Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy Journal Article
| Authors: | Ashman, J. B.; Zelefsky, M. J.; Hunt, M. A.; Leibel, S. A.; Fuks, Z. |
| Article Title: | Whole pelvic radiotherapy for prostate cancer using 3D conformal and intensity-modulated radiotherapy |
| Abstract: | Purpose: To investigate the correlations between observed clinical morbidity and dosimetric parameters for whole pelvic radiotherapy (WPRT) for prostate cancer using either three-dimensional conformal radiotherapy (3D-CRT) or intensity-modulated radiotherapy (IMRT). Methods and Materials: Between December 1996 and January 2002, 27 patients with prostate adenocarcinoma were treated with conformal WPRT as part of their definitive treatment. WPRT was delivered with 3D-CRT in 14 patients and with IMRT in 13 patients. For each of the patients treated with IMRT, optimized conventional two-dimensional (2D) and 3D-CRT plans were retrospectively generated for the whole pelvic phase of the treatment. Dose-volume histograms for the bowel, bladder, and rectum were compared for the three techniques. Acute toxicities were evaluated for all 27 patients, and late toxicities were evaluated for 25 patients with sufficient follow-up. Toxicities were scored according to the Radiation Therapy Oncology Group morbidity grading scales. Median follow-up was 30 months. Results: Three-dimensional-CRT resulted in a 40% relative reduction (p < 0.001) in the volume of bowel receiving 45 Gy compared with 2D, and IMRT provided a further 60% reduction relative to 3D-CRT (p < 0.001). Compared with either 2D or 3D-CRT, IMRT reduced the volume of rectum receiving 45 Gy by 90% (p < 0.001). Overall, 9 patients (33%) experienced acute Grade 2 gastrointestinal (GI) toxicity, and only 1 of these patients was treated with IMRT. Antidiarrhea medication was required for 6 patients (22%). However, 5 of these 6 patients also received chemotherapy, and none were treated with IMRT. No Grade 3 or higher acute or late GI toxicities were observed. No cases of late radiation enteritis were observed. Acute and late genitourinary toxicity did not appear significantly increased by the addition of conformal WPRT. Conclusions: Compared to conventional 2D planning, conformal planning for WPRT resulted in significant reductions in the doses delivered to the bowel, rectum, and bladder. IMRT was superior to 3D-CRT in limiting the volume of bowel and rectum within high-dose regions. These dosimetric findings correlated with low rates of acute and late GI morbidity. © 2005 Elsevier Inc. |
| Keywords: | adult; cancer chemotherapy; clinical article; controlled study; aged; aged, 80 and over; middle aged; three dimensional; intensity modulated radiation therapy; diarrhea; paclitaxel; cancer patient; cancer radiotherapy; radiation dose; chemotherapy; follow up; pelvis; carboplatin; pain; tumor volume; radiotherapy; morbidity; patient monitoring; retrospective study; hematuria; vinblastine; radiation dosage; prostate cancer; prostatic neoplasms; leuprorelin; gastrointestinal toxicity; correlation analysis; disease severity; statistical significance; tumors; radiotherapy, intensity-modulated; dosimetry; urinary bladder; scoring system; medical society; intermethod comparison; enteritis; rating scale; prostate adenocarcinoma; loperamide; urinary urgency; radiotherapy, conformal; bicalutamide; toxicity; acute toxicity; computer assisted radiotherapy; intestine, small; biological organs; colon; intestine; atropine; dysuria; histogram; rectum; rectum hemorrhage; bladder; antidiarrheal agent; alpha adrenergic receptor blocking agent; dosimeters; conformal radiotherapy; urethra stricture; intensity-modulated radiotherapy (imrt); three dimensional conformal radiotherapy; diphenoxylate; whole pelvic radiotherapy; proctitis; estramustine; nocturia; urination disorders; phenazopyridine; spasmolytic agent |
| Journal Title: | International Journal of Radiation Oncology, Biology, Physics |
| Volume: | 63 |
| Issue: | 3 |
| ISSN: | 0360-3016 |
| Publisher: | Elsevier Inc. |
| Date Published: | 2005-11-01 |
| Start Page: | 765 |
| End Page: | 771 |
| Language: | English |
| DOI: | 10.1016/j.ijrobp.2005.02.050 |
| PUBMED: | 15913914 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 71" - "Export Date: 24 October 2012" - "CODEN: IOBPD" - "Source: Scopus" |
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