Abstract
Background and purpose
This study reports on the treatment techniques, toxicity, and outcome of pelvic intensity-modulated radiotherapy (IMRT) for lymph node-positive prostate cancer (LNPPC, T1-4, c/pN1 cM0).
Patients and methods
Pelvic IMRT to 45–50.4 Gy was applied in 39 cases either after previous surgery of involved lymph nodes (n = 18) or with a radiation boost to suspicious nodes (n = 21) with doses of 60–70 Gy, usually combined with androgen deprivation (n = 37). The prostate and seminal vesicles received 70–74 Gy. In cases of previous prostatectomy, prostatic fossa and remnants of seminal vesicles were given 66–70 Gy. Treatment-related acute and late toxicity was graded according to the RTOG criteria.
Results
Acute radiation-related toxicity higher than grade 2 occurred in 2 patients (with the need for urinary catheter/subileus related to adhesions after surgery). Late toxicity was mild (grade 1–2) after a median follow-up of 70 months. Over 50% of the patients reported no late morbidity (grade 0). PSA control and cancer-specific survival reached 67% and 97% at over 5 years.
Conclusion
Pelvic IMRT after the removal of affected nodes or with a radiation boost to clinically positive nodes led to an acceptable late toxicity (no grade 3/4 events), thus justifying further evaluation of this approach in a larger cohort.
Zusammenfassung
Hintergrund
Diese Studie beschreibt Behandlungstechniken, Nebenwirkungen und Ergebnisse einer intensitätsmodulierten Bestrahlung (IMRT) des Beckens bei lymphonodal-positiven Prostatakarzinomen (LNPPC, T1–4, c/pN1 cM0).
Material und Methoden
Eine Becken-IMRT bis 45–50,4 Gy wurde bei 39 Patienten entweder nach chirurgischer Entfernung histologisch befallener Lymphknoten (n = 18) oder mit einem IMRT-Boost auf klinisch befallene Lymphknoten (n = 21) bis 60–70 Gy durchgeführt und mit einer antihormonellen Langzeittherapie (n = 37) kombiniert. Prostata und Samenblasen erhielten 70–74 Gy, nach radikaler Prostatektomie wurde die Prostataloge ggf. mit residuellen Samenblasenanteilen bis 66–70 Gy bestrahlt. Akute und späte Nebenwirkungen wurden nach den Kriterien der Radiation Therapy Oncology Group (RTOG) erfasst.
Ergebnisse
Akutnebenwirkungen ≥ Grad 2 traten bei 2 Patienten auf (Blasenkatheteranlage, Subileus aufgrund von postoperativen Adhäsionen). Die Spätnebenwirkungen nach einer medianen Nachsorgedauer von 70 Monaten waren mild (Grad 1–2). Über die Hälfte der Patienten berichtete über keine postradiogenen Spätnebenwirkungen (Grad 0). Die biochemische Kontrolle und das krebsspezifische Überleben erreichten Werte von 67% und 97% nach > 5 Jahren.
Schlussfolgerung
Die Becken-IMRT nach Entfernung befallener Lymphknoten oder mit Boost klinisch befallener Lymphknoten war mit akzeptablen Spätnebenwirkungen (kein Grad 3 oder 4) verbunden, sodass eine Evaluation dieses Vorgehens in einem größeren Kollektiv gerechtfertigt ist.
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Acknowledgements
The authors acknowledge the assistance of Silke Theden in the data management, and the assistance of Bettina Frey in generating treatment plans.
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On behalf of all authors, the corresponding author states that are no conflicts of interest.
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Müller, AC., Lütjens, J., Alber, M. et al. Toxicity and outcome of pelvic IMRT for node-positive prostate cancer. Strahlenther Onkol 188, 982–989 (2012). https://doi.org/10.1007/s00066-012-0169-1
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DOI: https://doi.org/10.1007/s00066-012-0169-1