayley A, et al. Phase II trial of hypofractionated image-guided intensity-modulated radiotherapy for localized prostate adenocarcinoma. Int J Radiat Oncol Biol Phys 2007;69:1084-9. https://doi.org/10.1016/j.ijrobp.2007.04.049
  15. Faria S, Dal Pra A, Cury F, et al. Treating intermediate-risk prostate cancer with hypofractionated external beam radiotherapy alone. Radiother Oncol 2011;101:486-9. https://doi.org/10.1016/j.radonc.2011.07.005
  16. Leborgne F, Fowler J, Leborgne JH, Mezzera J. Later outcomes and alpha/beta estimate from hypofractionated conformal three-dimensional radiotherapy versus standard fractionation for localized prostate cancer. Int J Radiat Oncol Biol Phys 2012;82:1200-7. https://doi.org/10.1016/j.ijrobp.2010.12.040
  17. Arcangeli S, Strigari L, Gomellini S, et al. Updated results and patterns of failure in a randomized hypofractionation trial for high-risk prostate cancer. Int J Radiat Oncol Biol Phys 2012;84:1172-8. https://doi.org/10.1016/j.ijrobp.2012.02.049
  18. Pollack A, Walker G, Horwitz EM, et al. Randomized trial of hypofractionated external-beam radiotherapy for prostate cancer. J Clin Oncol 2013;31:3860-8. https://doi.org/10.1200/JCO.2013.51.1972
  19. Fonteyne V, Soete G, Arcangeli S, et al. Hypofractionated highdose radiation therapy for prostate cancer: long-term results of a multi-institutional phase II trial. Int J Radiat Oncol Biol Phys 2012;84:e483-90. https://doi.org/10.1016/j.ijrobp.2012.04.012
  20. Dearnaley D, Syndikus I, Sumo G, et al. Conventional versus hypofractionated high-dose intensity-modulated radiotherapy for prostate cancer: preliminary safety results from the CHHiP randomised controlled trial. Lancet Oncol 2012;13:43-54. https://doi.org/10.1016/S1470-2045(11)70293-5
  21. Coote JH, Wylie JP, Cowan RA, Logue JP, Swindell R, Livsey JE. Hypofractionated intensity-modulated radiotherapy for carcinoma of the prostate: analysis of toxicity. Int J Radiat Oncol Biol Phys 2009;74:1121-7. https://doi.org/10.1016/j.ijrobp.2008.09.032
  22. Kupelian PA, Willoughby TR, Reddy CA, Klein EA, Mahadevan A. Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland Clinic experience. Int J Radiat Oncol Biol Phys 2007;68:1424-30. https://doi.org/10.1016/j.ijrobp.2007.01.067
  23. Hoffman KE, Voong KR, Pugh TJ, et al. Risk of late toxicity in men receiving dose-escalated hypofractionated intensity modulated prostate radiation therapy: results from a randomized trial. Int J Radiat Oncol Biol Phys 2014;88:1074-84. https://doi.org/10.1016/j.ijrobp.2014.01.015
  24. Patel N, Faria S, Cury F, et al. Hypofractionated radiation therapy (66 Gy in 22 fractions at 3 Gy per fraction) for favorable-risk prostate cancer: long-term outcomes. Int J Radiat Oncol Biol Phys 2013;86:534-9. https://doi.org/10.1016/j.ijrobp.2013.02.010
  25. Arcangeli G, Fowler J, Gomellini S, et al. Acute and late toxicity in a randomized trial of conventional versus hypofractionated three-dimensional conformal radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 2011;79:1013-21. https://doi.org/10.1016/j.ijrobp.2009.12.045
  26. Lund JA, Kaasa S, Wibe A, Widmark A, Fransson P. Late radiation effects to the rectum and anus after treatment for prostate cancer; validity of the LENT/SOMA score. Acta Oncol 2013;52:727-35. https://doi.org/10.3109/0284186X.2013.747695
  27. Smeenk RJ, Louwe RJ, Langen KM, et al. An endorectal balloon reduces intrafraction prostate motion during radiotherapy. Int J Radiat Oncol Biol Phys 2012;83:661-9. https://doi.org/10.1016/j.ijrobp.2011.07.028
  28. Aizer AA, Yu JB, McKeon AM, Decker RH, Colberg JW, Peschel RE. Whole pelvic radiotherapy versus prostate only radiotherapy in the management of locally advanced or aggressive prostate adenocarcinoma. Int J Radiat Oncol Biol Phys 2009;75:1344-9. https://doi.org/10.1016/j.ijrobp.2008.12.082
  29. Seaward SA, Weinberg V, Lewis P, Leigh B, Phillips TL, Roach M 3rd. Identification of a high-risk clinically localized prostate cancer subgroup receiving maximum benefit from wholepelvic irradiation. Cancer J Sci Am 1998;4:370-7.
  30. Lawton CA, DeSilvio M, Roach M 3rd, et al. An update of the phase III trial comparing whole pelvic to prostate only radiotherapy and neoadjuvant to adjuvant total androgen suppression: updated analysis of RTOG 94-13, with emphasis on unexpected hormone/radiation interactions. Int J Radiat Oncol Biol Phys 2007;69:646-55. https://doi.org/10.1016/j.ijrobp.2007.04.003
  31. Pommier P, Chabaud S, Lagrange JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol 2007;25:5366-73. https://doi.org/10.1200/JCO.2006.10.5171
  32. Asbell SO, Martz KL, Shin KH, et al. Impact of surgical staging in evaluating the radiotherapeutic outcome in RTOG #77-06, a phase III study for T1BN0M0 (A2) and T2N0M0 (B) prostate carcinoma. Int J Radiat Oncol Biol Phys 1998;40:769-82. https://doi.org/10.1016/S0360-3016(97)00926-7
  33. Mantini G, Tagliaferri L, Mattiucci GC, et al. Effect of whole pelvic radiotherapy for patients with locally advanced prostate cancer treated with radiotherapy and long-term androgen deprivation therapy. Int J Radiat Oncol Biol Phys 2011;81:e721-6. https://doi.org/10.1016/j.ijrobp.2010.12.003

Cited by

  1. Texture analysis on the edge-enhanced fluence of VMAT vol.10, pp.None, 2014, https://doi.org/10.1186/s13014-015-0382-z
  2. A practical review of magnetic resonance imaging for the evaluation and management of cervical cancer vol.11, pp.None, 2016, https://doi.org/10.1186/s13014-016-0591-0
  3. Analysis of Geometric Shifts and Proper Setup-Margin in Prostate Cancer Patients Treated With Pelvic Intensity-Modulated Radiotherapy Using Endorectal Ballooning and Daily Enema for Prostate Immobiliz vol.95, pp.2, 2016, https://doi.org/10.1097/md.0000000000002387
  4. The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures vol.11, pp.5, 2014, https://doi.org/10.1371/journal.pone.0154499
  5. Dosimetric effects of sectional adjustments of collimator angles on volumetric modulated arc therapy for irregularly-shaped targets vol.12, pp.4, 2014, https://doi.org/10.1371/journal.pone.0174924
  6. Monte Carlo simulation for scanning technique with scattering foil free electron beam: A proof of concept study vol.12, pp.5, 2014, https://doi.org/10.1371/journal.pone.0177380
  7. Analysis of Motion-dependent Clinical Outcome of Tumor Tracking Stereotactic Body Radiotherapy for Prostate Cancer vol.33, pp.14, 2014, https://doi.org/10.3346/jkms.2018.33.e107