Dose escalation with 3D-CRT in prostate cancer: French study of dose escalation with conformal 3D radiotherapy in prostate cancer—preliminary results

Bey, P.; Carrié, C.; Beckendorf, V.; Ginestet, C.; Aletti, P.; Madelis, G.; Luporsi, É.; Pommier, P.; Cowen, D.; Gonzague-Casabianca, L.; Simonian-Sauve, Michèle; Maingon, P.; Naudy, S.; Lagrange, Jean‐Léon; Marcié, S.

doi:10.1016/s0360-3016(00)00691-x

Cited by 74 publications

(24 citation statements)

References 11 publications

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“…Although such differences were measurable and statistically significant, they were arguably of little clinical significance as side effects settled within 3 months of treatment completion. The incidence of late rectal toxicity varies considerably in other studies, Grade 2 or more side effects being reported in 2 -32% of patients (Lee et al, 1996;Schultheiss et al, 1997;Hanks et al, 1998;Zelefsky et al, 1999Zelefsky et al, , 2001Bey et al, 2000;Michalski et al, 2000;Skwarchuk et al, 2000). Risk factors include dose, technique, past history of diabetes mellitus, rectal volume and the occurrence of acute toxicity (Schultheiss et al, 1997;Denham et al, 1999;Skwarchuk et al, 2000).…”

Section: Discussionmentioning

confidence: 99%

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

et al. 2005

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Radical radiotherapy is a standard form of management of localised prostate cancer. Conformal treatment planning spares adjacent normal tissues reducing treatment-related side effects and may permit safe dose escalation. We have tested the effects on tumour control and side effects of escalating radiotherapy dose and investigated the appropriate target volume margin. After an initial 3 -6 month period of androgen suppression, 126 men were randomised and treated with radiotherapy using a 2 by 2 factorial trial design. The initial radiotherapy tumour target volume included the prostate and base of seminal vesicles (SV) or complete SV depending on SV involvement risk. Treatments were randomised to deliver a dose of 64 Gy with either a 1.0 or 1.5 cm margin around the tumour volume (1.0 and 1.5 cm margin groups) and also to treat either with or without a 10 Gy boost to the prostate alone with no additional margin (64 and 74 Gy groups). Tumour control was monitored by prostate-specific antigen (PSA) testing and clinical examination with additional tests as appropriate. Acute and late side effects of treatment were measured using the Radiation Treatment and Oncology Groups (RTOG) and LENT SOM systems. The results showed that freedom from PSA failure was higher in the 74 Gy group compared to the 64 Gy group, but this did not reach conventional levels of statistical significance with 5-year actuarial control rates of 71% (95% CI 58 -81%) in the 74 Gy group vs 59% (95% CI 45 -70%) in the 64 Gy group. There were 23 failures in the 74Gy group and 33 in the 64 Gy group (Hazard ratio 0.64, 95% CI 0.38 -1.10, P ¼ 0.10). No difference in disease control was seen between the 1.0 and 1.5 cm margin groups (5-year actuarial control rates 67%, 95% CI 53 -77% vs 63%, 95% CI 50 -74%) with 28 events in each group (Hazard ratio 0.97, 95% CI 0.50 -1.86, P ¼ 0.94). Acute side effects were generally mild and 18 weeks after treatment, only four and five of the 126 men had persistent XGrade 1 bowel or bladder side effects, respectively. Statistically significant increases in acute bladder side effects were seen after treatment in the men receiving 74 Gy (P ¼ 0.006), and increases in both acute bowel side effects during treatment (P ¼ 0.05) and acute bladder sequelae (P ¼ 0.002) were recorded for men in the 1.5 cm margin group. While statistically significant, these differences were of short duration and of doubtful clinical importance. Late bowel side effects (RTOGX2) were seen more commonly in the 74 Gy and 1.5 cm margin groups (P ¼ 0.02 and P ¼ 0.05, respectively) in the first 2 years after randomisation. Similar results were found using the LENT SOM assessments. No significant differences in late bladder side effects were seen between the randomised groups using the RTOG scoring system. Using the LENT SOM instrument, a higher proportion of men treated in the 74 Gy group had Grade X3 urinary frequency at 6 and 12 months. Compared to baseline scores, bladder symptoms improved after 6 months or more follow-up in all groups. Sexual function d...

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Section: Discussionmentioning

confidence: 99%

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

et al. 2005

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“…Advanced radiotherapy treatments with IMRT can deliver dose distributions that are more conformal to the tumor targets and that simultaneously minimize radiation damage to the surrounding normal tissues. ( 1 – 7 ) …”

Section: Introductionmentioning

confidence: 99%

Monte Carlo determination of radiation‐induced cancer risks for prostate patients undergoing intensity‐modulated radiation therapy

Stathakis

Charlie

2007

J Applied Clin Med Phys

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The application of intensity‐modulated radiation therapy (IMRT) has enabled the delivery of high doses to the target volume while sparing the surrounding normal tissues. The drawbacks of intensity modulation, as implemented using a computer‐controlled multileaf collimator (MLC), are the larger number of monitor units (MUs) and longer beam‐on time as compared with conventional radiotherapy. Additionally, IMRT uses more beam directions—typically 5 – 9 for prostate treatment—to achieve highly conformal dose and normal‐tissue sparing. In the present work, we study radiation‐induced cancer risks attributable to IMRT delivery using MLC for prostate patients.Whole‐body computed tomography scans were used in our study to calculate (according to report no. 116 from the National Council on Radiation Protection and Measurements) the effective dose equivalent received by individual organs. We used EGS4 and MCSIM to compute the dose for IMRT and three‐dimensional conformal radiotherapy. The effects of collimator rotation, distance from the treatment field, and scatter and leakage contribution to the whole‐body dose were investigated. We calculated the whole‐body dose equivalent to estimate the increase in the risk of secondary malignancies.Our results showed an overall doubling in the risk of secondary malignancies from the application of IMRT as compared with conventional radiotherapy. This increase in the risk of secondary malignancies is not necessarily related to a relative increase in MUs. The whole‐body dose equivalent was also affected by collimator rotation, field size, and the energy of the photon beam. Smaller field sizes of low‐energy photon beams (that is, 6 MV) with the MLC axis along the lateral axis of the patient resulted in the lowest whole‐body dose. Our results can be used to evaluate the risk of secondary malignancies for prostate IMRT patients.PACS: 87.53.wz, 87.53.‐j

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“…Thus, 281 of the 849 pts (33.1%) were treated with EBRT at doses <76 Gy. In the year 2000, our institution switched to high-dose radiotherapy based on findings from multiple studies [10][11][12][13][14][15] and updated international guidelines. 16 Thus, all patients treated from August of that year (565 pts) were prescribed ≥76 Gy.…”

Section: Patient Cohortmentioning

confidence: 99%

Localized prostate cancer treated with external beam radiation therapy: Long-term outcomes at a European comprehensive cancer centre

Boladeras

Martinez

Ferrer

et al. 2016

Reports of Practical Oncology & Radiotherapy

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Results: Median follow-up was 109.6 months (range, 68.3-193.4 and 71.4% (high) (p = 0.0666). Toxicity included rectitis: grade 1 (G1) (277 pts; 32.6%), G2 (108; 12.7%), and G3 (20; 2.6%) and urethritis: G1 (294; 34.6%); G2 (223; 26.2%), and G3 (11; 1.3%). By dose rate (<76 Gy vs. ≥76 Gy), 5 and 10-year BRFS rates were 83.1% and 68.3% vs. 88.4% and 74.8% (p = 0.038). Conclusions:Our results are comparable to other published series in terms of disease control and toxicity. These findings confirm the need for dose escalation to achieve better biochemical control and the benefits of ADT in high-risk PCa patients.

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Dose escalation with 3D-CRT in prostate cancer: French study of dose escalation with conformal 3D radiotherapy in prostate cancer—preliminary results

Cited by 74 publications

References 11 publications

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

Phase III pilot study of dose escalation using conformal radiotherapy in prostate cancer: PSA control and side effects

Monte Carlo determination of radiation‐induced cancer risks for prostate patients undergoing intensity‐modulated radiation therapy

Localized prostate cancer treated with external beam radiation therapy: Long-term outcomes at a European comprehensive cancer centre

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