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Strahlentherapie und Onkologie

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01.11.2012 | Original article

Toxicity and outcome of pelvic IMRT for node-positive prostate cancer

verfasst von: Dr. A.-C. Müller, J. Lütjens, M. Alber, F. Eckert, M. Bamberg, D. Schilling, C. Belka, U. Ganswindt

Erschienen in: Strahlentherapie und Onkologie | Ausgabe 11/2012

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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.

(NCCN) NCCN (2011) Prostate cancer. NCCN Clinical Practice Guidelines in Oncology. Vol Version 4.2011: http://www.nccn.org. MS-18

Aizer AA, Yu JB, McKeon AM et al (2009) Whole pelvic radiotherapy versus prostate only radiotherapy in the management of locally advanced or aggressive prostate adenocarcinoma. Int J Radiat Oncol Biol Phys 75:1344–1349PubMedCrossRef

Alongi F, Fiorino C, Cozzarini C et al (2009) IMRT significantly reduces acute toxicity of whole-pelvis irradiation in patients treated with post-operative adjuvant or salvage radiotherapy after radical prostatectomy. Radiother Oncol 93:207–212PubMedCrossRef

Arcangeli S, Saracino B, Petrongari MG et al (2007) 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 84:148–155PubMedCrossRef

Ashman JB, Zelefsky MJ, Hunt MS et al (2005) Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 63:765–771PubMedCrossRef

Bayley A, Rosewall T, Craig T et al (2010) Clinical application of high-dose, image-guided intensity-modulated radiotherapy in high-risk prostate cancer. Int J Radiat Oncol Biol Phys 77:477–483PubMedCrossRef

Bayouth JE, Pena J, Culp L et al (2008) Feasibility of IMRT to cover pelvic nodes while escalating the dose to the prostate gland: dosimetric data on 35 consecutive patients. Med Dosim 33:180–190PubMedCrossRef

Bolla M, Collette L, Blank L et al (2002) Long-term results with immediate androgen suppression and external irradiation in patients with locally advanced prostate cancer (an EORTC study): a phase III randomised trial. Lancet 360:103–106PubMedCrossRef

Bolla M, Descotes JL, Artignan X et al (2007) Adjuvant treatment to radiation: combined hormone therapy and external radiotherapy for locally advanced prostate cancer. BJU Int 100(Suppl 2):44–47PubMedCrossRef

10.

Briganti A, Karnes RJ, Da Pozzo LF et al (2011) Combination of adjuvant hormonal and radiation therapy significantly prolongs survival of patients with pT2-4 pN+ prostate cancer: results of a matched analysis. Eur Urol 59:832–840PubMedCrossRef

11.

Chung HT, Xia P, Chan LW et al (2009) Does image-guided radiotherapy improve toxicity profile in whole pelvic-treated high-risk prostate cancer? Comparison between IG-IMRT and IMRT. Int J Radiat Oncol Biol Phys 73:53–60PubMedCrossRef

12.

Cozzarini C, Fiorino C, Di Muzio N et al (2007) Significant reduction of acute toxicity following pelvic irradiation with helical tomotherapy in patients with localized prostate cancer. Radiother Oncol 84:164–170PubMedCrossRef

13.

Da Pozzo LF, Cozzarini C, Briganti A et al (2009) Long-term follow-up of patients with prostate cancer and nodal metastases treated by pelvic lymphadenectomy and radical prostatectomy: the positive impact of adjuvant radiotherapy. Eur Urol 55:1003–1011CrossRef

14.

Deville C, Both S, Hwang WT et al (2011) Clinical toxicities and dosimetric parameters after whole-pelvis versus prostate-only intensity-modulated radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 78:763–772CrossRef

15.

Deville C, Vapiwala N, Hwang WT et al (2011) Comparative toxicity and dosimetric profile of whole-pelvis versus prostate bed-only intensity-modulated radiation therapy after prostatectomy. Int J Radiat Oncol Biol Phys (Epub ahead of print)

16.

Engels B, Soete G, Tournel K et al (2009) Helical tomotherapy with simultaneous integrated boost for high-risk and lymph node-positive prostate cancer: early report on acute and late toxicity. Technol Cancer Res Treat 8:353–359PubMed

17.

Eschmann SM, Pfannenberg AC, Rieger A et al (2007) Comparison of 11C-choline-PET/CT and whole body-MRI for staging of prostate cancer. Nuklearmedizin 46:161–168PubMed

18.

Fiorino C, Alongi F, Perna L et al (2009) Dose-volume relationships for acute bowel toxicity in patients treated with pelvic nodal irradiation for prostate cancer. Int J Radiat Oncol Biol Phys 75:29–35PubMedCrossRef

19.

Fonteyne V, De Gersem W, De Neve W et al (2009) Hypofractionated intensity-modulated arc therapy for lymph node metastasized prostate cancer. Int J Radiat Oncol Biol Phys 75:1013–1020PubMedCrossRef

20.

Ganswindt U, Paulsen F, Corvin S et al (2007) Optimized coverage of high-risk adjuvant lymph node areas in prostate cancer using a sentinel node-based, intensity-modulated radiation therapy technique. Int J Radiat Oncol Biol Phys 67:347–355PubMedCrossRef

21.

Ganswindt U, Schilling D, Muller AC et al (2011) Distribution of prostate sentinel nodes: a SPECT-derived anatomic atlas. Int J Radiat Oncol Biol Phys 79:1364–1372PubMedCrossRef

22.

Garcia JR, Soler M, Blanch MA et al (2009) PET/CT with (11)C-choline and (18)F-FDG in patients with elevated PSA after radical treatment of a prostate cancer. Rev Esp Med Nucl 28:95–100PubMedCrossRef

23.

Geier M, Astner ST, Duma MN et al (2012) Dose-escalated simultaneous integrated-boost treatment of prostate cancer patients via helical tomotherapy. Strahlenther Onkol 188:410–416PubMedCrossRef

24.

Goldner G, Potter R (2008) Radiotherapy in lymph node-positive prostate cancer patients—a potential cure? Single institutional experience regarding outcome and side effects. Front Radiat Ther Oncol 41:68–76PubMedCrossRef

25.

Goldner G, Potter R, Kranz A et al (2011) Healing of late endoscopic changes in the rectum between 12 and 65 months after external beam radiotherapy. Strahlenther Onkol 187:202–205PubMedCrossRef

26.

Guerrero Urbano T, Khoo V, Staffurth J et al (2010) Intensity-modulated radiotherapy allows escalation of the radiation dose to the pelvic lymph nodes in patients with locally advanced prostate cancer: preliminary results of a phase I dose escalation study. Clin Oncol (R Coll Radiol) 22:236–244

27.

Heidenreich A, Varga Z, Von Knobloch R (2002) Extended pelvic lymphadenectomy in patients undergoing radical prostatectomy: high incidence of lymph node metastasis. J Urol 167:1681–1686PubMedCrossRef

28.

Hong TS, Tome WA, Jaradat H et al (2006) Pelvic nodal dose escalation with prostate hypofractionation using conformal avoidance defined (H-CAD) intensity modulated radiation therapy. Acta Oncol 45:717–727PubMedCrossRef

29.

John SS, Zietman AL, Shipley WU et al (2008) Newer imaging modalities to assist with target localization in the radiation treatment of prostate cancer and possible lymph node metastases. Int J Radiat Oncol Biol Phys 71:43–47CrossRef

30.

Kaplan EL, Meier P (1958) Nonparametric estimation from incomplete observations. J Am Stat Assoc 53:457–481CrossRef

31.

Leitlinienprogramm Onkologie der AWMW DKeVu, e.V DK (2011) Interdisziplinäre Leitlinie der Qualität S3 zur Früherkennung, Diagnose und Therapie der verschiedenen Stadien des Prostatakarzinoms. German S3-Guideline 2011;Version 2.0-1. Aktualisierung 1–236

32.

McCammon R, Rusthoven KE, Kavanagh B et al (2009) Toxicity assessment of pelvic intensity-modulated radiotherapy with hypofractionated simultaneous integrated boost to prostate for intermediate- and high-risk prostate cancer. Int J Radiat Oncol Biol Phys 75:413–420PubMedCrossRef

33.

Meijer HJ, Debats OA, Kunze-Busch M et al (2012) Magnetic resonance lymphography-guided selective high-dose lymph node irradiation in prostate cancer. Int J Radiat Oncol Biol Phys 82:175–183PubMedCrossRef

34.

Messing EM, Manola J, Sarosdy M et al (1999) Immediate hormonal therapy compared with observation after radical prostatectomy and pelvic lymphadenectomy in men with node-positive prostate cancer. N Engl J Med 341:1781–1788PubMedCrossRef

35.

Messing EM, Manola J, Yao J et al (2006) Immediate versus deferred androgen deprivation treatment in patients with node-positive prostate cancer after radical prostatectomy and pelvic lymphadenectomy. Lancet Oncol 7:472–479PubMedCrossRef

36.

Muren LP, Wasbo E, Helle SI et al (2008) Intensity-modulated radiotherapy of pelvic lymph nodes in locally advanced prostate cancer: planning procedures and early experiences. Int J Radiat Oncol Biol Phys 71:1034–1041PubMedCrossRef

37.

Perna L, Alongi F, Fiorino C et al (2010) Predictors of acute bowel toxicity in patients treated with IMRT whole pelvis irradiation after prostatectomy. Radiother Oncol 97:71–75PubMedCrossRef

38.

Pervez N, Small C, MacKenzie M et al (2010) Acute toxicity in high-risk prostate cancer patients treated with androgen suppression and hypofractionated intensity-modulated radiotherapy. Int J Radiat Oncol Biol Phys 76:57–64PubMedCrossRef

39.

Pinkawa M, Piroth MD, Holy R et al (2011) Combination of dose escalation with technological advances (intensity-modulated and image-guided radiotherapy) is not associated with increased morbidity for patients with prostate cancer. Strahlenther Onkol 187:479–484PubMedCrossRef

40.

Sanguineti G, Endres EJ, Parker BC et al (2008) Acute toxicity of whole-pelvis IMRT in 87 patients with localized prostate cancer. Acta Oncol 47:301–310PubMedCrossRef

41.

Schilling D, Schlemmer HP, Wagner PH et al (2008) Histological verification of 11C-choline-positron emission/computed tomography-positive lymph nodes in patients with biochemical failure after treatment for localized prostate cancer. BJU Int 102:446–451PubMedCrossRef

42.

Schumacher MC, Burkhard FC, Thalmann GN et al (2008) Good outcome for patients with few lymph node metastases after radical retropubic prostatectomy. Eur Urol 54:344–352PubMedCrossRef

43.

Sheets N, Goldin GH, Meyer AM et al (2011) Comparative long-term morbidity of intensity modulated vs. conformal radiation therapy (RT) for prostate cancer: a SEER-medicare analysis. Int J Radiat Oncol Biol Phys 78:43CrossRef

44.

Su AW, Jani AB (2007) Chronic genitourinary and gastrointestinal toxicity of prostate cancer patients undergoing pelvic radiotherapy with intensity-modulated versus 4-field technique. Am J Clin Oncol 30:215–219PubMedCrossRef

45.

Swanson GP, Thompson IM, Basler J (2006) Treatment options in lymph node-positive prostate cancer. Cancer 106:2531–2539PubMedCrossRef

46.

Tward JD, Shrieve CD (2010) Radiotherapy is correlated with superior survival in clinically node positive prostate cancer. Int J Radiat Oncol Biol Phys 78:31CrossRef

47.

Weckermann D, Goppelt M, Dorn R et al (2006) Incidence of positive pelvic lymph nodes in patients with prostate cancer, a prostate-specific antigen (PSA) level of < or = 10 ng/mL and biopsy Gleason score of < or = 6, and their influence on PSA progression-free survival after radical prostatectomy. BJU Int 97:1173–1178PubMedCrossRef

48.

Weidner AM, Lin EN van, Dinter DJ et al (2011) Ferumoxtran-10 MR lymphography for target definition and follow-up in a patient undergoing image-guided, dose-escalated radiotherapy of lymph nodes upon PSA relapse. Strahlenther Onkol 187:206–212PubMedCrossRef

49.

Wurschmidt F, Petersen C, Wahl A et al (2011) [18F]fluoroethylcholine-PET/CT imaging for radiation treatment planning of recurrent and primary prostate cancer with dose escalation to PET/CT-positive lymph nodes. Radiat Oncol 6:44–51PubMedCrossRef

50.

Zurlo A, Collette L, Tienhoven G van et al (2002) Acute toxicity of conventional radiation therapy for high-risk prostate cancer in EORTC trial 22863. Eur Urol 42:125–132PubMedCrossRef

Titel: Toxicity and outcome of pelvic IMRT for node-positive prostate cancer
verfasst von: Dr. A.-C. Müller
J. Lütjens
M. Alber
F. Eckert
M. Bamberg
D. Schilling
C. Belka
U. Ganswindt
Publikationsdatum: 01.11.2012
Verlag: Springer-Verlag
Erschienen in: Strahlentherapie und Onkologie / Ausgabe 11/2012
Print ISSN: 0179-7158
Elektronische ISSN: 1439-099X
DOI: https://doi.org/10.1007/s00066-012-0169-1

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Toxicity and outcome of pelvic IMRT for node-positive prostate cancer