International Journal of Radiation Oncology * Biology * Physics
Volume 75, Issue 4 , Pages 1013-1020 , 15 November 2009

Hypofractionated Intensity-Modulated Arc Therapy for Lymph Node Metastasized Prostate Cancer

  • Valérie Fonteyne, M.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • Corresponding Author InformationReprint requests to: Valérie Fonteyne, M.D., Department of Radiotherapy, Ghent University Hospital, De Pintelaan 185, Ghent 9000 Belgium. Tel: (+32) 9-332-5972; Fax: (+32) 9-332-3040
    • ,
  • Werner De Gersem, Ir., Ph.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Wilfried De Neve, M.D., Ph.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Filip Jacobs, Ir., Ph.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Nicolaas Lumen, M.D.

      Affiliations

    • Department of Urology, Ghent University Hospital, Ghent, Belgium
    • ,
  • Katrien Vandecasteele, M.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium
    • ,
  • Geert Villeirs, M.D., Ph.D.

      Affiliations

    • Department of Radiology, Ghent University Hospital, Ghent, Belgium
    • ,
  • Gert De Meerleer, M.D., Ph.D.

      Affiliations

    • Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium

Received 10 September 2008 ,Revised 18 December 2008 ,Accepted 19 December 2008.

References 

  1. Cooperberg MR, Lubeck DP, Mehta SS, et al. CaPSURE: Time trends in clinical risk stratification for prostate cancer: Implications for outcomes (data from CaPSURE). J Urol. 2003;170:S21–S27(erratum: J Urol (2004;171:811)
  2. Cooperberg MR, Moul JW, Carroll PR. The changing face of prostate cancer. J Clin Oncol. 2005;23:8146–8151
  3. Zietman AL, DeSilvio 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. Peeters ST, Heemsbergen WD, Koper PC, et al. Dose-response in radiotherapy for localized prostate cancer: Results of the Dutch multicenter randomized phase III trial comparing 68 Gy of radiotherapy with 78 Gy. J Clin Oncol. 2006;24:1990–1996
  5. 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
  6. Pollack A, Hanlon A, Horwitz E, et al. Prostate cancer radiotherapy dose response: An update of the Fox Chase experience. J Urol. 2004;171:1132–1136
  7. Dearnaley DP, Sydes MR, Graham JD, et al. Escalated-dose versus standard-dose conformal radiotherapy in prostate cancer: First results from the MRC RTO1 randomised controlled trial. Lancet Oncol. 2007;8:475–487
  8. Kao J, Stone NN, Lavaf A, et al. (125)I monotherapy using D90 implant doses of 180 Gy or greater. Int J Radiat Oncol Biol Phys. 2008;70:96–101
  9. Pavlovich CP, Trock BJ, Sulman A, et al. 3-Year actuarial biochemical recurrence-free survival following laparoscopic radical prostatectomy: Experience from a tertiary referral center in the United States. J Urol. 2008;179:917–921
  10. Zagars GK, Pollack A, von Eschenbach AC, et al. Management of unfavorable locoregional prostate carcinoma with radiation and androgen ablation. Cancer. 1997;80:764–775
  11. Lawton CA, Cox JD, Glisch C, et al. Is long-term survival with external beam irradiation for stage D1 adenocarcinoma of the prostate?. Cancer. 1992;69:2671–2676
  12. Kupelian PA, Katcher J, Levin HS, et al. Stage T1-T2 prostate cancer: A multivariate analysis of factors affecting biochemical and clinical failures after radical prostatectomy. Int J Radiat Oncol Biol Phys. 1997;37:1043–1052
  13. Colleen A, Winter K, Byhardt R, et al. Androgen suppression plus radiation versus radiation alone for patients with D1 (pN+) adenocarcinoma of the prostate (results based on a national prospective randomized trial, RTOG 85-31). Int J Radiat Oncol Biol Phys. 1997;38:931–939
  14. Whittington R, Malkowicz S, Machtay M, et al. The use of combined radiation therapy and hormonal therapy in the management of lymph node-positive prostate cancer. Int J Radiat Oncol Biol Phys. 1997;39:673–680
  15. Robnett T, Whittington R, Malkowicz S, et al. Long-term use of combined radiation therapy and hormonal therapy in the management of stage D1 prostate cancer. Int J Radiat Oncol Biol Phys. 2002;53:1146–1151
  16. Pollack A, Zagars G, Antolak J, et al. Prostate biopsy status and PSA nadir level as early surrogates for treatment failure: Analysis of a prostate cancer randomized radiation dose escalation trial. Int J Radiat Oncol Biol Phys. 2002;54:677–685
  17. Jacob R, Hanlon A, Horwitz E, et al. The relationship of increasing radiotherapy dose to reduced distant metastasis and mortality in men with prostate cancer. Cancer. 2004;100:538–543
  18. Pollack A, Smith LG, von Eschenbach AC. External beam radiotherapy dose response characteristics of 1127 men with prostate cancer treated in the PSA era. Int J Radiat Oncol Biol Phys. 2000;48:507–512
  19. Coen JJ, Zietman AL, Thakral H, et al. Radical radiation for localized prostate cancer: local persistence of disease results in a late wave of metastases. J Clin Oncol. 2002;20:3199–3205
  20. Ashman JB, Zelefsky MJ, Hunt MS, et al. Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys. 2005;63:765–771
  21. Cozzarini C, Fiorino C, Muzio ND, et al. Significant reduction of acute toxicity following pelvic irradiation with helical tomotherapy in patients with localized prostate cancer. Radiother Oncol. 2007;84:164–170
  22. De Meerleer GO, Fonteyne VH, Vakaet L, et al. Intensity-modulated radiation therapy for prostate cancer: Late morbidity and results on biochemical control. Radiother Oncol. 2007;82:160–166
  23. De Meerleer GO, Vakaet LA, De Gersem WR, et al. Radiotherapy of prostate cancer with or without intensity modulated beams: A planning comparison. Int J Radiat Oncol Biol Phys. 2000;47:639–648
  24. Duthoy W, De Gersem W, Vergote K, et al. Clinical implementation of intensity-modulated arc therapy (IMAT) for rectal cancer. Int J Radiat Oncol Biol Phys. 2004;60:794–806
  25. 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
  26. Brenner DJ, Martinez AA, Edmundson GK, et al. Direct evidence that prostate tumours 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
  27. Wang JZ, Guerrero M, Li XA. How low is the α/β ratio for prostate cancer?. Int J Radiat Oncol Biol Phys. 2003;55:194–203
  28. Kal HB, Van Gellekom MPR. How low is the α/β ratio for prostate cancer?. Int J Radiat Oncol Biol Phys. 2003;57:1116–1121
  29. Kupelian PA, Willoughby TR, Reddy CA, et al. Hypofractionation 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
  30. Arcangeli S, Saracino B, Petrongari MG, et al. Analysis of toxicity in patients with high risk prostate cancer treated with intensity-modulated pelvic radiation therapy and simultaneous integrated dose escalation to prostate area. Radiother Oncol. 2007;84:148–155
  31. Yeoh EE, Holloway RH, Fraser RJ, et al. Hypofractionated versus conventionally fractionated radiation therapy for prostate carcinoma: Updated results of a phase III randomized trial. Int J Radiat Oncol Biol Phys. 2006;66:1072–1083
  32. Pollack A, Hanlon AL, Horwitz AM, 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;64:518–5126
  33. Fonteyne V, Villeirs G, Speleers B, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: Report on acute toxicity after dose escalation with a simultaneous integrated boost on the intraprostatic lesion. Int J Radiat Oncol Biol Phys. 2008;72:777–781
  34. Roach M, Marquez C, Yuo HS, et al. Predicting the risk of lymph node involvement using the pre-treatment prostate specific antigen and Gleason score in men with clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 1994;28:33–37
  35. American Joint Committee on Cancer. Manual for staging of cancer. 5th ed.. Philadelphia: JB Lippincott; 1997;
  36. De Meerleer G, Villeirs G, Bral S, et al. The magnetic resonance detected intraprostatic lesion in prostate cancer: Planning and delivery of intensity-modulated radiotherapy. Radiother Oncol. 2005;75:325–333
  37. De Meerleer G, Vakaet L, Meersschout S, et al. Intensity-modulated radiotherapy as primary therapy for prostate cancer: Acute toxicity in 114 patients. Int J Radiat Oncol Biol Phys. 2004;60:777–787
  38. Fonteyne V, De Neve W, Villeirs G, et al. Late radiotherapy-induced lower intestinal toxicity (RILIT) of intensity-modulated radiotherapy for prostate cancer: The need for adapting toxicity scales. Radiother Oncol. 2007;84:156–163
  39. Raghavaiah NV, Jordan WP. Prostatic lymphography. J Urol. 1979;121:178–181
  40. Cerny JC, Farah R, Rian R, et al. An evaluation of lymphangiography in staging carcinoma of prostate. J Urol. 1975;113:367–370
  41. Brossner C, Ringhofer H, Hernady T, et al. Lymphatic drainage of prostatic transition and peripheral zones visualized on a three-dimensional workstation. Urology. 2001;57:389–393
  42. Duthoy W, De Gersem W, Vergote K, et al. Whole abdominopelvic radiotherapy (WAPRT) using intensity modulated arc therapy (IMAT): First clinical experience. Int J Radiat Oncol Biol Phys. 2003;58:1019–1032
  43. De Meerleer G, Vakaet L, De Gersem W, et al. Direct segmentation aperture and weight optimization for intensity-modulated radiotherapy of prostate cancer. Strahlenther Oncol. 2004;180:136–143
  44. Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment (EORTC). Int J Radiat Oncol Biol Phys. 1995;31:1341–1346
  45. Lawton CA, Winter K, Byhardt R, et al. Androgen suppression plus radiation versus radiation alone for patients with D1 (pN+) adenocarcinoma of the prostate (results based on a national prospective randomized trial, RTOG 85-31). Int J Radiat Oncol Biol Phys. 1997;38:931–939
  46. Wang-Chesebro Xia P, Coleman Y, et al. Intensity-modulated radiotherapy improves lymph node coverage and dose to critical structures compared with three-dimensional conformal radiation therapy in clinically localized prostate cancer. Int J Radiat Oncol Biol Phys. 2006;66:654–662
  47. Sanguineti G, Cavey ML, Endres E, et al. Does treatment of the pelvic nodes with IMRT increase late rectal toxicity over conformal prostate-only radiotherapy to 76 Gy?. Strahlenther Onkol. 2006;182:543–549
  48. Yuen J, Rodrigues G, Trenka K, et al. Comparing two strategies of dynamic intensity modulated radiation therapy (dIMRT) with 3-dimensional conformal radiation therapy (3DCRT) in the hypofractionated treatment of high-risk prostate cancer. Radiother Oncol Epub. 2008 Jan 7;doi: 10.1186/1748-717X-3-1
  49. Skwarchuk MW, Jackson A, Zelefsky MJ, et al. Late rectal toxicity after conformal radiotherapy of prostate cancer (I): Multivariate analysis and dose-response. Int J Radiat Oncol Biol Phys. 2000;47:103–113
  50. Kupelian AP, Reddy CA, Carlson TP, et al. Preliminary observations on biochemical relapse-free survival after short-course intensity-modulated radiotherapy (70 Gy at 2.5 Gy/fraction) for localized prostate cancer. Int J Radiat Oncol Biol Phys. 2002;53:904–912
  51. Liu L, Glicksman AS, Coachman N, et al. Low acute gastrointestinal and genitourinary toxicities in whole pelvic irradiation of prostate cancer. Int J Radiat Oncol Biol Phys. 1997;38:65–71
  52. Koper PC, Jansen P, Van Putten W, et al. Gastro-intestinal and genito-urinary morbidity after 3D conformal radiotherapy of prostate cancer: Observations of a randomized trial. Int J Radiat Oncol. 2004;73:1–9
  53. Pommier P, Chabaud S, Lagrange JL, et al. Is there a role for pelvic irradiation in localized prostate adenocarcinoma? Preliminary results of GETUG-01. J Clin Oncol. 2007;34:5366–5373
  54. Muren LP, Wasbo E, Helle SI, et al. Intensity-modulated radiotherapy of pelvic lymph nodes in locally advanced prostate cancer: planning procedures and early experiences. Int J Radiat Oncol. 2008;71:1034–1041

 Sponsored by a scientific grant from the “Foundation Against Cancer.”

 Conflict of interest: none.

PII: S0360-3016(09)00015-7

doi: 10.1016/j.ijrobp.2008.12.047

International Journal of Radiation Oncology * Biology * Physics
Volume 75, Issue 4 , Pages 1013-1020 , 15 November 2009

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