Intensity modulated radiotherapy (IMRT) or conformational radiotherapy (3D-CRT) with conventional fractionation for prostate cancer: Is there any clinical difference?

Abstract

Purpose: To compare the treatment outcomes of a cohort of prostate cancer patients treated with conventional schedule using IMRT or 3DRT technique. Materials and Methods: Between 2010-2017, 485 men with localized prostate cancer were treated with conventional radiotherapy schedule with a total dose ≥74Gy using IMRT (231) or 3DCRT (254). Late gastrointestinal (GI) and genitourinary (GU) toxicity were retrospectively evaluated according to modifi ed RTOG criteria. The biochemical control was defi ned by the Phoenix criteria (nadir + 2ng/mL). The comparison between the groups included biochemical recurrence free survival (bRFS), overall survival (OS) and late toxicity. Results: With a median follow-up of 51 months (IMRT=49 and 3DRT=51 months), the maximal late GU for >=grade-2 during the entire period of follow-up was 13.1% in the IMRT and 15.4% in the 3DRT (p=0.85). The maximal late GI ≥ grade-2 in the IMRT was 10% and in the 3DRT 24% (p=0.0001). The 5-year bRFS for all risk groups with IMRT and 3D-CRT was 87.5% vs. 87.2% (p=0.415). Considering the risk-groups no signifi cant difference for low-, intermediate-and high-risk groups between IMRT (low-95.3%, intermediate-86.2% and high-73%) and 3D-CRT (low-96.4%, intermediate-88.2% and high-76.6%, p=0.448) was observed. No signifi cant differences for OS and DMFS were observed comparing treatment groups. Conclusion: IMRT reduces signifi cantly the risk of late GI severe complication compared with 3D-CRT using conventional fractionation with a total dose ≥74Gy without any differences for bRFS and OS.

Penile cancer: a Brazilian consensus statement for low- and middle-income countries

“…Conformational radiotherapy (RT3D) is the minimum technique for administering the radiation dose when radical teletherapy is indicated (with or without chemotherapy) in which lymph nodes will (consensus, LE: 2b) or will not be treated (recommendation, LE: 2b). The ideal technique is modulated intensity radiotherapy (IMRT) combined with imaging-guided radiotherapy (IGRT), based on the evaluation of IMRT from prostate cancer patients, with lower toxicity in pelvic organs compared with RT3D (Viani et al 2019 ) (recommendation, LE: 2b). …”

“…be treated (recommendation, LE: 2b). The ideal technique is modulated intensity radiotherapy (IMRT) combined with imaging-guided radiotherapy (IGRT), based on the evaluation of IMRT from prostate cancer patients, with lower toxicity in pelvic organs compared with RT3D (Viani et al 2019) (recommendation, LE: 2b).…”

Conformational Radiotherapy of Prostatic Adenocarcinoma at the Dalal Jamm Hospital, Senegal—(Retrospective Analysis of a Series of 62 Cases)

“…Gustavo Viani et al [14] compared a RC3D technique with intensity modulation (IMRT) and found a significant difference in grade II late genitourinary toxicity (13.1% vs 15.4%, p = 0.85), and grade II gastrointestinal toxicity (10% vs 24% with p = 0.0001) in favor of IMRT. No difference was observed in terms of overall survival, without progression and without metastases between the two techniques.…”

International Continence Society (ICS) report on the terminology for sexual health in men with lower urinary tract (LUT) and pelvic floor (PF) dysfunction

“…As a result, a higher and more effective dose of radiation can be delivered directly to cancerous cells. 125 13.5 Focal therapy: Tissue-preserving strategy aimed to target the cancer and not the whole organ when it is morphometrically possible to do so and thus reduce damage to collateral tissues. 116 (NEW) 13.5.1 Cryotherapy: Focal delivery of the cryoprobe transrectally to the prostate to induce extremely low temperatures with subsequent thawing.…”