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01.03.2014 | Original Research

Late toxicity from salvage radiation therapy for prostate cancer: intensity-modulated radiation therapy vs. 3D-conformal radiation therapy

verfasst von: Katherine S. Tzou, Steven J. Buskirk, Michael G. Heckman, Jennifer L. Peterson, Richard J. Lee, Nitesh N. Paryani, Stephen J. Ko, Larry C. Daugherty, Laura A. Vallow

Erschienen in: Journal of Radiation Oncology | Ausgabe 1/2014

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Abstract

Objective

This study aims to compare late toxicity in patients undergoing salvage radiation therapy (SRT) for a detectable prostate-specific antigen level after radical prostatectomy between those who received low-dose three-dimensional-conformal radiation therapy (3D-CRT), high-dose 3D-CRT and intensity-modulated radiation therapy (IMRT).

Methods

We retrospectively identified 266 patients who underwent SRT at our institution. Patients were categorized into three groups: low-dose 3D-CRT (≤66.6 Gy, N = 142), high-dose 3D-CRT (>66.6 Gy, N = 49), and high-dose IMRT (>66.6 Gy, N = 75). Low-dose IMRT patients were not included due to their small number (N = 22). Late toxicity was defined as occurring 90 days or more after SRT completion.

Results

The cumulative incidence of any late complication at 5 years after SRT was 11.0 % for the low-dose 3D-CRT group, 18.8 % for the high-dose 3D-CRT group, and 14.7 % for the high-dose IMRT group, with no significant differences between groups (P ≥ 0.17). No significant difference between groups was found in the occurrence of any specific complication, although there were nonsignificant trends toward an increased incidence of diarrhea at 5 years in the high-dose 3D-CRT group (7.0 %) compared with the low-dose 3D-CRT (1.4 %, P = 0.061) and high-dose IMRT groups (0.0 %, P = 0.068), and more grade 2+ late complications in the high-dose 3D-CRT group (14.0 %) than the low-dose 3D-CRT group (6.0 %, P = 0.059).

Conclusion

Our results indicate that with the advancement in planning and delivery of SRT, it is possible to administer IMRT at higher doses without significantly increasing the risk of late complications. Future studies involving larger numbers of high-dose IMRT patients will further strengthen these findings.

De Meerleer G, Fonteyne V, Meersschout S, Van den Broecke C, Villeirs G, Lumen N, Ost P, Vandecasteele K, De Neve W (2008) Salvage intensity-modulated radiotherapy for rising PSA after radical prostatectomy. Radiother Oncol 89:205–213PubMedCrossRef

Pisansky TM, Kozelsky TF, Myers RP, Hillman DW, Blute ML, Buskirk SJ, Cheville JC, Ferrigni RG, Schild SE (2000) Radiotherapy for isolated serum prostate specific antigen elevation after prostatectomy for prostate cancer. J Urol 163:845–850PubMedCrossRef

Ward JF, Zincke H, Bergstralh EJ, Slezak JM, Blute ML (2004) Prostate specific antigen doubling time subsequent to radical prostatectomy as a prognosticator of outcome following salvage radiotherapy. J Urol 172:2244–2248PubMedCrossRef

Pazona JF, Han M, Hawkins SA, Roehl KA, Catalona WJ (2005) Salvage radiation therapy for prostate specific antigen progression following radical prostatectomy: 10-year outcome estimates. J Urol 174:1282–1286PubMedCrossRef

Chawla AK, Thakral HK, Zietman AL, Shipley WU (2002) Salvage radiotherapy after radical prostatectomy for prostate adenocarcinoma: analysis of efficacy and prognostic factors. Urology 59:726–731PubMedCrossRef

Bernard JR Jr, Buskirk SJ, Heckman MG, Diehl NN, Ko SJ, Macdonald OK, Schild SE, Pisansky TM (2010) Salvage radiotherapy for rising prostate-specific antigen levels after radical prostatectomy for prostate cancer: dose–response analysis. Int J Radiat Oncol Biol Phys 76:735–740PubMedCrossRef

King CR, Spiotto MT (2008) Improved outcomes with higher doses for salvage radiotherapy after prostatectomy. Int J Radiat Oncol Biol Phys 71:23–27PubMedCrossRef

Wong GW, Palazzi-Churas KL, Jarrard DF, Paolone DR, Graf AK, Hedican SP, Wegenke JD, Ritter MA (2008) Salvage hypofractionated radiotherapy for biochemically recurrent prostate cancer after radical prostatectomy. Int J Radiat Oncol Biol Phys 70:449–455PubMedCrossRef

US Department of Health and Human Services; National Institutes of Health; National Cancer Institute. Common terminology criteria for adverse events (CTCAE): version 4.0. 2009 May 28. http://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf. Accessed: 10 Oct 2011

10.

Cookson MS, Aus G, Burnett AL, Canby-Hagino ED, D’Amico AV, Dmochowski RR, Eton DT, Forman JD, Goldenberg SL, Hernandez J, Higano CS, Kraus SR, Moul JW, Tangen C, Thrasher JB, Thompson I (2007) Variation in the definition of biochemical recurrence in patients treated for localized prostate cancer: the American Urological Association Prostate Guidelines for Localized Prostate Cancer Update Panel report and recommendations for a standard in the reporting of surgical outcomes. J Urol 177:540–545PubMedCrossRef

11.

Buskirk SJ, Pisansky TM, Schild SE, Macdonald OK, Wehle MJ, Kozelsky TF, Collie AC, Ferrigni RG, Myers RP, Prussak KA, Heckman MG, Crook JE, Parker AS, Igel TC (2006) Salvage radiotherapy for isolated prostate specific antigen increase after radical prostatectomy: evaluation of prognostic factors and creation of a prognostic scoring system. J Urol 176:985–990PubMedCrossRef

12.

Macdonald OK, Schild SE, Vora SA, Andrews PE, Ferrigni RG, Novicki DE, Swanson SK, Wong WW (2003) Radiotherapy for men with isolated increase in serum prostate specific antigen after radical prostatectomy. J Urol 170:1833–1837PubMedCrossRef

13.

Maier J, Forman J, Tekyi-Mensah S, Bolton S, Patel R, Pontes JE (2004) Salvage radiation for a rising PSA following radical prostatectomy. Urol Oncol 22:50–56PubMedCrossRef

14.

Feng M, Hanlon AL, Pisansky TM, Kuban D, Catton CN, Michalski JM, Zelefsky MJ, Kupelian PA, Pollack A, Kestin LL, Valicenti RK, DeWeese TL, Sandler HM (2007) Predictive factors for late genitourinary and gastrointestinal toxicity in patients with prostate cancer treated with adjuvant or salvage radiotherapy. Int J Radiat Oncol Biol Phys 68:1417–1423PubMedCrossRef

15.

Choo R, Pearse M, Danjoux C, Gardner S, Morton G, Szumacher E, Loblaw DA, Cheung P (2008) Analysis of gastrointestinal and genitourinary morbidity of postoperative radiotherapy for pathologic T3 disease or positive surgical margins after radical prostatectomy using National Cancer Institute expanded common toxicity criteria. Int J Radiat Oncol Biol Phys 72:989–995PubMedCrossRef

16.

Pearse M, Choo R, Danjoux C, Gardner S, Morton G, Szumacher E, Loblaw A, Cheung P (2008) Prospective assessment of gastrointestinal and genitourinary toxicity of salvage radiotherapy for patients with prostate-specific antigen relapse or local recurrence after radical prostatectomy. Int J Radiat Oncol Biol Phys 72:792–798PubMedCrossRef

17.

Peterson JL, Buskirk SJ, Heckman MG, Crook JE, Ko SJ, Wehle MJ, Igel TC, Prussak KA, Pisansky TM (2009) Late toxicity after postprostatectomy salvage radiation therapy. Radiother Oncol 93:203–206PubMedCrossRef

18.

Nath SK, Sandhu AP, Rose BS, Simpson DR, Nobiensky PD, Wang JZ, Millard F, Kane CJ, Parsons JK, Mundt AJ (2010) Toxicity analysis of postoperative image-guided intensity-modulated radiotherapy for prostate cancer. Int J Radiat Oncol Biol Phys 78:435–441PubMedCrossRef

19.

Goenka A, Magsanoc JM, Pei X, Schechter M, Kollmeier M, Cox B, Scardino PT, Eastham JA, Zelefsky MJ (2011) Improved toxicity profile following high-dose postprostatectomy salvage radiation therapy with intensity-modulated radiation therapy. Eur Urol 60:1142–1148PubMedCrossRef

20.

Michalski JM, Lawton C, El Naqa I, Ritter M, O’Meara E, Seider MJ, Lee WR, Rosenthal SA, Pisansky T, Catton C, Valicenti RK, Zietman AL, Bosch WR, Sandler H, Buyyounousky MK, Ménard C (2010) Development of RTOG consensus guidelines for the definition of the clinical target volume for postoperative conformal radiation therapy for prostate cancer. Int J Radiat Oncol Biol Phys 76:361–368PubMedCentralPubMedCrossRef

21.

Radiation Therapy Oncology Group (RTOG) (Internet). Philadelphia: RTOG, 2008. Shipley WU, Lukka H, Major P, Heney NM, Grignon D; Radiation Therapy Oncology Group RTOG 96-01. A phase III trial of radiation therapy with or without casodex in patients with PSA elevation following radical prostatectomy for pT3N0 carcinoma of the prostate. 17 Jul 2011. http://www.rtog.org/ClinicalTrials/ProtocolTable/StudyDetails.aspx?study=9601

Titel: Late toxicity from salvage radiation therapy for prostate cancer: intensity-modulated radiation therapy vs. 3D-conformal radiation therapy
verfasst von: Katherine S. Tzou
Steven J. Buskirk
Michael G. Heckman
Jennifer L. Peterson
Richard J. Lee
Nitesh N. Paryani
Stephen J. Ko
Larry C. Daugherty
Laura A. Vallow
Publikationsdatum: 01.03.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Radiation Oncology / Ausgabe 1/2014
Print ISSN: 1948-7894
Elektronische ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-013-0105-8

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Late toxicity from salvage radiation therapy for prostate cancer: intensity-modulated radiation therapy vs. 3D-conformal radiation therapy