Incidence of Late Rectal and Urinary Toxicities After Three-Dimensional Conformal Radiotherapy and Intensity-Modulated Radiotherapy for Localized Prostate Cancer

Zeléfsky, Michael J.; Levin, Emily J.; Hunt, Margie; Yamada, Yoshiya; Shippy, Alison M.; Jackson, Andrew; Amols, Howard

doi:10.1016/j.ijrobp.2007.11.044

Cited by 636 publications

(471 citation statements)

References 18 publications

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“…Our GI toxicity findings are consistent with the observations of a large retrospective series from the Memorial Sloan-Kettering Cancer Center in which an analysis of 1571 patients (of all risk groups, with or without concurrent AD) treated with either 3DCRT or IMRT was performed to assess incidence of and identify predictors for toxicity (25). The 10-year incidence of ≥ grade 2 GI toxicity for 3DCRT 13% and for IMRT was 5% (p<0.001).…”

Section: Discussionsupporting

confidence: 87%

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Sharma

Chen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Androgen deprivation therapy (AD) has been shown to increase late ≥ grade 2 rectal toxicity when used concurrently with three-dimensional conformal radiotherapy (3DCRT). Intensity modulated radiotherapy (IMRT) has the potential to reduce toxicity by limiting the radiation dose received by the bowel and bladder. This study compares both genitourinary (GU) and gastrointestinal (GI) toxicity in men treated with 3DCRT+AD versus IMRT+AD.Methods and Materials-From July 1992 to July 2004, 293 men received 3DCRT (n=170) or IMRT (n=123) with concurrent AD (< 6 months, n=123; ≥ 6 months, n =170). Median RT doses were 76 Gy for 3DCRT (ICRU) and 76 Gy for IMRT (95% to the PTV). Toxicity was assessed by a patient symptom questionnaire assessing toxicity completed at each visit and recorded using a modified late effects normal tissue task force radiation morbidity scale (LENT).Results-Mean follow-up was 86 months (SD=29.3) for the 3DCRT group and 40 months (SD=9.7) for the IMRT group. Acute GI toxicity (OR=4, 95% CI: 1.6-11.7, p=0.005) was significantly higher with 3DCRT than with IMRT and was independent of AD duration (i.e. <6 vs. ≥6 months). Time to development of late GI toxicity was significantly longer in the IMRT group. The 5-year Kaplan-Meier estimates for ≥ grade 2 GI toxicity were 20% for 3DCRT versus 8% for IMRT (p=0.01). On MVA, ≥ grade 2 late GI toxicity (HR=2.1, 95% CI: 1.1-4.3, p=0.04) was more prevalent in 3DCRT patients. Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Conclusions-Compared to 3DCRT, IMRT significantly decreased acute and late GI toxicity in patients treated with AD. NIH Public Access

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Section: Discussionsupporting

confidence: 87%

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Sharma

Chen

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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“…Intensity‐modulated radiotherapy (IMRT) (5) as the development of 3D CRT becomes the most popular RT technique for its good sparing of surrounding critical organs and excellent conformity and homogeneity of PTV by using nonuniform radiation beam intensities and inverse planning method. With regard to both improving tumor control by increase prescription target dose and reducing genitourinary and gastrointestinal toxicity by reducing the volumes of the rectal and bladder walls exposed to high‐dose levels, IMRT becomes the standard technique to deliver external beam radiation therapy treatment to the prostate 6 , 7 . Among IMRT techniques, fixed field IMRT (shorten for IMRT) is the most common radiotherapy technique for its accurate output dose 8 , 9 and easy quality assurance (10) …”

Section: Introductionmentioning

confidence: 99%

Dosimetric comparison of intensity‐modulated radiotherapy and volumetric‐modulated arc radiotherapy in patients with prostate cancer: a meta‐analysis

Ren

Sun

Liu

et al. 2016

J Applied Clin Med Phys

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Intensity‐modulated radiotherapy (IMRT) and volumetric‐modulated arc therapy (VMAT) are two main radiotherapy techniques. The aim of this study is to explore which is the preferred technique in prostate treatment through the related publications and meta‐analysis. Two authors independently identified all relevant articles available regarding eligibility criteria on PubMed, Embase, and Cochrane Library databases until December 2015. Publication bias was evaluated with funnel plot, and statistical analyses were performed with Stata software. P<0.05 was thought statistically significant. Ten studies comprised a total of 110 patients; in total 110 IMRT plans and 110 VMAT plans that were included in this study. V40, V60, and V70 of rectum were significantly decreased in VMAT than in IMRT. However, V50 of rectum and V40, V50, V60, V70 of bladder had no statistical differences between IMRI and VMAT plans. Compared with IMRT, the treatment time and MUs of VMAT were significantly lower. VMAT protects rectum better than IMRT and improves the delivery efficiency. VMAT may be the preferred modality for treating prostate cancer.PACS number(s): 87.55. D‐

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“…17,18 Improved physical targeted radiation, such as three-dimensional external beam conformal radiotherapy and intensity-modulated RT, has enabled more precise dose delivery to tumor masses, while limiting the exposure of surrounding normal tissues. 19,20 Nevertheless, the treatment of certain malignancies remains problematic, as malignant tumors are a type of complicated disease that involves the activation and inactivation of different oncogenes during the process of tumorigenesis. 21 With respect to its efficiency and safety, gene therapy, introduced in the late 1970s after the development of Figure 7.…”

Section: Discussionmentioning

confidence: 99%

The radiation dose-regulated AND gate genetic circuit, a novel targeted and real-time monitoring strategy for cancer gene therapy

Ding

Zhang

et al. 2012

Cancer Gene Ther

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The AND gate functions such that when all inputs are activated the downstream gene will be transcribed and it is off otherwise. To accomplish optimal and targeted gene therapy in solid tumor patients, we have constructed an AND gate genetic circuit and investigated whether it could be activated by low-dose radiation in vitro and in vivo. The enhancement green fluorescent protein (EGFP) expression in different tumor cells transfected with control vector plxsn-EGFP confirmed that 2 Gy of radiation and 1% O 2 for 3 h could activate our AND gate. Besides, the obvious different levels of EGFP expression between 2 and 6 Gy of radiation demonstrated that the AND gate could be regulated by radiation doses. Additionally, through EGFP expression and the codistribution of p53 and HIF-1a in xenografts, we illustrated the targeted activation property of the AND gate and real-time monitoring to hypoxic districts in vivo. Moreover, significant growth inhibition and cell cycle arrest in vitro and apoptosis-inducing effects in vitro and in vivo proved that the AND gate induced ideal antitumor effects. In conclusion, the radiation dose-regulated AND gate genetic circuit could not only effectively monitor the therapeutic process in real-time but also induce ideal antitumor efficacy, and can be further exploited for personal therapy in clinical tumor patients.

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Incidence of Late Rectal and Urinary Toxicities After Three-Dimensional Conformal Radiotherapy and Intensity-Modulated Radiotherapy for Localized Prostate Cancer

Cited by 636 publications

References 18 publications

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Intensity Modulated Radiation Therapy Reduces Gastrointestinal Morbidity in Patients Treated With Androgen Deprivation Therapy for Prostate Cancer

Dosimetric comparison of intensity‐modulated radiotherapy and volumetric‐modulated arc radiotherapy in patients with prostate cancer: a meta‐analysis

The radiation dose-regulated AND gate genetic circuit, a novel targeted and real-time monitoring strategy for cancer gene therapy

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