Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma Journal Article
| Authors: | Zelefsky, M. J.; Cowen, D.; Fuks, Z.; Shike, M.; Burman, C.; Jackson, A.; Venkatramen, E. S.; Leibel, S. A. |
| Article Title: | Long term tolerance of high dose three-dimensional conformal radiotherapy in patients with localized prostate carcinoma |
| Abstract: | BACKGROUND. The current study was undertaken to evaluate the incidence and predictors of late toxicity in patients with localized prostate carcinoma treated with high dose three-dimensional conformal radiotherapy (3D-CRT). METHODS. A total of 743 patients with prostate carcinoma classified as T1c- T3 were treated with 3D-CRT that targeted the prostate and seminal vesicles. A minimum tumor dose of 64.8 gray (Gy) was given to 96 patients (13%), 70.2 Gy to 266 patients (365), 75.6 Gy to 320 patients (43%), and 81.0 Gy to 61 patients (8%). The median follow-up time was 42 months (range, 18-109 months). Late toxicity was graded according to the Radiation Therapy Oncology Group morbidity scoring scale. RESULTS. Late gastrointestinal (GI) and urinary (GU) toxicities were absent or minimal (Grade 0 or 1) in 90% of patients. The 5-year actuarial likelihood of the development of Grade 2 and 3 late GI toxicities was 11% and 0.75%, respectively. A multivariate analysis identified doses ≥75.6 Gy (P < 0.001), history of diabetes mellitus (P = 0.01), and the presence of acute GI symptoms during treatment (P = 0.02) as independent predictors of Grade ≥2 late GI toxicity. The 5-year actuarial likelihood of the development of Grade 2 and 3 late GU toxicities was 10% and 3%, respectively. Doses ≥75.6 Gy (P = 0.008) and acute GU symptoms (P < 0.001) were independent predictors of Grade ≥2 late GU toxicity. Among 544 patients who were potent before treatment (73% of all patients), 211 (39%) became impotent after 3D-CRT. The 5-year actuarial risk of potency loss was 60%. Doses ≥75.6 Gy (P < 0.001) and the use of neoadjuvant androgen deprivation (P = 0.01) were independent predictors of posttreatment erectile dysfunction. CONCLUSIONS. The incidence of severe late complications after high dose 3D-CRT was minimal. Radiation doses ≥75.6 Gy and the presence of acute treatment-related symptoms during 3D-CRT correlated with a higher incidence of Grade ≥2 late GI and GU toxicities. In addition to higher doses, the use of androgen deprivation therapy increased the likelihood of permanent impotence in these patients. Intensity-modulated radiotherapy, which makes it possible to enhance the conformality of the dose distribution, has recently been implemented in an attempt to reduce the incidence of moderate grade toxicities in patients receiving high dose 3D-CRT. |
| Keywords: | adult; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; radiation dose; follow-up studies; adenocarcinoma; radiation injury; dose-response relationship, radiation; prostatic neoplasms; gastrointestinal toxicity; diabetes mellitus; complications; radiotherapy, conformal; hydrocortisone; urogenital tract disease; impotence; prostate carcinoma; rectum hemorrhage; gastrointestinal diseases; alpha adrenergic receptor blocking agent; conformal radiotherapy; urethra stricture; urologic diseases; likelihood functions; urethral stricture; proctitis; dose escalation; humans; human; male; priority journal; article |
| Journal Title: | Cancer |
| Volume: | 85 |
| Issue: | 11 |
| ISSN: | 0008-543X |
| Publisher: | Wiley Blackwell |
| Date Published: | 1999-06-01 |
| Start Page: | 2460 |
| End Page: | 2468 |
| Language: | English |
| DOI: | 10.1002/(sici)1097-0142(19990601)85:11<2460::aid-cncr23>3.0.co;2-n |
| PUBMED: | 10357419 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | Article -- Export Date: 16 August 2016 -- Source: Scopus |
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