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

Abstract

PurposeWe 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 MethodsWe 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.ResultsThe 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 ≥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.ConclusionHypo-IMRT with a customized rectal balloon resulted in excellent biochemical control rates with minimal toxicity in localized prostate cancer patients.

The Effectiveness of Intensity Modulated Radiation Therapy versus Three-Dimensional Radiation Therapy in Prostate Cancer: A Meta-Analysis of the Literatures

“…Late GI toxicity was discussed in 13 studies with 6519 patients [ 33 , 37 , 38 , 40 , 41 , 43 , 44 , 46 , 48 , 50 – 52 , 54 ]. A significant overall benefit of grade 2–4 late GI toxicity in favor of IMRT was found for all studies with a RR of 0.54 [95% CI (0.38, 0.78)] ( Fig 2D ).…”

“…Biochemical control was reported in 6 studies with 2416 patients [ 33 , 37 , 41 , 44 , 45 , 50 , 52 ]. There was a significant difference in biochemical control favoring IMRT [RR = 1.17, 95% CI (1.08, 1.27)] ( Fig 3A ).…”

A practical review of magnetic resonance imaging for the evaluation and management of cervical cancer

“…With the ability to contour the target in 3D, it has become clear that previous fixed-geometry applicator based methods with point-based planning either delivered too large dose volumes for small and too small dose volumes for large tumors resulting in the risk of overdosing of normal tissues on the one side and under dosing the tumor on the other [ 7 , 50 , 51 ]. Even in small tumors, MRI-guided brachytherapy was found to reduce dose to the highest exposed 2 cc volumes (D2cc) to normal tissues by 12–32 % [ 52 ].…”

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 Immobilization

“…For example, bladder emptying, rectal enema, and endorectal balloon insertion are good ways to limit organ movement. 8 The relative position of the prostate in pelvic bony anatomy is useful for the daily setup verification, and the degree of patient setup shifts is thought to be the major determinant for the proper PTV margin in radiotherapy.…”