International Journal of Radiation Oncology * Biology * Physics
Volume 73, Issue 1 , Pages 39-45 , 1 January 2009

Clinical and Dosimetric Predictors of Acute Toxicity After a 4-Week Hypofractionated External Beam Radiotherapy Regimen for Prostate Cancer: Results From a Multicentric Prospective Trial

  • Stefano Arcangeli, M.D.

      Affiliations

    • Departments of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy
    • Corresponding Author InformationReprint requests to: Stefano Arcangeli, M.D., Department of Radiotherapy, Regina Elena National Cancer Institute, via Elio Chianesi, 53, 00144 Rome, Italy. Tel: (+39) 06-52663028; Fax: (+39) 06-52665667
    • ,
  • Lidia Strigari, Ph.D.

      Affiliations

    • Laboratory of Medical Physics and Expert Systems, Regina Elena National Cancer Institute, Rome, Italy
    • ,
  • Guy Soete, M.D., Ph.D.

      Affiliations

    • Department of Radiotherapy Oncology Center, Universitair Ziekenhuis Brussels, Jette, Belgium
    • ,
  • Gert De Meerleer, M.D., Ph.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Sara Gomellini, M.D.

      Affiliations

    • Departments of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy
    • ,
  • Valerie Fonteyne, M.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Guy Storme, M.D., Ph.D.

      Affiliations

    • Department of Radiotherapy Oncology Center, Universitair Ziekenhuis Brussels, Jette, Belgium
    • ,
  • Giorgio Arcangeli, M.D.

      Affiliations

    • Departments of Radiotherapy, Regina Elena National Cancer Institute, Rome, Italy

Received 6 February 2008 ,Revised 1 April 2008 ,Accepted 7 April 2008.

References 

  1. Pollack A, Zagars GK, Starkschall G, et al. Prostate cancer radiation dose response: results of the M.D. Anderson Phase II randomized trial. Int J Radiat Oncol Biol Phys. 2002;52:1097–1105
  2. Peeters ST, Heemsbergen WD, Koper PC, et al. Dose-response in radiotherapy for localized prostate cancer. Results of the Dutch multicenter randomized Phase II trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24:1990–1996
  3. Zietman AL, De Silvio ML, Slater JD, et al. Comparison of conventional dose vs high dose conformal radiation therapy in clinically localized adenocarcinoma of the prostate: A randomized controlled trial. JAMA. 2005;294:1233–1239
  4. Nahum AE, Movsas B, Horwitz EM, et al. Incorporating clinical measurements of hypoxia into tumor local-control modeling of prostate cancer: Implications for the a/b ratio. Int J Radiat Oncol Biol Phys. 2003;57:391–491
  5. Brenner DJ, Hall EJ. Fractionation and protraction for radiotherapy of prostate carcinoma. Int J Radiat Oncol Biol Phys. 1999;43:1095–1101
  6. Fowler J, Chappell R, Ritter M, et al. Is alpha/beta for prostate tumors really low?. Int J Radiat Oncol Biol Phys. 2001;50:1021–1031
  7. King CR, Fowler JF. A simple analytic derivation suggests that prostate cancer α/β ratio is low. Int J Radiat Oncol Biol Phys. 2001;51:213–214
  8. Brenner DJ, Martinez AA, Edmundson GK, et al. Direct evidence that prostate tumors show high sensitivity to fractionation (low alpha/beta ratio), similar to late responding normal tissue. Int J Radiat Oncol Biol Phys. 2002;52:6–13
  9. Chappell R, Fowler J, Ritter M. New data on the value of alpha/beta—evidence mounts that it is low. Int J Radiat Oncol Biol Phys. 2004;60:1002–1003
  10. Soete G, Arcangeli S, De Meerleer G, et al. Phase II study of a four-week hypofractionated external beam radiotherapy regimen for prostate cancer: Report on acute toxicity. Radiother Oncol. 2006;80:78–81
  11. Roach M III. The use of prostate specific antigen, clinical stage and Gleason score to predict pathological stage in men with localized prostate cancer. J Urol. 1993;150:1923–1993
  12. NCCN Clinical Practice Guidelines in Oncology 2007/2008. Fort Washington, PA: National Comprehensive Cancer Network. Available at http://www.nccn.org/.
  13. Villeirs G, Van Vaerenbergh K, Vakaet L, et al. Interobserver delineation variation using CT versus combined CT + MRI in intensity-modulated radiotherapy for prostate cancer. Strahlenther Onkol. 2005;181:424–430
  14. Boersma LJ, van den Brink M, Bruce AM, et al. Estimation of the incidence of late bladder and rectum complications after high dose (70–78 Gy) conformal for prostate cancer, using dose–volume histograms. Int J Radiat Oncol Biol Phys. 1998;41:83–92
  15. Fiorino C, Cozzarini C, Vavassori V, et al. Relationships between DVHs and late rectal bleeding after conformal radiotherapy for prostate cancer: Analysis of a large group of patients pooled from three institutions. Radiother Oncol. 2002;64:1–12
  16. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer. Int J Radian Oncol Biol Phys. 1995;31:1341–1346
  17. De Meerleer G, Vakaet L, Meersschout S, et al. Intensity modulated radiotherapy as primary treatment for prostate cancer: Acute toxicity in 114 patients. Int J Radiat Oncol Biol Phys. 2004;60:777–787
  18. Barry MJ, Fowler FJ, O'Leary MP, et al. The American Urological Association symptom index for benign prostatic hyperplasia. The measurement Committee of the American Urological Association. J Urol. 1992;148:1549–1557
  19. Fowler JF, Harari PM, Leborgne F, et al. Acute radiation reactions in oral and pharyngeal mucosa: Tolerable levels in altered fractionation schedules. Radiother Oncol. 2003;69:161–168
  20. Schinkel C, Carlone M, Warkentin B, et al. Analytic investigation into effect of population heterogeneity on parameter ratio estimates. Int J Radiat Oncol Biol Phys. 2007;69:1323–1330
  21. Lloyd-Davies RW, Collins CD, Swan AV. Carcinoma of the prostate treated by radical external beam radiotherapy using hypofractionation. Twenty-two years' experience (1962–1984). Urology. 1990;36:107–111
  22. Livsey JE, Cowan RA, Wylie JP, et al. Hypofractionated conformal radiotherapy in carcinoma of the prostate: Five-year outcome analysis. Int J Radiat Oncol Biol Phys. 2003;57:1254–1259
  23. Lukka H, Hayter C, Julian JA, et al. Randomized trial comparing two fractionation schedules for patients with localized prostate cancer. J Clin Oncol. 2005;23:6132–6138
  24. Yeoh EE, Fraser RJ, McGowan RE, et al. Evidence of efficacy without increased toxicity for hypofractionated radiotherapy for prostate carcinoma: Early results of a Phase III randomized trial. Int J Radiat Oncol Biol Phys. 2003;55:943–955
  25. Kupelian PA, Thakkar VV, Khuntia D, et al. Hypofractionated intensity-modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Long term outcomes. Int J Radiat Oncol Biol Phys. 2005;63:1463–1468
  26. Ritter MA, Chappell RJ, Tome WA, Kupelian PA. A multi institutional phase I/II trial of dose-per-fraction escalation for localized prostate cancer. [Abstract] Int J Radiat Oncol Biol Phys. 2005;63:S124
  27. Chou RH, Wilder RB, Ji M, et al. Acute toxicity of three dimensional conformal radiotherapy in prostate cancer patients eligible for implant monotherapy. Int J Radiat Oncol Biol Phys. 2000;47:115–119
  28. Teh BS, Mai WY, Uhl BM, et al. Intensity-modulated radiation therapy (IMRT) for prostate cancer with the use of a rectal balloon for prostate immobilization: Acute toxicity and dose volume analysis. Int J Radiat Oncol Biol Phys. 2001;49:705–712
  29. Nuyttens JJ, Milito S, Rust PF, et al. Dose-volume relationship for acute side effects during high dose conformal radiotherapy for prostate cancer. Radiother Oncol. 2002;64:209–214
  30. Ryu JK, Winter K, Michalski JM, et al. Interim report of toxicity from 3D conformal radiation therapy (3D-CRT) for prostate cancer on 3DOG/RTOG 9406, level III (79.2 Gy). Int J Radiat Oncol Biol Phys. 2002;54:1036–1046
  31. Zelefsky MJ, Fuks Z, Hunt M, et al. High-dose intensity modulated radiation therapy for prostate cancer: Early toxicity and biochemical outcome in 772 patients. Int J Radiat Oncol Biol Phys. 2002;53:1111–1116
  32. Lebesque J, Koper P, Slot A, et al. Acute and late GI and GU toxicity after prostate irradiation to doses of 68 Gy and 78 Gy: Results of a randomized trial. Int J Radiat Oncol Biol Phys. 2003;57:S152
  33. Beckendorf V, Guerif S, Le Prise E, et al. The GETUG 70 Gy vs. 80 Gy randomized trial for localized prostate cancer: Feasibility and acute toxicity. Int J Radiat Oncol Biol Phys. 2004;60:1056–1065
  34. Karlsdottir A, Johannessen DC, Muren LP, et al. Acute morbidity related to treatment volume during 3D-conformal radiation therapy for prostate cancer. Radiother Oncol. 2004;71:43–53
  35. Michalski JM, Winter K, Purdy JA, et al. Toxicity after three dimensional radiotherapy for prostate cancer with RTOG 9406 dose level IV. Int J Radiat Oncol Biol Phys. 2004;58:735–742
  36. Peeters ST, Heemsbergen WD, van Putten WL, et al. Acute and late complications after radiotherapy for prostate cancer: Results of a multicenter randomized trial comparing 68 Gy to78 Gy. Int J Radiat Oncol Biol Phys. 2005;61:1019–1034
  37. Madsen BL, Hsi LA, Pham HT, et al. Stereotactic Hypofractionated Accurate Radiotherapy of the Prostate (SHARP), 33.5 Gy in five fractions for localized disease: First clinical trial results. Int J Radiat Oncol Biol Phys. 2007;67:1009–1105
  38. Kupelian PA, Willoughby TR, Reddy CA, et al. Hypofractionated intensity- modulated radiotherapy (70 Gy at 2.5 Gy per fraction) for localized prostate cancer: Cleveland Clinic experience. Int J Radiat Oncol Biol Phys. 2007;68:1424–1430
  39. Martin JM, Rosewall T, Bayley A, et al. Phase II trial of hypofractionated image- guided intensity modulated radiotherapy for localized prostate adenocarcinoma. Int J Radiat Oncol Biol Phys. 2007;69:1084–1089
  40. Pollack A, Hanlon AL, Horwitz EM, et al. Dosimetry and preliminary acute toxicity in the first 100 men treated for prostate cancer on a randomized hypofractionation dose escalation trial. Int J Radiat Oncol Biol Phys. 2006;64:518–526

 Conflict of interest: none.

PII: S0360-3016(08)00642-1

doi: 10.1016/j.ijrobp.2008.04.005

International Journal of Radiation Oncology * Biology * Physics
Volume 73, Issue 1 , Pages 39-45 , 1 January 2009

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